Diabetes expert in Lebanon – 13 Easy Tips to Apply

Jan 26, 2021 | Diabetes, News

Diabetes Tips to Apply

1. Tips to decrease your triglyceride level

When we speak of increased cholesterol levels, it doesn’t always mean one thing. In fact, “total cholesterol” is defined as the sum of the good cholesterol (HDL), the bad cholesterol (LDL) and triglycerides.

The danger to the heart and vessels come from either one or a combination of:

1. low HDL levels
2. elevated LDL levels
3. elevated triglyceride levels.

In some patients, there is a hereditary predisposition and even transmission of disease. These people would need medical treatment to get rid of their elevated dyslipidemia.

As for some others, a good medical nutritional therapy can be attempted.

For patients with increased triglyceride levels, along with physical activity, here are some tips to naturally decrease them:

1. control the amount of carbohydrates ingested at meals
2. focus on the good quality of carbohydrates, ie the richer in fibers and less processed. This includes whole grain foods, oats, wild rice, grains, etc….
3. try not to mix two or more kinds of carbohydrates per meal
4. avoid sweets, especially the rich Arabic ones
5. Limit your alcohol intake
6. Avoid fruit juices, even natural juice, and rather focus on eating the fruit with its fibers instead
7. Try not consuming your fruits on an empty stomach, rather incorporate some proteins in the meal, such as dairy and raw nuts.

After a month of these tips, recheck your lipid levels and follow with your physician.

Tip: remember that moderation and balance are necessary for a healthy body, and physical activity helps!

2. Tips to decrease your LDL level

When we speak of increased cholesterol levels, it doesn’t always mean one thing. In fact, “total cholesterol” is defined as the sum of the good cholesterol (HDL), the bad cholesterol (LDL) and triglycerides.

The danger to the heart and vessels come from either one or a combination of:

1. low HDL levels
2. elevated LDL levels
3. elevated triglyceride levels.

In some patients, there is a hereditary predisposition and even transmission of disease. These people would need medical treatment to get rid of their elevated dyslipidemia.

As for some others, a good medical nutritional therapy can be attempted.

For patients with increased LDL levels, along with physical activity, here are some tips to naturally decrease them,

1. limit your fats to 25 to 35% of your daily calorie intake; less than 7% should come from saturated fats
2. focus on good fats, such as lean meats, fatty fish, nuts, oils like olive oil
3. eat plenty of soluble fibers, such as those in wholegrain foods, legumes and fruits like apples and pears
4. Switch to low fat rather than full fat dairy
5. Focus on white cheeses rather than yellow cheeses
6. Limit consumption of charcuterie and cold cuts
7. Limit salt as it increases your heart disease risk.

After a month of these tips, recheck your lipid levels and follow with your physician.

Tip: remember that moderation and balance are necessary for a healthy body

3. Tips for better sleep

Today, more and more people are complaining of insomnia or lack of sleep. There are different kinds of insomnia, and these are:

• Acute insomnia. A brief episode of difficulty sleeping.
• Chronic insomnia. A long-term pattern of difficulty sleeping.
• Comorbid insomnia. Insomnia that occurs with another condition.
• Onset insomnia. Difficulty falling asleep at the beginning of the night.
• Maintenance insomnia. The inability to stay asleep.

Here are some tips to reduce insomnia:

1. Stick to a sleep schedule: the general recommendation is to get 7 hours of sleep per day, and not more than 8 hours. Go to bed and get up at the same times every day, including weekends. If you don’t fall asleep within 20 minutes, leave your room and do something relaxing, such as reading or listening to soothing music. Go back to your room when tired.
2. Pay attention to what you eat or drink: don’t go to bed hungry or full, and avoid heavy meals within a couple of hours of bedtime. Nicotine, caffeine and alcohol should be consumed with caution, as their effect may last hours after consumption.
3. Create a restful environment: avoid having electronic and light-emitting devices just before bed-time. Enjoy calming activities before sleeping, such as taking a bath, reading or using relaxation techniques.
4. If you do not work at night, limit daytime naps to 30 minutes.
5. Include physical activity in your daily routine, and spend time outdoors
6. Learn to limit your worries before bed time. Stress management may help, and organization of your time and priorities could limit overthinking at bedtime.

Tip: Many have occasional restless sleep. Contact your doctor if your insomnia lasts longer.

4. Advice for a healthy gut

Did you now that a healthy gut can boost your immune system? Research shows that there is a close connection between gut microflora and various aspects of health, such as nutritional status, behavior and stress response.

What can you do to keep your gut healthy?

1. Make sure you are getting enough fibers: they help feed the good bacteria
2. Eat fermented foods like yogurt, because they contain healthy bacteria known as probiotics, which replenish your gut microbiome. This is especially important in situations where you took antibiotics, which affect the balance of your gut flora
3. Avoid processed foods and sugar: these are what the “bad” bacteria feed on!
4. Decrease stress: practice breathing exercises, physical activity such as yoga, hiking and outdoor activities, which provides you with fresh air. There is a direct connection through the vagus nerve between your gut and your brain, and they both affect each other!
5. Get regular exercise
6. Get enough sleep.

Tip: Keeping your gut healthy helps boost your immunity!

5. Tips to avoid the metabolic syndrome

The metabolic syndrome is a grouping of 5 main elements that put your body at risk of diabetes and heart disease. These elements are:

1. Elevated blood sugar
2. Elevated blood pressure
3. Elevated triglycerides
4. Low HDL levels (good cholesterol)
5. Waist circumference more than 88 cm in women, and 103 cm in men.

Metabolic syndrome is associated with insulin resistance and increased fat in the abdomen

Here are some tips you can do daily to help with the weight loss:

1. Avoid drinking extra calories: decrease consumption of juices, sodas, sweet teas and energy drinks. Replace these with water, mineral or carbonated.
2. Be careful with drinks labeled “no sugar added”. They are usually filled with sugars, even if naturally occurring
3. Eat less processed foods, focus on fresh fruits and vegetables
4. Choose complex carbohydrates, they are high in fibers and low in sugar
5. Avoid foods with a long shelf life
6. Forget the extra sugars: even the organic ones! They are still high in calories.
7. Increase your daily energy expenditures: park your car a bit further from your destination, take the stairs instead of the elevator, exercise at least 150 minutes per week.

Tip:  A 5 to 10% weight loss can help prevent it and even reverse metabolic syndrome

6. Tips for ladies with PCOS

Polycystic ovary syndrome (PCOS) is disorder of the ovaries characterized by

1. Increased levels of the male hormone testosterone, which is manifested by excess facial hair, acne, and hair loss in a typical male pattern
2. Abnormal menstruation
3. Increase in weight.

Different treatment modalities exist, depending on the major manifestation of the disease, and individual complaint.

Presence of this syndrome is associated with insulin resistance, seen either with increased insulin on laboratory exams, or clinical findings, such as darkening of some areas of the body with folds.

There is not specific diet for ladies with PCOS, however dietary guidelines include:

1. Eating less processed foods: focus on healthy and clean eating
2. Avoid simple sugars
3. Eat complex carbohydrates higher in fiber and healthy fats.

Tip: management of PCOS first starts in the kitchen!

7. Tips for patients taking thyroid hormone replacement

Hypothyroidism affects millions of people worldwide. The most common cause in the developed world and around the Mediterranean is an autoimmune condition called Chronic Lymphocytic Thyroiditis, or Hashimoto’s Thyroiditis.

The treatment of hypothyroidism is replacement of the deficient thyroid hormone with a synthetic hormone, called Levothyroxine. It is found in Lebanon as “Euthyrox” or “Eltroxin”

This treatment has to be taken in a specific manner: fasting (usually in the morning), with a glass of water, at least 30 minutes before coffee or breakfast.

It is very important to separate the thyroid replacement treatment from 4 other medications that could be prescribed:

1. Vitamins
2. Calcium
3. Iron
4. Gastric protection.

In fact, these four elements have been shown to alter the absorption of the Levothyroxine supplement. Therefore, they have to be taken at least 4 hours away.

Tip: Take your supplement the correct way for it to work the correct way!

8. Tip of the day: increase your water intake!

Did you remember to drink water today?

Recommendations discuss drinking 8 glasses of water per day. But these should take into consideration physical activity, age, environmental factors and, of course, body weight. Why is water so important for weight maintenance and/or weight loss?

1. Water is a natural appetite suppressant! When the stomach is full, it sends a signal to the brain to increase satiety and decrease appetite. Also, in a world where we are surrounded by unnatural light, air-conditioning and heaters, a more sedentary behavior, etc… our bodies are having difficulty differentiating hunger from thirst!
2. Water increases calorie burning, by temporarily increasing the body’s resting energy expenditure. It is also said that drinking COLD water (rather than HOT as always advocated) enhances the calorie burning since more energy is needed to heat it for digestion
3. Water helps remove wastes from the body: it helps the kidneys filter toxins better, and helps avoid constipation, so the intestines can empty themselves smoothly and effectively. When waste builds up in the body, the person can feel heavy, full and bloated.
4. Drinking water can decrease overall liquid intake, from juices, soda or sweetened beverages. So, drinking water and non-caloric hot beverages help weight loss
5. Water is necessary to burn fat! Without water, fat and carbohydrates cannot be properly metabolized. In fat metabolism, called lipolysis, the first step is hydrolysis: water molecules interact with triglycerides to start the process.
6. Water helps with workouts! With physical activity, water helps the muscles, connective tissues, and joints move correctly. It also keeps the lungs, heart and other organs work correctly. This way, it protects against fatigue and exhaustion, and promotes better tolerance and endurance to keep working out.

Tip: Drinking water is great for your skin, kidneys, intestines, general wellbeing and weight management!

9. Tips for patients with diabetes on insulin injections

Different treatments of diabetes exist: some are pills, others are injectable. Among the injectable kinds of treatment, we find insulin.

Insulin is essential for people with type 1 diabetes, as their pancreas no longer secretes its own hormone. In their case, synthetic insulins are necessary.

In some people who have longstanding type 2 diabetes, or are severely uncontrolled on their oral medication, or have special health conditions, insulin may also be prescribed.

In knowledgeable hands, insulin is a safe and efficacious therapy. For this, it is important to follow these few tips:

1. When an insulin pen is used, it is important to keep it in a cool and dark place, away from direct sunlight. It could remain in your nightstand, or even your purse when needed.
2. The remaining pens should be placed in the fridge, in the vegetable drawer to avoid fluctuating temperatures and sometimes freezing.
3. It is important to know where to inject the insulin, as it should be in the skin. The abdomen, 4 fingers away from the bellybutton is an option. The thigh is also an option, starting 4 fingers above the knee, and last, in the fat of the arm, if we are able to reach
4. It is important to insert the needle perpendicularly, away from visible blood vessels, push on the button until it marks zero, count to 10, then remove it.
5. It is important to make sure the needles are clean, and changing them every few days.
6. The most important aspect is to rotate the injection site, so as to avoid fat nodule formation, which would prevent the insulin from getting into the body.

Tip: don’t forget to ask your doctor to demonstrate the correct way of insulin injection!

10. A tip to all people living with diabetes: don’t forget to check your smile!

We all know that diabetes affects the blood vessels and body organs, but did you know that diabetes also affects the gums and teeth?

People with uncontrolled diabetes usually have less saliva production; and as saliva protects the teeth, a dry mouth may put your gums and teeth at risk. In this case, you are at a higher risk of gingivitis and cavities.

With increasing blood sugar, there is a higher risk of infections inside your mouth, delayed wound healing, and formation of abscesses. Periodontal disease happens when the bacteria in your mouth make a home in your gums. Around 22% of people living with diabetes have periodontal disease, especially in those with increased age and uncontrolled blood sugar levels.

In fact, one of the causes of uncontrolled diabetes is the presence of an oral infection!   

Periodontal disease may lead to tooth avulsion and falling. 1 in 5 cases of total tooth loss is linked to diabetes!

For this reason, people with diabetes are advised to

1. Keep their diabetes under control with their endocrinologist
2. Switch to a healthier diet
3. Visit their dentist regularly, and inform them they have diabetes
4. Avoid smoking
5. If wearing dentures, clean them every day
6. Brush twice a day with a soft brush, and clean between the teeth daily.

11. Tips to prevent childhood obesity

As you have noticed, obesity is on the rise worldwide. Children are not spared, and, because of the change in lifestyle and dietary habits, childhood obesity is now becoming of concern.

In Europe, 1 out of 3 11-year old children is obese.

How can you help promote healthy habits and prevent obesity in your children?

1. Empower and encourage, praising their efforts and avoiding blaming them for their weight
2. Lead by example: be active together, eat healthy together
3. Bring them shopping, and let them choose one new vegetable to try
4. Cook together: it is fun, cheaper, and an opportunity to promote good habits!
5. Eat together at the table
6. Offer smaller portion at mealtimes: let them choose their cutlery next time you go shopping!
7. Avoid using food as a reward! Stimulate good behavior using stickers, activities or play instead
8. Encourage drinking plenty of water and avoiding sugary drinks
9. Reduce screen time and encourage playing outdoors
10. Get enough sleep!

12. Tips for mindful eating

One of the most important aspect of eating is doing it mindfully. In fact, studies have shown that having a clean eating routine is associated with better food absorption, early satiety, weight loss and better health in general.

Here are some tips to help you eat mindfully:

1. Starting at the grocery shopping level, do not go to buy food on an empty stomach. This makes you buy less nutritious foods high in saturated fats and salt
2. Do not eat food straight out of the packet; instead, put it in a bowl or a plate, and estimate the quantities you may eat.
3. Choose spicing food rather than salting or oiling it, to make it more palatable
4. Sit at the table
5. Remove distractions such as telephones and televisions
6. Take smaller bites and chew well, slow down!
7. Take a moment to appreciate the texture, the consistency and the smell of your food
8. Put the fork or spoon down between bites
9. If you feel full, save your food for later.

Tip: enjoy the eating experience!

13. Tip to manage stress better!

Today most of us are under stress, which is especially true during times of unrest and pandemic.

Stress can be negative and harmful for our bodies and minds.

Here are a few healthy habits that you can do to fight stress:

1. Slow down! Organize your time and plan ahead, so that you don’t have to rush
2. Sleep more: practice healthy and restorative sleeping habits, up to 8 hours a night
3. Worry less: the world will not end if you have not reached your target on time!
4. Laugh more: it is the best medicine and stress reliever
5. Get connected! Having friends and family to connect with can boost your morale
6. Get organized: “to do” lists will help you decide what is a priority and what can wait
7. Practice helping others: volunteering your time or helping your friends helps you
8. Be active every day: exercise relieves mental and physical tension. Find something that you like and practice it
9. Give up the bad habits, such as smoking, caffeine. These increase anxiety and blood pressure
10. Lean into things you can change: make time to learn a new skill, work towards a goal…

Tip: Stress is stressful! Rely on habits you can create to manage it yourself.

Diabetes advice in Lebanon – Surprising Info in 2021

Jan 26, 2021 | Diabetes, News

Advice for patients living with Diabetes

1. Your small blood vessels are at risk if your sugar levels are not at target!

High sugar levels affecting the small vessels include damage to the retinal vessels, the small vessels of the kidney and the distal vessels of the nerves.

Uncontrolled diabetes, whatever type it is, may results in diabetic retinopathy and blindness, kidney disease leading to dialysis, and nerve injury which predisposes to amputations.

For this reason, I advise you of the following:

1. Visit your endocrinologist once or twice a year, more so if your sugar levels are not at target (too high or too low)
2. Have a yearly eye checkup at the ophthalmologist, including a pupil dilatation and retinal exam
3. Have a yearly urine microalbuminuria test
4. Have a yearly foot exam, done during your visit to the endocrinologist.

Tip: Don’t ignore your diabetes. If you treat it right, it will treat your right!

2. Your medium and large blood vessels are at risk if your sugar levels are not at target!

High sugar levels affecting the medium and vessels include damage to the coronaries, to the carotids, the aorta and the vessels of the limbs.

Uncontrolled diabetes, whatever type it is, may result in heart attacks, emboli to the brain, and emboli to the lower limbs.

What are the tests required to prevent these complications?

At the diagnosis of type 2 diabetes, it is preferable to check for the presence of medium to large vessel complications, since they could be present without symptoms. This includes:

1. An electrocardiogram
2. A cardiac ultrasound
3. A stress test if needed
4. An ultrasound exam of the vessels of the neck and lower limbs.

A repeating schedule is decided with the physician according to the findings.

Tip: Don’t ignore your diabetes. If you treat it right, it will treat your right!

3. Do not ignore hypoglycemia!

It is the result of when the sugar level drops, characterized by 3 elements:

1. Symptoms of hypoglycemia
2. Sugar level < 55mg/dL
3. Resolution of the symptoms after the sugar level is increased.

It is called Whipple’s Triad, and can occur at different sugar levels, depending on the patient.

For most patients, a drop in sugar causes symptoms, including:

1. Palpitations
2. Sweating
3. Hunger
4. Shaking
5. Inability to concentrate
6. Anxiety
7. Nausea.

Hypoglycemia is not dangerous by itself. It is important to remain calm and seated when symptoms happen, measure sugar levels in the finger, and resolve the issue with a controlled amount of sugar. Patients should keep checking their sugar levels every 15 minutes until resolution.

Tip: patients with diabetes are at risk of hypoglycemia, especially if taking specific kinds of diabetes medication. Contact your physician in case you get it!

4. What do to in case of hypoglycemia? 

Hypoglycemia is not dangerous by itself. It is important to remain calm and seated when symptoms happen, and follow the 15:15 rule: consume 15 g of sugar and wait for 15 min.

15 g of sugar are equivalent to:

1. 3 small cubes of sugar
2. Half a glass of juice
3. A small can of regular soda
4. 6 or 7 regular hard candy.

Avoid chocolate, fruits, bread and other sources of sugar as they need more time for absorption.

If the sugar level does not rise within 15 minutes, consume another 15 g of sugar. Keep monitoring and repeating every 15 minutes until resolution, and don’t forget to ask yourself what could be the cause:

1. Did you take your medication and forgot or took a longer time to eat?
2. Did you omit carbohydrates at the meal?
3. Did you take an extra dose of medication?
4. Did you engage in strenuous activity?
5. In case you are on insulin, have you overestimated your meal?

Tip: Don’t forget the 15:15 rule, and inform your doctor of your hypoglycemia. She/he may adjust the medication dose, or even remove it.

5. How to care for your feet?

Diabetes is associated with small blood vessel disease, affecting the retina, the kidney, and the small nerves. For this reason, diabetes may lead to foot disease, even reaching amputation, if we are not very careful.

Here are some tips to prevent diabetic foot disease:

1. Inspect your feet daily. Make sure no new lesions or discoloration are seen. If you are unable to see your sole, you can use a mirror.
2. Wash your feet in lukewarm water, not in hot water, as hot water may burn the skin if the pain sensation is decreased
3. Be gentle when washing your feet, to avoid skin tearing. Make sure you wash in between the toes.
4. Dry your feet well after the bath. If you would like to use a hair dryer, make sure the temperature is not set at hot
5. Moisturize your feet but not between your toes: this would increase the humidity there and increase your risk for fungal infections.
6. Cut your toe nails carefully, avoiding to injure the skin or cut the nail too sharp. It is better to schedule an appointment with a medical team of doctors, podiatrists and nurses certified in foot care for patients with diabetes.
7. Never try to remove excess skin or corns yourself!
8. Never walk barefoot! Instead, make sure your socks are made of cotton
9. Never wear shoes that are very tight, you might injure yourself
10. Shake out your shoes before wearing them; you can even pass your hand inside to make sure no sharp objects or pebbles are stuck in.
11. Take care of your diabetes: keep your sugar levels stable, follow up with your physician, and ask for help to quit smoking.

Tip: if you take care of them, your feet will take you a long way

6. Avoid gaining weight, especially during quarantine!

Being in quarantine has a lot of impact on weight, as many have noticed. Increased stress, no gyms, and confinement have all contributed to many complaining of weight gain!

Here are some tips to avoid the quarantine fifteen:

1. Create a routine: set a breakfast / lunch / dinner mealtime
2. Set a snack schedule, 1 to 3, with healthy snacks available
3. Eat mindfully, avoid doing so in front of your laptop or tv
4. Make healthy shopping choices: avoid shopping on a healthy stomach, and remember that boosting your immunity starts in the kitchen!
5. Get a lot of sleep: set an alarm in the morning and a bedtime schedule
6. Make sure you drink enough water, as thirst sometimes is perceived as hunger
7. Set a time for exercise, whether at home or in nature
8. Enroll in an online physical activity class, or benefit from the free live sessions on social media
9. Keep contact with your friends: schedule live online meetings and phone calls, you will benefit from their support
10. Pick up old hobbies, or even try new ones!

Tip: Maintaining a healthy lifestyle does not only maintain your weight, but boosts your immunity status to protect you against viruses, especially during the pandemic

7. Advice on starting Intermittent Fasting

Intermittent fasting is NOT a diet, but a timed approach to eating. Unlike diets, it does not specify what foods to eat and what to avoid.

It may have some health benefits, seen in studies, such as weight loss, decreased inflammation, better well-being, but it may not be beneficial for everyone: people on chronic medication need to be followed closely by their physician to avoid complications.

Here are 5 tips to help you start your intermittent fasting:

1. Identify personal goals for IF
2. Pick the method: 16:8 or 5:2: eating 500 to 600 calories on alternate days
3. Figure out caloric needs
4. Figure out a meal plan
5. Focus on the nutritional values and calories of the foods to eat

Tip: IF is a great approach to eating, but be sure to follow with your doctor and your nutritionist!

8. Advice for women who are approaching menopause

Menopause is the natural stopping of a woman’s menstruation. The timing is dependent on many factors, including age, family history, and medication, among others.

Menopause does not have to be very bothersome, if managed in the right way. Here are some tips for the ladies approaching menopause or are already in it:

1. Learn to cope without food: focus on “me-time”, try deep breathing or meditation, try being more outdoors
2. Eat less: people in their 50s need around 200 Cal less than their 40s, and need more muscle mass to increase their metabolism. Focus on nutritious food such as vegetables, fibers, fruits and wholegrain
3. Stay hydrated as skin tends to lose its elasticity, and is at risk for dehydration
4. Get moving! Engage in more physical activity, whether it is parking a bit further and walking, joining aerobic classes or going on hikes
5. Make sure to contact your physician for further information and management options and advice.