Diabetic Living India - March - April 2016 PDF

India’s first magazine about diabetes
MAR-APR 2016
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India’s first and only magazine about diabetes Logistics, infrastructure... Idealism
TCG Media Limited, 101, Arunachal Building, 19, Barakhamba Road, New Delhi-110001, Voice 91.11.41543666
contents VOLUME-6 | ISSUE-2 | MAR-APR 2016

related ailments MAR-APR 2016 in every issue
15 Stomach in knots 3 Welcome
A report on how diabetes is affecting
PALLIATIVE CARE
`100 4 Editorial Advisory Board
the productive age group in India. for Cancer
patients 6 Letters to the Editor
myths 8 Ask your Expert
17 The liver connect 7about a
DATE WITH THE
Your diabetes affects your liver in

DENTIST 10 Ask your Expert
unnoticed ways. Don’t let it. protein (Juvenile Diabetes)
Shrimp
SPOTLIGHT
12 Thrive
20 Skin cancer 92 Health Tarot
Be aware about the most common
threats to your skin and wellbeing.
DiabeticLivingOnline.in 1
contents
VOLUME-6 | ISSUE-2 | MAR-APR 2016
well being fitness 75 Protein spotlight: Shrimp

Low in fat and calories, this flavour-
popping seafood serves up good fats.
28 Date with the dentist 53 Run to stay fit
Seven myths that need to An expert answers all your questions on
be busted before a diabetic 80 Four healthy habits
the simplest exercise – running.
goes to see a dentist. Just a few simple lifestyle changes can
help you control your diabetes.
61 10 things people ignore during
35 Extending comfort a workout
Minimising the symptoms and side- 85 Sweet ending
Remember these points the Take extra care of yourself as the
effects of cancer with palliative care.
next time you hit the gym. holiday season comes to an end,
with our favourite drinks.
39 The Ayurveda way
Manage diabetes better by food
lifestyle transitions and diet as 86 Pear power
laid down in Ayurveda. 66 Drinking for good health Include pears, nature’s storehouse
Exploring the benefits of the healthy of nutrients, in your diet with
concoction – green tea. these savoury recipes.
living
44 Partner power 68 Ease under pressure

Prepare scrumptious and healthful meals;
A couple works together for
motivation, inspiration, this time in a pressure cooker.
health and happiness.
.
46 Take charge
Take control of your
diabetes by consuming
the right supplements, testing
regularly and being responsible.
48 Eat, pray, love

Expert advice on whether or not to
fast when you have diabetes.
.
2 Diabetic Living mar-apr 2016

INDIA
Every day needs to be INDIA EDITION
WORLD HEALTH DAY

Publisher & CEO NITIN AGARWAL
COO ALOK KATIYAR
Days and nights alternate; seasons come and go; the

hands of a clock refuse to slow down – there is no MEREDITH CORPORATION
way we can control what goes on. The only thing Chairman and CEO STEPHEN M. LACY
that stays within the gamut of our focus is our own Vice Chairman MELL MEREDITH FRAZIER
body and health. As the world is all set to celebrate Editor MARTHA MILLER JOHNSON
World Health Day in April, we ask whether it is International Director MIKE LOVELL
justified for individuals to designate just one day in
the entire year for their fitness and wellbeing. This, of
Information info@tcg.media
course, is only a symbolic deputation and seriously Subscriptions subscribe@tcg.media
needs to be understood in the real light. Submissions dl@tcg.media
With this in view, this issue of Diabetic Living Advertising adsales@tcg.media
concentrates on a variety of health problems, Desk editorial@tcg.media
lifestyle hacks and fitness management tips as well
as innovative food recipes using the most basic
and easily available ingredients. Deconstructing TCG Media Limited
the Liver Connect discusses the relation between 101, Arunachal Building, 19, Barakhamba Road,
diabetes and complications in the liver so that they New Delhi-110001, India
don’t go unnoticed. Especially as the symptoms Tel: 91.11.41543666
may be too subtle to take immediate action. The
Diabetic Living India magazine is printed and
Diabetes Arthritis Connection lays down how published by Nitin Agarwal
Type 2 diabetes may put you at risk for joint pain, on behalf of TCG Media Limited.
and what actions may be taken to prevent it. Date Printed at: TCG Media Limited,
with the Dentist fragments the myth that dental A-89, Naraina Industrial Area, Phase I
care has no ties with diabetes by highlighting how New Delhi - 110028
your dentist’s ignorance of your blood glucose levels Diabetic Living India magazine is published bi-monthly.
may lead to further impediments. An expert dispels Diabetic Living India magazine is a trademark of Meredith
everything that you need to know about running in Corporation and TCG Media Limited. The entire content of
Diabetic Living India magazine are copyrighted to Meredith
Run to Stay Fit. Pack your microwave back in the
Corporation and TCG Media Limited. All rights reserved. The
box and dust off the pressure cooker to make some
writing, artwork and/or photography contained herein shall not be
amazing preparations in Ease under Pressure. used or reproduced without the express written permission by
Pears, the storehouse of nutrients, can help you TCG Media Limited. TCG Media Limited or any employee(s)
manage the early stages of diabetes. Eat them raw does not assume responsibility for loss or damage of unsolicited
or include them in your diet with the scrumptious products, manuscripts, photographs, artwork, transparencies or
recipes in Pear Power. other materials. TCG Media Limited does not assume any
Eat healthy, stay fit and live like a rockstar! liability for services or products advertised herein.
Editorial team www.diabeticlivingonline.in
Disclaimer: Diabetic Living (India) is not responsible nor liable

for any advice, course of treatment, diagnosis or any other
information, services or products that you obtain
through this magazine.
Find us on Facebook
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IT’S ALL GOOD INSIDE
Page 14 Page 27 Page 65

Related Ailments Well being Food
INDIA
Editorial advisory board
The following health care professionals—all experts in diabetes management—
review articles that appear in Diabetic Living ® magazine:
Connie Crawley is a nutrition and health specialist for the University of Georgia
Cooperative Extension Service in Athens, specialising in diabetes and weight loss.
Connie is a member of the American Dietetic Association Diabetes Care and Education
practice group.
Marion J. Franz has authored more than 200 publications on diabetes, nutrition, and
exercise, including core-curriculum materials for diabetes educators. Marion is a member
of the American Dietetic Association Diabetes Care and Education practice group.
Joanne Gallivan is executive director of the National Diabetes Education Program at the
National Institutes of Health. Joanne is a member of the American Dietetic Association
Diabetes Care and Education practice group.
Marty Irons practises at a community pharmacy and has served in industry and the military.
Jeannette Jordan works for the Medical University of South Carolina in Charleston and
consults with the Centers for Disease Control and Prevention.
Irene B. Lewis-McCormick is a fitness presenter and educator. Certified by the

nation’s leading fitness organisations, she is a faculty member of the American
Council on Exercise.
Chris Smith, The Diabetic Chef ® is the president of Health Range, Inc., and a
professionally trained chef. He is a food consultant and cookbook author and conducts
healthy-cooking classes.
Hope S. Warshaw is a writer specialising in diabetes care. She has authored several
American Diabetes Association books. Hope is a member of the American Dietetic
Association Diabetes Care and Education practice group.
Fred Williams practises endocrinology and specialises in diabetes. He is an active

member of the American Association of Clinical Endocrinologists and serves on the
board of directors.
John Zrebiec is director of Behavioural Health Services at the Joslin Diabetes Center in
Boston and a lecturer in the department of psychiatry at Harvard Medical School.

INDIA
Editorial advisory board, India
The following health care professionals—all experts in diabetes management—review
articles that appear in Diabetic Living® magazine’s India edition:
Decorated with the Padma Shri and BC Roy award, Dr. Anoop Misra is Chairman, Fortis-CDOC
Center of Excellence for Diabetes, Obesity, Metabolic Diseases, and Endocrinology, in New
Delhi. He is also Chairman of the National Diabetes, Obesity and Cholesterol Foundation
(N-DOC) and Director of the Diabetes and Metabolic Diseases, Diabetes Foundation of
India. Dr. Misra has led several pioneering research studies on diabetes and has published
more than 300 research papers.
Dr Ambrish Mithal MD, DM: (Padma Bhushan Awardee 2015) Member Governing Council,
Indian Council of Medical Research (ICMR), Doctor of the year DMA 2005, cited in the Limca
Book of Records since 2005 - is presently the Chairman and Head of Endocrinology and
Diabetes Division at Medanta, the Medicity where he has established one of India’s premier
diabetes and endocrinology centres.
Dr. V. Mohan is Chairman and Chief Diabetologist of Dr. Mohan’s Diabetes Specialities Centre
and President & Director of Madras Diabetes Research Foundation, Chennai. He has
published over 600 papers in prestigious peer reviewed journals and contributed over 100
chapters to text-books on diabetes. He has received the prestigious Dr. B.C. Roy National
Award, and Fellowships from all the four Royal College of Physicians of London, Edinburgh,
Glasgow and Ireland.
Dr. Shashank R Joshi is a well-known endocrinologist in Mumbai. He is president of the
All India Association of Advancement for Research in Obesity and vice president of the
Association of Physicians of India.
Padma Shri and BC Roy awardee Dr. KK Aggarwal is an eminent name in cardiology. President
of the Heart Care Foundation of India and editor-in-chief of the Indian Journal of Clinical
Practice, Dr. Aggarwal has a keen interest in mind-body healing. He is a regular columnist
and expert for both print and television networks.
Rekha Sharma is director of Clinical Nutrition and Dietetics at the Diabetes Foundation of India.
This former chief dietician of the All India Institute of Medical Sciences in New Delhi has
devoted several years of her life to the study of diabetes management.
Madhuri Ruia is a nutritionist and fitness expert in Mumbai. A certified pilates expert from the
Pilates Institute of UK, she runs Integym, a state-of-the-art centre that promises ‘intelligent
fitness’ to its clients.
Dr. DS Chadha is head of cardiology at the Command Hospital in Bengaluru. He has won
dozens of awards, written several research papers in leading medical journals and chaired
several national and international conferences on health issues.
Working Committee
Dr. Swati Bhardwaj is vice head at the Center for Nutrition and Metabolic Research and
a nutritionist with the Diabetes Foundation (India) and National Diabetes Obesity and
Cholesterol Foundation (N-DOC).
Shubhda Bhanot is a certified diabetes educator and a nutritionist with 14 years of experience
in the field. A life time member of ADE (Association of Diabetes Educators), she is presently
working as chief diabetes educator at Medanta, The Medicity, Gurgaon.
India’s fir
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MAR-APR
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INDIA
for every diabetic & their concrete answers
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A S K Y O U R E X P E R T
Dr Anoop Misra
Chairman, Fortis-C-DOC (Centre of
Excellence for Diabetes, Metabolic Diseases
and Endocrinology); Chairman, National
QA
Diabetes,Obesity and Cholesterol
Foundation (N-DOC)
Q1
I’ve had diabetes for seven
months and I’m always
tired. Is there anything I
can do to overcome being
tired all the time?
Ans: Are you monitoring your blood

glucose levels? Tiredness is common when
glucose stays too high. The target level for
fasting blood glucose (before eating) is
70-130 mg/dl and under 180 mg/dl one to
two hours after meals. Monitoring your
blood glucose can tell you a lot, including
how meals and activity affect your blood
glucose trends. Another thing to consider
people
who keep
is how you’re coping with this new reality.
A diagnosis of diabetes can contribute to
anxiety or even depression. Depression
can cause you to feel tired. Ask your
provider to screen you for depression.
Some things that help keep your blood
food records often
glucose levels steady, such as getting
enough sleep and daily physical activity,
have greater success
can help treat depression too. Also, ask
your doctor about sleep apnea – a at weight loss.
condition that prevents deep sleep.
Depression and sleep apnea are common
with Type 2 diabetes; both are treatable.

Q + A
Q2
How many grams of
carbohydrates should a
woman with diabetes
have each day? Take off
your shoes
Ans: Generally speaking, being a woman means you likely
need to eat fewer carbohydrates each day than a man.
However, the amount of carbohydrates you need should
and socks
depend on many factors, including your size, age, activity,
desire to lose weight, and food preferences. There is no
one-size-fits-all amount of carbohydrates for all women.
Everyone is different and has diverse nutritional needs.
Carb intake depends on: 1. Height and weight. Are you
currently underweight, normal weight, or overweight?
at every visit to
2. Activity level. Are you sedentary, moderately active, or
highly active? 3. Gender. Generally, men require more
remind your
calories, and thus more carbohydrates, than women.
4. Pregnant women and those who are breast-feeding doctor to check
require more as well.
Most adults need 6 - 11 servings of carbs per day,
depending on the factors listed above. The general starting
the weight of
point for a moderate-size woman is 45 - 60 grams of
carbohydrates at each meal; for moderate-size men, 60 - 75
your feet.
grams of carbs per meal. Most people with diabetes don’t
need to eat snacks. If you enjoy eating a snack in the late
afternoon or before bed, use some of your allotted carb be due to diabetic neuropathy –
grams, say 15 - 30 grams, for a snack. nerve damage from higher than
normal blood glucose levels over
time. It is common for diabetic
neuropathy to cause numbness,
Q3
pain, tingling and other symptoms
in the legs and feet. Even though
you were recently diagnosed with
diabetes, it is likely that your
blood glucose has been elevated
I’m 41 years old, overweight and was just diagnosed with for some time. As your blood
Type 2 diabetes. My legs and feet hurt due to poor circulation. glucose levels become closer to
Will this lead to amputation? Is there anything I can do to improve normal, the pain may gradually
the blood flow to my feet? decrease. Keeping your blood
glucose close to normal and
Ans: Rest assured, by getting and caring for your feet can help
keeping your blood glucose under improve circulation and delay
control and practising preventive further complications. You should
measures with regular foot care take off your shoes and socks at
and annual (or more frequently if every visit to remind your doctor
needed) leg and foot exams by to check your feet. Look at your
your healthcare provider, feet daily, using a mirror or
amputation can be avoided in magnifying glass to examine
many instances. The pain in your the tops, bottoms, and sides.
legs and feet may be due in part Seek medical attention if you
to poor circulation but may also spot a problem.
J U V E N I L E D I A B E T E S
tender
Dr. Neeta Kejriwal,
Associate Consultant,
Paediatrics, Fortis Memorial
Research Institute, Gurgaon
years
QA +
Our expert answers all
queries regarding your
little one’s well-being.
Q + A
Q1
My 3 year old
daughter is diabetic.
Please tell me about the
educate
yourself
and everyone around you
about how to take care of
children with diabetes and
foods to eat and avoid? related complications.
Ans: First of all there should be a routine of three

healthy meals a day including a nutritious breakfast and
three healthy snacks per day meaning regular small
frequent meals. Replace processed food with whole
grain and high fibre foods. Food with high glycemic
index like white rice, white pasta, white bread, potatoes,
most baked goods, sweets, chips, honey, jaggery, ice
creams, pastries and processed foods should be limited
in your diet. Instead replace them with brown rice,
whole-wheat bread and whole-wheat pasta. Avoid fruit
juice, instead give fresh fruits. Fruits such as mango,
grapes, custard apple, strawberry and prunes (dates)
should be avoided to lower the blood sugar level. Don’t
fry foods, instead bake, sauté or boil in a pan.
Q4. My kid is really fond of cakes. Would

it be fine for me to use sugar substitutes
Q2. How long will my daughter have Q3. Due to some complication instead. How do I help my son control his
Type 1 diabetes? Can you outgrow it? during my pregnancy, my son was cravings? He is only nine years old.
What is the life expectancy? born with diabetes. I would like to
know if remission is at all possible?
Are there any clinical trials where I Ans: Yes, you can use artificial
Ans: At this point, Type 1 diabetes (T1D) can send in an application for him? sweeteners, their sweetening power is at
is a chronic disease and one can never least 100 times more intense than regular
outgrow it. Although you can never sugar, so use only a small amount. Some
outgrow it, treatment options are Ans: Diabetes does not develop natural sweeteners like stevia can also be
improving all the time and your daughter as a complication of pregnancy used. Eating for diabetes doesn’t mean
can lead a normal and active life. Keep but, if either parent is diabetic, it eliminating sugar. Your son can still enjoy
her blood sugar levels under control and does increase the risk of diabetes a small serving of his favourite dessert
she can enjoy a normal life. Insulin in the child. You cannot cure your once a while. The key is moderation. Give
therapy and regular monitoring is son’s diabetes but you can keep it him a small portion along with meals
important. Lifestyle modification of the very much under control with rather than as a stand alone snack. It
whole family through a balanced diet and treatment, regular monitoring and would be very important to make him
exercise will go a long way in giving your lifestyle modification. A better understand what diabetes is all about and
daughter a happy life. Keep yourself understanding of the disease and the importance of healthy eating habits.
updated with newer modes of treatment, its complication can avert all The whole family should adopt healthy
use your resources and always discuss untoward events and you can give eating habits. Encourage him to take fresh
with your doctor regarding it. your son a normal, happy life. fruits to curb his cravings for sweets.
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AILMENTS
“I believe that
the greatest
gift you can
give your
family and the
world is a
healthy you.”
—Joyce Meyer

stomach in
NOTS
K
Diabetes can damage nerves, including
those in the stomach and intestines,
?
causing gastroparesis. Yet, some doctors
are slow to diagnose it.
by Winnie Yu | photos by Jason Donnelly
I magine getting sick to your

stomach on a daily basis. It
happened to Alfred Ruprecht
five years ago. Every morning after
eating breakfast, he would vomit.
down or become less efficient at
emptying. Nerves anywhere along
the gastrointestinal tract become
damaged and don’t work as well.
“Gastroparesis literally
with Type 2 diabetes also can
experience it. More cases have
been diagnosed in recent years
as the prevalence of Type 2 grows
and people are living longer.
It became so severe that he had translates to a paralysed Even so, many health care
to quit his job as a machinist in stomach,” says Michael Cline, providers are not quick to
Cleveland. “It was such a miserable D.O., a gastroenterologist at the suspect gastroparesis.
thing,” says Alfred, who has had Cleveland Clinic who specialises in
Type 1 diabetes for 30 years. gastroparesis. “It used to be a rare Spotting the signs
Alfred, 45, wanted answers, but problem, but now we’re seeing Symptoms of gastroparesis may
doctors were at a loss to explain more of it.” include nausea, vomiting, loss of
his symptoms. After two years, he It’s most common among appetite, heartburn, abdominal
was diagnosed with gastroparesis, people who have had uncontrolled pain, and bloating. Constipation
a form of neuropathy in which diabetes for a long time, especially may also occur, and it may
the stomach and intestines slow Type 1 diabetes, although people alternate with diarrhea. You are
more likely to have gastroparesis weight loss — and not the healthy to help with meal planning.
if you have nerve damage in your kind. “If the stomach slows down to a While some people find relief
eyes, feet, or kidneys. significant degree, you can become with dietary changes alone,
Erratic blood glucose levels malnourished,” Cline says. “When others require medications or
also may be a clue you have malnutrition kicks in, that becomes surgery. Prescription drugs
gastroparesis. “The glucose- the primary issue.” may help increase gastric
lowering medicine peaks, but your Some people experience the op- emptying, but they can cause
stomach doesn’t empty, so the posite and gain weight. “When the serious side effects.
medicine doesn’t have anything stomach slows down, one of the few When medications don’t
to work on,” Cline says. “When the things people can keep down are work, some patients, such as
stomach finally empties hours later, simple carbohydrates like cookies Alfred, have a gastric pacemaker
blood glucose goes up, but now and cakes,” Cline says. “These foods implanted. The device is inserted
there are no drugs to cover it.” don’t need a lot of work to digest. in the abdomen laparascopically
Gastroparesis can be diagnosed Patients wind up gaining weight by and connected to the stomach
with a breath test called the Gastric eating only what they can tolerate.” to stimulate motility. Most people
Emptying Breath Test (GEBT). The who have a pacemaker see better
GEBT, conducted over a four- Finding relief glucose numbers, Cline says.
hour period after an overnight Treatment for gastroparesis For Alfred, the pacemaker has
fast, is designed to show how fast varies. “The first step is to get been a lifesaver. He has regained
the stomach empties solids by blood glucose levels under seven kilos and rarely gets sick
measuring carbon dioxide in control,” says Joann Kwah, M.D., any more. Today, he eats
a patient’s breath. a gastroenterologist at Montefiore healthfully and tests his sugar four
Once diagnosed, gastroparesis Medical Center in New York City. She times a day. “I know now the most
must be treated promptly. If left tells her patients to work closely with important thing is maintaining my
untreated, it can lead to major a registered dietitian blood sugar,” he says.
EATING WELL WITH GASTROPARESIS

Experts agree that good nutrition is a large part of preventing and treating
gastroparesis. Try following these tips from Monique Richard, RDN, a
registered dietitian and nutritionist in Johnson City, Tennessee, who
treats people with gastroparesis.
• Eat small, frequent meals. “Since gastroparesis delays stomach

emptying, limiting the amount of food to be digested and processed
at one time helps the body work more effectively,” Richard says.
• Limit your fibre intake. Too much fibre of any kind can slow gastric
emptying, but foods high in soluble fibre (such as oatmeal, fruits, and
seeds) can be especially difficult to digest. The insoluble fibre in
vegetables and whole grains is more beneficial because it isn’t completely
absorbed. “Just make sure you introduce fibre slowly since too much at
once can worsen symptoms,” Richard says.
• Choose healthier fats. Fat is an essential component to a healthful
eating plan, but too much saturated fat slows gastric emptying. Instead,
eat foods high in mono and polyunsaturated fats like avocados, nuts,
and olive oil.
• Drink lots of fluids between meals. Your stomach empties liquids fast-
er than food, and meal-replacement drinks or smoothies can provide
nutrients if you’re nauseated.
• Stay physically active. “Light movement can help with
peristalsis, allowing the stomach to empty more easily,”
Richard says. Ask your health care provider about doing yoga.
Or take a short walk after a meal.

Deconstructing the
LIVER
CONNECT
Diabetes affects a lot of organs in the body and one of
them is the liver. Let this not go unnoticed, especially as
the symptoms may be too subtle to take immediate action.
by Dr. Gourdas Choudhuri
O ne could wonder why in
diabetes, a condition in
which the blood sugar
concentration in the blood goes up, we
need to worry about the liver. Or for
Healthy Liver Cirrhosis
that matter, even take the blood sugar

reports seriously at all.
Doctors have begun to realise that the
elevated blood sugar value is only the
tip of the iceberg. Patients with Type 2
diabetes, the common form of the
disease that occurs in adulthood, often
go on to develop problems with
several other organs of the body, such
as the kidneys, brain, blood vessels,
heart, feet and the liver.
Why do blood levels go up? Cirrhosis is a slowly progressing disease in which

At the root of the problem in Type 2
healthy liver tissue is replaced with scar tissue,
diabetes, is the question, “Why do
blood sugar levels rise?” The intuitive
thus preventing the liver from functioning properly.
answer would point at a shortage of
the hormone called insulin that is
produced by the pancreas that insulin levels too. cells. The liver becomes unusually
does the job of driving blood sugar Insulin resistance (IR) brings with it enlarged and is pale and greasy to see.
levels down. But contrary to several changes in the body such as A fatty liver usually has no clear
expectations, the blood levels of insulin thickening of the basement membrane, symptoms in the early stages. It gets
in this condition are increased! the floor on which cells of all organs of recognised during investigations for
The answer is, therefore, complex. It the body are lined up and pushes up abnormal readings on liver function
starts with the recognition of the fatty acids in blood circulation, which tests (AST, ALT or GGT levels in blood)
underlying condition called Insulin then get deposited in the liver and or during an ultrasound examination.
Resistance (IR). One finds that as time blood vessels. A more reliable new test that is quick,
goes on, some people need higher and accurate and painless is the latest
higher amounts of circulating insulin in Liver trouble version of the Liver Fibroscan with
the blood to push the blood glucose Diabetes, therefore, affects several CAP. This machine uses low frequency
into cells and keep the sugar in check. organs of the body, and hence does ultrasound waves and, through a new
This is in contrast to Type 1 diabetes not usually come alone. It can be technology, is able to measure the
that is caused by shortfall in insulin associated with obesity, increased amount of fat in the liver. It scores
production. But the common blood lipids (cholesterol or over ultrasound as the latter cannot
Type 2 diabetes is characterised, at triglycerides) and high blood pressure; quite give a measurement value with
least in its early stages, by not just all of which can be caused by IR as grades of mild to severe, often
high blood sugar levels, but by high the underlying mechanism. depending upon the impression
Diabetes affecting the kidneys, of the sonographer.
eyes, feet and heart is common There are other tests to estimate liver
knowledge. Its effects on the liver fat too. The time tested method has
often go unnoticed. been liver biopsy. This procedure
is, however, painful and requires
Diagnosis hospitalisation for a day. Other
A ‘fatty liver’ is very commonly seen in methods include a special version of
patients with Type 2 diabetes, and can MRI that uses spectroscopy to measure
be picked up by a simple ultrasound fat. The fibroscan has however
examination in up to 70 per cent of emerged as the simplest and easiest
cases. This condition results from one so far.
excess accumulation of fat in the liver

Complications
Although fatty liver disease does not
produce many symptoms in the early
stages, and sometimes, even when the
blood tests for liver function are
normal, it is not an innocuous
condition. Research shows that
patients with extra fat in their
livers die early, that is, their
lives are shorter than their
fat-free counterparts.
What damage does liver
fat do? Some of them go on
to develop a state of
weakness of the liver called
Cirrhosis. In this condition, liver
cells die insidiously and are replaced
by scar tissue. The organ gradually
starts functioning poorly, sometimes
causing swelling of feet or retention of
water in the abdomen. The veins in the not know for sure why some seem to liver transplantation.
food pipe can get engorged and progress more rapidly while others Another recent finding that research
rupture, causing blood vomiting. seem to remain stable for years. has shown up is that patients with
When the liver gets very weak due to The advent of the Fibroscan has diabetes and fatty liver are at increased
the cirrhosis, transplantation of the made a significant change in the way risk of developing liver cancer. They
diseased organ is sometimes required. patients with fatty livers are evaluated often come silently or are incidentally
This condition is getting so common nowadays. An estimation of fat content picked up on imaging tests, but
that it makes up around a third of all is the starting point. Those with very progress aggressively over a few
causes of liver transplantation. high values need to work hard to get months. Scientists are debating
Why the disease progresses rapidly in their livers in shape. whether all Type 2 diabetics with
some and goes slow in others, is not The test also measures the stiffness of excess fat in their liver should be
always evident. Understandably, those the liver at the same time and tells monitored periodically with CT
who also have other contributory whether scarring of the organ has scans or MRI scans to watch for
factors such as obesity, excess alcohol begun. If indeed it has, one needs to early liver cancer.
consumption, hypertension or elevated get serious and work hard to make sure Diabetics also develops stones in their
blood cholesterol levels are more likely that the disease does not progress to gallbladders more frequently. It is best
to progress rapidly. But doctors still do the stage of liver failure, requiring a to have them removed by a
laparoscopic surgery before they cause
pain or complications.
Conclusion
Diabetics are prone to developing fatty
livers. This condition, earlier thought to
be innocuous, has been observed to
progress to liver cirrhosis or liver
cancer, in a significant proportion of
patients. Good control of diabetes with
diet, exercise and medications, and
maintenance of proper body weight
reduces the risk.
Dr. Gourdas Choudhuri, Director &

HOD, Gastroenterology & Hepatobiliary
Sciences, Fortis Memorial Research
Institute (FMRI), Gurgaon
S kin cancers are cancers that arise from the skin.
It is the uncontrolled growth of abnormal skin
cells and occurs when unrepaired DNA damage
to skin cells (most often caused by ultraviolet
radiations from sunshine or tanning beds) triggers
mutations or genetic defects that lead the skin cells to
multiply rapidly and form malignant tumours.
CANCER
SKIN Be aware about the most
common types of cancers in
the skin that can be
a threat to your
well being. Prevention is
better than cure.
by Dr. D.J.S. Tulla
Types of skin cancer

1. Basal-Cell Cancer (BCC)
Basal-cell cancer grows slowly and can damage the
tissue around it, but is unlikely to spread to distant
areas or result in death. It often appears as a painless
raised area of skin that may be shiny, with small blood
vessel running over it. It may also appear as a raised
area with an ulcer.
Symptoms of basal cell carcinoma:
• Smooth and pearly blotch.
• Waxy.
• Appearance as a firm, red lump.
• Occasional bleeding.
• Development of a crust or scab.
• May begin to heal but never completely heals.
• Itchy.
• Looks like a flat, red spot which is scaly and crusty.
• Development into a painless ulcer.

2. Squamous-Cell Cancer (SCC) eraser) across may be suspect, skin cancer.
Squamous-cell cancer is more likely to although some melanomas may • Excessive sun exposure.
spread. It usually presents as a hard even be smaller than this. • Indoor tanning.
lump with a scaly top but may also Other potential signs of melanoma in • A history of sunburns, particularly
form an ulcer. a mole include: early in life.
Symptoms of squamous cell • A sore that does not heal. • Skin that burns, freckles, or reddens
carcinoma: • Pigment, redness or swelling that easily, or becomes painful in the sun.
• Looks scaly. spreads outside the border of a spot • Blue or green eyes.
• Has a hard, horn-like cap. to the surrounding skin. • Blond or red hair.
• Makes the skin raised in the area of • Itchiness, tenderness or pain. • Certain types of moles.
the cancer. • Changes in texture or scales, oozing
• Feels tender to touch. or bleeding from an existing mole. If you are the type of person who
• Sometimes bleeds. always burns and never tans when in
The first two together along the sun, or if you burn easily, you are at
3. Melanoma with a number of less common skin an increased risk of developing skin
Melanomas are the most aggressive cancers are known as non-melanoma cancer. Contrary to popular belief, a
ones. Signs of this cancer include a skin cancer.. tan does not indicate good health. It's a
mole that has changed in size, shape, sign of injury to skin cells by UV rays;
colour; has irregular edges, has 4. Non-melanoma skin cancer the cells respond to this injury by
more than one colour and is itchy or These are usually curable. The producing more pigment.
Basal-cell carcinoma Squamous-cell carcinoma Melanoma
may bleed. treatment of such cancers is generally Who is at risk for skin cancer?
Melanoma symptoms: by surgical removal but may less Although anyone can get skin cancer,
Melanoma skin cancer signs include commonly involve radiation therapy or the risk is greatest for people who have
new spots on the skin or a change in topical medications. Treatment of fair or freckled skin that burns easily,
size, shape or colour of an existing melanoma may involve some light eyes and blond or red hair. Darker
mole. The ABCD rule is another way combination of surgery, chemotherapy, skinned individuals are also susceptible
to recognize abnormal growths: radiation therapy and targeted therapy. to all types of skin cancer, although
• A is for Asymmetry: A mole that has In patients whose disease has spread to their risk is substantially lower.
an irregular shape or two different other areas of their bodies, palliative Besides complexion, other risk factors
looking halves. care may be used to improve the include a family or personal history of
• B is for Border: Irregular, blurred, quality of life. skin cancer, having an outdoor job and
rough or notched edges. living in a sunny climate. A history of
• C is for Colour: Most moles are of an Risk Factors severe sunburns and an abundance of
even color – brown, black, tan or The risk factors vary for different types large and irregularly-shaped moles are
even pink – but change in the shade of skin cancer. However, any of the risk factors unique to melanoma.
or distribution of colour throughout following can increase your risk of
developing skin cancer: CAUSES OF SKIN CANCER
the mole.
• D is for Diameter: Moles larger than • Lighter natural skin color. More than 90 per cent of the cases of
¼ inch (6 mm, the size of a pencil • Family or personal history of skin cancer are caused by exposure to
ultraviolet radiations from the sun. This cell or squamous cell skin cancers. You Biological therapy
exposure increases the risk of all three are most likely to have this if: Biological therapy uses your body's
main types of cancer. • The cancer covers a wide area. immune system to kill cancer cells.
• Exposure has increased partly due to • It is in an area that is difficult to
a thinner ozone layer. operate on. Prevention
• Tanning beds are becoming • Surgery is not suitable for you, for • Sunscreen is effective and thus
another common source of example, if a patient is elderly or has recommended to prevent melanoma
ultraviolet radiation. other health problems. and squamous-cell carcinoma. There
• For melanomas and basal-cell In some situations both radiotherapy is little evidence that it is effective in
cancers, exposure during childhood as well as surgery may be used. If preventing basal-cell carcinoma.
is particularly harmful. there is a risk that cancer cells may • Other advice to reduce rates of skin
• For squamous-cell cancers total have been left behind, radiotherapy cancer includes avoiding sun burns,
exposure, irrespective of when it may be used after surgery. This is wearing protective clothing,
occurs, is more important. called adjuvant treatment. It reduces sunglasses and hats, and attempting
the risk of the cancer coming back in to avoid sun exposure or periods of
Between 20 and 30 per cent of the future. peak exposure.
melanomas develop from moles. • The risk of developing skin cancer
People with light skin are at higher risk Chemotherapy can be reduced through a number of
as are those with poor immune Chemotherapy tablets or injections are measures including decreasing indoor
function such as from medications or only used in certain circumstances for tanning and mid day sun exposure,
HIV/AIDS. A diagnosis has to be skin cancer. More often, chemotherapy increasing the use of sunscreen and
conducted by biopsy. creams are used: avoiding the use of tobacco products.
• To treat actinic keratosis. • There is insufficient evidence
Skin cancer treatments • For skin cancers that are only on the either for or against screening
Surgery top layer of the skin. for skin cancers. Vitamin supplements
Most basal cell and squamous cell and antioxidant supplements have not
skin cancers can be successfully Freezing been found to have an effect in
treated with surgery. There are several Your doctor may destroy actinic prevention.
different types of surgical techniques keratoses and some small, early skin • Evidence for a benefit from dietary
that can be used based on the cancers by freezing them with liquid measures is tentative.
following variations: nitrogen (cryosurgery). The dead tissue • Zinc oxide and titanium oxide
• The type of skin cancer you have. sloughs off when it thaws. are often used in sun screens to
• The size of the cancer. provide board protection from UVA
• The location of the cancer. Photodynamic therapy and UVB ranges.
• The stage of the cancer (if relevant). This treatment destroys skin cancer
cells with a combination of laser light
Radiotherapy and drugs. This makes cancer cells Dr. D.J.S. Tulla, HOD, Department of
Radiotherapy can be used to treat basal sensitive to light. Cosmetics and Reconstructive Surgery,
Primus Super-Specialty Hospital

the
diabetes arthritis
CONNECTION Type 2 diabetes may put you at risk for joint pain,
but you can take actions to prevent it — and
improve your diabetes control.
by Beth Howard illustration Richard faust
W ork in the garden one day

and you’re stiff the next.
Take a long walk and your
knees ache. It’s just part of aging, right?
Yes, but your Type 2 diabetes may
Erlangen in Nuremberg, Germany,
followed more than 900 people with
and without diabetes for two decades
and found that people with diabetes
are more likely to develop arthritis;
wears down.
Diabetes is more prevalent among
people who are older and overweight,
populations already at higher risk for
arthritis. But that doesn’t fully explain
have something to do with it. People severe enough to need joint- why people with diabetes have achier
with Type 2 diabetes are almost twice replacement surgery. Osteoarthritis knees and hips. When researchers
as likely as those with normal blood is the most common form of arthritis accounted for both age and body mass
glucose to develop osteoarthritis. A and happens when the cartilage that index in their data, the connection
2013 study from the University of cushions the ends of your bones between blood glucose and joint
Early Intervention Is Key
Unfortunately for many people with multiple health
issues, joint pain often takes a back seat. “Doctors
don’t ask about it, or patients think it’s just a normal
health was still strong. part of aging,” says Joanne Jordan, M.D., MPH,
The conclusion: Diabetes must have a director of the Thurston Arthritis Research Center at
direct effect on the joints. “Diabetes is the University of North Carolina in Chapel Hill. Caring
an independent predictor for severe for your joints may play an important role in
osteoarthritis,” says the study’s author, controlling your diabetes, she says. “Arthritis in the
George Schett, M.D. knees and hips is very likely to interfere with the
ability to exercise, which you need to do to control
Linking the two weight and cholesterol,” she says.
Scientists aren’t sure why
diabetes contributes to joint damage,
but they have theories. “People with
diabetes, especially those whose
diabetes is poorly controlled, tend to
have difficulty in healing,” says CONSIDER A PHYSICAL THERAPIST
George L. King, M.D., professor of Ask your health care provider to refer you to a physical therapist.
medicine at Harvard Medical School. “Muscles can get very weak, even before you’re experiencing
“That’s as true in the joints as other discomfort,” Jordan says. Strength exercises may ease your pain,
parts of the body. It takes longer for allowing you to perform everyday activities more easily. “Have an
joints to heal after injury — whether agenda when you go,” she suggests. “Be emphatic about what you
from exercise or normal use — and can’t do that you’d like to do.”
joint damage is the result.”
Out-of-control diabetes also may
promote the production of
inflammatory substances that degrade Try to lose weight
joints. When they examined the knees Being just five kilos overweight
of people with diabetes, the increases the force on your
researchers found more inflammation
knees by 13 – 27 kilos.
than in the joints of a similar group
of people without diabetes, Schett Shedding any weight takes
says. Controlling glucose may be pressure off joints and may
essential to protecting joints from lower blood glucose. If you
osteoarthritis, he says. have pre-diabetes and lose 5
Researchers are starting to think of – 10 per cent of your body
osteoarthritis less as a wear and tear
weight, you can lower
condition and more as part of the
disease complex known as metabolic your risk of developing
syndrome. Here are some ways to Type 2 diabetes by 58
protect your joints. per cent.

50 per cent of adults
65 years and older have been
diagnosed with arthritis.
—Centers for Disease Control and Prevention
EAT HEALTHFUL FOODS

Choosing healthful foods, including low-fat dairy
foods, whole grains, legumes, fruits, and vegetables,
Get off the couch and the right amount of calories is key to managing
Nearly one-third of people with diabetes and may also alleviate joint pain. An eating
diabetes and arthritis are inactive, plan that emphasises vegetables, fish, healthful fats
compared with 21 per cent of people like olive oil, and whole grains is a good place to start.
who have only diabetes and 17 per This way of eating may lower glucose and cut the
cent of people with only arthritis, cardiovascular risks associated with metabolic
according to the U.S. Center for syndrome. Plant-based, whole-food diets that rely on
Disease Control and Prevention. But unsaturated fats — especially omega-3 fatty acids
exercise is one of the best things you contained in fish — may reduce pain.
can do to treat both conditions:
Moving your joints combats the pain
and stiffness of arthritis and it controls
the blood glucose and weight
problems associated with diabetes.
A small study published in the Manage your meds
November 2013 issue of the journal Some anti-inflammatory medications
Radiology shows that exercise may also may improve glucose control. A
benefit people with diabetes even if
2013 study found that A1C levels
they don’t make any other lifestyle
changes because exercise reduces were 37 per cent lower in a group of
harmful fat around the heart and liver, subjects taking the anti-inflammatory
and it increases insulin resistance and medication salsalate compared with
improves insulin sensitivity early in the people not on the drug. However,
disease process. Try joint friendly steroids such as prednisone, used to
activities such as walking, swimming,
treat severe arthritis, can make glucose
and riding a bike.
spike, King says. Work closely with
your health care provider to choose
the right drugs.
Beware of surgical complications

If your joint damage leads to the need for surgery, such as
arthroscopy or joint replacement, it’s wise to have your glucose well
controlled before and after the procedure to enhance your ability
to heal. People with elevated glucose tend to heal more slowly
and face higher cardiac risks prior to and following surgery.
“It’s important to have a surgeon who knows how to help you
manage your diabetes and who understands how to control
these risks,” King says.
Type 1 Diabetes &
Rheumatoid Arthritis
Kipp Chambers, 35,
a marketing engineer in
Denver, has rheumatoid
arthritis (RA) and
Type 1 diabetes.
That’s not uncommon. that the disease duo

Both are autoimmune shares a genetic connection,
disorders, diseases in which although the link isn’t
the body attacks itself. In fully understood.
people with Type 1 diabetes, conditions, patients can live
the body’s immune system life to the fullest. Although
Treatment can be tricky.
attacks the insulin-making Steroids like prednisone, Chambers wears an insulin
beta cells of the pancreas, which are often used to pump and sometimes copes
much in the same way it treat RA, increase the risk for with severe flare-ups in joint
attacks the lining of the diabetes. But other diabetes pain, he runs marathons,
joints in people with RA. drugs, such as Plaquenil and snowboards in the winter,
medications in a group and even holds state and
Having either one of these known as tumour necrosis world records in skydiving.
conditions makes the other factor blockers, such as
more likely. “If a person has Remicade and Humira, have “When I broke the Colorado
one type of autoimmune been shown to improve state skydiving record,
disorder, he could well have glucose tolerance and I woke that day with an
another,” says Yehuda prevent diabetes. awfully achy and swollen
Handelsman, M.D., chair of knee,” he says. “I just put
the scientific committee of It may sound daunting, but my head down and plowed
the American Association of with careful — and through, sliding in for
Clinical Endocrinologists. sometimes creative — most landings instead of
New research also suggests management of these standing up.”
WELLBEING
“Being truly
happy in life
involves you
feeling more in
control of the
direction your life
is going.”
—Deborah Dey
date with the
DENTIST
Seven myths that need to be busted before a diabetic goes to see a dentist.
by Dr. Manikandan GR

It’s a sad fact that India has evolved as There are several long standing myths
the diabetes capital of the world. Oral around the relationship between oral
health plays a prominent role in the health and diabetes, which need to be
glycaemic control of diabetic patients. shattered in order to ensure the
Despite this we see many patients who overall wellbeing of the individual.
do not take their oral health seriously Let’s begin with busting some of them
and end up developing complications. here for your benefit.
1
I don’t need
to tell my
dentist
about my
diabetes
history.
Patients often think of different doctors

as being completely independent of
each other, including their dentists.
Most of the time they consider it
unimportant to discuss their diabetes
situation with the dentist and end up
concealing valuable information which
is crucial for the right treatment.
It’s important to know that dentists
have to make sure that the patient’s
glycaemic level is under control and
needs to frequently monitor it using
tests like random or fasting,
postprandial blood sugars or glycated recommended for those patients who require an additional blood glucose
haemoglobin, in certain cases. The are at risk of hypoglycaemia. reading to make sure the values are
wound healing process may be delayed Most patients with diabetes are not dropping below 70 mg/dL.
in these patients after dental extraction recommended to eat a meal or snack Readings at the end of appointments
too. Also the drugs that patients take every four-five hours and those with are important to make sure the patient
for diabetes may have drug interaction gestational diabetes every two-three is safe to leave the clinic, particularly
with the ones prescribed by the dentist. hours. To avoid hygpoglycaemic those who drive.
Another complication that can occur episodes during a dental procedure,
while in the dental chair is a chance including a prophylaxis, blood glucose Carbohydrate sources for treating
episode of hypoglycaemia. Not all values are to be obtained. If the blood patients with hypoglycaemia
patients with diabetes experience glucose level is below 70 mg/dL, then (70 mg/dL or lower):
hypoglycaemia. Those taking insulin or the patient needs to be treated • Glucose tablets
anti-diabetes medications (i.e., accordingly. One should consume • 1 tube glucose gel
sulfonylureas and meglitinides) with 15-20 grams of a carbohydrate source • 8 hard candies
possible side effects like and retest their blood glucose level 15 • Raisins
hypoglycaemia may experience minutes later. If the blood glucose • 113 g of regular soda
difficulties. An appointment value is still under 70 mg/dL, repeat • 113 g fruit juice
scheduled after a meal or snack is the treatment. Long appointments will • 226 g skim milk
2 I’m sure diabetes has no relation
with dental trouble.
Periodontal disease has been In addition to periodontal infection

reported as the sixth complication of and gingival inflammation, a
diabetes, along with neuropathy, number of other oral complications
nephropathy, retinopathy, as well as have often been reported in patients
micro and macro-vascular diseases. with diabetes. These include
Many studies have been published Xerostomia, dental caries, candida
describing the bi-directional inter- infection, burning mouth syndrome,
relationship exhibited by diabetes and lichen planus, and poor wound
periodontal disease. Studies have healing. Proper management of
evidenced that control of periodontal these complications requires proper
infection has an impact on diagnosis. Many of the problems
improvement of glycaemic control by can be properly identified by a
a decrease in demand for insulin and comprehensive oral examination at
decreased haemoglobin A1c levels. each medical or dental visit.
3 I don’t think my laziness in getting my teeth cleaned

affects my blood sugar.
In addition to the emerging evidence
supporting periodontal disease as a
potential risk factor for developing
diabetes complications, there is also
greater chance – up to two times
greater – of getting Type 2 diabetes
than people with healthy gums.
The next question that researchers
observation that it does. Out of 35
reports (11 randomised clinical trials,
the highest form of scientific
evidence, and 24 non-randomised
evidence that periodontal disease set out to answer is whether clinical treatment studies), 20 of the
may be a risk factor for the periodontal infection adversely studies found that the amount of
development of Type 2 diabetes and affects glycaemic control among long-term blood sugar was lower
possibly gestational diabetes. In fact, people with diabetes. There is a after gum treatment. This means
a study shows that people with growing body of evidence that treating gum disease seems to
periodontal disease have a much supporting the long-held clinical better help control diabetes.

GO TO THE RIGHT DENTIST
Many medical conditions, You know you’re at the right dentist if he that they need periodic dental and
particularly diabetes, periodontal examinations (every six
predispose patients to 1. ...asks individuals with diabetes about months or more frequently) as
development of more severe their oral health, specifically if they have recommended by the ADA.
and progressive forms of noticed any signs of infection, bad
periodontal disease. In an breath, or a bad taste in their mouth or 4. ...encourages contact with patients'
effort to focus attention on if they have any other symptoms. dental care provider if they notice signs
the need for better oral health of infection such as sore, swollen, or
outcomes for patients with 2. ...inquires about the last dental and bleeding gums, loose teeth, mouth
diabetes and periodontitis or oral health examination. ulcers or pain.
other oral complications,
several steps need to be taken. 3. ...reminds individuals with diabetes 5. ...performs an oral examination.
4
It’s my Diabetes might also result in increased poorly-fitting dentures. Gums can
bone resorption among denture sometimes recede, exposing your bone
dentist’s wearers. So the measurements taken directly. With reduced saliva, too, your
fault if during fabrication of the current mouth is more vulnerable towards
my new denture may change after a year. This infections. This can include infection of
denture may result in a need for frequent dentures, sores, but can also include a
replacement of dentures among number of minor infections, such as
doesn’t fit diabetic patients. cheilitis or candida (thrush). This minor
well and Reduced blood supply can make your fungal infection is about twice as
keeps me gums vulnerable to damage from common among diabetics than others.
on toes.

5
Something A combination of factors
the dentist appears to play a role in this
prescribed process. Burning mouth
syndrome is a chronic, oral
worsened pain condition associated with
my burning sensations of the
sensation. tongue, lips and mucosal
I feel regions of the mouth. The
pathophysiology is mainly
burning idiopathic but can be
inside the associated with uncontrolled
mouth. diabetes, hormone therapy,
psychological disorder,
neuropathy, Xerostomia and
candidiasis. Generally, there
are no detectable lesions
associated with the syndrome,
which is based solely on
patient report of discomfort.
Treatment is targeted at the
symptoms and requires
attention to glycaemic control,
which will result in reduction
of other complications
involved in the process.
Medications often used for this
condition, benzodiazepines,
tricyclic antidepressants, and
anticonvulsants, have been
shown to be effective
therapies. Care must be taken
while prescribing these
medications to patients with
diabetes because of associated
xerostomic effects. So, keep
your dentist in the loop.
6
Diabetic patients with renal out on the day after dialysis. Renal
I have problems may have impaired drug condition is optimal at this time and
some renal excretion. Drugs used in dental the anticoagulant effect has stopped.
complications sedation and general anaesthesia
should be used with caution and in
The arm with vascular access for
dialysis (the surgically created
of diabetes consultation with a physician. Renal arterio-venous fistula) should not be
that my disease influences the use of other used for venepuncture by the dentist.
dentist has drugs in dentistry, particularly Patients, who have had a kidney
no right to NSAIDS and some antimicrobials.
Platelet dysfunction may occur in
transplant, may need corticosteroid
cover, have a bleeding tendency if
ask about. renal patients giving rise to a anti-coagulated, may have gingival
bleeding tendency. Patients on hyperplasia if taking cyclosporin and
haemodialysis may be heparinised. are prone to infections due to
Dental treatment should be carried immune-suppression.
7
Neuropathic problems may affect the Diabetic neuropathy could be the
If I have oral tissues also and they may manifest underlying cause of BMS in patients
neural as frequent atypical neuralgias and with diabetes. The nerve damage in
problems phantom pain sensations. Also diabetic diabetic neuropathy has been reported
of diabetes patients with neural problems may
have difficulty in handling dentures and
to show an increase in the Langerhans
cells that are associated with immune
what may break them accidentally. The disturbance. Therefore, it is crucial to
special neuropathic medications need to be screen patients who have symptoms of
thing is he known to the dentist to avoid drugs BMS for diabetes mellitus.
going to causing interactions.
do if I tell
that to my
dentist?
Glycaemic control is probably the single most important component in maintenance of good oral health in individuals with
diabetes. Attention to all these steps will be very helpful towards achieving improved overall oral and systemic health. So the
diabetic patient should know these things next time they consult a dentist. Proper communication can benefit them with
good treatment outcomes. As is often quoted ‘the mouth is a mirror of all diseases’, oral manifestations may point to many
underlying systemic pathologies. Make routine dental care a habit and be stringent in keeping the oral cavity healthy by
brushing and flossing daily. Let the healthy smile stay with you forever.

Extending
COMFORT
Cancer is an
overwhelming medical
condition that, besides
the obvious physical pain,
also causes a lot of stress.
Palliative care makes sure
that the symptoms and
side effects are minimised,
in addition to the related
psychological, social and
spiritual problems.
by Dr. Mandeep Singh Malhotra
P alliative care is a specialised
medical care extended by
medical professionals for people
with serious illnesses. In cases that
involve patients suffering from
Who should receive
palliative care?
Patients who should receive palliative
care but not any cancer-directed
therapy can be defined by the
symptoms of pain, physical stress and following conditions:
mental stress of a serious medical 1. Patient has limited scope for taking
condition, the intent is to provide relief care of themselves and has to
and support to the patient and his depend on others.
family members. The goal of such 2. Patient has received no benefits
therapy is improvement in the quality from prior evidence based treatment.
The goal of of life for the patient and his family. 3. Patient is ineligible to participate in
such therapy as Palliative care comes under the
purview of team of physicians, nurses
any appropriate clinical trial.
4. The physician sees no benefits from
palliative and other paramedical staff and treatment followed.
care is
healthcare professionals who work The above characteristics are generic
hand-in-hand with the primary care and can be applied on patients with
doctor to provide additional support. It other diseases also.
improvement in the is appropriate at any age and at any A World Health Organisation
quality of life stage in a serious illness and can be

provided along with curative treatment.
statement describes palliative care as,
“An approach that improves the quality
for the patients Some diseases and cases may require

only palliative care and medical
of life of patients and their families
facing the problems associated with
and their family. speciality professional organisations

or doctors may not recommend
life-threatening illness, through the
prevention and relief of suffering by
therapy associated or directed means of early identification and
towards the disease. impeccable assessment and treatment
of pain and other problems, physical,
psychosocial and spiritual.” More
generally, however, the term ‘palliative
care’ may refer to any care that
alleviates symptoms, whether or not
there is hope of a cure by other means.
Thus, palliative treatments may be used
to alleviate the side effects of curative
treatments, such as relieving the
nausea associated with chemotherapy
Cancer Symptoms and

Treatment — How Palliative
Care Can Help
Palliative care specialists work in
close partnership with oncologists
(cancer specialists). This care is
extended to any person, of any age,
with any type or stage of cancer for
better health benefits.
Palliative care teams have a high
understanding about the disease itself,
the treatments for it and the suffering it
can cause. Cancer symptoms are
known to include pain, nausea,
vomiting, fatigue, anxiety, depression,
constipation, diarrhoea, confusion or

shortness of breath. The palliative care
team specialises in relieving the
symptoms of cancer and also help with
other situations where the patient and
their family is overwhelmed by
complicated medical information,
confusion or worries about making
important treatment decisions.
Palliative care specialists are
trained and equipped to
interpret the complex
medical information they
receive from the oncologist
and have the time and
expertise to deal with diverse
situations these medical conditions
can manifest in. They are also
equipped to help the patient
understand what the symptoms mean
and extend support to deal with it.
Palliative care includes ensuring that
the patient leads the best quality life in
diverse medical circumstances. The
team supports in explaining without diabetes. Diabetes and
procedures, supplying adequate hyperglycemia are associated with The association
information on treatment procedures higher infection rates, shorter
and help in making appropriate re-mission periods, and shorter between diabetes
treatment choices. They help the
patient by making them adequately
median survival times, as well as
higher mortality rates.
and some cancers
prepared to deal with the outcomes of • The association between diabetes may partly be due
to shared risk
procedures like radiation, chemo- and some cancers may partly be due
therapy or surgeries. Counselling and to shared risk factors between the
mental support forms a part of the
palliative care team responsibilities.
two diseases, such as ageing, obesity,
diet and physical inactivity. factors between
A recent study has revealed that
cancer patients who received
• Possible mechanisms for a direct link
between diabetes and cancer include
the two diseases,
palliative care lived longer than those
who did not.
hyperinsulinemia, hyperglycemia, and
inflammation. Carcinogenesis is a
such as ageing,
complex process. Normal cells must obesity, diet and
Diabetes and Cancer undergo multiple genetic ‘hits’ before
• Diabetes (primarily Type 2) is the full neoplastic phenotype of physical inactivity.
associated with increased risk for growth, invasion and metastasis
some cancers (liver, pancreas, occurs. This process of malignant
endometrium, colon and rectum, transformation can be divided into
breast, bladder). Diabetes is multiple steps: initiation (irreversible
associated with reduced risk of first step toward cancer), promotion
prostate cancer. For some other (stimulation of the growth of initiated
cancer sites there appears to be no cells) and progression (development
association or the evidence is of a more aggressive phenotype of
inconclusive. promoted cells). Factors that affect
• Several studies have also one or more steps of this pathway
demonstrated that patients with could be associated with cancer
diabetes and cancer have a poorer incidence or mortality. Diabetes may
prognosis compared with those influence the neoplastic process by
several mechanisms, including
hyper-insulinemia (either
Lower under control before they can safely
undergo cancer treatment. Until
endogenous, due to insulin resistance
or exogenous due to administered
insulin levels recently, a patient’s diabetes and
cancer were treated as if they were
insulin or insulin secretogogues), have been unrelated. However, physicians are
hyperglycemia, or chronic finding that some diabetes treatments
inflammation. associated with seem to be more effective than others
• A potentially important interaction
between diabetes and cancer is the
better outcomes for controlling blood sugar in patients
with concurrent cancer. The evidence
common thread of insulin signaling. in diabetic patients for specific drugs affecting cancer risk
with prostate
Insulin is a potent promoter of cell is limited and observed associations
growth and may be implicated in the may have been confounded by
or breast
development of some common indications for specific drugs. Effects
cancers. Insulin-like growth factor on other cancer risk factors such as
receptors are often mutated in
cancers, and the resulting cancer. body weight and hyperinsulinemia and
the complex progressive nature of
dysregulation of the insulin signaling hyperglycemia and pharmacotherapy
system may lead to rampant in Type 2 diabetes are also present.
proliferation in some types of cancer. Although still limited, early evidence
suggests that metformin is associated
Hyperinsulinemia, which can result with a lower risk of cancer and that
from the disruption of insulin signaling exogenous insulin is associated with an
or production, is a risk factor for the increased cancer risk. Further research
development and progression of is needed to clarify these issues and
several cancer types, including prostate evaluate if insulin glargine is more
and breast cancers. In contrast, lower strongly associated with cancer risk
insulin levels have been associated with compared with other insulins.
better outcomes in diabetic patients
with prostate or breast cancer. Dr. Mandeep Singh Malhotra, Consultant,
Surgical Oncology, Fortis Hospital,
Shalimar Bagh
Treatment of diabetic
cancer patients
Many diabetic cancer patients have
poorly controlled blood sugar at the
time of their cancer diagnoses. These
patients’ blood sugar must be brought

the
AYURVEDA
WAY
Diet, as well as lifestyle transitions (the everyday
intake of a healthy diet and pursuing an active life)
are imperative for a healthy life.
There are several Ayurvedic medicines which
help manage diabetes better.
by Dr. Sonica Krishan
D
id you know that drinking a cup imbalanced diet and incorrect eating
of water stored overnight in a habits. Diet and lifestyle modifications
copper vessel helps keep are two main necessities in Ayurvedic
diabetes at bay? Taken daily just before diabetes management. While diet
meals, turmeric works wonders in control of mainly starches and sugars is
controlling your insulin. Ayurvedic imperative for a diabetic patient, daily
experts have been treating diabetic exercise schedule – like brisk walking
mellitus since Vedic times. This is a in fresh air for an hour or practising
sliver of that immense knowledge that yoga and pranayama – is highly
has been followed through the ages. recommended. Here are some ways to
keep diabetes at bay, the Ayurveda way.
Ayurvedic analysis of diabetes • Grind the seeds of a bitter gourd and
Diabetes is known as prameha or consume the powder twice a day with
madhumeha in Ayurveda. Twenty types warm water. Juice extracted by
Ayurveda
of prameha have been specified in grinding fresh bitter gourd is another
Ayurvedic texts. They can broadly be excellent cure. Consume 10 to 20 ml
in
classified as under: juice every morning on an empty
• Diabetes borne out of vitiation of stomach. Drinking at least one
general
vatta or the air-body humour. There tablespoon of bitter gourd juice daily
are four varieties of the same. will reduce blood sugar levels in your
• Diabetes due to vitiation of pitta blood and urine.
or the fire-body humour. This • Having bitter gourd cooked in ghee advises that a
occurs in six varieties.
• The disease of diabetes is a
for a period of three months is
known to bring diabetes under
diabetic patient
consequence of vitiation of kapha or control significantly. needs to inculcate
the phlegm dosha. There are ten
varieties of the same. To a great
• Chew tender leaves of neem or
azadirachta indica in the morning on tastes
the
extent, they are considered curable.
Ayurveda in diabetes
an empty stomach. Next, drink a
glass or two of warm water. This also of bitter,
management
helps control frequent urination.
• Bael or aegle marmelos is highly
pungent and
Diabetes is a lifestyle disease, which recommended for diabetic patients. astringent in their
mainly relates to sedentary lifestyle, It has the property of declining the
daily diet plan.
blood sugar levels and abates are a strict no-no for groundnut flour with wheat flour
excessive urination. It could be diabetic patients. and make chapattis.
more beneficial to take the juice • Ayurveda forbids the habit of • Go for a mixed cereal intake. Mix
extracted from its leaves on an overeating. Eat only when flours of wheat, jowar, bajra, chana
empty stomach. hungry. Avoid over snacking or or gram flour and makki or corn.
• Being pungent and astringent, unnecessary munching. While making chapattis, you may
brahmi or bacopa monnieri is • The flour of groundnut is believed to take equal quantities of groundnut
believed to be very helpful in be beneficial for those suffering or soyabean flour. Try and drink
diabetes. Diebetics are thus advised from diabetes. You could mix water from a glass made of vijaysaar
to supplement the herb preparations
along with their routine therapy.
• Take one teaspoon of jamun
powder, prepared by crushing the
dried seeds of the fruit. Supplement
this with your routine medication.
• Juice extracted from fresh
mango leaves, when consumed
along with an equal quantity of bitter
DIABETES
gourd juice on an empty stomach LIFESTYLE
during the initial stages of the
disease, proves quite beneficial in
eradicating diabetes.
• Fresh juice of amla or the Indian • Avoid sleeping
gooseberry is another herbal
recommendation that should be during daytime.
consumed regularly. A tablespoon • Avoid smoking.
of amla juice mixed with a cup of
fresh bitter gourd juice, taken daily • Take adequate care
for two months can enable the of your eyes.
pancreas to secrete insulin.
• Drinking a glass of water with 10 • Do exercise on a
tulsi leaves, 10 neem leaves and 10 regular basis.
belpatras early morning on an empty
stomach helps in keeping sugar • Take extra care of
levels under control. your feet.
• Mix and grind seeds of fenugreek
(100 gm), turmeric (50gm) and
white pepper. Take one teaspoon of
this powder with a glass of warm
milk twice daily.
• Put one cup of water in a copper
vessel at night and drink the water
next day morning.
Ayurveda dietary
recommendations
• Diet products rich in carbohydrates
should be avoided in daily diet. Such
carbohydrate-rich foods include:
potatoes, sweet potatoes, rice,
maize, very sweet fruits like mango,
fruit juices and all other
sweetened drinks.
• Likewise, oily, fried and fatty foods
DIABETES
MANAGEMENT
• Light but regular exercise needs to

become part of a diabetic patient’s
regular diet regimen.
• Yoga poses like matsyendra asana,
According to hala asana, bhujanga asana,
Ayurveda, mandook asana, and several
diabetes, others prove to be quite beneficial
is in better management of diabetes.

• Practise the Surya Namaskara
primarily a every day.
kapha disorder, or the
dosha that governs
physical
well- wood. It’s all the more beneficial if
being. you keep this overnight and drink

the water next day morning on an
empty stomach.
• Include bitter, pungent and
astringent foods in your daily
diet plan.
Ayurvedic medicinal formulations

There are a number of classical
Ayurvedic medications that have been
used to treat diabetes. However, this
does require access to authentic herbs.
Ayurvedic medicines like basant
kusumakar rasa, shilajitvadi vatti,
churan and chanderkala vati are some
time-tested remedies which should
only be taken under the supervision of
an Ayurveda physician. Some lifestyle
modifications like healthy eating, daily
exercise, stress management and
regular Ayurveda treatment, can easily
help manage diabetes.
Dr. Sonica Krishan is an Ayurveda and

natural lifestyle consultant and health
writer. She has authored many books.

LIVING
strengtH
exErcise
eAt
Live
fiTness
cHallenge
enjoY
PARTNER
POWER A couple works together
for motivation, inspiration,
health and happiness.
by Gina Shaw | photos by Shannon Greer
beauty styling by Ananda Khan

“My husband has helped
tremendously with lowering
my A1C. I would not be as
healthy as I am if he didn’t
give me that extra push
and support.”
W hen Blenae Abebe

and her husband,
Giovanni Pagan, married
in 2007, she was an old pro at
managing her diabetes. Then
British researchers
in JAMA Internal
Medicine in
January found that
having a partner
29, she’s been living with Type 1 who became more
since age eight. Still, she was physically active
amazed at how much easier it made people five
was to make healthy lifestyle choices times more likely
as part of a team. to exercise. One
“Shortly after we married, we joined partner losing
a gym together and started seeing weight improved
the same nutritionist, who also has the other’s
Type 1 diabetes,” says Blenae, who chances of
works in the cardiology division at slimming down
Columbia University Medical Center threefold.
in New York City. “I used to have That’s not
problems going to the gym because surprising, says
my blood sugars would spike, but William Polonsky,
seeing a nutritionist who’s also Ph.D., CDE,
diabetic helped me figure so many cofounder and president of the on it, he used to give me a little side
things out. It’s really changed my life.” Behavioral Diabetes Institute in eye, like: Are you sure you want to
Today, Blenae and Giovanni grocery San Diego. do that? I know he cares and doesn’t
shop, cook, and work out together “There’s always been good want me to slip and now if I indulge,
almost daily. “We always stop in the evidence for the power of modeling,” he’ll just say: ‘OK, just make sure you
middle of a workout and check my Polonsky says. “We’re influenced by adjust your basal insulin in the
blood sugar,” Blenae says. “It’s so the choices others make. You do pump,’ instead of something critical.”
much easier to eat healthy, exercise, better when you’re making positive We’re all creatures of habit — but
and manage your blood sugar when changes together.” being in a supportive partnership can
you have a supportive partner.” Adopting a healthy lifestyle turn habits into assets. “Most people
Research shows the power of two together can help partners decrease are not necessarily adventurous
isn’t all talk. At an American Heart the “diabetes burden,” says Kara about trying new things,” Polonsky
Association meeting last March, Harrington, Ph.D., a psychologist at says. “Getting active or choosing to
researchers from Johns Hopkins the Joslin Diabetes Center in Boston. eat differently can be difficult. It’s
University presented a study “If one partner is willing to make easier when other people are joining
showing that about 70 percent of lifestyle changes, it can really you in making those changes.”
men and 40 percent of women influence the other.” Blenae agrees. “When you’re
adopted exercise guidelines if their And there’s a difference between alone, it’s easier to slip and not
partner was already committed to partnering and nagging, which give a hoot. I know I could do it on
exercising, too. Blenae and Giovanni figured out. my own, but it’s just much easier
Even more, a study published by “If I had a bagel and put some jelly with him around.”
TAKE CHARGE!
ALL “More than half the world’s
PREGNANT diabetics believe that a
WOMEN recommended dose of fish oil can
NEED A help prevent heart disease. The
DIABETES truth is you’d have to consume so
TEST much fish oil to get a relatively
minimal heart benefit that you
A panel of medical
experts recommends that would literally smell like a fish.”
all women be tested for
—Cleveland Clinic Heart Health Survey findings
gestational diabetes by their
24th week of pregnancy.
The U.S. Preventive Services
Task Force made the
recommendation earlier
this year, saying screening
and treatment lower the
risk of preeclampsia and
other complications of
pregnancy, labour, and
delivery. Gestational
diabetes affects about
seven per cent of pregnant
women in the United States
and it puts mother and
baby at risk of developing
diabetes later in life.

YOU ARE WHAT YOU THINK
Learning how to have a positive outlook people who motivate and encourage me.
— specifically toward diabetes — can result • I don’t have to climb the mountain
in a longer, healthier life. Try saying some in one day.
of these affirmations every day. • I will not expect perfection every day; I
• I am the CEO of my body. will do my best and keep moving forward.
• Living with diabetes is not the end of • I am too big a gift to my family and
the world. friends to waste time with pity
• I will only surround myself with positive and sadness.
MONITORING TrialNet for Type 1

REALLY MATTERS If you have Type 1 diabetes, your relatives
are 15 times more likely to develop Type 1
With regular blood glucose monitoring, you can than the general population. They can
compare day-to-day results with your A1C level. find out more about their risk by visiting
You also quickly learn how certain foods, meals, diabetestrialnet.org.
stress, illness, and activities affect your blood Family members of a person with Type 1
glucose, says Betty Brackenridge, RD, CDE, diabetes simply answer an online survey and,
director of professional training for Diabetes based on the results, get a screening kit in the
Management and Training Centers, Inc., in mail. If found to have a risk for Type 1,
Phoenix. She also lives with Type 2 diabetes. TrialNet will let the person know if he or she
Don’t wait for months until you see your is a candidate for a prevention study.
provider and have pages of records. Instead, ask Those eligible for screening:
for some guidelines so you can make care • Anyone between ages one and 45 with a
adjustments between visits. “Results lose power sibling, child, or parent with Type 1 diabetes.
the minute you take them,” Brackenridge says. • Anyone between ages one and 20 with a
“The quicker you evaluate your numbers and sibling, child, parent, cousin, uncle, aunt,
take action if need be, the more effectively the niece, nephew, grandparent, or half-sibling
numbers can help you.” with Type 1 diabetes.
All through the year
there are many
occasions that tempt
you to fast, for religious
reasons or otherwise.
But the debate is
whether or not to fast
when you have
diabetes. We get you
some expert advice.
by Swati Bharadwaj | Dr. Anoop Misra

If diabetics
fast...
F asting, a partial or total abstention from all

foods or a select abstention from prohibited
foods, is a common trend among Indians.
Some of us fast for spiritual reasons, some for
losing weight and still others have other reasons.
Some of the major complications
associated with fasting in patients with
diabetes can be summed up as under:
1. Low blood sugar level (hypoglycaemia).
2. Very high blood sugar level
As a potential non-pharmacological intervention (hyperglycaemia).
for improving health and increasing longevity, fasting 3. Rise in acids in blood (diabetic
has been the subject of numerous scientific ketoacidosis).
investigations. However, fasting has been 4. Dehydration (water depletion) and
uniformly discouraged by medical professionals blockage of arteries (thrombosis).
for patients with diabetes.
Hypoglycaemia Hyperglycaemia
Decreased food intake is a well-known risk Diabetic patients may also suffer
factor for the development of hypoglycaemia. It from high blood sugar levels
has been estimated that hypoglycaemia accounts for (hyperglycaemia) during fasting due to
two to four per cent of mortality in patients with Type 1 excessive reduction in dosages of
diabetes. During fasting, there is an increased risk of medications to prevent hypoglycaemia or in
hypoglycaemia. Long-term morbidity and mortality cases where patients indulge in food and/
studies in people with diabetes have demonstrated a or sugar after opening the fast or eat
strong link between hyperglycaemia and other starchy/ low fiber foods (sago, fried
complications associated with diabetes like coronary potato, fruit juices etc) which are
heart diseases, blockage in the blood vessel of the permissible during the fast.
brain (stroke), damage to the kidneys (diabetic
nephropathy), damage to the nerves (diabetic
neuropathy) and damage to the retina of
the eyes (diabetic retinopathy). Diabetic
ketoacidosis
Patients with diabetes, especially
those with Type 1, who continuously fast
Monitor during Ramadan or Navratra or other similar
your sugar occasions are at an increased risk for developing
level diabetic ketoacidosis (high concentrations of
ketone bodies; rise in acids in blood), particularly if
If at all one has to keep their diabetes is poorly controlled before the fasts.
fasts, continuous monitoring In addition, the risk for diabetic ketoacidosis may
of blood sugar levels is a be further increased due to excessive
must for all diabetics reduction of insulin dosages based on the
during fasting. assumption that food intake is
reduced during the month.
Dehydration and Management
The medical recommendation
Thrombosis for diabetic patients is not to
Limitation of fluid intake during the fast, especially if undertake fasting. However, as fasting for
prolonged, is a cause of dehydration. Dehydration may patients with diabetes is a personal decision, it
become severe as a result of excessive perspiration in hot and should be done only after careful consideration
humid climates and among individuals who perform hard physical of the associated risks and in consultation with
labour. In addition, hyperglycaemia leads to osmotic diuresis health care providers. Patients who insist on
(excessive urination), further contributing to volume and electrolyte fasting need to be aware of the various risks
depletion. Orthostatic hypotension (blood pressure suddenly falls on involved and the techniques to lessen this risk.
standing up or on stretching) may also develop, especially in patients Patients may be at higher or lower risk for
with pre-existing autonomic neuropathy (group of symptoms that occur fasting related complications depending
when there is damage to the nerves that manage regular body on the number and extent of their
functions such as blood pressure, heart rate, bowel and bladder risk factors.
emptying and digestion). Syncope falls (fainting due to spontaneous
loss of consciousness caused by insufficient blood to the brain),
injuries and bone fractures may result from hypovolemia
(state of decreased blood volume) and the associated
hypotension (low blood pressure). Increased blood Seek medical
viscosity due to dehydration may enhance advice
the risk of thrombosis and stroke. 1. Management of the condition in
consultation with your doctor is the mantra that
all diabetics must follow, especially while observing
a fast. Monitor your blood sugar level regularly and
more frequently during fasting.
2. Therapy: check with your doctor if you can reschedule
Nutrition medication/insulin in accordance with the fast timings or
change the dosage. Usually in such cases the therapy is
Fasting involves a major change in the dietary slightly modified/ adjusted to meet the requirements.
pattern. Most health problems are likely to arise 3. Do not adjust the dosage or skip medication without
from inappropriate diet or as a consequence of over/ consulting your doctor.
under-eating and insufficient sleep. Therefore, the diet 4. Discuss with your doctor the frequency and
during fasting for people with diabetes should not differ duration of the fast and type of diet. Diets may
significantly from a healthy and balanced diet. vary as per the kind of fast being observed.
1. Nutritional advice should be in accordance with the
type of fasts and medical problems. It should aim at
maintaining a constant body mass.
2. The common practice of ingesting large amounts
of foods rich in carbohydrates and fats, especially
while eating the ‘permissible foods’ (often
starchy and fat rich) or after opening the
fast should be avoided.
Exercise
Normal levels of physical
activity (light walk) may be
maintained. However, excessive
physical activity (jogging, running,
strenuous exercises) may lead to
a higher risk of hypoglycaemia
and should be avoided.

DIET DOS & DON’TS
Ramadan
1. Diabetics who fast during Ramadan should remember that their sehri
(pre-dawn meal) should contain complex carbohydrates like whole wheat,
oats, unpolished rice, whole pulses etc. These take time to get digested,
last longer in the stomach and keep hunger pangs away.
2. The pre-dawn meal should be taken as late as possible.
3. While breaking the fast after sundown, foods with refined/simple
carbohydrates like refined flour and white bread which gives instant
energy is recommended.
4. Drinking lots of fluids is essential during non-fasting hours.
5. Strenuous exercise should be avoided.
Navratra
1. The thumb rule is to resist temptation and avoid fried foods like Navratra specialties
made from singhara atta (pakora, poories, paranthas), potatoes and arbi (colocasia) as
these can be harmful.
2. Remember that even during fast a diabetic should have small meals at equal intervals
of three hours, which should include foods high in fibre and low in glycaemic index.
3. For those following the fast regimen during the Navratras, gourd, pumpkin, leafy
vegetables, salads, apples, skimmed milk, curds, cucumber and citrus fruits are
recommended for consumption in small portions every three hours.
4. Buckwheat flour can also be used in non-fried items as it has a low glycaemic index
(it does not raise the blood sugar levels rapidly).
5. It is recommended to include lots of fluids to keep yourself well hydrated.
WHEN NOT TO FAST

It is important to know when to medications are taken at predawn. advanced diabetes and in case of
avoid a fast or discontinue one. • The fast should be immediately some patients taking certain types
Understand that not all diabetics discontinued if blood glucose of blood pressure drugs.
can observe fasts. exceeds 300 mg/dl. • Those who have diabetic
• Patients should avoid fasting ketoacidosis (a dangerous
• A patient must always and on ‘sick days’. complication of diabetes in which
immediately end the fast if • Patients who have suffered from the chemical balance of the body
hypoglycaemia (blood glucose of severe hypoglycaemia (low blood becomes far too acidic) should
≤ 60 mg/dl occurs because their sugar) three months prior to also avoid fasting.
blood glucose may drop further if fasting should not change their • In case of pregnancy, kidney, liver
they delay the treatment. routine. It is all the more and heart problems, strokes,
• The fast should also be dangerous in case of those with a ulcers, gangrene and amputation,
discontinued if blood glucose history of recurrent hypo- fasting is absolutely ruled out.
reaches 70 mg/dl in the first few glycaemia. Often they are unaware • Patients living alone should also
hours of starting the fast, especially of their condition. Low blood refrain from fasting.
if insulin or other diabetic sugar occurs among those with
Dr. Anoop Misra is chairman, Fortis-C-DOC Centre of Excellence

Swati Bhardwaj is head, Nutrition and Fatty Acid Research, for Diabetes, Metabolic Diseases and Endocrinology; Chairman,
National Diabetes, Obesity and Cholesterol Foundation (N-DOC) National Diabetes, Obesity and Cholesterol Foundation (N-DOC)
FITNESS
“Take care of
your body.
It’s the only
place you
have to live.”
—Jim Rohn

RUtoN
st a y fit
Prakash Shetty
design
Marathons have become quite a rage to staying fit. Is it safe

for you to run? How much is enough? Do you need a special
training? Will it affect your knees? Daniel Vaz, head coach,
Nike + Run Club answers all your questions and more.
by Siddharth M Joshi
newbie to run
every day?
1
Is it okay for a
It is recommended that one not

run every day. Take at least one -
two days off as it helps in
2
reducing the frequency of
overuse injuries. By taking
adequate rest, you give your body
a chance to recover and repair
itself. Additionally, the individual Do we need to have a
would feel better and stronger certain body type to run?
during their run. Taking a break
also helps the individual relax All body types can take up running. However, if
mentally and not just physically. your body mass index is over 25 then you need to
Beginners should run on alternate be extra careful by using proper cushioning for your
3
days and average running three shoes and avoid concrete surfaces for running.
- four times a week.
How much should one run

to start with?
A beginner can start off by running two to four
times a week for about 20 to 30 mins per run. It is
best to start slow and go easy on the run. Starting off
with a jog is the general recommendation. Gradually,
in order to avoid injuries, individuals can increase
their run time over the weeks.
However, if the individual is a true beginner
and can’t run even for ten minutes then
it is best to start off with a
walk/run plan.

4 What is the
difference
between running
on a treadmill and
running outdoors?
A treadmill requires less effort when running at
the same speed as doing it outside. This is
because the belt moves below your feet and
reduces the effort in your stride. Periodically
running outdoors is essential if you are going to
take part in races because the road makes your
calves and ankles work harder. The advantage
of a treadmill though, is that you get to control
various speeds and inclinations thus allowing
you to challenge your workout in a closed
setting. Also, on days when the weather outside
is not conducive to running (rain, extreme cold,
too warm, etc), you can do your workout
comfortably on a treadmill.
5 How does
running help
building of
muscles?
Yes, it is possible to build your leg muscles
by running. However, running alone won’t
help you build overall musculature. Finding a
balance between running, weight training
and nutrition is the key to building muscles
and the right balance also depends on
one’s specific goals.
6
Is it okay to run barefoot?
In order to run barefoot it is better to first make
a transition by using ‘minimalistic shoes’. Also,
if your body mass index is higher than 25
then barefoot or even minimalistic shoe
running is not advisable due to
higher load on the knees
and hips.
7
A lot of
people prefer
There is a
common belief
that running
is bad for your
knees. Is it true?
jogging over Most common running injuries
generally hit the knees.
running. What However, this isn’t only because
is better? of running. In fact, running helps
in strengthening the knee, as it
There is no difference thickens the cartilage in the
between jogging and joint. As you start running, your
running and it is just
body gradually adapts to it and
8
terminology used to
since running doesn’t involve
classify the everyday
runner who runs purely bending the knee too much,
to keep fit. As Dr. twisting or turning, it is a safe
George Sheehan says, form of exercise. One of the
“The difference between ways to reduce the chance
a jogger and a runner of a knee injury, while
is a race bib.” running, is to strength train
and change your shoes
periodically.

9 Is it okay
to eat
before
running?
Eating just before the run is
generally not advised as it
leads to cramps or side
stitches. However, running
on empty stomach is also
not advisable as it can leave
the individual fatigued.
Having a light meal, which
is high on carbohydrates
and low on fats, an hour
before the run is ideal. The
idea is to make sure that
blood glucose levels are
10
stable while running.
What are the nutrition

requirements for a
runner?
There are no specific nutritional
requirements for a recreational runner
doing up to 21K races, except that your
carbohydrate intake after every run
should be adequate to fuel your body
for the loss of glycogen. However, for
runners doing a full or ultra marathon
the carbohydrate requirement can be in
the region of 10-14 g/kg of body
weight. In addition, your protein intake
should generally be 1.2-1.4 g/kg of
body weight.
11
How can we maintain
our running pace while in
a marathon?
Training and practicing the pace before the
marathon is an absolute must if you intend to race for
a goal time. Warming up before the race with easy
strides and running gait exercises is recommended
as it helps your muscles prepare for the pace you
will set. Starting off slow and easy and
eventually picking up speed can help in
maintaining one’s pace and also
avoid cramps and fatigue.
12
Running looks pretty easy.
How important is it to have
a running coach?
The need for a coach is absolutely essential if one is training for
races that have distances equal to or more than a half marathon.
This is because the running mileage, if not tailored to suit the
individual, can lead to over-training and/or injuries. Also, the
progressions of running distance and speed can only be
recommended if you have a coach. It is seldom possible to take a
training schedule off the internet and hope that it fits.
13
What is the best time to run?
There is no best time for a run, as such. It is based
on individual time constraints and preferences.
However, doing your training first thing in the morning
allows you to finish it and get on with the rest of the day
without any pressure.

14
When
should one
replace
their
running
shoes?
Running shoes
should generally be
replaced every 1,000
km or after one year,
whichever is earlier.
15
What kind of shoes
do you suggest for new
runners or anyone who wants
to run on a daily basis?
The kind of shoe an individual opts for, again, may vary from person
to person. There are several parameters, based on which one can
decide what kind of shoes would suit them the best. Body frame,
amount of cushioning required and the way your foot pronates (how
your foot reacts to pressure) are few crucial factors to be considered
before deciding on the right shoe. Running biomechanics is a crucial
parameter to be considered when opting for the right kind of shoe.
If an individual prefers to feel really close and connected to the
ground, experiencing the more au-natural feel of a barefoot
running, Nike Free series is the shoe to go for. For runners
who would like to stay fast and light on their feet, Nike
Zoom series is the right shoe. If your feet over
pronates, a stability shoe like the Nike Lunar Glide
7 is recommended. The Nike Air Zoom
Structure 19 is another stability shoe
for everyday training.
16 How important
is it to keep
ourselves
hydrated while
17
running?
How can we Any tips to avoid getting cramps
ensure that in a while running?
marathon? One way to avoid cramps while running is to not eat just
Hydration is a non-negotiable before the run. Appropriate hydration before, during
requirement even before a and after the run is also advised as one can experience
race. Arriving at the start line cramps because of loss of fluids in muscles. Warming
by ensuring clear urine, when up before the run, like doing some stretch exercises can
voiding the bladder, is a must. also help in avoiding cramps while running. Most importantly,
During the race you will lose keeping one’s pace consistent and avoiding running faster
18
than you did while training, will also help.
body fluid through sweat,
depending on the weather. In
any case, the general guideline
is to drink about 150-200 ml
of water every 20 minutes.
This may need to be increased
based on how warm it is and
how profusely the runner
sweats. The only way to check
your fluid intake needs is to Is it safe for diabetics run
train in similar weather and
keep a record of your fluid
a marathon?
intake. At the end of a run, if
Diabetics need to monitor their blood sugar before
your urine is the colour of beginning a run even when training. Also, taking in
apple juice, it would mean that adequate carbohydrate to ensure that blood sugar
you were dehydrated and you does not drop, is essential. Depending on the
need to increase your fluid severity of the body sugar levels, it is advisable to
intake for such conditions. consult your doctor on the need to time your
medication when working out. All of this has
to be practiced in training runs before
participating in a race.
10
things that
P
PEOORELE
IGN
during a
R KO U T
WO t e s i s not
a
D i a b e s o n to
rea t e yo u r
asti n a an
procr oals. You c
sg as
fitnes your body lse.
keep e
s a n yo n e e s e
a h
toned member t ou Shetty
e y
Just r next time
s
p o i n t th e g y m . .
Prakash
hit x u
Le Ro
Adrian
design
by
1
Training Goal
Purely from a motivational point of
view it is important to have a training or
performance goal. You can set your eyes
on the prize and focus at the task at hand.
Keep the goal realistic but don’t make it too
easy. Enter for an event or a race even if it
is months away. This will motivate and
drive you to put in the time and prove
2
to yourself that you can!
3
Training Plan
A structured plan is vital to the
Resistance
Exercise
Don’t ignore resistance exercises and
only focus on aerobic exercise, even if
weight loss is your main objective. A
resistance exercise programme has many
benefits in general conditioning, health,
functional strength and increased
success of any business or sports metabolism. A balanced combination
4
team. So as an individual with set between resistance and aerobic
goals, ensure that you have a plan that exercise is sure to deliver results.
not only guides you to do what you
need to do, but also acts as a tool that
monitors progression over weeks
and months.
The Half Hour

Workout
Don’t underestimate the value of the
30 minute workout. Many use time or
the lack of time as their excuse not to go
for a workout. With a well-structured half
hour workout, you can achieve very good
results. Plan well before you enter the
gym on what you want to do and at
what intensity. Once you start, go all
out to get the most of your time
in the gym.

5
Rest Intervals
Between sets, the muscle needs time
to recover. Depending on your training
6
goals, these intervals can anything from
10 seconds up to 180 seconds. Use your
recovery interval wisely to get the most
out of your session. Also, don’t waste
valuable time chatting with your friends
when you should be back at it!
7
Sports Drinks
We know that nutrition and hydration
are important ingredients in the success of
any training programme. However, if weight
loss is one of your training goals, don’t drink high
energy or sports drinks during your workout.
Normally they contain a high number of calories
and sugar. Drinking these you only put back the Time Slots
calories that you burn during your session. All gyms have peak hours. If
Sometimes you will even put back more you are struggling to find machines
calories than you actually burn during your or weights during these times try to
workout. Stay hydrated – and the best restructure your day so that you go
to the facility at a less busy time. This
way to do that is with pure water!
way you will not only have more
space but also more
options to play around with
different programmes.
8
Routines
Do not ignore new
routines. The body very quickly
adjusts and gets used to a specific
9
workout routine. You’ll find that you will
see good results for a few weeks and then
things will stand still with very little progress.
Avoid going week in and week out with the
same routine and workout. Change the
order of exercises every now and then
and from a training programme point
of view ideally it should be
changed every four to
10
six weeks.
Core &
Abdominal
Training
Firstly, don’t ignore the importance of core or
abdominal training but more importantly do not
leave these exercises for the end of your routine
only. Incorporate total body and functional core
exercises in your routine. Work on a good
Other People’s posture and controlled movements. You can
space even do some of these exercises
Remember all members in the between sets during your normal
gym are paying members. You are exercise routine.
all interested in the same thing.
Respect each other’s space and
training environment.
Adrian Le Roux, Strength &
Conditioning Director, Prosport
Fitness & Sports Clinic

FOOD
“The healthy man

is the thin man.
But you don’t
need to go
hungry for it:
Remove the
flours, starches
and sugar;
that’s all.”
—Samael Aun Weor
drinking for
GOOD HEALTH Drinking green tea is not just a fad. Exploring
the benefits of this healthy concoction.
by Dolly Kumar

M
ost of us kick-start our day with a hot steaming cup
of tea. Now consider replacing your favourite drink
with a healthy version of the beverage... green tea.
Those who’ve made the switch, often with a dash of honey,
instantly find themselves energised and rejuvenated.
Considered one of the healthiest beverages, green tea is
mainly found in the colder regions of India and China and is
derived from the dried leaves of the Camellia Sinesis bush.
It is one of the least processed teas when compared to
black and oolong tea, making it your friend-in-need when
it comes to attaining optimal health and a prized body.
Super-drink for ‘super-health’

3.
Rich in nutrients, polyphenols and honey, the complex fibers also keeps heart diseases away.
Epigallocatechin Gallate (ECGC), a detoxify the body leaving you
Combats allergies.
2.
powerful anti-oxidant, this super-drink rejuvenated all day long.
has a number of health benefits, many With a sudden nip in the air, most
of which are unknown to us. Reduces cholesterol. of us are either down with a cold
In today’s time, we all have easy
1.
or find ourselves coughing away
access to greasy foods and drinks
to sleep. Green tea is proven to
Aids in weight loss. which in the long run, affect our
have anti-allergic components
One of the foremost benefits of body. You just need to develop
green tea is its ability to increase a taste of this mild drink and that help combat your seasonal
one’s metabolic rate. Packed enjoy it as a healthy alternative. allergy issues. This green liquid
with fat-burning qualities, this The powerful anti-oxidants and when consumed with honey
is the perfect tea for all weight- tannins in this tea help lower contains anti-oxidants that
watchers. When consumed with LDL cholesterol in the body and suppress colds effectively.
Super-drink for ‘super-skin’

One doesn’t always have to drink the blemishes. Mix green tea with honey, blemishes. Mix a tablespoon of green
stuff to reap its benefits. In addition to to boost your skin’s complexion (helps tea with an egg-white and a dash of
its health benefits which are mentioned cut the tan from your face) and apply honey. Apply this for 10 minutes every
4.
above, green tea when combined with on the face for five minutes and wash day and see the difference.
honey also makes for a wonderful with lukewarm water. Use this face
Anti-ageing
2.
topical beauty ingredient. Often found wash twice a week to see the results.
in many skincare products, the With the hustle bustle of everyday life,
anti-oxidants found in this super-food Reduces puffiness of eyes we often forget to relax and that takes
help in keeping one’s eyes, skin and Lack of sleep may ruining the glow in a toll on our skin. The anti-oxidants
hair nourished. your face and cause dark circles. found in green tea not only reactivate
1.
Green tea contains Vitamin K which dead cells in our body but also keep
helps battle puffy eyes and busts eye our skin supple. Use one tablespoon of
Improves skin complexion circles. Keep cold green tea bags on powdered green tea along with half a
You must have come across several your eyes for 20 minutes and feel spoon of yoghurt and a dash of honey.
3.
skin care products that promise you refreshed all day long! Apply the mixture on the face for 30
improved skin complexion but never minutes and rinse. You won’t only feel
match up to their claims. Green tea Acne treatment your skin tighten but would also find
may be your humble answer! The The healthy concoction of green tea your lost glow back.
anti-oxidants found in this tea not only and honey also has anti-bacterial and
help flush out toxins from your skin but anti-fungal properties that help in
Dolly Kumar,
also help in the healing of scars and reducing acne problems and Founder and Director at GAIA
ease under
PRESSURE
Lemon and Dill

Fish Packets
recipe on page 74

Ratatouille
recipe on page 74
Move over, microwaves — pressure cookers

are back! Leading the charge is the
pressure cooker king, chef Bob Warden.
We mastered his failproof technique
for the time-saving tool and lightened
up a few of his recipes for tasty,
diabetes-friendly, healthful meals.
photos by Adam Albright | food styling by Charlie Worthington
pressure
cooker 101
Gone are the days of the pressure
cooker splattering food all over
the kitchen ceiling. Modern
electric cookers are easier, safer,
and more versatile than ever.
And because these airtight pots
cook with steam pressure, the
cooking process is much faster.
Familiarise yourself with pressure
Herbed Green Beans,
Carrots, and Cranberries cooking 2.0 with some of Chef
Bob Warden’s best tips:
START WITH THE MANUAL

Before you begin, read the
instructions for your pressure
cooker to understand how it
works and how to use it safely.
PRESSURE PREHEAT
After you add ingredients to a
pressure cooker, figure that it
will take an additional five to
15 minutes to bring the cooker
up to pressure. Bob likens it to
preheating an oven.
RELEASE PRESSURE
Pork Vindaloo There are a few methods for
releasing steam from a pressure
cooker at the end of cooking time.
For the quick-release method,
open the steam valve or lid to let
the pressure escape all at once to
stop the cooking. If you prefer the
natural release method, when the
recipe is done, just let the cooker
sit until all the pressure dissipates
on its own. It usually takes about
15 minutes.

Herbed Green Beans, into 2- to 3-inch lengths. For faster 1 cup reduced-sodium
Carrots, and Cranberries prep, use packaged fresh julienne- chicken broth
SERVINGS 6 (3⁄4 cup each) cut carrots. 2 cups hot cooked brown rice
CARB. PER SERVING 18 g STOVE-TOP PRESSURE COOKER Snipped fresh cilantro
PREP 10 minutes DIRECTIONS: Using a 4 to 6-quart (optional)
COOK 2 minutes stove-top pressure cooker, prepare
STAND 2 minutes as directed in Step 1. Cover with lid 1. In the cooking pot of an electric
and lock securely. Over high heat, pressure cooker combine the first
1 450- to 650-g pkg. frozen bring cooker up to 2 to 3 kilos of 16 ingredients (through cloves),**
whole green beans pressure. Reduce heat just enough stirring to coat. Cover and marinate
11⁄2 cups julienned carrots* to maintain steady pressure. Cook in the refrigerator for 2 hours.
1⁄
2 cup vegetable broth for 2 minutes. Remove from heat. Stir in broth.
3 tbsp. butter Quick-release the pressure. Unlock; 2. Cover with lid and lock securely.
6 cloves garlic, minced remove lid. Continue as directed. Cook on high for 15 minutes. Allow
1 tbsp. dried parsley PER SERVING: 129 cal., 6 g total fat
pressure to release naturally for
1 tsp. dried Italian seasoning, (4 g sat. fat), 15 mg chol., 10 minutes before quick-releasing
crushed 234 mg sodium, 18 g carb. (4 g fibre, the remaining pressure.
1⁄ 10 g sugars), 2 g pro.
2 tsp. onion powder Unlock and remove lid.
1⁄
2 cup dried cranberries 3. Using a slotted spoon, serve
1⁄
4 tsp. salt Pork Vindaloo meat mixture over rice. Drizzle with
1⁄
8 tsp. black pepper SERVINGS 6 (3⁄4 cup meat mixture cooking liquid. If desired, sprinkle
1⁄
and 3 cup rice each) with cilantro.
1. In the cooking pot of an CARB. PER SERVING 18 g STOVE-TOP PRESSURE COOKER
electric pressure cooker combine PREP 25 minutes DIRECTIONS: Using a 4 to 6-quart
the first eight ingredients (through MARINATE 2 hours stove-top pressure cooker, prepare
onion powder). COOK 15 minutes as directed in Step 1. Cover with lid
2. Cover with lid and lock securely. STAND 10 minutes and lock securely. Over high heat,
Cook on low for 2 minutes. (For bring cooker up to 5 to 6 kilos of
crisper vegetables, cook for 1 min.) 1 kg boneless pork loin roast, pressure. Reduce heat just enough
Quick-release the pressure. Unlock trimmed and cut into to maintain steady pressure. Cook
and remove lid. 1-inch pieces for 15 minutes. Remove from heat.
1⁄
3. Stir in the remaining ingredients. 2 cup chopped onion Allow pressure to release naturally
Let stand for 2 to 3 minutes or until 3 tbsp. red wine vinegar for 10 minutes before quick-
cranberries are softened. Use a 2 tbsp. olive oil releasing the remaining pressure.
slotted spoon for serving. 6 cloves garlic, minced Unlock and remove lid. Serve as
*TEST KITCHEN TIP: To julienne-cut 1 tsp. sugar* directed.
carrots, peel and cut carrots in half 1 tsp. dry mustard *SUGAR SUBSTITUTE: We do not
lengthwise. Lay halves down on 1 tsp. ground turmeric recommend using a sugar substitute
1⁄
their flat sides and cut lengthwise 2 tsp. salt for this recipe.
1 1⁄
into about ⁄ 8-inch-thick strips. 2 tsp. ground cumin **NOTE: Don’t have all these spices?
1⁄
Stack strips a few at a time and cut 2 tsp. ground cinnamon Substitute 1 tablespoon curry powder.
1⁄
2 tsp. ground cardamom
PER SERVING: 324 cal., 10 g total fat
1⁄
2 tsp. ground ginger (3 g sat. fat), 100 mg chol.,
1⁄ 369 mg sodium, 18 g carb. (2 g fibre,
4 tsp. chili powder
1⁄ 2 g sugars), 37 g pro.
4 tsp. black pepper
1⁄
8 tsp. ground cloves
1⁄
Turkey and 4 cup seasoned fine dry a stove-top pressure cooker
Vegetable Meat Loaf bread crumbs for this recipe.
SERVINGS 6 (5 ounces meat loaf 6 cloves garlic, minced PER SERVING: 277 cal.,
1⁄
and 3 cup sauce each) 1 tsp. dried thyme, crushed 13 g total fat (3 g sat. fat),
1⁄ 112 mg chol., 605 mg sodium,
CARB. PER SERVING 10 g 2 tsp. salt
1⁄ 10 g carb. (1 g fibre, 5 g sugars),
PREP 20 minutes COOK 25 minutes 2 tsp. black pepper 30 g pro.
1⁄
STAND 10 minutes 8 tsp. ground allspice
2 lb. 93% lean ground turkey
1 8-oz. can tomato sauce
1⁄
2 cup reduced-sodium 1. In the cooking pot of an
chicken stock or broth electric pressure cooker combine
1 tbsp. packed light the first five ingredients (through
brown sugar Italian seasoning).
1 tbsp. cider vinegar 2. In a large bowl combine the
1⁄
2 tsp. dried Italian seasoning, next nine ingredients (through
crushed allspice). Add ground turkey; mix
1⁄
2 cup finely chopped well. Shape mixture into a round
yellow onion loaf and place in cooker.
1⁄
2 cup finely chopped zucchini 3. Cover with lid and lock securely.
1⁄
4 cup finely chopped Cook on high for 25 minutes. Allow
red sweet pepper pressure to release naturally for
10 minutes before quick-releasing
the remaining pressure. Unlock and
remove lid. Serve with sauce.
NOTE: We do not recommend using

White Chicken Chili
SERVINGS 6 (12⁄3 cups each)
CARB. PER SERVING 35 g
PREP 50 minutes
COOK 20 minutes
STAND 10 minutes
1 cup dried navy beans

1 tbsp. vegetable oil
1 lb. skinless, boneless chicken breast
halves, cut into 1-inch pieces
1 cup chopped onion
4 cups reduced-sodium chicken stock or
broth
11⁄2 cups frozen whole kernel corn
1 cup water
3⁄
4 cup chopped green
sweet pepper
3 tbsp. snipped fresh cilantro
2 tbsp. lime juice
6 cloves garlic, minced
2 tsp. chili powder
1 tsp. ground cumin
1 tsp. dried oregano, crushed
1⁄
4 tsp. salt
1⁄
4 tsp. black pepper
Sour cream (optional)
1. Rinse beans; drain. In a medium bowl soak

beans in enough water to cover for 45
minutes. Drain and rinse beans.
2. Meanwhile, in the cooking pot of an electric
pressure cooker heat oil on high or “brown.”
Add chicken and onion; cook for 5 to 7
minutes or until chicken is lightly browned,
stirring occasionally. Add the next 12
ingredients (through black pepper).
Stir in beans.
3. Cover with lid and lock securely. Cook on
high for 20 minutes. Allow pressure to release
naturally for 10 minutes before quick-releasing
the remaining pressure. Unlock and remove
lid. If desired, serve with sour cream.
White Chicken Chili
STOVE-TOP PRESSURE COOKER DIRECTIONS: Using
a 4 to 6-quart stove-top pressure cooker,
prepare as directed through Step 2, cooking the
chicken and onion over medium-high heat.
Cover with lid and lock securely. Over high
heat, bring cooker up to 5 to 7 kilos pressure.
Reduce heat just enough to maintain steady
pressure. Cook for 20 minutes. Remove from
heat. Allow pressure to release naturally.
1 medium eggplant (1 lb.), cut into
1-inch pieces
2 large zucchini and/or yellow
summer squash, coarsely
chopped
2 medium green and/or red sweet
peppers, cut into
1⁄
2-inch pieces
1 cup coarsely chopped tomatoes
2 tsp. dried Italian seasoning,
crushed
1⁄
2 tsp. black pepper
1⁄
4 tsp. salt
1⁄
2 cup vegetable broth
1⁄
4 cup shaved or shredded
Parmesan cheese (2 oz.)
Ratatouille (optional)
Lemon and Dill 1. In the cooking pot of an electric

Fish Packets pressure cooker heat oil on high or
“brown.” Add onion and garlic; cook for
CONTINUED FROM PAGE 68 2 minutes or until onion begins to
Cook on high for 5 minutes. Quick- soften. Stir in tomato paste. Add the next
release the pressure. Let stand for seven ingredients (through salt). Pour
Lemon and Dill 5 minutes before serving. broth over mixture in cooker.
Fish Packets STOVE-TOP PRESSURE COOKER DIRECTIONS: 2. Cover with lid and lock securely.
SERVINGS 2 (1 fish fillet each) Using a 4 to 6-quart stove-top pressure Cook on low for 6 minutes. Allow
CARB. PER SERVING 3 g cooker, prepare as directed through pressure to release naturally for
PREP 15 minutes COOK 5 minutes Step 3. Cover with lid and lock securely. 6 minutes before quick-releasing the
STAND 5 minutes Over igh heat, bring cooker up to 5 to remaining pressure.* Unlock and
7 kilos pressure. Reduce heat just enough remove lid. If desired, sprinkle servings
2 5 to 6-oz. fresh or frozen tilapia to maintain steady pressure. Cook for 5 with cheese.
or cod fillets, thawed minutes. Remove from heat. Quick- STOVE-TOP PRESSURE COOKER DIRECTIONS:
1⁄
4 tsp. salt release the pressure. Unlock and remove Using a 4 to 6-quart stove-top pressure
1⁄
4 tsp. garlic powder lid. Let stand 5 minutes before serving. cooker, prepare as directed in Step 1,
1⁄
4 tsp. black pepper cooking the onion and garlic over
2 sprigs fresh dill medium-high heat. Cover with lid and
4 slices lemon lock securely. Over high heat, bring
(3 g sat. fat), 10 mg chol., 396 mg sodium,
2 tsp. butter 3 g carb. (1 g fibre, 1 g sugars), 26 g pro. cooker up to 2 to 3 kilos pressure.
1 cup water Reduce heat just enough to maintain
CONTINUED FROM PAGE 69 steady pressure. Cook for 6 minutes.
1. Rinse fish; pat dry. Place each fillet in Remove from heat. Allow pressure to
the centre of a 14-inch square of Ratatouille release naturally for 6 minutes before
parchment paper. Sprinkle fish with the SERVINGS8 (1 cup each) quick-releasing the remaining pressure.*
next three ingredients (through pepper); CARB. PER SERVING11 g Unlock and remove lid. Serve as directed.
add dill. Top with lemon and butter. PREP 45 minutes COOK 6 minutes *TEST KITCHEN TIP: For crisper vegetables,
2. Bring up two opposite edges of STAND 6 minutes quick-release the pressure immediately
papers; seal with a double fold. Fold after cooking without allowing the
remaining ends to enclose fish, leaving 2 tbsp. olive oil pressure to release naturally.
space for steam to build. 1 large onion, quartered and thinly
3. Place a small metal rack or trivet in sliced PER SERVING: 81 cal., 4 g total fat
bottom of cooker; add the water. Place 12 cloves garlic, minced (1 g sat. fat), 0 mg chol., 162 mg sodium,
fish packets on rack. (2 tbsp.) 11 g carb. (4 g fibre, 6 g sugars), 2 g pro.
4. Cover with lid and lock securely. 2 tbsp. tomato paste

spotlight
protein
SHRIMP
Low in fat and calories, this flavour-popping
seafood serves up good fats that offset its higher
cholesterol profile. The fast-cooking protein is
the most consumed seafood in the U.S.
recipes by Lauren Grant | photos by Adam Albright
food styling by Charlie Worthington
Peppered Shrimp
and Green Bean Salad
recipe on page 79
Citrus Shrimp 2 oranges orange juice.
with Black Rice 11⁄ 3 cups water 2. Meanwhile, rinse shrimp; pat dry. For
1 3⁄
SERVINGS 4 ( ⁄2 cup rice, 3 ounces 4 cup uncooked black rice marinade, in a medium bowl combine
3⁄
shrimp, and 1 cup arugula each) 4 tsp. salt oil, garlic, pepper,
CARB. PER SERVING 29 g 1 lb. fresh or frozen peeled and the remaining 1 ⁄ 2 teaspoon orange
PREP 20 minutes COOK 30 minutes and deveined medium zest, 1 ⁄4 cup orange juice, and
1⁄
STAND 5 minutes shrimp, thawed 4 teaspoon salt. Add shrimp; toss to
2 tbsp. olive oil coat. Cover and marinate in the
2 cloves garlic, minced refrigerator for 10 minutes.
1⁄
4 tsp. black pepper 3. Heat a large skillet over medium heat.
4 cups baby arugula Add shrimp mixture; cook and stir for 5
Orange wedges (optional) minutes or until shrimp are opaque.
Using a slotted spoon, remove shrimp
1. Remove 1 teaspoon zest and from skillet. For sauce, bring marinade to
squeeze 1 ⁄ 2 cup juice from the simmering. Cook for 1 to 2
two oranges; set aside. In a minutes or until marinade is
medium saucepan bring the water, slightly thickened.
rice, and 1 ⁄ 2 teaspoon of the salt to 4. To serve, spoon warm rice and shrimp
boiling; reduce heat. Simmer, over arugula and drizzle with sauce. If
covered, for about 30 minutes or desired, serve with orange wedges.
until water is absorbed. Remove PER SERVING: 290 cal., 9 g total fat
from heat and let stand for 5 (1 g sat. fat), 183 mg chol., 579 mg sodium,
minutes. Stir in 1 ⁄ 2 teaspoon of the 29 g carb. (2 g fibre, 4 g sugars), 27 g pro.
orange zest and 1 ⁄4 cup of the
76 Diabetic Living mar-apr 2016 DiabeticLivingOnline.com 76

Shrimp and
Cauliflower Bake
PREP 15 minutes BAKE 40 minutes
4 cups small cauliflower florets
(1 medium head)
1⁄
2 cup chopped onion
2 tbsp. olive oil
1⁄
2 tsp. crushed red pepper
1⁄
4 tsp. salt
1 lb. fresh or frozen peeled and
deveined medium shrimp,
thawed
2 14.5-oz. cans no-salt-added
diced tomatoes, drained
1 tsp. lemon zest
1⁄
2 cup crumbled reduced-fat
feta cheese
1 tbsp. snipped fresh dill
Lemon wedges (optional)
1. Preheat oven to 220°C. In a large

bowl toss together the first five
ingredients (through salt). Spread
mixture in a 3-quart shallow baking
dish. Bake for 25 minutes or just until
cauliflower is tender.
2. Meanwhile, rinse shrimp; pat dry.
In a medium bowl combine shrimp
and the next three ingredients
(through lemon zest). Pour
shrimp mixture over
cauliflower mixture. Bake for
15 minutes more or until
shrimp are opaque.
3. Combine cheese and
dill; sprinkle over shrimp
mixture. If desired, serve with
lemon wedges.
(3 g sat. fat), 193 mg chol.,
561 mg sodium, 18 g carb. (6 g fibre,
10 g sugars), 29 g pro.
1⁄
Shrimp Salad Sandwiches 8 tsp. salt slotted spoon, immediately transfer
1⁄
SERVINGS 4 (1 sandwich with 8 tsp. black pepper shrimp to a bowl of ice water to
1⁄
about 2 cup filling each) 4 reduced-calorie whole stop cooking. Drain and coarsely
CARB. PER SERVING 32 g wheat hamburger buns, chop shrimp.
START TO FINISH 25 minutes split and toasted 3. In a large bowl, combine the
Lettuce leaves (optional) reserved 1 teaspoon lemon juice
1 lemon and 2 tablespoons snipped parsley,
1⁄
4 of a bunch fresh Italian 1. Bring a large pot of water to the shrimp, and the next seven
parsley boiling. Squeeze 1 teaspoon juice ingredients (through pepper).
8 oz. fresh or frozen peeled from lemon; set aside. Squeeze the Serve shrimp mixture in toasted
and deveined medium remaining juice into the boiling buns, adding lettuce if desired.
shrimp, thawed water; add lemon rinds. Remove PER SERVING: 215 cal., 3 g total fat
1 medium mango, halved, leaves from parsley, reserving leaves (1 g sat. fat), 91 mg chol.,
seeded, peeled and stems separately. Finely snip 419 mg sodium, 32 g carb. (1 g fibre,
and chopped 2 tablespoons of the leaves. Using
1⁄
2 cup finely chopped celery 100%-cotton string, tie parsley
1⁄
4 cup chopped green onions stems into a bundle and add to the
1⁄
4 cup plain fat-free Greek boiling water. Add shrimp.
yogurt 2. Boil for 1 to 2 minutes or just
11⁄2 tsp. Dijon-style mustard until shrimp are opaque. Using a
Buy shrimp with firm meat, a fresh scent,

and translucent shells without black spots.
Keep chilled up to two days or frozen up to
six months before cooking.
78 Diabetic Living mar-apr 2016 DiabeticLivingOnline.com 78

Peppered Shrimp and Green
Bean Salad
SERVINGS4 (2 cups each)
34 g
CARB. PER SERVING
PREP 25 minutes
Peppered Shrimp ROAST 25 minutes
and Green Bean Salad
12 oz. fingerling potatoes, halved
lengthwise (quartered if large)
2 tbsp. olive oil
1 lb. fresh green beans
1 lb. fresh or frozen peeled and
deveined medium shrimp,
thawed
1 tsp. olive oil
1⁄
4 cup thinly sliced shallots
2 tbsp. sherry vinegar
2 tbsp. honey
1 tsp. black pepper
1⁄
2 tsp. salt
3 tbsp. snipped fresh Italian
parsley
2 tbsp. pine nuts, toasted
1. Preheat oven to 205°C. Line a

large shallow baking pan with nonstick
foil. In a large bowl toss potatoes with
1 tablespoon of the oil. Spread
potatoes in the prepared pan.
Roast for 10 minutes.
2. In the same large bowl toss green
beans with the remaining
1 tablespoon oil. Add green beans to
potatoes in pan. Roast for 15 minutes
more or until vegetables are tender.
3. Meanwhile, rinse shrimp; pat dry. In
a large skillet heat the 1 teaspoon oil
over medium heat. Add shallots and
garlic; cook and stir for 2 to 3 minutes
or until shallots are tender. Add shrimp
and the next four ingredients (through
salt). Cook and stir for 1 to 2 minutes
more or until shrimp are opaque.
4. To serve, combine roasted
vegetables and shrimp mixture.
Sprinkle with parsley and pine nuts.
FOUR
HEALTHY
HABITS Just a few simple lifestyle changes can
help you control your diabetes.
NO.1 K FAST
ST A RT W I T H B R E A
Kick-starting your day
with a beneficial breakfast
can reinforce your
resolve to eat well the
rest of the day. It’s a great
opportunity to fit in whole
grains, fruits, dairy and
fiber. Plus, several studies
show that people who
eat breakfast are more
successful at keeping off
those extra pounds.
Pumpkin-Apple
Smoothie
recipe on page 84 recipes by Carla Christian, RD, LD
photos by Adam Albright
food styling by Charlie Worthington

Roasted Vegetable
Pasta with Walnuts
and Sage
NO. 2 E AT
E AT L E S S M
People who eat less
meat have a lower risk
of being overweight,
developing insulin
resistance and having
metabolic syndrome
(a precursor to Type 2
diabetes), according to
several studies. You don’t
have to go meatless —
you gain benefits just
from cutting back.
Roasted Vegetable Pasta 2 tsp. snipped fresh sage Drain, reserving 1 ⁄ 2 cup cooking
with Walnuts and Sage 1 oz. reduced-fat cream water. Keep pasta warm.
SERVINGS 4 (11⁄4 cups each) cheese (Neufchâtel), 3. In a large skillet, bring tomatoes,
CARB. PER SERVING 36 g softened sage, and the remaining
1⁄ 1⁄ 1
PREP 25 minutes 3 cup grated Parmesan 4 teaspoon salt and ⁄ 8 teaspoon
ROAST 20 minutes cheese pepper to boil; reduce heat.
1⁄
4 cup broken walnuts, toasted Simmer for 10 minutes.
Nonstick cooking spray 4. Reduce heat to low and whisk in
2 cups 1⁄2-inch pieces carrots 1. Preheat oven to 205°C. Line a cream cheese until smooth. Stir in
8 oz. Brussels sprouts, 15×10-inch baking pan with foil; roasted vegetables, pasta and
trimmed (halved if large) coat foil with cooking spray. In a Parmesan cheese; cook and stir just
2 tsp. olive oil large bowl combine the next three until cheese is melted. If needed,
1⁄
2 tsp. salt ingredients (through oil), stir in enough reserved pasta
1⁄ 1⁄
4 tsp. black pepper 4 teaspoon of the salt, and cooking water to reach desired
11⁄4 cups dried multigrain penne
1⁄
8 teaspoon of the pepper. Spread consistency. Top servings with
pasta in prepared baking pan. Roast for walnuts and additional sage.
1 15-oz. can no-salt-added 20 to 25 minutes or until vegetables PER SERVING: 296 cal., 12 g total fat
fire-roasted diced tomatoes, are tender and lightly browned. (3 g sat. fat), 11 mg chol.,
undrained 2. Meanwhile, cook pasta 518 mg sodium, 36 g carb. (7 g fibre,
according to package directions.
DiabeticLivingOnline.in81
DiabeticLivingOnline.com 81
NO.3
E A T M O R E F R U I T S & V E G G I ES
Roasted Beet
Fruits and vegetables
and Pear Salad
— fresh, canned, or
frozen — are nutrient-
packed, disease-fighting
PREP 15 minutes ROAST 1 hour
foods that can help you
COOL 15 minutes
stay healthy and reduce
chronic inflammation. The
8 oz. beets, without tops
USDA recommends you
(3 small)
eat 21 ⁄ 2 cups of fruits and
2 tbsp. sherry vinegar
21 ⁄ 2 cups of vegetables
1 tbsp. olive oil
every day. 1⁄
2 tsp. Dijon-style mustard
1⁄
4 tsp. black pepper
1⁄
8 tsp. salt
3 cups fresh baby arugula or
spinach
2 cups sliced pears
(2 medium)
3 tbsp. shaved Gouda cheese
4 tsp. slivered almonds,
toasted
1. Preheat oven to 220°C. Trim

root ends from beets. Wrap each
beet in foil and place in a 15×10-
inch baking pan. Roast for 1 hour
or until tender. Remove from foil;
cool for 15 minutes. Remove skins
by wrapping beets, one at a time,
in a paper towel and gently
rubbing off the skins. Cut beets
into bite-size pieces; cool.
2. Meanwhile, for dressing, in a
small bowl whisk together the
next five ingredients (through salt).
3. In a serving dish toss arugula
with half of the dressing. Top with
beets and pears; drizzle with the
remaining dressing. Sprinkle with
cheese and almonds.

Orange Chicken
and Barley
recipe on page 84
NO.4 H O L E G R A I NS
SW A P I N W
If you’re like most Indians,
you eat plenty of grains,
but you’re shy on getting
enough nutrient and
fiber-filled whole grains.
Swap out refined grains,
such as white rice, for
whole grains, such as
barley. Whole grains help
you feel full and reduce
heart disease risk factors.
M O R E H E A L H TY H A B I T S !
Learn more life-changing habits with our newest book,
Eat to Beat Diabetes™, a full 368 pages packed with healthy
and delicious recipes approved by registered dietitians.
On sale from January 5, 2016, wherever books are sold.
Pumpkin-Apple
Smoothie
Orange
Chicken and
Barley
Continued from page 80 Continued from page 83 2. In a large saucepan bring broth to
boiling; stir in barley. Simmer, covered,
Pumpkin-Apple Smoothie Orange Chicken for 10 to 12 minutes or until tender.
SERVINGS 4 (1 cup each) and Barley Remove from heat. Stir in pea pods. Let
CARB. PER SERVING 25 g SERVINGS 4 (11⁄2 cups each) stand, covered, for 5 minutes; drain if
START TO FINISH 10 minutes CARB. PER SERVING 38 g necessary. Stir in the next three
START TO FINISH 45 minutes ingredients (through mustard),
11⁄2 cups unsweetened vanilla 1⁄
4 teaspoon of the salt, and
1⁄
almond milk 3 Cara Cara or navel oranges 8 teaspoon of the pepper.
11⁄ 3 cups chopped apples 11⁄2 cups reduced-sodium chicken Stir in orange sections and the
(2 medium) broth remaining orange juice.
1⁄ 3⁄
2 of a 15-oz. can pumpkin 4 cup quick-cooking barley 3. Sprinkle chicken with the remaining
3⁄ 1⁄ 1
4 cup plain fat-free 2 cups fresh snow pea pods, 4 teaspoon salt and ⁄ 8 teaspoon
Greek yoghurt trimmed and thinly pepper. Coat a large nonstick skillet
1⁄
2 cup ice bias-sliced with cooking spray; heat over medium
2 tbsp. maple syrup 2 tbsp. canola oil heat. Add chicken; cook and stir until
1⁄
4 tsp. pumpkin pie spice 1 tbsp. snipped fresh mint no longer pink. Remove from skillet.
1⁄
8 tsp. salt 2 tsp. Dijon-style mustard Add mushrooms to skillet; cook
1⁄ 1⁄
4 cup high-protein honey- 2 tsp. salt 5 minutes or until tender and beginning
1⁄
almond-flavor granola, such as 4 tsp. black pepper to brown, stirring occasionally.
Bear Naked brand 1 lb. skinless, boneless chicken 4. To serve, stir chicken and
breast halves, cut into bite-size mushrooms into barley mixture.
1. In a blender, combine the first eight strips Sprinkle with orange zest.
ingredients (through salt). Cover and Nonstick cooking spray PER SERVING: 369 cal., 11 g total fat
blend until smooth. Top each serving 2 cups sliced fresh mushrooms (1 g sat. fat), 83 mg chol., 611 mg sodium,
with 1 tablespoon of the granola. 38 g carb. (7 g fibre, 12 g sugars),
1. Remove 1 teaspoon zest from an 33 g pro.
(0 g sat. fat), 0 mg chol., 173 mg sodium, orange. Peel and section oranges over a
25 g carb. (4 g fibre, 17 g sugars), 8 g pro. bowl to catch juices; reserve 2
tablespoons juice.

egranate M
y-Pom oji
to
err
b
sp
Ra
Take extra
care of yourself
as the holiday
season comes
to an end,
with our mp
agne
ha
favourite
C
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drinks.
sweet
ple
Ap
a by Carla Christian, RD, LD
photos by Jason Donnelly
ending
food styling by Dianna Nolin
Raspberry-
Pomegranate Mojito Chai-Peach Tea Cider
In a large glass measuring cup, (nonalcoholic)
combine 1 cup pomegranate seeds In a large saucepan combine
and ¼ cup fresh mint. Using the 5 cups water, 3 cups peach nectar,
handle of a wooden spoon, gently 2 tbsp. sugar, 6 thin slices fresh
bruise seeds and mint against glass. ginger, 6 whole cardamom pods,
Stir in 1 cup black raspberry liqueur three 3-inch cinnamon sticks,
(such as Chambord). Strain into 8 whole black peppercorns,
pitcher. Stir in 3 cups light white 3 whole cloves, 1 whole star anise,
grape juice, ½ cup pomegranate and a pinch of ground nutmeg.
seeds, and ½ cup fresh mint leaves. Bring to boiling; remove from heat
Top with 4 cups chilled club soda. and add ¼ cup orange juice and
Serve in 8 glasses over ice. 5 white or green tea bags. Let it
Per glass: 116 cal., 19 g carb. stand for 3 minutes. Strain into
(7 g sugars). 8 mugs; add cinnamon stick.
Per mug: 63 cal., 15 g carb.
Apple-Rosemary Champagne (15 g sugars).
Place 2 tbsp. chopped fresh Chai
-Pe
rosemary in a pitcher. Use the ac
handle of a wooden spoon to
h
Te
bruise leaves against side of pitcher.

aC
Add 4 cups chilled light apple juice

ider
drink; cover and chill for 15 to 30

minutes. Strain into 8 flutes. Use
a 750-millilitre bottle of chilled
champagne to top flutes. Garnish
with 1 small thinly sliced apple.
Per flute:
103 cal., 12 g carb. (8 g sugars).
PEAR
power
Pears, the storehouse of nutrients, can help you manage the
early stages of diabetes. Eat them raw or include them in
your diet with these scrumptious recipes.
recipes by Gitanjali Gurbaxani
P ears offer a vast assortment

of vitamins and minerals that
you need to stay healthy.
These nutrients are important for
everyone, especially diabetics. Pears
low GI are recommended in the
prevention of coronary heart disease
and obesity, and in the management
of diabetes,” says Dr. Lotika Purohit,
Director, Diabetes Care Centre,
longer period of time, reducing the
chance of a spike in blood glucose.”
“Pears especially with the skin
left on are considered high fibre
food. One medium pear contains
contain calcium, iron, magnesium further stating, “Fibre is a very five grams of fibre. Besides, pears
and potassium and the Vitamins C, important part of a healthy diet for a contain a natural fruit sugar,
E, K, Folate, beta carotene, lutein, diabetic. Dietary fibre helps reduce ‘levulose’ that adds to the sweetness
choline and retinol. “Pears have cholesterol and control body weight of the fruit and it is easily converted
a low glycaemic index of just 38. and blood sugar. A meal or a snack to energy by diabetics. Pears are
Low glycaemic index foods are with fibre slows the absorption low in calories and carbohydrates
digested and absorbed more slowly, of carbs in the bloodstream. This and high on fibre. They are helpful
producing a gradual rise in blood makes for a more sustained and in reducing blood glucose and body
glucose and insulin levels. Food with slower rise in blood glucose over a weight,” concludes Dr. Purohit.

Arugula Brie and ¾ tsp Black gently with olive oil on over it.
Pear Panini pepper powder both sides. Layer one • Place the sandwich
Servings 3 3 tbsp Olive oil side with slices of brie, on a pre-heated
60 gms Arugula, sprinkle with salt and ridged pan or in a
INGREDIENTS REQUIRED torn into black pepper to taste. sandwich maker.
6 slices Ciabatta small • Divide the sliced pear • Cook till the cheese
bread pieces and arugula evenly has melted and the
150 gms Brie, cut Salt to taste between the three bread has gone golden
into thin sandwich portions. brown in colour. This
slices Method: • Place them over the should take 3-4
2 large pears, • Heat a ridged gill pan. brie cheese and place minutes on each side.
cored and sliced • Brush the bread slices a second slice of bread • Serve hot.

Roasted Pear Salad Method: cider vinegar and red wine.
with Walnuts • After the pears have been halved, use a • Pour some of this dressing over
Servings 3 small melon baller to scoop out the the pears and bake in a pre-heated
core and seeds from each pear, leaving oven at 180 C / 375 F for 30 minutes
INGREDIENTS REQUIRED a round well for the filling. or till tender.
3 large Pears, halved • Trim a small slice from the rounded • From time to time, keep basting the
½ cup Walnuts, chopped surface to enable it to sit on a baking pears with the red wine and apple
¼ cup Olive oil tray without tilting. cider vinegar mixture.
4 tbsp Honey • Lightly toss the pears in lemon juice to • Just before serving, mix together the
3 Lemon juice prevent them from turning brown. lemon juice and olive oil in a large
3 tbsp Red wine • Arrange them on a well greased baking bowl and whisk it up well.
6 tbsp Blue cheese, crumbled tray, spaced out a bit. • Place arugula on an individual serving
½ cup Apple cider vinegar • In a separate bowl, mix together plate and place one portion of the
5 cups Arugula leaves the crumbled blue cheese, sultanas baked pear over it. Drizzle the lemon
2 tbsp Sultanas and walnuts. juice and olive oil over it along with
Salt to taste • Divide this filling into 6 equal portions some of the basting liquid and sprinkle
and fill it in the pears. In the same salt over it.
bowl, mix together the honey, apple • Serve warm.
ROASTED BEET AND PEAR
SALAD WITH ORANGE AND
MINT DRESSING
Servings 4
INGREDIENTS REQUIRED
1 medium Red beetroot
1 tsp Apple cider vinegar
A fistful of Pine nuts, roasted
1 large Pear, sliced thinly
4 cups Mixed green salad leaves
2 tbsp Olive oil
1 tsp Fresh orange juice
¾ tsp Black pepper powder
1 ½ tsp Fennel seeds
Salt To taste
Method:
• Wash and peel the beetroot into 2
inch long wedges with half inch width.
• Place the apple cider vinegar, olive
oil, fresh orange juice, salt and black
pepper powder in a large bowl. Add to
it the beetroot wedges. Toss it up well.
• Place them on a well greased
baking tray, spaced out a bit.
• Pour the marinade over it evenly
and bake in a pre-heated oven at
2,000 0 C for about 30 minutes or till
beetroot is cooked.
• Let it cool completely. Place the
mixed greens in a large bowl. Add to it
the pear slices, pine nuts, fennel seeds
and baked beetroot wedges.
• Toss it up well.
INGREDIENTS REQUIRED FOR THE

ORANGE MINT DRESSING:
1 cup Fresh orange juice
1 tsp Salt
3 tbsp Apple cider vinegar
2 tbsp Mint, finely chopped
¼ cup Olive oil
Method:
• In a bowl, add in the orange juice,
mint leaves, apple cider vinegar and
salt.
• Mix well with a whisker. Pour in the
oil gently and mix well.
• Pour this dressing over the salad
and gently toss it up once again.
• Let it stay for 15 minutes.
• Serve at room temperature or cold.

PEAR AND GINGER CAKE Method: along with dates, ginger
Servings 10 • Lightly grease a 7 inch paste and vanilla essence.
round cake tin. Gently toss it.
INGREDIENTS REQUIRED • Place the thinly sliced • Pour in the blended coconut
400 ml Coconut milk / cream pear slices at the base of milk, coconut water and
1/3rd cup Coconut oil, melted the cake tin. coconut oil mixture and mix
2 tsp Vanilla essence • Cut the remaining pear slices well to make a smooth batter.
¼ tsp Salt into bite size pieces and set Add to it the chunks of pear.
2 cups Whole wheat flour aside. Mix together r the • Pour the batter into the cake
4 large Pears, sliced thinly coconut oil, coconut water and tin. Bake in a pre-heated oven
1/3rd cup Coconut water coconut milk. Blend well. Sieve at 1800 C for 30 – 40 minutes
2½ tsp Ginger paste together the whole wheat flour, or till a skewer inserted in the
½ cup Dates, chopped finely salt, baking powder together in centre comes out clean.
4 tsp Baking powder a large bowl. • Cool, un-mould, slice
½ cup Almonds, powdered finely • Add to it the ground almond and serve.
Dr Lotika Purohit is a Diabetologist and Gitanjali Gurbaxani is an author and is one of

Director at Diabetes Care Centre. Mumbai’s pioneers in eggless confectionery.
lotikaspurohit@gmail.com gitanjaligurbaxani@gmail.com
www.sugardoctor.in www.gitanjaligurbaxani.com
Tarot forecast for Mar-Apr 2016
ARIES TAURUS GEMINI

Card of the Period: Card of the Period: Card of the Period:
The Magician The Hanged Man Ten of Pentacles
It is high time you thought about This is the right time to start active A good saviour always aims high
bringing in some relaxation tools in meditation. Practicing yoga or to accomplish things without fail!
your bathroom area. Some essential oils meditation at least once a day You must exercise well in case
like lavender or rose can do wonders. will do miracles and boost your you feel you are experiencing
Most of the therapists use these health. If you are planning a trip breathlessness frequently,
essentials in their therapies. It not only or a vacation, it is better to hire a especially at your play time.
gives relaxation to your body but also travel agent than exhaust yourself Take a deep breath followed by
to the soul. Avoid taking hasty decisions with all the running around. Give exhaling in and out to improve the
related to your fitness regime. Make your full concentration to satisfy respiratory system. Try this and
sure to clean your room, especially the the needs for both mind and body. you shall experience a remarkable
clutter or piles of books or magazines Relax yourself, both mentally and improvement in your respiratory
as it will otherwise become a cause of physically and everything that you system. Learn to prioritise things
concern leading to mental stress. do will start falling in line. and stick to the list.
CANCER LEO VIRGO

The Hermit The Chariot The Lovers
The planetary aspects during this period A feeling of insecurity will make you Don’t hope too much for the cards
reminds you not to divert your attention thrive and exert yourself, which can and stars to cover up the damage that
from the health perspective. You may deteriorate your health. Do not doubt mood swings do to your personality.
not find things easy by your side or may your potentials as you can perform Performing chakra healing and
find yourself with negativity, but all you much better than what you imagine. yoga will help immensely. Due to
have to do is keep sipping water and Due to planetary transitions, your the changes, you will work hard on
ask your mind to relax in order to take morale and courage may diminish, your health, but you may not see
the right decisions. Keeping a balanced but don’t underestimate yourself. It is the desired results immediately.
diet and a disciplined fitness regime will highly advised not to focus on cutting Do not lose hope; consistency will
be the key to positively deal with such down your diet much. Concentrate certainly pay. Intake of plenty of water,
negative energies. After all, a healthy on working out instead. Your internal roughage and proteins will boost your
and sound mind can always deal with organs demand a lot of water; so make body, especially the skin. Believe in
such tough situations with ease. sure you keep them well hydrated. yourself and results will slowly follow.

Manisha Koushik (Astrologer, Tarot Card reader, Numerologist, Vastu &
Fengshui consultant) Email: support@askmanisha.com
www.askmanisha.com Contact: +91-11-26449898, 26489899
LIBRA SCORPIO SAGITTARIUS

Temperance Queen of Swords Ten of Cups
The fast planetary pace may keep The sensation of love and romance The changing planetary phase will
you so occupied that you don’t get is on the cards for which you might make you realise your passion. But,
much time for yourself. Whatever get aroused easily. In order to if you do not participate, then the
the case may be, promise yourself enhance this experience, make sure world will not wait for you. The
to include brisk walking in your daily that you revive your senses. Exercise chance will be gone. You will feel
routine. Anxiety and mental clutter two times a day, alternate between much more relaxed and stress-free
is preventing you from taking the the gym and a long walk. Try eating as compared to previous times.
right decision. By performing small lighter foods. This practice and A little work out and even a walk
sessions of meditation, you can routine will tickle you and most would make you feel very calm and
come out of the confused state of probably the other one too! You internal peace will follow. Make
mind. Even a long walk or a physical are quite an emotional person, but yourself inclined towards the things
exercise will be beneficial at this this time can bring you closer to the that are on your priority level and
phase of time. It’s all in your hands. feeling of being glamorous as well. work hard to address them well.
CAPRICORN AQUARIUS PISCES

Knight of Swords Queen of Pentacles Judgement
Devote more time and concentrate If your emotional temperament is Be kind to your body and you will
with a calm mind in order to find a making your heart go blue, don’t benefit in all ways. If you have several
new job or better opportunities in life. worry. Rather, choose to be with the things in hand and do not have a
The good news is that you will be able people you really care for. This will priority list, the situation might become
to balance your work and personal life bring you a feeling of relaxation. Such a cause of concern. Keep health on the
this time. A morning walk can make ups and downs can be controlled top spot. Cut down your stress with
the experience even better. If some just by practicing yoga that will give a full body massage. A sound sleep is
unwanted thoughts have made your peace of mind. This will enhance highly required. The time ahead will
internal memory foggy then try going your energy level and boost your give you moderate results, so try to
into the fresh air and take a long sub-conscious mind too. Do not over change your routine and eating habits
walk. This activity will help you clear do exercising, as it can damage your as well. Switch to lighter diets at night.
your mind and give you the power of muscles and ligaments. Better to take All the above activities will help in
better decision making. things as they come to you. balancing your daily routine.
INDIA
INDIA’S FIRST MAGAZINE ABOUT DIABETES

MAR-APR 2016
`100
PALLIATIVE CARE
for Cancer
patients
myths
7about a
DATE WITH THE
DENTIST
protein
Shrimp
SPOTLIGHT
reader survey
? how can we help you

thrive with diabetes?
Please take a few name
minutes to tell us address
what you think city state pin
about this magazine. e-mail

Then fold the sur-
vey, place it in an
envelope, and mail
(address on opposite 3 Where else do you find
diabetes education/support?
Please check all that apply.
6 How often do you look
for diabetes or other health
information online?
side). Your comments Daily
will help us meet Diabetes education class(es) Weekly
your needs as you Registered dietitian Monthly
Family doctor Less than once a month
live with diabetes. Endocrinologist I have never looked online for
In-person support group diabetes information (please
Online support group/community go to question 9).
1 Where did you get this issue Magazines/books

of Diabetic Living magazine?
At home
Videos/DVDs
Online
Other ________________________
7 Please list the top three
diabetes or health websites
you visit.
A store
Friend or family member
1.
Doctor’s office or clinic
Other _____________________
4 What information do you
feel has been missing from
your diabetes education?
2.
3.
2 Why are you interested in

reading about diabetes?
Please check all that apply.
I have Type 2 diabetes
For how long?_________
I have Type 1 diabetes
For how long?_________ 5 Where do you access the
Internet? Please check
all that apply.
I have pre-diabetes
(elevated blood glucose) At home
My child has diabetes At work
I am the caregiver for an Through a mobile device
adult with diabetes At the public library
Diabetes runs in my family I do not have Internet access
I am a medical professional (please go to question 9).
8 Which of the following would you like to read most in
Diabetic Living? Is there anything else
high
interest
moderate
interest
low/no
interest you’d like to tell us?
Diabetes medical news and research
Everyday recipes
30-minute (or less) recipes
Low-carb recipes
Low-sodium recipes
Special-occasion recipes
Holiday recipes
Recipes for two
Dessert recipes
What/how much to eat
Getting started (newly diagnosed)
Medication and treatments
Diabetes procedures and tests
Weight loss
Easy exercises
Reducing blood glucose and/or A1C
Pain management
How to avoid complications
Mentally coping with diabetes
Reducing stress
Diabetes products and services
Inspiration from people with diabetes Yes, the editors of Diabetic
Other Living magazine may contact
me for more information.
9 Please indicate your level of agreement with the following statements that describe your feelings
about Diabetic Living. agree agree neither agree disagree disagree
completely somewhat nor disagree some- completely
what
The magazine is well-organised

Articles do not give me enough information
Articles are colorful and attractive
The text size is too small to read
The text size is easy to see and to read
Stories inform and educate me
Stories inspire me to take self-care actions
Stories encourage me to talk to my doctor
or health care provider
I can get the same information elsewhere
The magazine keeps me up-to-date on the newest
information about diabetes
The articles are difficult to understand
The stories are realistic for someone with diabetes
The magazine shows/describes people I can relate to
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your feedback. addressed to: New Delhi-110001

MAR-APR 2016
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India’s first magazine about diabetes

MARCH 2016 / ` 125

from street-smart to LEARN

lifestyle to health- A PRO

MISTAKES.” in constant A sarkaari

Luxury fashion bible Stuff that men dream of

ONLY THE THE Q

India’s first magazine about diabetes

7about a myths Under a robust @

DATE WITH THE

Volvo’s driving progress E-commerce retail logistics in India

Diabetic Living Transreporter

India’s first magazine about diabetes

Your diabetes affects your liver in

well being fitness 75 Protein spotlight: Shrimp

44 Partner power 68 Ease under pressure

48 Eat, pray, love

2 Diabetic Living mar-apr 2016

WORLD HEALTH DAY

Days and nights alternate; seasons come and go; the

Editorial team www.diabeticlivingonline.in

Disclaimer: Diabetic Living (India) is not responsible nor liable

IT’S ALL GOOD INSIDE

Page 14 Page 27 Page 65

Irene B. Lewis-McCormick is a fitness presenter and educator. Certified by the

Fred Williams practises endocrinology and specialises in diabetes. He is an active

4 Diabetic Living mar-apr 2016

`100 p atients `100

lted 7abmouytt ahs

City ________________________________ State __________________________________ Pin Code __________________

Mobile ________________________________________ (Res) _________________________________________________

I am enclosing Cheque/ DD No. Dated D D M M Y Y

Year Issues Price Cover You Pay (`)*

Please Call: 91.11.41543666

Ans: Are you monitoring your blood

8 Diabetic Living mar-apr 2016

Ans: First of all there should be a routine of three

Q4. My kid is really fond of cakes. Would

*Dr. Anoop Gupta

TIMINGS: 9AM – 5PM

14 Diabetic Living mar-apr 2016

I magine getting sick to your

EATING WELL WITH GASTROPARESIS

• Eat small, frequent meals. “Since gastroparesis delays stomach

16 Diabetic Living mar-apr 2016

that matter, even take the blood sugar

Why do blood levels go up? Cirrhosis is a slowly progressing disease in which

18 Diabetic Living mar-apr 2016

Dr. Gourdas Choudhuri, Director &

Types of skin cancer

20 Diabetic Living mar-apr 2016

Basal-cell carcinoma Squamous-cell carcinoma Melanoma

22 Diabetic Living mar-apr 2016

W ork in the garden one day

24 Diabetic Living mar-apr 2016

EAT HEALTHFUL FOODS

Beware of surgical complications

That’s not uncommon. that the disease duo

City ____________ State Pin Code

Mobile (Res) _________