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Ismail Munir

Discover essential foot care practices for diabetic patients. Learn how to prevent complications and maintain healthy feet. Meri Sehat offers expert advice and resources for diabetic foot care

The Foot Care Guide For Diabetic Patients

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Can Gestational Diabetes Be Reversed?

Introduction

The International Diabetes Federation (IDF) estimates that by 2030 an estimated 783 million adults will be living with <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a>&nbsp;<a href="#accordion">[1]</a>.&nbsp;According to the latest figures, the prevalence of diabetes has steadily increased in low- and middle-income countries. With a 70% increase since 2019, Pakistan has the highest diabetes prevalence in the world<a href="#accordion">[1]</a>. Moreover, an estimated 11 million adults have Impaired Glucose Tolerance (IGT); thus, increasing their risk of <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">type 2 diabetes</a>&nbsp;<a href="#accordion">[1]</a>. However, researchers have not only reported an increase in cases of type 2 diabetes but also gestational diabetes mellitus (GDM).&nbsp; 
&nbsp;

The true prevalence of gestational diabetes in Pakistan remains unclear due to varying risk factors and diagnostic criteria. A cross-sectional study conducted across hospitals in Karachi and Hyderabad found a prevalence of 11.9%<a href="#accordion">[2]</a>. Another study conducted at The Indus Hospital in Karachi reported a 17.7% prevalence of GDM<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Understanding Gestational Diabetes

Gestational diabetes develops due to a combination of beta cell dysfunction and increased insulin resistance during pregnancy. The resulting hyperglycemia is detrimental to both maternal and fetal health. Complications such as neonatal hypoglycemia, stillbirth, macrosomia, shoulder dystocia, breathing difficulty, and maternal preeclampsia can occur.&nbsp; 
&nbsp;

Although maternal blood glucose levels return to normal after birth, approximately half of the women with gestational diabetes go on to develop type 2 diabetes<a href="#accordion">[4]</a>. Moreover, there&#39;s a two in three chance that Gestational Diabetes Mellitus (GDM) can return in future pregnancy<a href="#accordion">[5]</a>. However, proper antenatal and post-natal care can ensure that one&#39;s GDM stays reversed and their glucose levels remain within target.&nbsp;

&nbsp;

Gestational diabetes typically develops during the second trimester and is diagnosed between 24 to 28 weeks of pregnancy. Depending on the diagnostic criteria, doctors may conduct the following tests for diagnosing GDM: 
&nbsp;

<ul>
	<li>Initial Glucose Challenge Test - Patients drink a 50g glucose solution; after one hour, blood glucose levels are checked. Measurements &gt;140mg/dl point to a high risk of gestational diabetes. It is often followed by an oral glucose tolerance test to confirm a diagnosis of gestational diabetes. 
	&nbsp;</li>
	<li>Oral Glucose Tolerance Test (OGTT) - Patients must present in a fasting state for the test. After drinking a 100g glucose solution, samples are drawn every hour for a total of 3 hours. Diagnosis is based on blood glucose levels in fasting state, 1-hour, 2-hour, and 2-hour post glucose solution.&nbsp; 
	&nbsp;</li>
</ul>

The International Association of Diabetes and Pregnancy Study Groups (IADPSG) 2010 criteria recommends a one-step approach<a href="#reference" target="_blank">6</a>. Blood samples are drawn in a fasting state, and then 1- and 2-hours after drinking a 75g glucose solution (OGTT). While most women are screened during the second trimester, those at high risk may undergo screening at their first prenatal visit.&nbsp; 
&nbsp;

Non-modifiable risk factors of GDM include a family history of diabetes, increasing maternal age (&gt;25years), and a history of GDM. Although these cannot be controlled, several modifiable risk factors also exist for gestational diabetes. These include obesity, polycystic ovary syndrome, prediabetes, diet, and physical activity.&nbsp; 
&nbsp;

Antenatal interventions are aimed at making women aware of the risks associated with gestational diabetes and ways to control the modifiable risk factors of the disease. Moreover, they should be made aware of their blood glucose level targets. 
&nbsp;

<h5>Blood Glucose Monitoring</h5>

Using a glucose meter or sensor, pregnant women with GDM should daily test their fasting, pre-meal, 1-hour postprandial, and bedtime glucose levels. According to the American Diabetes Association (ADA), pregnant women with gestational diabetes should maintain their blood glucose levels within the following range<a href="#accordion">[7].</a>

<ul>
	<li>Fasting plasma glucose levels: less than 95mg/dl</li>
	<li>1-hour postprandial glucose levels: less than 140mg/dl</li>
	<li>2-hour postprandial glucose levels: less than 120mg/dl 
	&nbsp;</li>
</ul>

<h5>Dietary Changes</h5>

A certified dietician can help ensure that the mother reaches her caloric requirements and achieves a healthy weight gain during pregnancy. Women are mostly advised to eat 3 small-sized meals and three to four healthy snacks during the day. Moreover, a bedtime snack is recommended to help keep fasting blood glucose levels within range.&nbsp; 
&nbsp;

The recommended nutrition plan for women with GDM should contain a minimum of 175 g of carbohydrate, a minimum of 71 g of protein, and 28 g of fiber. Sugar and saturated fats are mostly limited.&nbsp; 
&nbsp;

<h5>Physical Activity</h5>

Regular exercise can help keep blood glucose levels within normal and combat insulin resistance. Recommended physical activity for pregnant women includes aerobic exercises like walking and swimming. 30 minutes of exercise for 3-5 days a week is often considered adequate. However, one should consult their doctor before starting any form of exercise during pregnancy.

&nbsp;

<h5>Insulin</h5>

If dietary changes and physical activity are unable to maintain blood glucose levels, doctors may prescribe insulin injections to pregnant women. Insulin is the first choice in gestational diabetes due to its safety profile and inability to cross the placenta. Metformin and sulfonylureas are contraindicated due to adverse outcomes in the fetus. However, with daily insulin injections, it is important that women are made aware of the risks of hypoglycemia.&nbsp;

&nbsp;

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Since blood glucose levels and insulin resistance decrease drastically after birth, it is important to re-evaluate a woman&#39;s insulin requirement. Most women do not require further treatment with insulin. However, blood glucose levels are checked the day after birth.&nbsp; 
&nbsp;

The American Diabetes Association recommends the following for postpartum care of gestational diabetes<a href="#accordion">[7]</a>.

<ul>
	<li>Using the 75g oral glucose tolerance test, screen women at 4-12 weeks postpartum</li>
	<li>Lifelong screening for type 2 diabetes or prediabetes every 1 to 3 years</li>
	<li>If women are found to have prediabetes, they should seek an experienced diabetologist that can advise lifestyle interventions and any diabetes medicines if needed.</li>
	<li>Psychosocial assessment of women should also be included in postpartum care 
	&nbsp;</li>
</ul>

According to research, diets consisting of &#39;high refined grains, fats, oils and fruit juice&#39;, &#39;high nuts, seeds, fat and soybean; low milk and cheese&#39;, and &#39;high added sugar and organ meats; low fruits, vegetables and seafood&#39; is associated with an increased risk of gestational diabetes<a href="#accordion">[8]</a>. Therefore, women with GDM are advised to continue with a healthy diet plan following birth. This will reduce their risk of developing gestational diabetes in future pregnancies. 
&nbsp;

Moreover, women with a history of GDM have a 10-fold higher risk of developing type 2 diabetes mellitus than non-GDM women<a href="#accordion">[9]</a>. Lifestyle interventions such as weight loss, healthy diet, daily exercise and/or metformin use can help reduce the progression of the disease. These modifications can further reduce the risk of cardiovascular complications in women with a history of GDM. 
&nbsp;

&nbsp;

Conclusion

The lack of awareness among the general population combined with limited healthcare access is a barrier to the prevention and management of gestational diabetes in low and middle income countries. Moreover, there is no universal consensus on GDM screening. However, multiple diagnostic criteria are available for diagnosing gestational diabetes. Therefore, there is a need for not only general awareness programs but also effective screening tests that can diagnose the condition early on. Preconception diabetes screening can help prevent GDM-related complications and congenital abnormalities. 
&nbsp;

Gestational diabetes can be quite a distressing state for a mother. It is important that family members are involved in providing emotional support to the mother. Psychological counselling might also be beneficial. Moreover, a healthcare professional should review contraceptive options as part of postpartum care as unplanned pregnancies can further increase the risk of complications.&nbsp; 
&nbsp;

Key Points

<ul>
	<li>Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder of pregnancy and affects both maternal and neonatal health. Common complications include neonatal hypoglycemia, macrosomia, obstructed labor, stillbirth, preterm delivery, increased risk of shoulder dystocia, maternal preeclampsia, and increased risk of type 2 diabetes in both mother and child.&nbsp;</li>
	<li>In women with GDM, blood glucose levels return to normal shortly after birth. However, 50% of women are at risk of developing type 2 diabetes in the future, and 2 in 3 women have a risk of developing GDM in a future pregnancy.</li>
	<li>A healthy and balanced diet, regular physical activity, blood glucose monitoring, and the use of insulin can help maintain blood glucose levels within the normal range in pregnant women with GDM. The American Diabetes Association (ADA) recommends fasting blood glucose levels &lt;95mg/dl, 1-hour postprandial levels &lt;140mg/dl, and 2-hour postprandial levels &lt;120mg/dl during pregnancy.</li>
	<li>4-12 weeks postpartum, women with GDM should undergo testing with 75g-OGTT. Moreover, they should be tested every 1-3 years for risk of type 2 diabetes.&nbsp; 
	&nbsp;</li>
</ul>

[1].International Diabetes Federation, 2021. With 1 in 4 adults living with diabetes, Pakistan has highest diabetes prevalence in the world. s.l.:s.n.

[2].Riaz, M. et al., 2019. Frequency of gestational diabetes mellitus using DIPSI criteria, a study from Pakistan. Clinical Epidemiology and Global Health, 7(2), pp. 218-221

[3].Wali, A. S. et al., 2020. High proportion of overt diabetes mellitus in pregnancy and missed opportunity for early detection of diabetes at a tertiary care centre in Pakistan. Pakistan journal of medical sciences, 36(1), pp. 38-43.

[4].CDC, 2021. Gestational Diabetes. [Online]

[5].American Diabetes Association, n.d. Gestational Diabetes - Treatment & Perspective.

[6].Rani, P. R. & Begum, J., 2016. Screening and Diagnosis of Gestational Diabetes Mellitus, Where Do We Stand. Journal of Clinical and Diagnostic Research, 10(4).

[7].American Diabetes Association, 2021. Management of Diabetes in Pregnancy. In: Standards of Medical Care in Diabetes. s.l.:s.n.

[8].Shin, D., Lee, K. W. & Song, W. O., 2015. Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus. Nutrients, 7(11).

[9].Vounzoulaki, E. et al., 2020. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ, Volume 13

Nimrah H. Sattar

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Your Morning Sickness Guide

Morning sickness affects roughly half to two-thirds of all pregnant women, especially in the first trimester. The most common signs are nausea and vomiting. Morning sickness occurs mostly early in the day, hence the name, but it can occur at any time of day or night.

&nbsp;

Morning sickness usually starts during the 4th week of pregnancy and lasts until weeks 12-14. However, 1 in every 5 women experiences morning sickness throughout their second trimester and a small fraction of unfortunate women suffer from nausea and vomiting throughout their pregnancy. In the west, the incidence of vomiting and nausea during pregnancy is about 50-80%<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

In most situations, morning sickness doesn&rsquo;t affect the pregnant woman or the unborn child. However, severe morning sickness, which involves weight loss and dehydration, requires immediate medical care and assistance.&nbsp; 
&nbsp;

Understanding Morning Sickness in Pregnancy

Morning sickness can cause a variety of signs and symptoms, including:

<ul>
	<li>Nausea and sickness</li>
	<li>Loss of appetite, which can lead to <a href="https://merisehat.pk/disease/anorexia-nervosa">anorexia&nbsp;</a></li>
	<li>Vomiting</li>
	<li>Psychological and mental effects, which include <a href="https://merisehat.pk/disease/depression">depression </a>and <a href="https://merisehat.pk/disease/anxiety">anxiety&nbsp;</a> 
	&nbsp;</li>
</ul>

The reason for morning sickness is unknown. However, it is believed that a combination of physical and metabolic factors plays a significant role. This includes:

<ul>
	<li>Hormonal imbalance, particularly high levels of estroge</li>
	<li>Changes in blood pressure, particularly low blood pressure</li>
	<li>Changes in the metabolism of carbohydrates</li>
	<li>Physiological changes that pregnancy provokes 
	&nbsp;</li>
</ul>

Early in pregnancy, the thyroid gland is activated, perhaps by hCG (human chorionic gonadotropin) or a similar chemical that may cause gestational emesis. Increased free T4 and hCG and decreased TSH are all linked with the intensity of morning sickness, and, according to a study, these changes are more pronounced in participants who also experienced nausea and vomiting<a href="#accordion">[2]</a>.

&nbsp;

<h5>Is Morning Sickness Harmful to Baby?</h5>

Some mothers are worried that the action of vomiting may harm their unborn child. The physical mechanics of vomiting and retching do not harm the unborn child, but it may strain the abdominal muscles and cause localized pain, discomfort, and soreness. Nevertheless, the fetus remains well-cushioned and protected within its amniotic fluid sac. Several studies have found that mild morning sickness is associated with a lower chance of miscarriage.&nbsp;

&nbsp;

On the other hand, prolonged vomiting that leads to dehydration and weight loss can deprive the fetus of sufficient nourishment and increase the risk of the baby being underweight at birth. 
&nbsp;

Hyperemesis gravidarum (HG), which is also known as severe morning sickness, affects approximately 1 in every 1000 pregnant women<a href="#accordion">[3]</a>. The signs and symptoms of HG are frequent vomiting, weight loss, and dehydration. Hospitalization and the administration of intravenous fluid and nourishment is necessary to treat it.

&nbsp;

Untreated hyperemesis gravidarum may lead to the following possible complications:

<ul>
	<li>Electrolyte imbalances</li>
	<li>Severe anxiety, sadness, and despair</li>
	<li>Malnourishment of the fetus</li>
	<li>Severe stress on essential organs, such as the liver, heart, kidneys, and brain 
	&nbsp;</li>
</ul>

Doctors usually recommend vitamin B-6 supplements (pyridoxine), ginger, and over-the-counter medications, like doxylamine (Unisom), for management. If nausea and other symptoms of morning sickness persist, they may prescribe anti-nausea medicine. 
&nbsp;

<h5>Does Morning Sickness Cause Electrolyte Imbalance?</h5>

Mild to severe pregnancy related nausea and vomiting can usually cause dehydration and electrolyte (e.g., sodium or potassium) imbalance. For mild to severe morning sickness, more fluids and prescription drugs are suggested.

&nbsp;

A healthcare provider will discuss it with the expecting mother how frequently they have experienced nausea, the number of times they vomited, their ability to keep fluids down, and whether they tried any home remedies. For nausea and vomiting, there are a number of prescription drugs that are safe to take during pregnancy, but it all depends on the severity of the symptoms exhibited.

&nbsp;

It&#39;s best to consult with a doctor before taking any over-the-counter drugs or supplements during pregnancy. Especially if it&rsquo;s a case of hyperemesis gravidarum, which requires close monitoring and treatment with intravenous (IV) fluids and anti-nausea medications at a hospital. 
&nbsp;

To help ease symptoms of morning sickness:

&nbsp;

<ul>
	<li>Select Foods Carefully</li>
</ul>

Avoid oily, spicy, and fatty foods. Instead, opt for foods that are high in protein, low in fat, and easy to digest. Bananas, rice, applesauce, bread, and other bland foods are relatively easy to digest. Adding some ginger to your food can be beneficial at times. For some pregnant women, herbal ginger supplements appear to ease morning sickness. The majority of evidence suggests that ginger can be consumed safely during pregnancy, but there is some risk that ginger may interfere with fetal sex hormones.

&nbsp;

<ul>
	<li>Snack Frequently</li>
</ul>

Eat a couple of soda crackers or a piece of dry toast before getting out of bed in the morning. Instead of eating three large meals, snack throughout the day; this helps keep the stomach from becoming too full or empty, either of which may worsen nausea.

&nbsp;

<ul>
	<li>Drink Plenty Of Liquids&nbsp;</li>
</ul>

Drink some water or ginger ale. Every day, consume 6-8 glasses of non-caffeinated beverages to stay hydrated.

&nbsp;

<ul>
	<li>Steer Clear Of Nausea Triggers</li>
</ul>

Keep an eye out for foods or odors that seem to worsen nausea. Having a backup plan, like carrying snacks or essential oils (aromatherapy), is helpful in case of social gatherings to avoid nausea.&nbsp; &nbsp;

&nbsp;

<ul>
	<li>Inhale Fresh Air</li>
</ul>

If the weather permits, open the windows at home or workplace. Take a walk outside every day. It&rsquo;s soothing for the senses and can, therefore, act as a remedy for morning sickness.

&nbsp;

<ul>
	<li>Follow Prenatal Vitamins Guidelines</li>
</ul>

If the nausea hits after taking the prenatal vitamins, take them with a snack or right before bed. If these steps don&#39;t work, consult a doctor about alternate ways to get the iron and vitamins needed for a healthy pregnancy.

&nbsp;

<ul>
	<li>Rinse With Water After Vomiting</li>
</ul>

The acid from the stomach can erode tooth enamel. If possible, rinse with a cup of water mixed with a teaspoon of baking soda. This will help in the neutralization of the acid and protect teeth as well. 
&nbsp;

Several alternative therapies for morning sickness have been suggested, including:

&nbsp;

<ul>
	<li>Acupressure</li>
</ul>

Acupressure wristbands are accessible in most pharmacies without a prescription. Acupressure wristband studies have shown different results, but some women claim to find the wristbands beneficial.

&nbsp;

<ul>
	<li>Acupuncture</li>
</ul>

A qualified practitioner inserts hair-thin needles into the skin for acupuncture. Although it seems to help some women, acupuncture isn&#39;t a proven treatment for morning sickness.

&nbsp;

<ul>
	<li>Hypnosis</li>
</ul>

Despite the lack of study on the subject, some women have experienced relief from morning sickness through hypnosis.

&nbsp;

<ul>
	<li>Aromatherapy</li>
</ul>

Although there is limited study on the subject, particular aromas typically made using essential oils can help some women deal with morning sickness.

&nbsp;

NOTE:&nbsp;Some women are tempted to use marijuana as a way to relieve sickness and nausea if they reside in a place where it&#39;s legal. However, the American College of Obstetricians and Gynecologists advises pregnant women not to consume marijuana because the drug&#39;s effects on the mother and fetus have not been well researched. Additionally, chronic marijuana usage may also cause nausea and vomiting syndrome, which is also known as cannabinoid hyperemesis syndrome.

&nbsp;

Consult a doctor before taking any herbal remedies or alternative treatments to ease the symptoms of morning sickness.&nbsp; 
&nbsp;

Moderate nausea and vomiting during pregnancy are unlikely to cause any difficulties for the mother or the fetus.

&nbsp;

If left untreated, however, severe nausea and vomiting can lead to dehydration, an electrolyte imbalance, decreased urination, and hospitalization. The research on whether hyperemesis gravidarum affects poor weight gain in the fetus is unclear. 
&nbsp;

<h4>How To Prevent Morning Sickness?</h4>

Morning sickness cannot be totally prevented. However, avoiding triggers such as strong scents, severe fatigue, spicy foods, and sugary foods helps. 
&nbsp;

Morning sickness can affect any pregnant woman, although it may be more frequent if the expecting mother has:

<ul>
	<li>Experienced nausea or vomiting due to motion sickness, migraines, particular scents or tastes, or estrogen exposure (for example, in birth control pills) prior to the pregnancy</li>
	<li>Experienced morning sickness in their previous pregnancy</li>
	<li>A pregnancy with twins or other multiples 
	&nbsp;</li>
</ul>

They are more likely to develop hyperemesis gravidarum if:

<ul>
	<li>They are pregnant with a girl</li>
	<li>They have a family history of hyperemesis gravidarum</li>
	<li>They have already experienced hyperemesis gravidarum during a previous pregnancy&nbsp; 
	&nbsp;</li>
</ul>

<h5>Is A Doctor Consultation Necessary?</h5>

Always consult a doctor if the morning sickness feels really bad, if there&rsquo;s a sudden and extreme decrease in body weight, or if there&rsquo;s an unexplained sense of sadness or anxiety. They can prescribe a medication that will not harm your or your developing baby. 
&nbsp;

<h5>1.&nbsp;Morning Sickness Only Occurs in the Morning</h5>

It&rsquo;s a wrong concept. Morning sickness can occur at any time throughout the day. Morning sickness is named after the fact that most women feel nausea and vomiting in the morning. However, nothing guarantees that they won&#39;t feel sick at other times of the day or be sick all day and all night.

&nbsp;

<h5>2. Nausea and Vomiting are The Only Signs of Morning Sickness</h5>

Wrong again. While they are the most frequent signs and symptoms, other symptoms of morning sickness include dizziness, lightheadedness, motion sickness, and excessive salivation. None of these symptoms is pleasant and some of them, such as motion sickness, can cause nausea and vomiting.

&nbsp;

<h5>3. Don&rsquo;t Try to Eat Anything</h5>

This is bad advice. Contrary to belief, eating can occasionally help with morning sickness. Eating small meals throughout the day and a light snack before bed helps to control the blood sugar and keep morning sickness symptoms at bay. Simply avoid foods that can upset the stomach.

&nbsp;

<h5>4. Every Woman Experiences Morning Sickness</h5>

This is not true. Some women never suffer from morning sickness, no matter how many children they have. No signs of morning sickness should not be a matter of concern. Just breathe a sigh of relief.

&nbsp;

<h5>5. Morning Sickness Causes Malnutrition in the Developing Baby</h5>

It may appear that vomiting is depriving the unborn baby of essential nutrients, but this is not the case. They will get enough nutrition to develop and grow if the mother&rsquo;s consuming small meals throughout the day. It&#39;s best to consult your OB/GYN and nutritionist to create a meal plan suitable for you. 
&nbsp;

Everyone has an opinion and a solution for morning sickness. The issue is that morning sickness is not a one-size-fits-all problem with a single treatment. Every woman is unique. In fact, some women may suffer from morning sickness during one pregnancy but not in their next pregnancy! Morning sickness can be unpleasant and can have a negative impact on the daily life of the expecting mother. However, it normally clears itself by weeks 16-20 of a pregnancy and generally poses no harm to the fetus. However, in rare cases like hyperemesis gravidarum, hospitalization is a must.&nbsp;

<ul><li>Morning sickness is characterized by nausea and vomiting during pregnancy. Even though it is known as morning sickness, it can occur at any time of the day.</li><li>Morning sickness typically begins at 6 weeks of pregnancy and ends in the second trimester.</li><li>Hormone imbalances, blood pressure irregularities, and alterations in carbohydrate metabolism are all possible causes.</li><li>Hyperemesis gravidarum is characterized by severe nausea and vomiting that demands medical attention (typically in a hospital) to help the individual recover.</li><li>The signs and symptoms of morning sickness can be eased by eating a few dry crackers before getting out of bed, avoiding foods and scents that make the person nauseous, drinking enough liquids, and eating high-carbohydrate and high-protein foods.</li></ul>

[1] STRONG Jr TH. Alternative therapies of morning sickness. Clin Obstet Gynecol. 2001;44(4):653–60.

[2] Mori M, Amino N, Tamaki H, Miyai K, Tanizawa O. Morning sickness and thyroid function in normal pregnancy. Obstet Gynecol [Internet]. 1988 Sep;72(3 Pt 1):355—359.

[3] Fejzo MS, Trovik J, Grooten IJ, Sridharan K, Roseboom TJ, Vikanes Å, et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Prim. 2019;5(1):1–17.

Neelam Asad

Madeeha Syed

A Basic Skincare Guide For Men

Overview

Basic skincare is gender neutral: cleanse, exfoliate, and moisturise. But since men have more testosterone in their bodies, male skin tends to be thicker and oilier. This texture slows down the appearance of fine lines and wrinkles, which means that men have a reduced need to apply <a href="https://merisehat.pk/article/collagen-the-secret-to-healthy-skin-hair-and-bones">collagen synthesisers</a>, such as retinol, but an increased need to exfoliate and cleanse. 
&nbsp;

Skincare Guide for Men

The primary form of skincare for men is actually hygiene maintenance.&nbsp;

<ul>
	<li>A good quality cleanser will clean up the top layer of the skin;&nbsp;</li>
	<li>An exfoliator will scoop out dead skin cells, excess oil, and dirt from the pores;&nbsp;</li>
	<li>A moisturiser will restore any essential oil that&rsquo;s been accidentally washed down the drain.&nbsp;</li>
	<li>But since the under-eye area is thinner in texture, men notice the first signs of aging here. This makes under-eye creams and serums a good investment.&nbsp; 
	&nbsp;</li>
</ul>

<h5>What About The Beard?</h5>

Another important aspect of male skincare is the presence or absence of facial hair. People who shave typically use an antiseptic substance, known as aftershave, immediately after. This closes up the pores and kills off any harmful bacteria that might invade the exposed epidermis (top layer of the skin).&nbsp;&nbsp;

However, experts believe that there&rsquo;s actually no real need to apply an aftershave because the same germ and bacteria can be killed with a good splash of soapy water. The same experts also believe that alcohol-based aftershaves are detrimental in the long-term, not to mention painful to use, as they will strip the skin of essential oils.&nbsp;

If needed, natural bactericides, such as coconut and jojoba oil, can be a good alternative to the infamous sting.&nbsp; 
&nbsp;

<h5>Beard Dandruff (Seborrheic Dermatitis)</h5>

If you don&rsquo;t shave at all, you&rsquo;d want to work harder at cleaning out dead skin and dirt from underneath the beard. Otherwise, you&rsquo;d end up with seborrheic dermatitis, which sounds like a terrible disease, but is actually just another name for pesky beard dandruff. One way to prevent this is to apply steam (through a hot shower or a warm, wet washcloth); it softens the skin underneath the beard and makes it easier to exfoliate and cleanse 
&nbsp;

Bottom Line

<h5>Gender Neutrality And The Essential Difference</h5>

At the end of the day, basic skincare is extremely gender neutral and revolves around maintaining a good hygiene and delaying premature aging due to UV rays. The idea that skincare is a feminine enterprise is dated and was rooted simply in the aforementioned texture.&nbsp;

The perennial &ldquo;lesser effort&rdquo; in maintaining male skin exists only in one direction - moisturizing and inducing collagen production-, and the other one (keeping it clean) requires twice as much work, especially with the presence of facial hair.&nbsp;

Additionally, since male skin has larger pores, due to the aforementioned sebaceous glands, men who prefer to reduce their appearance can and should use serums for enlarged pores. Everyone has a right to optimise their physical appearance without being shamed for it, especially with something as basic as this. The best way to do it, however, is to understand the science &mdash; or inner workings &mdash; of our respective skin types and address whatever problem naturally occurs.

Zuha Malik

O’ Sweet Kidney Of Mine!

This is surely not an article on how cannibalism is good. I mean there shouldn’t be any articles on “how cannibalism is good”, right? Rest assured, the information summoned here, is related to the sugary stuff and its effects on your health. So, get ready as you’re in for a treat, no pun intended!

Understanding Diabetic Nephropathy

Nephropathy is the progressive deterioration of the kidney&rsquo;s function. Diabetic nephropathy, then, refers to the deterioration of the kidney as a result of longstanding or complicated<a href="https://merisehat.pk/disease/diabetes-type-1-and-2"> diabetes</a><a href="#accordion">[5]</a>. As the disease progresses and reaches the final stage, it is termed as kidney failure or end-stage renal disease (ESRD)<a href="#accordion">[2]</a>.&nbsp;

According to the CDC reports, diabetes is the most common cause of ESRD. In 2011, there were around 26 million diabetic people in the U.S., and more than 200,000 people with ESRD were either going through chronic renal dialysis or had kidney transplant<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

There are essentially two types of diabetes:&nbsp;

1. Type I (Inherited or Juvenile)&nbsp;

2. Type II (Adapted)

&nbsp;

Type I diabetes is the most likely of the two types of diabetes to progress into ESRD, the fifth and last stage of diabetic nephropathy, while patients who develop type II diabetes mellitus may present with albuminuria (the presence of albumin protein in the urine) at the time of diagnosis.

However, diabetic nephropathy in type I diabetes develops over the course of 15-20 years after the diagnosis. This difference in the timeline is because it&rsquo;s difficult to pinpoint the precise onset of type II diabetes. It&rsquo;s identified only when the kidney&rsquo;s structural and functional changes occur due to diabetes, causing proteinuria and hypertension the hallmarks of diabetic nephropathy<a href="#accordion">[1]</a>. 
&nbsp;

<ul>
	<li>Ethnic Groups: Some groups of the population, such as&nbsp;African Americans, Native Americans, and Mexican Americans, are more at risk than others. Researchers have noted familial clustering (occurrence of the disease within some families in excess of what would be expected from the occurrence in the population) in these cases, which indicates that genetics also play a vital role in developing nephropathy<a href="#accordion">[1]</a>.&nbsp;</li>
	<li>Blood Sugar Level: The high levels of blood sugar associated with diabetes damage the kidney through various pathways. The damage is mostly directed toward&nbsp;the blood vessels that are responsible to filter the blood in order to make urine.</li>
</ul>

&nbsp;

Diabetic nephropathy has a high morbidity and mortality rate&nbsp;mainly because of other issues due to diabetes<a href="#accordion">[1]</a>:

<ul>
	<li>Chronic Kidney Disease (CKD): As of now, diabetic nephropathy is the leading cause of CKD in the United States as well as other Western societies<a href="#accordion">[6]</a>.&nbsp;</li>
	<li>Hypertension: Like CKD, hypertension (commonly known as high blood pressure) is also believed to be both a cause of and a result of the damage that is done by the disease. An individual suffering from uncontrolled hypertension progresses toward&nbsp;stage V diabetic nephropathy faster than those who don&rsquo;t have high blood pressure<a href="#accordion">[2]</a>.&nbsp; 
	&nbsp;</li>
</ul>

On the basis of the clinical presentation, doctors have broken down this kidney disease into 5 stages, depending on the glomerular filtration rate (GFR) which is essentially the rate at which the kidneys filter the blood. GFR is basically a representation of the effectiveness of the kidney function in percentage. The stages are as follows<a href="#accordion">[3]</a>:

Stage 1: The kidney is damaged; however, the kidney function is normal and a GFR of 90% or above is seen.

Stage 2: The kidney faces some degree of damage and a GFR of 60&ndash;89% is observed.

Stage 3: Mild to severe loss of kidney function is recorded with a GFR of 30&ndash;59%.

Stage 4: This stage refers to the severe loss of function and a GFR of 15&ndash;29%.

Stage 5: Kidney failure and a GFR of under 15% defines stage 5. 
&nbsp;

Diabetic nephropathy is always a cause for alarm if the individual has diabetes mellitus as a comorbidity along with a history of the following<a href="#accordion">[1]</a>:

1. Foamy urine

2. An unexplained proteinuria

3. Diabetic retinopathy, i.e., diabetes affecting the visual sense

4. Fatigue and foot edema because of hypoalbuminemia, i.e., decreased levels of albumin protein)

5. Hypertension

6. Coronary artery disease

&nbsp;

Diabetic nephropathy sounds dangerous, and rightfully so! However, there are ways to lower the risk<a href="#accordion">[4]</a>:&nbsp;

<ul>
	<li>Keep up with regular checkups; an annual appointment with a healthcare team helps with diabetes management, hence, helping avoid complications like diabetic nephropathy, retinopathy, and neuropathy.&nbsp;</li>
	<li>Take antidiabetic drugs with utmost efficiency. When it&rsquo;s impossible to resist chocolate cake, tiramisus, or maybe some soft succulent, and sweet gulab jamuns, why hold back on the medicines that actually allow devouring these delicacies in moderation? There is no doubt that medication can be very effective and may even help prevent diabetic nephropathy.&nbsp;</li>
	<li>Manage blood pressure as it increases the risk of kidney disease<a href="#accordion">[3]</a>. Moreover, take care while taking nonprescription pain relievers (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (e.g., naproxen and ibuprofen) as they can lead to kidney damage in case of diabetic nephropathy.&nbsp;</li>
	<li>Also try to maintain a balanced body mass index<a href="#accordion">[3]</a>.&nbsp;</li>
	<li>Another crucial thing to take care of&nbsp;to avoid diabetic nephropathy and its complications is smoking. The solution is pretty simple: don&rsquo;t smoke. Cigarette smoking is responsible for damaging the kidneys and can even make existing kidney damage worse<a href="#accordion">[3]</a>.</li>
</ul>

&nbsp;

A doctor advising medical intervention will discuss the best drug according to the severity of the disease. Therapeutic agents for glycemic (sugar) control in diabetic patients, who have developed kidney disease as well, include<a href="#accordion">[3]</a>:

<ul>
	<li>Dipeptidyl Peptidase Inhibitors, e.g., Sitagliptin</li>
	<li>Alpha-Glucosidase Inhibitors, e.g., Acarbose</li>
	<li>Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors, e.g., Canagliflozin</li>
	<li>Glucagon-like peptide-1 (GLP-1) Receptor Agonists or Incretin Mimetics, e.g., Dulaglutide&nbsp;</li>
	<li>Amylin Analogs, e.g., Pramlintide</li>
	<li>Nonsteroidal, Selective Mineralocorticoid Receptor (MR) Antagonists, e.g., Finerenone&nbsp; 
	&nbsp;</li>
</ul>

It may take months or years for complications of diabetic nephropathy to develop. Whatever the reason, whether it was non-compliance on your part or whether it was due to the fact that the disease was already in its advanced stages, it is important to know the current status of your condition so that it can be treated accordingly before it develops into the following complications<a href="#accordion">[4]</a>:

1. Fluid Retention: Fluid retention can cause swelling in the arms and legs, hypertension, or even cause pulmonary edema, whereby fluid builds up in the lungs.

2. Hyperkalemia: Hyperkalemia is an increase in potassium levels in the blood and it can lead to abnormal heart rhythms.

3. Cardiovascular Disease: Another major complication is cardiovascular diseases which, in turn, can lead to stroke.

4. Diabetic Retinopathy: Uncontrolled diabetic nephropathy can also damage the blood vessels of the retina, the light-sensitive tissue at the back of the eye, and cause diabetic retinopathy.

5. Blood Loss: It will lead to a reduced number of red blood cells to transport oxygen, a condition known as anemia

6. Bone And Mineral Disorders: Since the kidneys are losing their ability to function properly, it will affect the level of calcium and phosphorus in blood.

7. Miscellaneous Conditions: Some other conditions caused due to diabetic nephropathy are foot sores, erectile dysfunction, diarrhea, damaged nerves and blood vessels, and pregnancy complications. 
&nbsp;

Dialysis or a kidney transplant is used as the last resort, i.e., if the kidneys are damaged beyond repair, then the patient may need dialysis on a regular basis - at least until they can get a transplant - to survive<a href="#accordion">[3]</a>.

&nbsp;

Additionally, the doctor may give some instructions regarding their diet to avoid an unfortunate event<a href="#accordion">[3]</a>:

<ul>
	<li>Water: Water is definitely essential; however, excess fluid can increase the risk of swelling and hypertension.</li>
	<li>Sodium: An excessive intake of sodium can raise blood pressure pathologically.</li>
	<li>Protein: A drawback of kidney disease is the consumption of too much protein can lead to a buildup of waste products in the blood, putting unnecessary pressure on the kidneys</li>
	<li>Phosphorus: Phosphorus is found in high quantities in dairy products. A high level of phosphorus can weaken the bones and again put excessive pressure on the kidneys.</li>
	<li>Potassium: People with kidney disease reportedly have a higher level of potassium than a healthy adult; too much and/or too little&nbsp;potassium is bad for the neurons. 
	&nbsp;</li>
</ul>

Diabetes takes away a person’s integrity slowly and bit by bit. However, with due management and precautionary methods, it can be kept at bay and the patient can live a fairly decent life filled with heavenly desserts (in moderation of course)!

<ul>
	<li>Nephropathy is the progressive deterioration of the kidney&rsquo;s function. Diabetic nephropathy, by extension, is the deterioration of the kidney due to long-standing or complicated diabetes.</li>
	<li>According to the CDC reports, diabetes is the most common cause of ESRD.</li>
	<li>In 2011, there were around 26 million diabetic people in the U.S., and more than 200,000 people with ESRD were either going through chronic renal dialysis or had undergone a kidney transplant.</li>
	<li>There are essentially 5 stages of diabetic nephropathy; ESRD is the fifth and last stage.</li>
	<li>Some groups, such as African Americans, Native Americans, and Mexican Americans are at a high risk of developing diabetic nephropathy.</li>
	<li>Researchers have noted familial clustering, which means that genetics play a vital role in developing nephropathy.</li>
	<li>Diabetic nephropathy is one of the most prominent long-term complications when it comes to morbidity and mortality of a diabetic person.</li>
	<li>Hypertension is an inevitable threat posed by diabetes. It is also a major reason why diabetic nephropathy develops in the first instance.</li>
	<li>The damage is mostly directed towards the blood vessels responsible to filter the blood to make urine.</li>
	<li>If the kidney&rsquo;s structural and functional changes occur due to diabetes, it results in proteinuria and hypertension, which are the hallmarks of diabetic nephropathy.</li>
	<li>Diabetic nephropathy is an alarming condition given the patient also has diabetes mellitus as a comorbidity.</li>
	<li>Do not skip regular checkups. An annual appointment with the healthcare team is necessary since it sheds light on how well the person can manage diabetes, and thereby, avoid complications like diabetic nephropathy, retinopathy, and neuropathy.</li>
	<li>Moreover, take nonprescription pain relievers (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (e.g., naproxen and ibuprofen) as prescribed by the doctor since their side effects often include kidney damage.</li>
	<li>Cigarette smoking is responsible for damaging the kidneys and can even make existing kidney damage worse.</li>
	<li>Kidney disease is categorized into 5 stages, depending on the glomerular filtration rate.</li>
	<li>In Stage 1, the kidney is damaged; however, the kidney function is normal and a GFR of 90% or above is seen.</li>
	<li>In Stage 2, the kidney faces some degree of damage&nbsp;and a GFR of 60&ndash;89% is observed.</li>
	<li>Stage 3 is when there is mild to severe loss of kidney function and a GFR of 30&ndash;59%.</li>
	<li>Stage 4 refers to the severe loss of function and a GFR of 15&ndash;29%.</li>
	<li>Stage 5 is defined by kidney failure and a GFR of under 15%.</li>
	<li>The doctor may suggest a medical intervention to discuss the treatment options according to the severity of the disease.</li>
	<li>Complications of diabetic nephropathy include fluid retention, diabetic retinopathy, and hyperkalemia.</li>
	<li>If a person has diabetic nephropathy, then they need to keep a check on their intake of sodium, phosphorus, and water specifically.</li>
</ul>

[1] Diabetic nephropathy - statpearls - NCBI bookshelf.

[2] Diabetic nephropathy (kidney disease). Diabetic Nephropathy (Kidney Disease) | Johns Hopkins Medicine.

[3] Diabetic nephropathy: Symptoms, stages, causes, and treatment. Medical News Today.

[4] Diabetic nephropathy (kidney disease). Mayo Clinic.

[5] EmmaHook. Diabetic nephropathy (kidney disease). Diabetes UK.

[6] Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: Diagnosis, prevention, and treatment. American Diabetes Association.

Arbaz Ansari

Iqra Mazhar

Importance Of Insulin In Diabetic Care

Nearly 463 million people in the world are diagnosed with <a href="https://merisehat.pk/disease/diabetes-a-complete-overview">diabetes</a>, out of which nearly 150-200 million people need insulin therapy for their health<a href="#accordion">[1]</a>.

If you have type 1 diabetes, you&rsquo;ll have to inject insulin on a regular basis to use glucose from meals and, basically, to survive. This is because your pancreas is no longer making any insulin or producing an insufficient amount of the hormone.

If you have type 2 diabetes, your body may be producing insulin, but due to the fact that you&rsquo;re overweight or inactive, it may not be utilizing the hormone properly. This is called insulin resistance. You may need insulin shots to help your body control high blood glucose levels or hyperglycemia.

About 5-10% of pregnant women develop gestational diabetes<a href="#accordion">[4]</a>&nbsp;If you have gestational diabetes, you may need to inject insulin as well to manage your blood glucose levels until the baby is born. 
&nbsp;

Understanding the importance of Insulin

Understanding the role of insulin therapy as part of diabetes treatment becomes a whole lot easier when you understand how the hormone typically works and what happens when you get diabetes. 
&nbsp;

<ul>
	<li>
	<h5>Regulating Blood Sugar Levels</h5>
	</li>
</ul>

When you eat or drink, your body breaks down the carbs into glucose, which is the primary source of energy for your body. This glucose enters the bloodstream, signaling the pancreas to release insulin. Insulin helps the blood sugar to enter the cells where it can be used as an energy source.

It also helps the blood sugar to be stored in the liver as glycogen for later use; in case of low insulin levels between meals, the liver releases this stored sugar, ensuring the blood sugar levels are within a narrow range. 
&nbsp;

As a result, the blood sugar levels in the bloodstream decrease and, accordingly, the insulin levels decrease, too.

The problem arises when there&rsquo;s a lot of blood sugar in the bloodstream. The pancreas either has difficulty keeping up with the rising blood sugar levels or the cells stop responding to all the insulin, which is why you need therapy. 
&nbsp;

<ul>
	<li>
	<h5>Preventing Diabetic Complications</h5>
	</li>
</ul>

Untreated high blood glucose can lead to various complications. This includes nerve damage, blindness, foot ulcers, kidney damage, heart disease, and stroke. There is lots of insulin in the bloodstream, too, instructing the liver and muscles to take up the excess blood sugar; when their capacity is full, the extra blood sugar is sent to fat cells and is stored as body fat, resulting in weight gain and increasing the risk of type 2 diabetes. Insulin therapy is crucial to managing blood sugar levels to reduce the risk of developing these life-threatening complications and also to maintain overall better health. 
&nbsp;

<ul>
	<li>
	<h5>Correcting Insulin Deficiency</h5>
	</li>
</ul>

Your body&rsquo;s immune system may mistakenly destroy the insulin-producing cells in the pancreas if you have type 1 diabetes. This leads to a complete deficiency of insulin. Some individuals with type 2 diabetes struggle when they don&rsquo;t have enough insulin or when other treatment options (e.g., oral medications) are not effective in controlling blood sugar. Insulin treatment supplements or replaces natural insulin with the aim to achieve normal blood glucose levels. 
&nbsp;

<ul>
	<li>
	<h5>Meal Scheduling</h5>
	</li>
</ul>

A lot of factors, including lifestyle and weight, influence your insulin therapy. Planning meals helps because you can then determine your insulin regimen (insulin pump therapy or multiple injections every day) according to the amount of carbohydrates you consume in a meal. It gives you the liberty to enjoy a varied diet along with better glycemic control. 
&nbsp;

<h5>Other Functions Of Insulin</h5>

Insulin is also involved in<a href="#accordion">[2]</a>:

<ul>
	<li>Modification of enzyme activity and the subsequent reactions in the body</li>
	<li>Management of the synthesis of lipids</li>
	<li>Uptake of potassium and amino acids by cells and regulate DNA replication and synthesis of proteins</li>
	<li>Management of the breakdown of lipids and proteins because of changes in fat cells</li>
	<li>Regulation of the excretion of sodium and fluid volume of urine</li>
	<li>Building muscle post-injury or sickness</li>
	<li>Enhance the memory 
	&nbsp;</li>
</ul>

Important!

<ul>
	<li>Starting insulin therapy can be frightening. Consult your doctor to know more about the type of insulin you need. Make sure you know how, when, and where to inject insulin, and also how to rotate your injection sites.</li>
	<li>Always keep a proper record of your insulin dose and your blood glucose levels.</li>
	<li>Insulin should be stored correctly for usage. Extreme (hot and cold) temperatures damage insulin.</li>
	<li>Proper disposal of syringes, lancets, pen needles, and cannulas is important.</li>
	<li>Inform a doctor if you need help adjusting your insulin doses. This change may be due to changes in diet, increased or decreased exercise, illness, medication, weight loss or weight gain, etc.</li>
	<li>Contact a doctor if you have any problems taking insulin or if you notice any side effects. 
	&nbsp;</li>
</ul>

Insulin is an important hormone that controls how tissues and cells absorb energy. Insulin shots are effective in counteracting the effects of insulin resistance or deficiency. While people with type 1 diabetes have to inject insulin for the rest of their lives, the majority of people with type 2 diabetes may not need it<a href="#accordion">[3]</a>. Regular blood sugar monitoring and close communication with healthcare providers are essential for optimizing insulin therapy and achieving optimal diabetes management. 
&nbsp;

[1] Buse JB, Davies MJ, Frier BM, Philis-Tsimikas A. 100 Years on: The impact of the discovery of insulin on clinical outcomes. BMJ Open Diabetes Research &amp; Care

[2] Smith Y. Insulin’s role in the human body. News.

[3] An overview of insulin. Medical News Today.

[4] Department of Health &amp; Human Services. Diabetes and insulin. Better Health Channel.

Shermeen Zuberi

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Best Exercises For Diabetics In Ramadan!

Fasting during Ramadan is one of the five pillars of Islam. The holy month is a time of spiritual reflection that is meant to develop a sense of gratitude and discipline, encouraging self-improvement and knitting the community closer.

For all its benefits, though, we know Ramadan can be challenging for diabetic people. However, one trick to managing these blood sugar spikes is regular exercise.

Oh no, don&rsquo;t worry! These are not high-intensity activities. The following exercises can easily be integrated into a daily routine without causing excessive strain or fatigue<a href="#accordion">[1][2]</a>: 
&nbsp;

Understanding Best Exercises For Diabetics In Ramadan

<ul>
	<li>
	<h5>Walking</h5>
	</li>
</ul>

Walking is an excellent low-impact exercise for <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetics </a>as it not only improves blood sugar control but also reduces the risk of heart disease. You can go out for a walk before Suhoor or after Iftar when your body has sufficient energy to fuel the activity.

&nbsp;

<ul>
	<li>
	<h5><a href="https://merisehat.pk/article/yoga-a-life-changing-approach">Yoga</a></h5>
	</li>
</ul>

Yoga is a gentle, cost-effective form of exercise that&rsquo;s more famous for improving body flexibility. But do you know it helps your body manage stress levels, too? It really does! So, if you&rsquo;re struggling to cope mentally and/or physically, then this is for you! Yoga during Ramadan will improve your blood circulation, lower blood pressure, manage insulin levels, and even help you maintain a healthy weight.

&nbsp;

<ul>
	<li>
	<h5>Tai Chi</h5>
	</li>
</ul>

Tai chi is an ancient Chinese practice involving slow movements and deep breathing. It is an effective way for people with type 2 diabetes to manage their blood glucose and A1C levels. Additionally, this form of meditation is known to improve balance and reduce nerve damage, although more research is required in this regard.

&nbsp;

<ul>
	<li>
	<h5>Swimming</h5>
	</li>
</ul>

Swimming during Ramadan helps cool down the body temperature and, consequently, reduces the loss of fluid through sweating. Also, it&rsquo;s a full-body workout, so it will leave you feeling more energetic and focused to go about your daily tasks. Moreover, it doesn&rsquo;t matter if you are at risk of gestational diabetes, young or elderly, or have hypertension or heart conditions; the exercise is ideal for everyone who&rsquo;s tackling diabetes in Ramadan without exhausting their bodies.

NOTE: Make sure to inform the lifeguard about your medical condition before taking a dip.

&nbsp;

<ul>
	<li>
	<h5>Cycling</h5>
	</li>
</ul>

Cycling is yet another exercise that doesn&rsquo;t put excessive pressure on your joints. It can be done indoors or outdoors, whichever is more convenient or suits your condition best. According to recent research, nearly half of the people with type 2 diabetes also have arthritis. Factors like diabetic neuropathy and obesity only make you more susceptible to suffering from joint pain. Cycling helps you keep up with your fitness goals while fasting. 
&nbsp;

<ol>
	<li>Begin slowly, especially if you haven&#39;t been physically active in a while. Do a 5-minute warm-up before exercising. Similarly, finish off with a 5-minute cool-down after exercising.</li>
	<li>Check blood sugar levels before and after exercise to understand how your body responds to it.</li>
	<li>Make sure your blood sugar is less than 250 mg/dl before exercising.</li>
	<li>Wear a medical alert ID band and carry a cell phone in case of emergency.</li>
	<li>Avoid exercising in extremely hot or cold temperatures.</li>
	<li>Always listen to your body. If you feel dizzy or short of breath, stop immediately.</li>
</ol>

NOTE: Always consult with a doctor before starting an exercise program to ensure it&#39;s safe and suitable for your condition<a href="#accordion">[3]</a>. 
&nbsp;

Fasting during Ramadan can make it challenging for diabetic people to maintain a regular exercise routine. Remember, it&rsquo;s okay to modify physical activities to suit your body&rsquo;s needs during this time. Some strategies include adjusting the timing and intensity of exercise, staying hydrated, and monitoring blood glucose levels closely. Consulting with a healthcare professional before starting any exercise program during Ramadan is essential. 
&nbsp;

[1] Grey H. The best 10 exercises if you have diabetes. Healthline.

[2] Migala J, By. 6 great exercises for people with diabetes. EverydayHealth.com.

[3] Team CC. 5 best exercises for people with diabetes. Cleveland Clinic.

Sarah Mhowwala

Humza Khizer

Best Regimens For Diabetics During Ramadan

<a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a> management during Ramadan is essential to avoid any health complications. This includes taking your medications as prescribed by your doctor and monitoring your blood sugar levels regularly. But more importantly, it involves being aware of the signs of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) and taking appropriate action when necessary. 
&nbsp;

Fasting Tips  for Diabetics

<ol>
	<li>Consult With A Healthcare Professional: Consult your doctor to determine if fasting is safe for you. Yes, fasting during Ramadan is a religious obligation, but it doesn&rsquo;t mean neglecting your health. 
	&nbsp;</li>
	<li>Monitor Blood Sugar Levels: Monitor your blood sugar levels regularly, especially during the fast. Inform your doctor if you notice any spike in these readings. 
	&nbsp;</li>
	<li>Stay Hydrated: Dehydration can cause blood sugar levels to rise, so make sure to drink plenty of water after Iftar/before Suhoor. 
	&nbsp;</li>
	<li>Consume Low Glycemic Index Foods: The glycemic index is a scale that measures how quickly foods raise blood sugar levels. </li>
</ol>

 
Foods with a high GI are digested quickly and cause a sudden spike in blood sugar levels, whereas foods with a low GI are digested more slowly and do not cause a sudden spike in blood sugar levels. 
&nbsp;

So, do yourself a favor and fill your plate with: 
&nbsp;

<ul>
	<li>Non-starchy vegetables, such as spinach, broccoli, and carrots</li>
	<li>Whole grains, such as brown rice, quinoa, and whole-wheat bread</li>
	<li>Lean protein, such as fish, chicken, and tofu</li>
	<li>Healthy fats, such as nuts, seeds, and avocado 
	&nbsp;</li>
</ul>

And at the same time, as tempting as they appear to be during Ramadan, keep away from high glycemic foods, such as: 
&nbsp;

<ul>
	<li>Sugary drinks, such as soda, juice, and sports drinks</li>
	<li>Processed snacks, such as chips and crackers</li>
	<li>White bread and pasta</li>
	<li>Fried foods, such as fried chicken and fries</li>
	<li>High-fat meats, such as bacon and sausage 
	&nbsp;</li>
</ul>

<ol start="5">
	<li>Do Not Skip Meals: Your body is already low on essential nutrients due to fasting. Skipping your dinner after Iftar or your Sehri can lead to hypoglycemia during the day.</li>
</ol>

&nbsp;

<ol start="6">
	<li>Break The Fast With A Balanced Meal: Have a balanced meal at Iftar that includes low glycemic index foods, protein, and healthy fats. 
	&nbsp;</li>
</ol>

Nutrient Content Guidance

<h5>Nutritional Recommendations:</h5>

<ul>
	<li>Carbohydrates: Consume 40-50% of daily calories from low-glycemic, high-fiber, whole grain sources</li>
	<li>Protein: Consume 20-30% of daily calories from lean meat, legumes, pulses, and vegetable protein sources.</li>
	<li>Fat: Consume less than 35%, with saturated fat intake under 7%. Choose healthier cooking methods, such as grilling, baking, and steaming.</li>
</ul>

&nbsp;

<h5>Lifestyle Recommendations:</h5>

<ul>
	<li>Hydration: Drinking enough water at Iftar helps overcome dehydration from fasting.</li>
	<li>Physical Activity: Staying active promotes overall health.</li>
	<li>Sleep: Maintaining a regular sleep schedule helps avoid sleeping longer than usual. 
	&nbsp;</li>
</ul>

Balanced and Healthy Meal Plan

Normally, a person should consume 1500 calories per day. This is how you can manage your meal plans: 
&nbsp;

Suhoor: 450-600 kcal/Meal

&bull; Omelette, 2 egg

&bull; Roti, 1 small

&bull; Milk/Lassi, 1 glass

&bull; Salad (tomatoes/onions), 1 small bowl

&bull; Water, 2 glasses 
&nbsp;

Iftar Snack: 150-240 kcal/Meal

&bull; Fruit, 1

&bull; Water/unsweetened drinks, 2 glasses

&nbsp;

Iftar Meal: 500-750 kcal/Meal

&bull; Chicken roast, 1 palm size

&bull; Daal/lentil curry, 1 cup

&bull; Vegetable curry, 1 cup

&bull; Cooked brown rice, &frac34; cup

&bull; Dahi baray, 1 small bowl

&bull; Salad

&bull; Water/unsweetened drinks, 2 glasses

&nbsp;

Post-Iftar Healthy Snack: 150-300 kcal/Meal

&nbsp;&bull; Fruit, 1 piece

&bull; Milk-based dessert (e.g., kheer, ras malai made with sweetener), 1 small

&bull; Water/unsweetened drinks, 2 glasses 
&nbsp;

Note: This is what a diabetic person can eat on average during Ramadan. Your diet can vary based on your daily calorie goals. 
&nbsp;

As a diabetic person, you need to take extra care of your health during Ramadan. Make sure to take meds as prescribed by your doctor and monitor your blood sugar levels regularly to stay fit while fasting during Ramadan. What&rsquo;s more, you can ask your doctor to refer a registered dietitian who can develop a personalized nutrition plan that meets your individual needs. 
&nbsp;

[1] CARB counting and diabetes. Carb Counting and Diabetes | ADA.

[2] IDF clinical practice recommendations for managing type 2 diabetes in

[3] Author links open overlay panelMohamed Hassanein a, a, b, et al. Diabetes and ramadan: Practical guidelines. Diabetes Research and Clinical Practice.

Behind The Scenes Of Postpartum Care

Your body has endured the most rigorous and remarkable changes to do something extraordinary: give birth to another human being. For 9 months, you took the necessary precautions, went to the best doctors to receive top-notch medical care, and followed all maternity books to ensure your baby finds its new abode comfortable.&nbsp;

&nbsp;

9 months and a healthy baby later, you are enveloped with maternal joy. What worries you now is natal development. While your concern is justified, it is necessary to remember that you need rest as well. For 9 months you were completely selfless and now, for the 12 weeks following the delivery, you must direct your time and energy to recuperate, heal, and recover.&nbsp;

<div>&nbsp;</div>

Understanding The Importance of Postpartum Care

There may have been unprecedented or unanticipated events during delivery. The delivery might have been riddled with complications or it might have been traditionally simple. You might have undergone a cesarean birth (C-section) or the doctor might have suggested a vaginal delivery. Your labor might have lasted for a couple of hours or even a day. Regardless of what your delivery situation resembled, your body has had to deal with an outstanding and remarkable trauma, and consequently, it needs to compensate for it with the appropriate time to recover and heal.&nbsp;

&nbsp;

Your postpartum journey could be by the book or it could be unique. But, at the end of the day, your hormones will fluctuate, and so will your body. You will feel puzzled and bewildered, confused and alone. It&rsquo;s easy to be excited yet intimidated. All these emotions are justified and appropriate.&nbsp;

&nbsp;

Remember, you should never hesitate to <a href="https://merisehat.pk/doctor-now">reach out to a doctor</a> for a safe consultation and to update them on your situation. Finding refuge and comfort with friends and family is also encouraged.

<div>&nbsp;</div>

So, you assumed labor was difficult? Well, think again. Postpartum changes after vaginal delivery necessitate conversations with your OB/GYN before delivery, so that you can have a relatively well-organized recovery. Some changes that you can expect include the following:

&nbsp;

<h5>Vaginal Soreness</h5>

Vaginal tears during labor are medically known as perineal lacerations (episiotomy) or just tears. It can occur in either of the two circumstances: (a) the child&#39;s head is getting through the vaginal opening and is excessively huge for the vagina to dilate around; or (b) the head is a typical size, but the vagina is unable to fully extend. These sorts of tears are normal and are made between the vagina and the anus<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

Post-delivery, these tears heal at a gradual pace and, therefore, cause vaginal soreness and discomfort. To ease and cope with the pain, an individual could try different home remedies and medications, such as:

i) Placing an ice pack on the tear or sitting on a padded pillow.

ii) Use warm water while washing the area, to ensure the prevention of any infection of the wound. Cool water can also be used if an individual finds it to be more soothing.

iii) Investing in a witch hazel pad sanitary napkin, cool for a while before placing it on the tear, which is usually localized between the vaginal opening and anus (perineum)<a href="#accordion">[5]</a>.

iv) Consult the doctor for painkillers and laxatives to help you deal with painful stools or constipation.

&nbsp;

During the postpartum visit to the doctor, inform them of every symptom, as any slight development could be an indication of an infection. 
&nbsp;

<h5>Vaginal Discharge</h5>

Vaginal discharge postpartum is called Lochia and contains a mix of&nbsp; uterine tissue, blood and mucus. The discharge is dark colored and released in copious amounts&nbsp; for the first couple of days, and later it becomes paler and the amount of discharge reduces<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

To be on the safe side,&nbsp; doctors advise against the use of tampons or vaginal douching until 4-6 weeks in the postpartum period. The involvement of such items&nbsp; in the early postpartum period increases the risk for uterine infection.&nbsp;

&nbsp;

If your vaginal discharge is putrid or pungent, refrain from using heavily scented vaginal cleansers and inform your doctor to avoid future complications. If you are experiencing heavy vaginal bleeding, such that the sanitary pad is soaked in a matter of hours then you must contact your primary care physician<a href="#accordion">[4]</a>. 
&nbsp;

<h5>Incontinence</h5>

Pregnancy and consequently labor has been associated with the stretching of the pelvic floor muscles, which bolster the uterus, bladder, and rectum<a href="#accordion">[4]</a>. This stretching can weaken the pelvic floor muscles leading to a possibility of incontinence or the lack of bladder control. For instance, urine might leak when you laugh, sneeze, or cough.&nbsp;

&nbsp;

While incontinence decreases after a few weeks, it is incredibly frustrating and embarrassing, especially in public. To avoid any unfortunate incidents, you could try wearing protective pads or diapers and exercising to tone the pelvic floor muscles. A specific set of exercises called Kegel (also known as pelvic floor muscle training) can be practiced thrice a day. Sit on a stable and flat surface and tighten the pelvic floor muscles as if you&rsquo;re stopping yourself from going to the toilet. Begin with tightening and quickly releasing the muscles. After some time, you can hold a contraction for at least 5 seconds. Try doing 8 squeezes for each set<a href="#accordion">[6]</a>. 
&nbsp;

<h5>Hemorrhoids</h5>

If you feel discomfort during bowel movements and there&#39;s swelling near your anus, then you might have a case of hemorrhoids. It is a swelling of veins in the rectum, which is usually caused during your pregnancy. If not, you might have gotten them from the excessive strain and forceful pushing at the time of your delivery. Hemorrhoids are extremely painful, and cause itching and bleeding after defecation<a href="#accordion">[2]</a>.

&nbsp;

Here are a few things you can try to ease the pain:

i) Use a topical hemorrhoid cream that is easily accessible at pharmacies or any cream containing hydrocortisone.

ii) Opt for pads that are made of witch hazel to soothe the affected area.

iii) Go for a Sitz bath i.e. Soaking the hips and buttocks in warm water for around 10-15 minutes twice or thrice a day. Sitz baths help in reducing swelling.&nbsp; &nbsp;

iv) If you are avoiding defecation due to hemorrhoids and if the situation has been aggravated due to constipation after delivery, then it is suggested to consult a doctor for laxatives. Also, make sure you have a diet rich in fiber and you&rsquo;re staying hydrated. 
&nbsp;

<h5>Tender Breasts</h5>

It is common for breasts to fill up with milk after delivery for lactation. They become firm, tender, and sore; this is called breast engorgement<a href="#accordion">[2]</a>. It is suggested to alternate between breasts or even try alternating feeding positions during breastfeeding to minimize engorgement.&nbsp;

&nbsp;

If your breasts remain engorged for a prolonged period, then it would be difficult for the baby to latch on to the nipple. To help the baby while feeding, you might rely on hand compressions or a breast pump. Additionally, to relieve yourself of pain, you could try easily accessible pain killers, take long warm showers before breastfeeding, and place cold damp cloths on your breasts during feeding<a href="#accordion">[5]</a>. 
&nbsp;

<h5>Hair Loss And Skin Changes&nbsp;</h5>

Physical changes after delivery do not just involve weight gain or weight loss. As the body is producing an abundance of hormones, hair is also produced at a faster rate than it sheds, therefore you may experience substantial hair loss, too.&nbsp;

&nbsp;

And in addition to the permanent stretch marks that transition from red to silver as they start to fade, you might witness scaly, irritated skin. This would disappear as well, but for the time being, it&rsquo;s going to be more prone to acne.&nbsp;

&nbsp;

Consulting an endocrinologist and a dermatologist after delivery could help with the management of such symptoms. These are primarily due to the hormonal changes and thus could be accompanied by other side effects such as mood swings and excessive perspiration<a href="#accordion">[5]</a>.

&nbsp;

A postpartum visit to the doctor follows a personal objective. Your doctor would discuss your symptoms in detail, such as the inconsistent contractions or uncomfortable vaginal soreness and help you find solutions to relieve your pain. Furthermore, the discussion could also involve future birth spacing, contraception, and your emotional well-being.&nbsp;

&nbsp;

The doctor would also perform a physical examination. This includes&nbsp; a thorough examination of the abdomen, vagina, cervix, and uterus to ensure there is no physical scarring or post-delivery injuries.&nbsp;

&nbsp;

This is a terrific opportunity to discuss any worries you have, including continuing sexual activity and how you are adjusting back to routine with a child, while maintaining a healthy sleep cycle and nourishing your body with sufficient nutrients. 
&nbsp;

During a C section, most individuals are conscious and are only provided local anesthesia during their surgery. Afterwards, the patient is kept under observation at the hospital for a day or two to monitor vitals and gauge any abnormal behavior of the body. This might exclude the usual grogginess and nausea after surgery, which is easily managed through prescriptions.&nbsp;

&nbsp;

While most of the changes will be similar to vaginal birth, if you are delivering your baby via a C-section, please note there would be some additional circumstances which require different care. 
&nbsp;

<h5>Rest</h5>

A cesarean is an intense surgery that drains an individual. While normally an individual is admitted for only a couple of days after a cesarean, complications might persist for a couple of weeks. It is important to soak in as much rest (both physical and mental) as you can. This is quite difficult as the individual might have to care for a demanding newborn child or there could be numerous unexpected visitors to deal with. But it&rsquo;s important that you prioritize yourself.

&nbsp;

Organize and plan for effective postpartum care before delivery. This includes hiring help, constructing a workable timetable, and asking friends and family to pitch in. Moreover, you can be happy that everyone&rsquo;s coming to meet your new bundle of joy and, at the same, excuse yourself from gatherings for some alone time to recover faster<a href="#accordion">[3]</a>.

 
&nbsp;

<h5>Minimal Activity</h5>

While moving around could help with the prevention of blood clots, most doctors advise against participating in strenuous activities such as driving, competitive swimming, vigorous exercise, and handling heavy objects.&nbsp;

&nbsp;

Take things slowly and gradually. It would take 4-8 four to eight weeks after surgery before you have enough stamina to rejoin usual activities. Listen to your gut; your body will tire easily reminding you to take a break and just rest<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

<h5>Incision Care</h5>

The region where the incision was made, is naturally covered after surgery. Consult the doctor to know when it is safe to remove the bandage. Until then, keep the incision covered. Once you receive the green signal from the doctor, remove it and clean the region with saline water regularly to protect it from infection<a href="#accordion">[2]</a>. 
&nbsp;

Postpartum depression is a type of clinical depression experienced by women after delivery<a href="#accordion">[1]</a>. It is often trivialized and misconceived. A common blunder is how frequently it&rsquo;s used interchangeably with &lsquo;baby blues&rsquo; when it&rsquo;s so much more distressing and can also worsen.&nbsp;

&nbsp;

It is characterized by a prolonged and complicated mix of emotions, where the individual frequently feels severe anxiety, despair, dejection, fear of the unknown, and gut-wrenching guilt.&nbsp;

&nbsp;

If you experience such emotions and think about harming yourself or the child, then it is extremely important to inform relevant authorities for the necessary help.&nbsp;

&nbsp;

Moreover, if partners, friends, and family members observe concerning signs and symptoms then they must consult a therapist before anyone gets hurt<a href="#accordion">[1]</a>. 
&nbsp;

Your post-pregnancy or postpartum care will not be the same as an 8-hour long sleep after a tiring day at work. Complete recovery from pregnancy, labor, and any other complication can take several months. While numerous individuals begin to feel better and invigorated after 12 weeks, it might take more time to feel like your pre-pregnancy self.&nbsp;

&nbsp;

While your concerns are totally real, however, there&rsquo;s no need to rush the healing stage. Postpartum is not a race. Do not challenge or tire or exhaust yourself to reach a weight goal, or to go back to your corporate life. During this time, you might feel like your body has betrayed you. Do whatever it takes to not get disappointed with your progress. Look for ways you can reassure yourself that your body is recovering at its own pace.&nbsp; The smartest option for you is to rest, eat well, and enjoy some well-earned respite.

<div>&nbsp;</div>

<ul><li>Postpartum care refers to the period of recovery after delivery.&nbsp;</li><li>It involves physical and mental healing.</li><li>Changes and symptoms differ according to the type of delivery - vaginal or cesarean.&nbsp;</li><li>Individuals should rest, focus on their diet, and consult a doctor for better and personalized guidance.</li><li>Postpartum depression is a condition of prolonged grief and anxiousness after delivery. Individuals should reach out for professional help if they experience symptoms of Postpartum depression. </li></ul>

[1] Cleveland Clinic. (2022, February 9). Caring For Your Health After Delivery.

[2] Family Doctor. (2020, August 28). Recovering from Delivery (Postpartum Recovery).

[3] Heningsman, S. A. (2021, December 21). 6 Tips for a Fast C-Section Recovery. Healthline.

[4] Liberto, R. (2016, December 20). Recovery and Care After Delivery. Healthline.

[5] Mayo Clinic. (2022, March 25). Postpartum care: What to expect after a vaginal birth.

[6] NHS. (2020, March 20). Episiotomy and perineal tears.

Zarlish Kazmi

A Guide To Basic Foot Care

The feet undergo a lot of daily wear and tear. They are the body part that are worked on and overburdened the most. What&rsquo;s worse is that many people fail to take care of their feet properly and frequently ignore their foot health. Other than being unhygienic,&nbsp;this can lead to various foot diseases and restrict your overall mobility and impairment.

Your feet are constantly stressed for most of the day. We can help you by giving some of the tips that can keep your feet in the best condition. 
&nbsp;

Tips To Basic Foot Care

Your feet are significantly more exposed to dirt and dust than other parts of your body because they are so close to the ground. Additionally, they sweat a lot since socks and shoes keep them covered for&nbsp;several of hours each day.

As a result, be sure to thoroughly wash them at least twice a day with lukewarm water and a mild or antibacterial detergent. While the soap helps get rid of any signs of sweat, filth, and bacteria, the mild heat of the water will assist loosen the dead skin that has built up on the feet.

After bathing, remove any moisture from your feet, especially in the space in between your toes, by letting them air dry or dabbing them with a fresh towel.&nbsp;

Athlete&rsquo;s feet and other bacterial and fungal illnesses can develop on damp skin.&nbsp; 
&nbsp;

As you move about, your feet are bearing the weight of your body and rubbing against the ground and your shoes. Your feet skin gets damaged and brittle as a result.

Such repeated stress gradually thickens or hardens the skin in the weight-bearing or high-friction areas, leading to the development of unevenly raised patches known as calluses or small spherical lumps known as corns. For this reason, it is important to exfoliate twice a week to remove dead skin and cells to prevent corns and calluses. 
&nbsp;

Here is an easy-to-prepare exfoliator at home:

<ul>
	<li>&frac12; cup of sugar</li>
	<li>Almond oil, one tablespoon</li>
	<li>1/4 cup of honey</li>
	<li>Tea tree oil, 2 to 3 drops 
	&nbsp;</li>
</ul>

<h4>Directions</h4>

<ul>
	<li>To create a paste, combine all the ingredients in a bowl.</li>
	<li>To soften the skin, soak your feet in lukewarm water for 8 to 10 minutes.</li>
	<li>Use this thick mixture to massage your feet for at least five minutes.</li>
	<li>Dry your feet with a soft towel after rinsing the substance off with cool water. 
	&nbsp;</li>
</ul>

Your feet&#39; skin may become dry as they frequently come in contact with the surface. During winter, the chances of wear and tear are even greater. Dry skin is more likely to lose its elasticity. The soles of the feet are particularly vulnerable to this type of skin injury, which frequently manifests as cracked heels because they are constantly in contact with the ground. Therefore, it&rsquo;s crucial to thoroughly moisturize your feet at least once a day to keep them hydrated and supple.&nbsp;

You can apply a moisturizer before going to bed and wear socks on top. This is to ensure that it is properly absorbed and not wiped off from the bed sheets.&nbsp; 
&nbsp;

You can also make your own moisturizer.

Ingredients

<ul>
	<li>1/4 cup cocoa butter</li>
	<li>Coconut oil, 1/2 tbsp</li>
	<li>Almond oil, 1/2 tbsp</li>
	<li>2-3 glycerine drops</li>
	<li>Tea tree oil, 2 to 3 drops 
	&nbsp;</li>
</ul>

In addition to gathering dirt, overgrown toenails are also more likely to break. Therefore, it&rsquo;s important to routinely trim your toenails with a nail clipper rather than a pair of scissors.

Scissors are not shaped properly to follow the curvature of your nails; they can only cut straight lines. After cutting, smooth the rough edges of the nails using a nail file or emery board.

Avoid trimming your nails too short since this can damage the nail bed and cause severe pain, especially when walking. Additionally, to avoid ingrown nails, trim them at an angle along their curve rather than straight across. If you do develop an ingrown nail, go to the doctor rather than trying to treat it yourself.&nbsp;

Last but not least, avoid cutting or plucking your cuticles because doing so can be painful and expose your nail bed to infections. Use a stick or pen made for this reason to gently push your cuticle back in if it is protruding. 
&nbsp;

Fortunately, feet require very little care, and keeping them healthy is crucial for the comfort of walking. To ensure they are at their best, moisturise and clean them often. If you detect any persistent swelling, skin rashes, or peeling on your feet, which could be an indication of an allergic response, see a <a href="https://merisehat.pk/doctor-now" target="_blank">doctor immediately</a>.

Namwer Rao

Care For Casts

Hey there, fellow cast-wearer! So, you&#39;ve found yourself in a situation where you&#39;re sporting a new accessory on your arm or leg. Sure, it may not be the most stylish thing in the world, but it&#39;s definitely a conversation starter. After all, who doesn&#39;t love a good conversation about how they got injured?

Let&#39;s dive in and make sure you and your cast have a smooth and speedy recovery! 
&nbsp;

Understanding Cast Care

According to the American Academy of Orthopedic Surgeons, more than 6,000,000 broken bones occur in the United States every year, and many of those injuries require casts1. And it does not only stop here.

If not taken care of, your cast can lead to various illnesses and severe discomfort. Children with casts usually experience a higher rate of itching and discomfort compared to adults. 
&nbsp;

<ul>
	<li>
	<h5>Casts vs. Splints</h5>
	</li>
</ul>

Both casts and splints are orthopedic devices used to support and protect injured or broken bones and joints until it fully heals.

Casts can provide greater protection and support to a limb that is either broken or injured as compared to a splint. They are made up of fiberglass or plaster.

On the other hand, splints, which are also called half-casts, provide less protection and support than casts. However, they are easier and more convenient to use. They can be applied faster and loosened or tightened accordingly. 
&nbsp;

<ul>
	<li>
	<h5>Types Of Casts</h5>
	</li>
</ul>

A cast is unique and custom-made to accommodate each person&rsquo;s specific injury. There are broadly two main types of casts<a href="#accordion">[3]</a>:

<ol>
	<li>Plaster Casts: For some applications, plaster casts are simpler to use than fiberglass casts. They are also typically less expensive than the other type of cast. In certain cases, they are more malleable, too. But they&rsquo;re heavier so they&rsquo;ll be difficult to handle for children. Plaster casts come in only one color &ndash; white. 
	&nbsp;</li>
	<li>Fiberglass Casts: Compared to plaster castings, these casts are often lighter, more durable, and more porous. Additionally, fiberglass casts are easier for X-rays to penetrate than plaster ones, which makes it simpler for your doctor to inspect while the cast is still on. Fiberglass casts are available in a variety of designs and colors. 
	&nbsp;</li>
</ol>

A shattered bone is treated with casts and splints. Other injuries, such as a dislocation or sprain, that require immobilization may also be dealt with casts to promote healing. Additionally, they can be applied after orthopedic surgery.

Splints are occasionally employed right away if there&rsquo;s swelling in the injured area. A full cast may be put on the wounded limb once the swelling has reduced. 
&nbsp;

If there&rsquo;s swelling and the cast begins to feel too tight and uncomfortable, you can follow these steps to lessen the swelling:

<ul>
	<li>Elevate The Area Under Influence: Use cushions to raise the cast for the first 24-72 hours after the cast is put on. If the cast is on the leg, lie down. 
	&nbsp;</li>
	<li>Apply Ice: An ice pack covered in a thin towel should be wrapped around the cast at the site of the injury. Covering the ice pack is crucial to keep the cast dry. However, the covering shouldn&rsquo;t be too thick; an ice pack that&rsquo;s tightly packed or touches the cast at only one point won&#39;t be as effective. 
	&nbsp;</li>
	<li>Stay Mobile: You should frequently move the fingers or toes of the injured limb. 
	&nbsp;</li>
</ul>

If the wounded area becomes less swollen and the cast grows looser during the healing process, then the cast needs to be replaced. In that case, a splint may be used in place of the cast to allow for more range of motion<a href="#accordion">[4]</a>. 
&nbsp;

Casts are typically designed to stay dry. As such, a wet cast can cause an infection or skin irritation. That said, the kind of cast you have determines if it&rsquo;s ok to get wet or not.

So, a cast made of fiberglass or plaster with standard cushioning is not waterproof. You&rsquo;ll have to cover it with two layers of plastic and secure it with a rubber band or piece of duct tape to keep it dry during a bath. It&rsquo;s also advised to avoid swimming with fiberglass or plaster casts with conventional padding.

A waterproof cast is used to treat only specific conditions. However, even if you do wear a fiberglass cast with a waterproof liner, it can also get wet. But the trick here is that you can dry out the inside padding with a hair dryer. Set it on low heat to avoid burning or irritating the skin<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>Don&rsquo;t Put Weight On Your Cast: In case of a leg injury, make sure your cast is completely hard and dry before you try to walk on it. A fiberglass cast takes nearly 1 hour, while a plaster cast will take 2-3 days. Wearing a cast shoe over the walking cast protects the bottom of the cast. Other assistive devices, like crutches, walkers, and wheelchairs, are recommended to avoid putting weight on the cast while moving around. 
	&nbsp;</li>
	<li>Keep The Cast Clean And Dry: If a fiberglass cast gets wet, a hairdryer in a relatively cooler setting can be used to dry it. If the cast does not dry or if the skin beneath the cast gets damp, contact your physician. 
	&nbsp;</li>
	<li>Cover The Cast With A Plastic Bag Before Coming In Contact With Water: You can easily find cast coverings made of plastic with Velcro straps or rubber gaskets at a drugstore. Use such material to cover your cast before you indulge in any water-related activity, like sitting in a hot tub or going to the beach. 
	&nbsp;</li>
	<li>Don&rsquo;t Put Anything Inside The Cast: Powders and lotions shouldn&#39;t be applied to the skin underneath a cast. 
	&nbsp;</li>
	<li>Don&rsquo;t Scratch The Itchy Skin Under Your Cast: Scratching with a sharp tool may cut your skin which can lead to an infection. 
	&nbsp;</li>
	<li>Pay Close Attention For Any Smell Coming From The Cast: Mold or fungus can develop under a cast due to sweat or moisture. Contact your doctor immediately as it can get infected. 
	&nbsp;</li>
	<li>Do Not Trim Around The Edge Of A Plaster Cast: A fiberglass cast&#39;s uneven edges can be smoothed with a metal file. Any other material used for this purpose can cause damage. 
	&nbsp;</li>
	<li>Do Not Remove The Cast Yourself: Your doctor will remove it with a special tool only when they feel your bone&rsquo;s sufficiently healed. 
	&nbsp;</li>
</ul>

Note:If the cast is not waterproof, kids should get sponge baths only. Don&rsquo;t put them in water. Depending on their health, some of them may also require assistance using a urinal or a bedpan. 
&nbsp;

Reported to your doctor&#39;s office right away if you experience the following symptoms<a href="#accordion">[6]</a>:

<ol>
	<li>Increased discomfort and a sensation that the cast or splint is too tight. This may indicate swelling.</li>
	<li>Tingling and numbness in the affected limb. It&#39;s possible that there&#39;s too much strain on the nerves causing this.</li>
	<li>A burning and stinging sensation brought on by too much pressure on the skin.</li>
	<li>Excessive swelling beneath the cast is another warning sign to look out for. It means the cast is slowing your blood circulation.</li>
	<li>Loss of active toe or finger movement. This requires URGENT evaluation by your doctor as it can mean nerve damage. 
	&nbsp;</li>
</ol>

There is a wide range of potential infectious problems associated with limb casts and splints. It includes limb- or life-threatening infections, like toxic shock syndrome and <a href="https://merisehat.pk/disease/necrotizing-fasciitis">necrotizing fasciitis</a>. Simply taking these diagnoses into account and taking off the cast to closely examine the injured extremity could be the key to early detection and the best possible result of cast problems.

Your doctor will take extra precautions if your cast has been exposed to water. If they suspect a severe infection, this may involve immediate surgical consultation, rigorous fluid management, and antibiotic therapy<a href="#accordion">[5]</a>.

Depending on how long the cast is worn, complications might range in severity from mild to serious: 
&nbsp;

1. Pressure Sores:Sores develop on the skin beneath the cast when the cast does not fit well or is overly tight, putting too much pressure on one area.

2. Compartment Syndrome:This is a serious problem brought on by a cast that is too tight or stiff and squeezes a swollen limb. Muscles, nerves, or blood arteries in the cast-covered area are damaged when the pressure inside the cast increases. The nerve damage can become permanent if it is not discovered and addressed right away. If you have any of the following symptoms, contact your physician:

<ul>
	<li>Numbness or tingling in the affected limb</li>
	<li>Cold or pale skin or skin with a bluish discoloration</li>
	<li>A sensation of burning or stinging</li>
	<li>An increase in pain or swelling 
	&nbsp;</li>
</ul>

In conclusion, taking care of your cast is no laughing matter, but with a little bit of patience and some extra TLC, you&#39;ll be back on your feet in no time. Remember, a well-cared-for cast is a happy cast, and a happy cast means a happy recovery! 
&nbsp;

Key Takeaways

<ul>
	<li>&nbsp;According to the American Academy of Orthopedic Surgeons, more than 6,000,000 broken bones occur in the United States every year, and many of those injuries require casts.</li>
	<li>Children with casts usually experience a higher rate of itching and discomfort compared to adults.</li>
	<li>For some applications, plaster casts are simpler to use than fiberglass casts. They are also typically less expensive than the other type of cast.</li>
	<li>Fiberglass casts are easier for X-rays to penetrate than plaster ones, which makes it simpler for your doctor to inspect while the cast is still on.</li>
	<li>A shattered bone is treated with casts and splints. Additionally, they can be applied after orthopedic surgery.</li>
	<li>If the wounded area becomes less swollen and the cast grows looser during the healing process, then the cast needs to be replaced.</li>
	<li>An ice pack covered in a thin towel should be wrapped around the cast at the site of the injury.</li>
	<li>Use material such as plastic covers to wrap around your cast before you shower.</li>
	<li>Mold or fungus can develop under a cast due to sweat or moisture. Contact your doctor immediately as it can get infected.</li>
	<li>There is a wide range of potential infectious problems associated with limb casts and splints, including infections, like toxic shock syndrome and necrotizing fasciitis, that can pose a threat to one&#39;s life.</li>
	<li>If your doctor suspects a severe infection, treatment may involve immediate surgical consultation, rigorous fluid management, and antibiotic therapy.</li>
</ul>

[1] Arm injury statistics (no date) Aids for One Armed Tasks.

[2] Incidence of skin complications and associated charges in children

[3] How to look after your child's cast (2022) Mayo Clinic. Mayo Foundation for Medical Education and Research.

[4] Splints & casts for bone fractures or injuries (no date) Cleveland Clinic.

[5] Delasobera BE, Place R, Howell J, Davis JE. Serious infectious complications related to extremity cast/splint placement in children. J Emerg Med. 2011;41(1):47-50. doi:10.1016/j.jemermed.2010.05.031

[6] Care of casts and splints - orthoinfo - aaos (no date) OrthoInfo.

Diabetes foot problems are quite common as, according to the American Diabetes Association, 1 in 5 people with diabetes seek hospital care for it<a href="#accordion">[1]</a>. However, that doesn&#39;t mean everyone with diabetes has diabetic feet. 
&nbsp;

You won&#39;t succumb to diabetic feet if you give your feet all the attention they deserve. It&rsquo;s all the more imperative if your blood sugar levels are continually out of range.&nbsp; 
&nbsp;

In short you need to be proactive while taking care of your feet to avoid diabetic foot or any other complications. 
&nbsp;

Understanding the Foot Care for Diabetic Patients

To understand the correlation between diabetes and foot problems, you first need to have a clear idea about what diabetes really is.&nbsp; 
&nbsp;

<h5>Understanding Diabetes&nbsp;</h5>

Diabetes mellitus, or diabetes for short, is a metabolic disorder that causes high blood sugar levels, which is referred to as hyperglycemia.&nbsp; 
&nbsp;

The reason for diabetes is either absolute or relative deficiency of insulin, or&nbsp; insulin resistance. Insulin is the hormone released by pancreas that helps to maintain a normal level of the blood glucose levels by ensuring glucose uptake in the liver and muscles after a meal.&nbsp; 
&nbsp;

There are 3 different types of diabetes:

1. Type 1 Diabetes Mellitus: This type of diabetes has an autoimmune basis, which means that the body&#39;s own immune cells start attacking the pancreas resulting in absolute deficiency of insulin. The reason behind this autoimmune destruction of cells in the pancreas that produce insulin remains unclear<a href="#reference" target="_blank">2</a>. This type of diabetes affects both children and young adults.

2. Type 2 Diabetes Mellitus: Almost 90-95% of individuals with diabetes have this type of diabetes. It occurs when cells in the body become unresponsive to insulin and the sugar levels peak in the blood resulting in hyperglycemia<a href="#accordion">[2]</a>. 
&nbsp;

3. <a href="https://merisehat.pk/disease/diabetes-gestational">Gestational Diabetes</a>: Some women experience this type of diabetes during pregnancy. Their placenta makes hormones that block insulin from functioning<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

If left untreated, all three types of diabetes result in blood sugar levels beyond the normal range, which ultimately damages multiple sites in the body like the kidneys, eyes, nerves, and other organs<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

Some common symptoms of diabetes include<a href="#accordion">[2][3]</a>: 
&nbsp;

<ul>
	<li>Increase in thirst&nbsp;</li>
	<li>Increase in hunger&nbsp;</li>
	<li>Increase in frequency of urination&nbsp;&nbsp;</li>
	<li>Weight loss (individuals with gestational diabetes would have increased weight gain during pregnancy)</li>
	<li>Blurry vision&nbsp;</li>
	<li>Sores that heal slowly or do not heal&nbsp;</li>
	<li>Fatigue&nbsp;</li>
	<li>Numbness or tingling in hand or feet&nbsp;</li>
	<li>Dry or itchy skin 
	&nbsp;</li>
</ul>

Now back to the initial question: how can diabetes cause foot problems? So, diabetes damages the nerves, a condition called diabetic neuropathy. As a result, you may experience pain, tingling, and burning sensation in your affected foot. If the nerve damage is extensive, you may feel nothing at all.&nbsp; 
&nbsp;

While the idea of having an area of skin being pain free may sound great, not being able to have any sensation in any region of your body is far from great. The dangers associated with not being able to sense anything are so serious that it can even cost you losing the affected part through amputation, that is, surgically removing the affected limb. 
&nbsp;

As an individual with diabetic neuropathy, you may not feel a stone or pebble underneath your sole; you won&rsquo;t even feel a blister or if your foot&rsquo;s sore. When these lesions are not treated early on, they can either become the portal of entry for bacteria and other microorganisms causing infection or they can result in ulcer formation due to delayed healing of the skin<a href="#accordion">[4]</a>. 
&nbsp;

Slow healing in diabetic individuals is because the blood vessels supplying the periphery become very narrow which reduces the amount of blood flowing in the leg and foot. This impedes the healing process and infections of the feet often take too long to heal or at times may not heal at all. When an infection doesn&#39;t resolve, it progresses to gangrene (death of a body tissue due to inadequate blood perfusion or due to a serious bacterial infection)<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

Once gangrene or ulcers form in the foot, treatment&nbsp; options include removing the dead tissue and treating existing infections. In extreme cases amputation of the involved part, such as the toe, foot, or part of the leg is the only option<a href="#accordion">[4]</a>.

Therefore, in order to prevent the loss of a part of your limb, precautions should be taken and foot care needs to be maximized. Controlling blood sugar levels is the only way to prevent diabetic foot<a href="#accordion">[4]</a>. In case a foot problem develops, a foot specialist or a podiatrist needs to be consulted immediately<a href="#accordion">[4]</a>. 
&nbsp;

Nerve damage eventually leads to diabetic foot if not treated. The following risk factors increase the risk of developing diabetic neuropathy<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>High blood sugar levels that are difficult to manage</li>
	<li>Having a long history of diabetes with blood sugar levels beyond normal ranges</li>
	<li>Being overweight</li>
	<li>Having hypertension (increased blood pressure</li>
	<li>Having high levels of cholesterol</li>
	<li>Being more than 40 years of age 
	&nbsp;</li>
</ul>

There are some measures that you can take to prevent nerve damage<a href="#accordion">[3]</a>:&nbsp;

<ul>
	<li>Maintain healthy blood sugar levels&nbsp;</li>
	<li>Quit smoking since smoking reduces the blood perfusion to the feet</li>
	<li>Use medications as prescribed by the doctor&nbsp;</li>
	<li>Become physically active&nbsp; 
	&nbsp;</li>
</ul>

You need to be consistent with your foot care regimen as it is the only way to prevent foot problems in diabetes. There&#39;s no denying that managing diabetes can get quite overwhelming with trying to maintain your blood sugar levels, going for doctor&#39;s appointments, taking medications, staying active along with eating healthy; and there is a chance that your feet get neglected in the process. 
&nbsp;

However, incorporating foot care into your daily routine will help reduce the risk of developing diabetic feet<a href="#accordion">[3]</a>. Remember, persistence is the key!&nbsp;

Here&#39;s a list of tips that you can follow to ensure that your feet stay healthy: 
&nbsp;

<ul>
	<li>
	<h5>Inspect Your Feet Daily</h5>
	</li>
</ul>

You need to regularly check your feet for any signs of bruises, scar marks, blisters, swelling, sores, calluses, or any change in color of the skin or nail. You can use a mirror to inspect the part of your feet that isn&#39;t visible to you or, if you don&#39;t find it convenient, ask a family member to help you or consult a doctor<a href="#accordion">[3]</a>. The earlier you detect any sore or blister, the easier it is to treat and vice versa.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Don&#39;t Walk Barefoot&nbsp;</h5>
	</li>
</ul>

Always wear slippers at home and shoes outdoors and never walk barefoot even in your house. This is to prevent injuries to the feet. Moreover, make sure that your shoes have no pebbles or any other object that can cause any injury to your feet<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Wash Your Feet Daily With Warm Water&nbsp;</h5>
	</li>
</ul>

Do not use hot water to wash your feet as it will cause skin&nbsp; dryness; instead, use warm water. Also, don&#39;t soak your feet. Just wash them properly and dry them right after<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Moisturize Your Feet</h5>
	</li>
</ul>

Diabetic individuals, especially those who have dry feet, are no strangers to cracks on their feet. The trick is to keep your feet moistened. However, make sure not to apply lotion or moisturizing cream between the toes as it can result in infection<a href="#accordion">[3]</a>&nbsp;and keep the application limited to the heel of the foot.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Choose The Right Shoes&nbsp;</h5>
	</li>
</ul>

Wear shoes that are the right size, not too tight or too loose. It would not only be difficult to walk, but would also increase the chances of developing foot problems. Most importantly, make it a habit to wear socks with your shoes<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Properly Trim Toenails</h5>
	</li>
</ul>

Try to cut your nails gently straight across and smooth them with a nail file. Avoid cutting your nails too deep as it may cause a break in the skin and become a space for an infection to set in<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Keep The Blood Flowing&nbsp;</h5>
	</li>
</ul>

To maintain perfusion in the feet, put your feet up while sitting and don&#39;t stand or hang your legs for too long. This is also for women with gestational diabetes as they need proper perfusion in their lower limbs (leg area). Wiggle your toes multiple times in a day to maintain perfusion<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Do Not Miss Your Doctor&#39;s Visit&nbsp;</h5>
	</li>
</ul>

Visit your doctor every year or as scheduled for your diabetes. Get your feet properly examined by a feet specialist, more so if your healthcare provider is suspecting diabetic neuropathy. 
&nbsp;

Stay vigilant and if you notice any of the symptoms listed below, consult a healthcare provider immediately to either treat or prevent diabetic foot<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>Pain in the legs and cramping in the thighs and calves during physical activity&nbsp;</li>
	<li>Inability to sense temperature, pain, or touch over the skin of your foot&nbsp;</li>
	<li>Tingling, painful, and burning sensation in your feet&nbsp;</li>
	<li>Dry skin with cracks</li>
	<li>Thick, yellow toenails&nbsp;</li>
	<li>Signs of fungal infection, such as athlete&#39;s foot&nbsp;</li>
	<li>Any sign of sore, blister, or ulcer anywhere on the foot 
	&nbsp;</li>
</ul>

Diabetes is a very common metabolic disorder and it is associated with a constellation of signs and symptoms. Moreover, the damage caused by diabetes is also widespread as it involves many organs of the body. Diabetic neuropathy affecting the foot is another dreaded complication of diabetes that can cause the diabetic individual to lose sensation over the affected area. It can progress to diabetic foot, which can result in amputation and loss of limb. Optimization of feet care and maintenance of healthy blood sugar levels can prevent the development of this condition.&nbsp; 
&nbsp;

<ul>
	<li>Diabetic foot is one of the common complications of diabetes yet the most dreaded.</li>
	<li>Diabetes causes nerve damage in the peripheries and this is often due to high blood sugar levels that are not managed.</li>
	<li>Nerve damage causes the foot to lose sensation, and blisters, sores, or minor injuries go unnoticed; it&rsquo;s dangerous because these points can become the site of entry for bacteria and result in infection.&nbsp;</li>
	<li>Infection in diabetic foot is often difficult to treat which then progresses to gangrene and ulceration</li>
	<li>Amputation remains the last resort to protect the infection from progressing throughout the body.</li>
	<li>Maintaining normal blood sugar levels and adopting a healthy foot care regimen are the only ways to prevent diabetic foot.&nbsp;</li>
</ul>