What Is A Diabetic Foot?

Ulcerated diabetic foot is a complex problem. Diminished blood supply (Ischaemia), Nerve changes(neuropathy) and infection are the three pathological components that lead to diabetic foot complications.

Neuropathy and ischaemia are the initiating factors, most often together as neuroischaemia, whereas infection is mostly a consequence.

Diabetes foot ulcers are the most common cause for prolonged hospitalizations

Diabetes is the most important cause of non traumatic foot amputations.

What Are The Different Types Of Diabetes?

There are three types of diabetes:

Type 1 Diabetes

The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. Approximately 10% of all diabetes cases are type.
People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years.
Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.

Type 2 Diabetes

The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).
Approximately 90% of all cases of diabetes worldwide are of this type.
Being overweight, physically inactive and eating the wrong foods all contribute to our risk of developing type 2 diabetes. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk.

Drinking just one can of (non-diet) soda per day can raise our risk of developing type 2 diabetes by 22%
Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels.


Gestational Diabetes

This type of diabetes affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose.
Diagnosis of gestational diabetes is made during pregnancy.The majority of gestational diabetes patients can control their diabetes with exercise and diet.
Apart from these types of diabetes, there is one more ailment, which is pre-diabetes. Learn more about What is Pre-Diabetes.


What Is Diabetes?

Diabetes is a condition in which there is too much sugar (glucose) in the blood. Although sugar is needed to provide energy for the body, when in excess, it causes problem.
Excess sugar level is due to

  • either because insulin production is inadequate
  • or because the body’s cells do not respond properly to insulin, or both

Is Diabetes Common?

  1. 150 million people affected worldwide (in 2000)
  2. Expected 300 million people by 2025 (mostly in India and China)
  3. Can occur at any age, common in middle age (30 – 40 yrs)

What Is Optimum Blood Sugar Level?


Fasting mg/dl 80-110 111-140 > 140
Fasting mg/dl 80-144 145-180 > 180


Fasting Blood Sugar is measured when the patient has not eaten anything for the past 8 hours. This test is typically carried out first thing in the morning before the patient has had anything to eat. Post Prandial test is usually conducted after the patient has had something to eat.

What Is Insulin?

Insulin is a hormone produced by pancreas, an organ situated behind the stomach. It makes our body’s cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy.
Insulin is the key which opens the door of the cells and allow sugar (glucose) to enter where it is utilized. When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells , sugar remains in the blood in high amounts.

Is Diabetes Serious?

Yes It Is! It works silently and is not a Mild Disease!
Do you know Untreated it will affect many vital organs of the body with serious consequences.
`It can cause multiple problems such as –

  • Gangrene/Infection
  • Heart Attack
  • Blindness
  • Stroke Paralysis


Are You Having These Symptoms?

Be Aware! It can be Diabetes? Report to Doctor.

  • Increased thirst, dry mouth
  • Increased Hunger
  • Increased frequency of urination especially in night.
  • Recent change in weight
  • Difficulty in vision(Blurred vision, Double vision, Cloudy vision, Floating spots in the visual field)
  • Non-healing wounds

Tips on Diet for a Diabetic

You must realize that your body needs energy to perform all vital functions and most of the energy is derived from carbohydrate and the most important energy producing end product in the body is glucose.

The hormone Insulin helps your cells to get the right amount of Glucose and also maintains the right level of glucose in the blood.

In diabetes either the insulin is not  produced in required quantity or even it is produced it does not  work right. (resistance) Even though your Insulin is not doing its job a healthy diet along with medication and weight management keeps your blood glucose under control.

Cheer up! Being diagnosed with diabetes does not mean that you stop enjoying a wide variety of foods as part of a healthy diet. At first, specially if you are a foodie you get depressed but the general principle is simple: Following a “diabetes diet” means choosing food that will work along with your activities and any medications to keep your blood sugar levels as close to normal as possible.  However do not get stamped that “Diabetic Diet” is for you only. The foods that are healthy for people with diabetes are also good choices for the rest of your family. Usually, there is no need to prepare special diabetic meals. The difference between a “diabetes diet”  and your family’s “normal” diet is this: If you have diabetes, you need to monitor what you eat a little more closely specially the  calories you consume and the amounts and types of carbohydrates, fats, and protein you eat.

What you eat depend on

  • excerise
  • Weight
  • Physical activity
  • Blood Sugar levels
  • Other disease conditions
  • Type of Food you eat


1. Count calories – Per day calorie intake should be between 1,500-1,800 calories with a proportion of 60:20:20 between carbohydrates, fats and proteins, respectively.
2. Keep a food Diary:- 1. What you are eating. 2. How much? 3. When ?

3. Carbohydrates are not evil:- For diabetics carbohydrates — or “carbs” as most of us refer to them — are good for diabetes. They form the foundation of a healthy diabetes diet — or of any healthy diet. Carbohydrates have the greatest effect on blood sugar levels, which is why you are asked to monitor how many carbohydrates you eat when following a diabetes diet. Moreover, carbohydrate foods contain many essential nutrients, including vitamins, minerals, and fiber. So one diabetes diet tip is to choose those with the most nutrients, such as whole-grain breads and baked goods, and high-fiber fruits and vegetables.

4. Avoid excessive protein intake: Because carbohydrates affect blood sugar levels so quickly, you may be tempted to eat less of them and substitute more protein. The main problem with too much of protein is that many foods rich in protein, such as meat, may also be filled with saturated fat. Eating too much of these fats increases your risk of heart disease. Eating too much of protein can increase the risk of insulin resistance.

5. Choose foods with low glycemic index(GI):- The Glycemic Index, or GI, is a ranking of carbohydrates in foods according to how they affect blood glucose levels.Foods with a low GI raise Blood Glucose Level(BGL) s more slowly and steadily than foods with a high GI. People with diabetes can benefit from eating low GI foods throughout the day, ideally one at each meal.

Low Glycemic Index foods include Cauliflower, Broccoli, Peanuts, Sea Food, Seeds, Nuts,Cucumber, Beans, Celery, Lettuce, Spinach, Tomatoes, Soybeans, Peas, Barley, Yoghurt, Apples, Whole Heavy Grain Breads ,Brown Rice, Oats And Muesli, Pasta, Corn, Sweet Potato, Low Fat Milk, Yoghurt ,Kiwi Lean Meat Etc. beans

Avoid fruits that spike blood sugar levels: these foods include fruit juices, canned fruits, and dried fruits.
6. Eat 20 – 25 grams of raw onion daily. Onions contain properties that actually fight against diabetes. It also aids digestion besides serving as a diuretic.
7. Eat at least 3 servings of fresh vegetables daily. Vegetables that can be consumed in larger quantities by diabetics are cabbage, mint, spinach, bitter gourd, lady’s finger, cauliflower, cucumber, carrots, radish, onion stalk and pumpkin.
8. Fenugreek/Methi is good for you – One teaspoon of methi seeds soaked overnight in 100 ml of water is very effective in controlling diabetes.
9. Drink tomato juice with pepper and a pinch of salt every morning on an empty stomach.
10. Drink Skimmed Milk – Milk is the right combination of carbohydrates and proteins and helps control blood sugar levels. Two servings of milk in a daily diet is a good option.
11. Whole grains, oats, channa atta, millets and other high fibre foods should be included in the meals.
12. Restrict Salt Intake – Diabetes can put you at increased risk for hypertension and cardiovascular complications. Try to reduce the intake of salt in your food.

  • Do not add extra salt.
  • Do not put salt shaker on the table.
  • Use salt free seasonings like onion, garlic
  • Avoid pickles,chips,processed foods

13. Drink plenty of water. Water is important for everybody, but especially for diabetics because decrease of the hydration-level can cause serious health problems.

14. Pulses are important in the diet as their effect on blood glucose is less than that of most other carbohydrate.

15. Choose foods lower in total fat and in particular low in saturated fats

Saturated fat is found mainly in animal foods, like red meat, cheese, butter and full cream dairy products as well as in takeaway and many pre-packaged foods (e.g. biscuits and chips).
To reduce your saturated fat intake try to choose low fat dairy foods, lean meats, skinless chicken, and margarine instead of butter, and limit fried take away foods. Take baked, grilled food.

16. Include small amounts of the healthier fats: Some fat in the diet is important for good health. Healthier fats include poly and monounsaturated margarines and oils such as canola or olive, fish, avocado, nuts and seeds.

17. You Donot Have to Give Up Desserts if You Have Diabetes.
Use artificial sweeteners in desserts. Artificial sweeteners are much sweeter than the equivalent amount of sugar, so it takes less of them to get the same sweetness found in sugar. This can result in eating fewer calories than when you do use sugar. The American Diabetes Association approves the use of several artificial sweeteners in diabetes diets like:Aspartame (NutraSweet, Equal).
Acesulfame potassium (Sunett),Sucralose.

18. Eat three meals a day and snacks spaced in long spans. Do not skip meals. Eat in small quantity keeping the total calorie in mind. Do not binge.

19. Alcohol – Talk to your doctor if you drink alcohol. Specially if you are on insulin, and antidiabetic drug your blood sugar may dip suddenly after you drink alcohol.
If you have to drink
Drink white wine(max-5 oz,)/light beer(-max-12 oz)
Drink with meals or after meals
Drink slowly
Consult your doctor and Dietitian for further guidance.


Hypertension, or high blood pressure, is often called a “silent disease” because you usually don’t know that you have it. There may be no symptoms or signs. Nonetheless, it damages the body and eventually may cause problems like heart disease.
Therefore, it’s important to regularly monitor your blood pressure, especially if it has ever been high or above the “normal” range, or if you have a family history of hypertension. Because hypertension can cause heart disease, you may also need to be tested for heart disease.

What Is High Blood Pressure?

Blood pressure refers to the force of blood pushing against artery walls as it courses through the body. Like air in a tire or water in a hose, blood fills arteries to a certain capacity. Just as too much air pressure can damage a tire or too much water pushing through a garden hose can damage the hose, high blood pressure can threaten healthy arteries and lead to life-threatening conditions such as heart disease and stroke.
Hypertension is the leading cause of stroke and a major cause of heart attack. In the U.S. alone, more than 30% of American adults have high blood pressure.
If you have high blood pressure, you’ll probably find out about it during a routine checkup. Or, you may have noticed a problem while taking your own blood pressure. Be sure to see your doctor for a definite diagnosis, and take the opportunity to learn what you can do to bring your blood pressure under control.

How Is Blood Pressure Measured?

Blood pressure is measured with a simple, painless test using a blood pressure cuff — doctors call it a sphygmomanometer. It consists of a small pressure gauge that is attached to a cuff.
The inflatable cuff is wrapped around your upper arm. Some blood pressure cuffs wrap around the forearm or wrist.
When taking your blood pressure, your doctor will use a stethoscope to listen to the blood moving through an artery.
The cuff is inflated to a pressure that’s known to be higher than your systolic blood pressure. As the cuff deflates, the first sound heard through the stethoscope is the systolic blood pressure. It sounds like a whooshing noise. When this noise goes away, that indicates the diastolic blood pressure.
The systolic blood pressure number is always said first, and then the diastolic blood pressure number is given. For example, your blood pressure may be read as “120 over 80″ or written 120/80.
Blood pressure is measured in millimeters of mercury (mm Hg).

How Often Should I Get My Blood Pressure Checked?

  • If your blood pressure is normal (less than 120/80), get it checked at least every 2 years or more frequently as your doctor suggests
  • If your blood pressure is borderline high — systolic blood pressure between 120 and 139 or diastolic blood pressure of 80 to 89 — check it at least every year or more often as your doctor suggests
  • If your blood pressure is 140/90 or higher, talk with your doctor as this is high blood pressure and requires a doctor’s attention


What Is “Normal” Blood Pressure?

Normal blood pressure rises steadily from about 90/60 at birth to about 120/80 in a healthy adult. If someone were to take your blood pressure immediately after you’d delivered a speech or jogged five miles, the reading would undoubtedly seem high. This is not necessarily cause for alarm: It’s natural for blood pressure to rise and fall with changes in activity or emotional state.
People with blood pressure readings of 140/90 or higher, taken on at least two occasions, are said to have high blood pressure. If the pressure remains high, your doctor will probably begin treatment. People with blood pressure readings of 180/120 or higher need treatment immediately. People at higher cardiovascular risk (such as diabetes, chronic kidney disease, or known heart and vascular disease) are treated if their blood pressure rises above 130/80, because they already have a high risk of heart disease
A blood pressure reading has a top number (systolic) and bottom number (diastolic).

What Does The Systolic Blood Pressure Number Mean?

When your heart beats, it contracts and pushes blood through the arteries to the rest of your body. This force creates pressure on the arteries. This is called systolic blood pressure.
A normal systolic blood pressure is below 120.
A systolic blood pressure of 120 to 139 means you have prehypertension, or borderline high blood pressure. Even people with prehypertension are at a higher risk of developing heart disease.

What Does The Diastolic Blood Pressure Number Mean?

The diastolic blood pressure number or the bottom number indicates the pressure in the arteries when the heart rests between beats.
A normal diastolic blood pressure number is less than 80.
A diastolic blood pressure between 80 and 89 indicates prehypertension.
A diastolic blood pressure number of 90 or higher is considered to be hypertension or high blood pressure.

To summarise

  • Normal: Less than 120 over 80 (120/80)
  • Prehypertension: 120-139 over 80-89
  • Stage 1 high blood pressure: 140-159 over 90-99
  • Stage 2 high blood pressure: 160 and above over 100 and above

People whose blood pressure is above the normal range should consult their doctor about steps to take to lower it.

What Is Prehypertension?

In prehypertension, the systolic (top number) reading is 120 mmHg-139 mmHg, or the diastolic (bottom number) reading is 80 mmHg-89 mmHg.
Prehypertension is a warning sign that you may get high blood pressure in the future.

Who Is At Risk For Prehypertension?

Hypertension is a growing epidemic
People with prehypertension may have a greater risk for other cardiovascular disease (CVD) risk factors. These risk factors — such as high cholesterol, obesity, and diabetes – are seen more in people with prehypertension than in those with normal blood pressure.

Is Prehypertension A Result Of Aging?

You may wonder if high blood pressure happens with aging, but experts say no.
Some populations across the globe have minimal rise in blood pressure with aging. In some parts of Mexico, the South Pacific, and other parts of the world, people have very low salt intake. In these areas, the age-related rise in blood pressure is small compared with the U.S.

Is There Treatment For Prehypertension?

  • Prehypertension is a warning sign. It means that you’re at a greater risk of high blood pressure. Depending on your blood pressure and risk factors for heart disease, you may only need to make a few lifestyle adjustments. Here are some strategies to help you manage prehypertension:
  • Lose weight if you are overweight. Being overweight increases the risk of high blood pressure. However, losing weight can lower high blood pressure. Studies show that modest weight loss can prevent hypertension by 20% in overweight people with prehypertension.
  • Exercise regularly. Exercise helps you lose weight. Exercise also helps lower blood pressure.
  • Eat plenty of fruits, vegetables, whole grains, fish, and low-fat dairy .Studies show high blood pressure can be lowered and prevented with the DASH diet. This[TM1]  diet is low in sodium and high in potassium, magnesium, calcium, protein, and fiber.
  • Cut back on dietary salt/sodium. A diet high in sodium (salt) can increase blood pressure. A low-sodium diet can lower high blood pressure — or prevent it. Aim for less than 2,300 milligrams of sodium daily (about 1 teaspoon of table salt).
  • Eat foods low in saturated and trans fat and cholesterol. Diets high in saturated fat (meats and high-fat dairy), trans fat (some margarine, snack foods, and pastries) and cholesterol (organ meats, high-fat dairy, and egg yolks) may lead to obesity, heart disease, and cancer.
  • Eat a plant-based or vegetarian diet. Add high-protein soy foods to your diet. Increase servings of fruits and vegetables by adding one serving at a time. You can add a serving of fruit at lunchtime. Then add a serving of vegetables at dinner.
  • Drink only in moderation. Drinking excess alcohol can increase blood pressure. Limit drinking to no more than two drinks a day for men, and one drink a day for women.

What is Insulin Therapy?

Some people who have type 2 diabetes need insulin therapy as well. Because normal digestion interferes with insulin taken by mouth, insulin must be injected.
Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks like an ink pen, except the cartridge is filled with insulin.
There are many types of insulin. According to the American Diabetes Association (ADA) there are over 20 types of insulin in the American market. They work in different ways, they are made differently, and they vary in price.

Rapid-acting insulin
This type of human insulin starts to work within five minutes of being injected and peaks after about one hour. It continues to be active for 2 to 4 hours. Examples of rapid-acting insulin are lispro marketed by Eli Lilly, insulin aspart marketed by Novo Nordisk, or insulin glulisine marketed by sanofi-aventis.
Short-acting insulin
Also known as Regular (acting) insulin. This type of human insulin reaches your bloodstream approximately 30 minutes after you inject it, and peaks from 2 to 3 hours after injection. It is effective for 3 to 6 hours.
Intermediate-acting insulin
This human insulin takes from 2 to 4 hours to reach the bloodstream after injection. It peaks at 4 to 12 hours. It is effective for approximately 12 to 18 hours.
Long-acting insulin
This insulin gets into your bloodstream about 6 to 10 hours after you inject it. It is effective for 20 to 24 hours. This type of insulin is also known as ultralente.
Pre-mixed insulin
Some patients have to mix two different types of insulin. If they find that difficult they can have the insulin pre-mixed. This is especially useful for people who are visually impaired.
Allergic reaction to insulin additives
The insulin a diabetic takes has additives to keep it free of bacteria and to tweak its time of action. Some patients may have an allergic reaction to some additives found in intermediate and long-acting insulins – however, this is very rare.
Diabetes treatment – insulin pump
Insulin pumps are mostly used by people with Diabetes Type 1. However, more and more people with Type 2 are starting to use them.
Users say that the pump allows them to get the treatment to adapt to them, instead of the other way round as is the case with insulin injections.
An Insulin Pump really can help you maintain your blood glucose levels with specific parameters.

What is insulin?

Insulin is a hormone. It makes our body’s cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy.
When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells. When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body systems, such as amino acid uptake by body cells. Insulin is not identical in all animals – their levels of strength vary.
Porcine insulin, insulin from a pig, is the most similar to human insulin. Humans can receive animal insulin. However, genetic engineering has allowed us to synthetically produce ‘human’ insulin.

The Pancreas And Insulin

The pancreas is part of the digestive system. It is located high up in your abdomen and lies across your body where the ribs meet at the bottom. It is shaped like a leaf and is about six inches long. The wide end is called the head while the narrower end is called the tail, the mid-part is called the body.

The pancreas has two important functions:

  • It produces pancreatic digestive juices.
  • It produces insulin and other digestive hormones

The endocrine pancreas is the part of the pancreas that produces insulin and other hormones.
The exocrine pancreas is the part of the pancreas that produces digestive juices.
Insulin is produced in the pancreas. When protein is ingested insulin is released.
Insulin is also released when glucose is present in the blood. After eating carbohydrates, blood glucose levels rise.
Insulin makes it possible for glucose to enter our body’s cells – without glucose in our cells they would not be able to function. Without insulin the glucose cannot enter our cells.
Within the pancreas, the Islets of Langerhans contain Beta cells, which synthesize (make) the insulin. Approximately 1 to 3 million Islets of Langerhans make up the endocrine part of the pancreas (mainly the exocrine gland), representing just one fiftieth of the pancreas’ total mass.

“Time is Brain”

What is a Stroke: A stroke occurs when blood flow to part of the brain is cut off due to blockage or bursting blood vessel. Without blood supply, brain cells are destroyed. It is a medical emergency and needs immediate attention!


Common Risk Factors include high BP, cholesterol, diabetes, obesity, smoking, no exercise and excessive alcohol

Warning Signs of Stroke include:

Difficulty in speaking: Ask the patient to repeat the phrase “You can’t teach old dog new tricks.”  If s/he slurs or is unable to repeat, then s/he likely having a stroke
Sudden numbness or weakness of the body, especially on one side.  Ask patient to extend both arms (palms up) for 10 seconds. If one arm drifts downward, it could be a stroke

  •         Droopy face with sagging of one side of face
  •         Sudden dizziness or loss of balance
  •         Sudden vision changes, difficulty in understanding others etc


Don’t ignore stroke warning signs . Call EMERGENCY medical services.


For post hospitalization stroke patient care and rehabilitation at home in Pune, call SRCF Elder Day Care & Training Center on +91 9595 15 7011 or email hello@src.foundation  

“Out of Bed”

A stroke which leaves a patient partially or fully paralysed is one of the most distressing experiences for the patient and family.
Right after emergency care is given and the patient stabilizes, the long road to rehabilitation begins. While rehabilitation of a stroke patient involves different specialized healthcare professionals, physiotherapy is the most critical.
Passive range of motion exercises are given to the paralysed parts to prevent contracture (shortening of muscles). Early mobilization also reduces risks of other complications such as thrombosis, pneumonia among others. Passive mobilization quickly progresses to active participation by the patient in exercises.
While managing a stroke rehabilitation patient, one has to have realistic goals. Achieving positive outcomes in the shortest possible time especially independence in performing activities of daily living such as cleaning oneself, bathing is dependent on the patient’s own effort and family’s support. Of course, a committed physiotherapist is critical to this recovery process.
Sanctus Healthcare provides multidisciplinary care and exclusive physiotherapy for post stroke rehabilitation patients. Call on 9595957003 and/or email on hello@src.foundation. See www.src.foundation for more information.