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The Importance of Sleep
Monday, August 04, 2008
Busy individuals are so used to depriving themselves of quality sleep just to get things done. I myself is not an exception. Because of too many things to do and with too little time, that is the most appropriate thing to do at the moment.

Coming from a family of diabetics, I am at risk of having one. But with regular exercise, and at the age of 42, I do my best to keep free from the disease. And I can say that so far, I am successful in that aspect. Lately, I read a study conducted by University of Chicago that suppressing deep slow-wave sleep for three consecutive nights increases the risk of having diabetes. So, this I have to work on.

Slow-wave sleep is the deep, restful type occurring at the onset of sleep, that is during the first hour, interrupted periodically by REM sleep, then recurs again. It comprises around 75% of the total sleep time of a young adult. The brain waves at this stage of sleep are very slow, and there is decrease in up to 30% of the blood pressure, respiratory rate, and basal metabolic rate. It is the stage of sleep that restores the normal balance among the neuronal centers.

In the study, it has been found that depriving one's self for three nights of adequate quality sleep decreases insulin sensitivity. This means that the body's ability to process glucose is reduced and thus increase diabetes risk.

See, reduced amounts of deep sleep is really bad. It has been associated with aging, obesity, and metabolic abnormalities. Now, with diabetes. So, I see to it that I don't deprive myself of sleep three nights in a row, even during my busy days. I want to live long enough to see my future grandchildren, or even my great grandchildren.

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posted by Amelyn R. Rafael,MD @ 9:19 AM   3 comments
Nutrition for Diabetics: Glucerna SR
Wednesday, June 25, 2008
High blood sugar is such a problem especially if one is used to eating sugar-rich food such as cakes. Most diabetics will just skip desert in order to avoid these sugar-laden goodies. But there is no room for deprivation even with high blood sugar as long as you watch what and how much you eat. The most important thing to do of course is exercise.

There is this new product in the market named Glucerna SR from Abbott (this is not a paid post). It's not actually that new as it is already in the market since last year. It's just that not many are using it either because they still haven't heard of it or because of the price. It is a low calorie drink in powder form which provides complete and balanced nutrition. It is high in monounsaturated fatty acids which help lower blood cholesterol. It also promotes a healthier heart. Though I am not a diabetic, I've tried it and I can say that it gives you the sustained energy that would last you for the rest of the day. You won't be looking for more food in between meals as diabetics often do. Therefore, it allows you to comply with your diet.

The good thing about it is that in can be used also for cooking once you get tired of using it plainly as a beverage. It can be used in making soups (like cream of tomato, cream of mushroom, cream of corn, broccoli soup, or carrot soup), in baking (as a substitute for chocolate in making brownies), in desserts, and in milk shakes if you want to add a twist to your beverage.

Here is a sample recipe using Glucerna SR (taken from the fliers given by Abbott).
Broccoli Soup
Ingredients:
  • 6 scoops Glucerna SR powder
  • 1 small head broccoli
  • 200 ml water
  • salt
  • pepper
Preparation:
  • Wash broccoli. Cut into small pieces
  • Steam broccoli until soft
  • Put steamed broccoli, Glucerna SR and water into blender
  • Blend ingredients together until well-incorporated and smooth
  • Add salt and pepper to taste
  • Heat to serving temperature. DO NOT BOIL
  • Serve in a soup bowl
Taste may differ from what you are used to but at least you are eating healthy. A healthy lifestyle is a must in diabetics. That includes a healthy diet, weight management, and exercise.


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posted by Amelyn R. Rafael,MD @ 10:53 AM   5 comments
Are You Sure You're Healthy?
Wednesday, May 21, 2008
Many people will say they are healthy when asked by a doctor. But on further questioning if they undergo routine physical examination and laboratory work-up, obviously they don't. How then can we say that we are in reality, healthy? Does it mean only the absence of symptoms, or simply feeling nothing? Does that guarantee us of a long and symptom-free life ahead of us?

I guess not. Not because doctors want to have patients all the time that they want people to go to them and look for any kind of illness that will make these people go back time and again. Not because doctors make up illnesses for these people which are in reality not present. The truth is that nobody can guarantee he is healthy even without feeling anything.


There are lots of diseases common nowadays which are often accidentally diagnosed simply because a person does not feel any symptom. Let's take diabetes as an example. Most of the time nothing is felt. It is only during the late stages wherein signs and symptoms appear and oftentimes it is too late. There is no going back.


Hypertension, also a common geriatric illness, is oftentimes misunderstood. People are still waiting for headache or nape pain to appear before they go and have their blood pressure checked. And if the doctor found his blood pressure to be high on several occasions, they would question the absence of symptoms. What if the person's pain tolerance is high that's why he is unable to feel anything? Isn't the blood pressure reading evidence enough?

Central obesity, which is defined as waist circumference > or = 90 cm for South Asian men and > or = 80 cm for South Asian women, is in itself symptom free. But it is a part of a group of symtoms which make up metabolic syndrome or syndrome X. The most important component of this syndrome is diabetes mellitus. And in order for a person to be said to have the syndrome, he must have central or abdominal obesity ( as defined ) plus any two of the following: hyperinsulinemia, hypertriglyceridemia, hypertension, and hypercholesterolemia. And as you can see, most of these conditions are symptom-free. They are usually seen after a thorough physical examination. Now do you still consider yourself healthy?

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posted by Amelyn R. Rafael,MD @ 11:29 AM   0 comments
Giving it Free
Saturday, September 15, 2007
It's free blood sugar examination, given every last Wednesday of the month in our clinic, from six to eight in the morning. Patients come this early so that they will not be so hungry for breakfast, as they are needed to fast before the examination. We do this to screen potential diabetics, those with positive family history, as more and more people are being afflicted with the disease. This way rich and poor alike have access to free screening. There are times that starter doses are available, and patients, especially the poor, will not be having a hard time with maintenance, as there are lots of affordable but equally effective anti-diabetic medicines in the market.

There are lots of this free screenings going around in other clinics. So what difference do we offer? We offer free consultation regarding the condition at the same time. Aside from that, we also offer free lectures on diabetes, in a way a layman would understand. We believe that patients who understand their illness better will be more compliant with regards to taking medicines religiously and will do the best they can to avoid certain foods that will surely affect blood sugar levels.

Why am I telling you all these? One is to educate potential diabetics that screening is not always expensive, that there's hope for the poor diabetics, that monitoring blood sugar levels is within reach, and most important of all, to encourage fellow doctors to give free consultation at the same time.

In other clinics offering the same screening, or any other medical screenings, it is only the nurse or the medical technology, or the medical representative who is physically present to interpret the result. Patients are just informed that their sugar levels are either normal or increased. They are not given the proper advice on what to take, what to avoid, nor given more detailed info about their condition. Sometimes a doctor would arrive on the place, but way too late for patients to wait. They're just too hungry to wait until ten or eleven in the morning, as they had not taken anything for breakfast. Most of these patients who avail of these free screenings are old, if not the senior citizens of our localities. Let's give better medical care for them by giving free consultations even for only once a month.

For more information about diabetes, please read here and here.


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posted by Amelyn R. Rafael,MD @ 8:52 PM   0 comments
Understanding Diabetes (Part II)
Sunday, June 17, 2007
How does one know that he has diabetes? What are the symptoms? The most common early symptoms are excessive hunger, excessive thirst, and frequent urination. The diabetic person always feels hungry even with regular meals because the glucose cannot enter the cell so that the cell sends signals to the brain of being hungry. The thirst on the other hand is due to loss of fluid inside the cell because water moves from an area of lower concentration (cell) to an area of higher concentration ( blood vessel). Frequent drinking then results to frequent urination.

The other symptoms like the numbness in hands and/or feet, and change of vision appear later in the condition when the nerves had already been affected. Aside from these, there is weight loss, fatigue, slow healing or non-healing wounds, very dry skin, and more infections than usual. Most of these can be explained by the absence of energy and build-up of glucose in the blood vessels.

What can be done? Control the weight by having a meal plan. It is also good to have regular exercise at least 3 to 4 times a week with at least 15 minutes per session. This will help lose the excess weight or maintain an ideal one. It also increases the body's sensitivity to medications.

For individuals who are: obese, with positive family history, lack exercise, with prior history of gestational diabetes (women only), please don't wait for symptoms to appear before seeking consult. It maybe too late. Act now and have your blood sugar evaluated.

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posted by Amelyn R. Rafael,MD @ 7:16 PM   2 comments
Understanding Diabetes (Part I)
Thursday, June 14, 2007
What is type 2 diabetes, what causes it, and why does it affect many individuals nowadays? Everywhere we go, it's very common and the number is increasing everyday.

Normally, insulin which is produced by the beta cells of the pancreas, bind to insulin receptors located on the cells of the body. This causes the opening of portals to allow glucose to enter the cell. It is inside the cell where glucose is converted to energy.

Where does glucose come from? It came from carbohydrates, the food that we eat. After a meal, sugars and starches are converted to glucose and is brought in the blood stream, others stored in the liver. This is the reason why our level of blood sugar increase after a meal.

What happens in diabetes? In diabetes, the pancreas produces little or no insulin at all. It also causes the body to lose its ability to respond normally to insulin. We call this insulin resistance. When insulin resistance takes over, glucose will have difficulty entering the cell thereby decreasing the production of energy. This results in accumulation of glucose in the blood vessels which can destroy the different body organs.

What can we do? This will be tackled in the next post of Understanding Diabetes.

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posted by Amelyn R. Rafael,MD @ 7:21 AM   0 comments
About Me

Name: Amelyn R. Rafael,MD
Home: San Fabian, Pangasinan, Philippines
About Me: Family Physician, and Associate Professor (Clinical Anatomy and Medical Physiology)
See my complete profile
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