Fight diabetes with physical activity and right diet
Dr Kanwaljit Chopra and Anurag Kuhad

Diabetes, a chronic metabolic disorder, has assumed alarming proportions. A WHO estimate shows at least 171 million people worldwide have diabetes and this is likely to increase to at least 366 million by 2030. The top 10 affected countries are India, China, the US, Indonesia, Japan, Pakistan, Russia, Brazil, Italy and Bangladesh.

According to the Indian Council of Medical Research, there are around 35 million diabetics in India and this figure will rise to 80 million by 2030. Developing countries will show more of this increase due to population growth, ageing and unhealthy diets. Another worrisome aspect is the growing incidence of Type II diabetes at a younger age. The mean age of diabetes in developing countries is between 35 and 64 years, implying that the most productive years of a patient’s life are going to be affected.

Diabetes has become one of the major causes of premature illness and death, mainly through increased risk of cardiovascular disease. The number of deaths attributed annually to diabetes is around 3.2 million.

Due to its chronic nature, the severity of its complications and the means required to control them, diabetes is a costly disease, not only for affected individuals and their families, but also for the health systems. Studies in India estimate that for a low-income Indian family with an adult with diabetes, as much as 25 per cent of the family income may be devoted to diabetes care.

The American Diabetes Association (ADA), a non-profit organisation and an authority on diabetes care, has issued a position statement regarding the standards of medical care. Nutrition and physical activity are integrating components of primary prevention. It can have a considerable impact by decreasing or delaying diabetes and its complications. The management plan should be formulated on an individual basis with the involvement of the patient, the physician and the affected family and this should become an integral component of care.

For people with diabetes, the ADA recommends an individualised meal — and lifestyle — plan as an important aspect of managing diabetes and weight. The ADA supports the USDA’s effort to emphasise the importance of balancing food intake with daily physical activity. Such a balance is essential in promoting health, including the prevention of diabetes and its complications, such as cardiovascular disease.

Physical activity can lower the blood glucose levels up to 36 hours after finishing the activity. For the maximum benefit, do 30-minute activity at least five days a week. An important aspect is that physical activity has to be a part of regular routine.

Other benefits of physical activity:

Physical activity builds healthy bones, muscles and joints, and reduces the risk of colon cancer.

Physical activity also helps psychologically. It reduces feelings of depression and anxiety, improves mood and promotes a sense of well-being.

The 1996 US Surgeon-General’s Report on Physical Activity also suggests that active people have a lower risk for stroke.

The writers are pharmacologists at the University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh.

eYESIGHT
HIV and eye care
Dr Mahipal Sachdev

I had just finished reading a mystery thriller, “Viral Match”, written by a career bureaucrat. What surprised me was how an IAS officer could give loads of information about HIV in such a masterly fashion.

The book was a stunner, a compelling mystery thriller which I could not leave once I started reading it. Apart from a gripping story of a young couple grappling to come to terms with their lives after knowing that they had tested HIV positive, the book gave me so much of information on HIV that it set my mind thinking about HIV and eye care.

What is the risk of an ophthalmologist contracting HIV from his or her routine OPD and 0T? Further, is there a real risk of transmission of the dreaded virus from one patient to the other in routine ophthalmic practice?

HIV has been isolated from tears and ocular tissues, including, conjunctiva, cornea, aqueous, iris and vitreous but no case of HIV transmission by fluids other than by blood, semen and vaginal secretions has been documented. HIV spreads through the exchange of body fluids, sexual contact with infected partners, direct exposure to contaminated blood or blood products or from infected mothers to their offspring.

HIV cannot be spread either by casual contact or by blood-sucking insects. Occupational transmission of HIV in health care workers is mostly from accidental needle stick exposure to blood contaminated with HIV. Less frequently, transmission has occurred from mucocutaneous exposure to infected blood.

The American Academy of Ophthalmology has recommended specific measures for the protection of the patient, the staff and the ophthalmologist in ophthalmic offices and operating rooms. In an ophthalmic clinic the following measures need to be taken:

Hand washing, a rigorous rubbing together of all the surfaces of the lathered hands is recommended for at least 10 seconds followed by a thorough rinsing under a stream of water. If there are cuts, scratches or dermatological lesions (e.g. weeping lesions) on the hands, then the use of gloves is advisable.

Eye drops’ bottle tip should not come into contact with the patient’s tears or conjunctiva.

To disinfect a particular medical device, it should be wiped clean and disinfected with 1: 10 dilution of household bleach (sodium hypochlorite) or 70 per cent isopropyl alcohol. After five minutes, the bleach is removed and the device is briskly irrigated with water and dried.

Trial fitting RGP, soft and hard lenses can be disinfected with hydrogen peroxide.

HIV is a fragile virus and there is no evidence of casual spread from the surfaces of ophthalmic instruments.

In the operating room — the situations where there is contact with high-infectivity tissues — the WHO recommends the following:

Use single /disposable surgical instruments

Avoid mixing instruments used on tissues of high infectivity vs. no infectivity.

Destroy reusable instruments where possible.

If destruction is not possible, decontaminate such instruments.

The risk of patients being infected by the ophthalmologist or ophthalmic medical personnel infected with the HIV is considered extremely remote.

If a person has been exposed to a source person already known to be seropositive for HIV, then post-exposure prophylaxis (PEP) can be initiated as soon as possible which includes a four-week regimen of antiretroviral drugs. This should be done in consultation with the physician having expertise in this field. In a known AIDS patient the viral load in the aqueous decreases after treatment; therefore, it is preferable to do surgery after treatment.

Like all physicians, ophthalmologists have a moral and ethical responsibility for providing care to all patients, regardless of whether they are known to be infected with HIV, or fall within a high-risk group. Nevertheless, one cannot rule out the possibility of mandatory HIV testing of all patients before surgery in future.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: msachdev@bol.net.in 

Ayurveda and You
Guggul: the herb with many benefits
Dr R. Vatsyayan

Botanically known as commiphora mukul, guggul is the gum resin of a small shrubby tree found in the dessert and other warm parts of the Indian subcontinent. It was mentioned in the works of Charaka and Sushruta and other ancient authors.

Now, when we understand many of its actions on human body from the modern point of view also, for an ayurvedic physician guggul continues to be the first drug of choice for many health problems, including arthritis and lipid disorders.

Ancient ayurvedic literature is full of praise for guggul for its wide range of therapeutic actions. It has been described as anti-inflammatory, antiseptic, diuretic, expectorant, uterine stimulant and a rejuvenating herb which also acts as a general tonic. Guggul which is older than one year has an additional quality of being an anti-lipid agent. As is the practice, guggul is purified by boiling it either in milk, cow’s urine or in the decoction of triphala before its therapeutic use.

Scientific studies have found that guggul lowers serum triglycerides, the LDL and the VLDL cholesterols. At the same time, it raises the levels of HDL (good cholesterol) and inhibits platelet aggregation, thus benefiting in preventing atherosclerotic vascular disease or the ischemic heart disease. Guggul also facilitates weight reduction and is a drug of choice in obesity-related problems. In hypothyroidism, too, its usage with other metabolism corrector medicines proves to be very effective.

Since guggul is basically an anti-vata and anti-kapha medicine, ancient ayurvedic masters have found it to be an excellent remedy for arthritis and other inflammatory conditions. In joint pains of any type, whether of autoimmune origin as the rheumatoid arthritis, degenerative like the osteoarthritis and metabolic such as gout, guggul has a beneficial role to play. Not surprisingly, modern research has found it to be equally effective and also safer than ibuprofen and phyenylbutazone.

Despite so many benefits it offers, guggul is not administered as a single medicine. Ayurvedic pharmacopoeia exclusively devotes a separate section to detail a number of preparations in which guggul is used as a chief ingredient. Of these, few like Yograj Guggul and Mahayograj Guggul have become household names to be used in all types of acute and chronic arthritis. Kaishore Guggul is given in gout and in conditions involving infections and skin ailments.

While treating glandular swellings, Kanchnar Guggul finds the top place in a prescription of an ayurvedic physician whereas Lakshadi Guggul is helpful in osteoporosis and fractures. For lipid control and treating obesity, Triphla Guggul and Medohar Guggul are the best medicines.

A word of caution: guggul being a uterine stimulant is contraindicated during the first trimester of pregnancy. Its high doses and prolonged use must be monitored by an expert physician.

The writer is a Ludhiana-based senior ayurvedic physician.