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Printed matter. For private circulation only LIVING WITH DIABETES IS STILL SWEETER NOW WITH STAR HEALTH Now you may also buy Policy online at www. starhealth. in 4 5 6 9 1 1 13 15 17 22 24 26 Star Criticare Plus Insurance Policy Diabetes Safe Insurance Policy Diabetes and the eye Diabetes Complicating Pregnancy Diabetic Diets Cardiovasular Disease & Diabetes Mellitus Infections and Diabetes Prevent Diabetic Kidney Disease Diabetes, Depression and Stress Fitness Section Time to get into your peak shape India’s First Stand Alone Health Insurance Company has begun its operations in May 2006. Today the Company’s Capital base stands at Rs. 03 Crores. About Your Company Board of Directors Mr. Syed Mohamed Salahuddin Chairman – Emeritus. Managing Director of ETA ASCON and ETA STAR group of Companies in Dubai, U. A. E. Mr. V. Jagannathan Chairman-cum-Managing Director with over 40 years of experience in Insurance Industry. Mr. D. R. Kaarthikeyan Held various prestigious positions including Chief of Special Investigation Team, CBI; Director of Police Academy, Mysore; Chief of Intelligence and Director General of National Human Rights Commission. He was the Chairman of the Special Task Force instituted by the Government of India in the Rajiv Gandhi assassination case.

Mr. Essa Abdullah Al Ghurair Member of the prominent Al Ghurair family in the U. A. E. Dr. M. Y. Khan Former Chairman of Jammu & Kashmir Bank Ltd. Mr. Mohamed Hassan Prominent Educationalist and Industrialist Mr. V. P. Nagarajan Executive Director of ETA Ascon and ETA Star Group of Companies in UAE Mr. Dinesh Chandra Gupta Former Finance Secretary, Government of India and Member, MRTP Commission Feathers in our Cap • • Star Health is the Lead Insurer for Kalaignar Kaapeetu Thittam, Health Insurance scheme for BPL families in Tamilnadu, which covers more than 1 crore families.

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Aarogyasri has been adjudged as the winner of eINDIA 2009 Awards in the category of eHealth Government/ Policy initiative of the year as well as Civil society / Development agency of the year. The Award was presented on 26th August 2009 at Hyderabad by center of Science Development and Media studies, Uttar Pradesh, India. Aarogyasri has won THE MANTHAN SOUTH ASIA AWARD 2009 on 19th December 2009 at New Delhi for eGovernance, implementation of Aarogyasri and first Health Insurance Company to revolutionalize ICT (Information, Communication & Technology).

We are proud to inform that we have opened a representative office in Dubai on 3rd March 2010. Our next issue will focus on Gastroenterology, apart from other informative health articles Publisher: Mr. V. Jayaprakash Printer: Mr. D. Srikanthan, • 306, Purasawakkam High Road, Chennai – 10 Editor: Dr. Asiya Shahima Khan Editorial Board Members: Dr. S. Prakash Dr. C. B. Krishna Kumar Dr. Jeba Victor Corporate Office Star Health and Allied Insurance Company Ltd #1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai – 600 034 Email: [email protected] in • • Star Health Specialties • • • • •

A user friendly website with Health tips 170 offices across India with more than 2500 Employees Cashless treatment facility with over 4200 Network Hospitals across India A full-fledged 24X7 call Centre with a Toll free facility (1800 425 2255) for effective claims handling 24 X 7 Health Information Helpline – 24 x 7 telephone Health Information Helpline that makes FREE Expert Medical Consultation available to all customers at all times Kindly let us have your views addressed to The Editor, Star Health and Allied Insurance Company Ltd. , to the address given above or mail to [email protected] n STAR Health  bed spread down straight our knee and straight, by n the ground in your ng your spinal cord on the his 5 to 10 MessageCMD from 2 Message From CMD My Dear policy holder, 4 This issue is dedicated to those who have diabetes and to those who would like to delay the onset (vulnerable group). Very eminent Doctors have written articles in this issue, which will be of great use when you go through them. Star always feels that its policy holders are part of its lift your knee by family and, therefore, they should be educated on all aspects relating to the human body so that ground.

Hold it opposite hand,would enable them to prevent occurrence of any disease. In case of there being any problem nother hand STAR will stand with their policy holders. hold ghtly and lift About your company’s performance, the financial year 2009-2010 is coming to a close and oulder for 10the company is expected to close the year around with Rs. 1000 crore premium, which Could be re over weight possible only because of the support given by you and references made by you to your friends ult, but with and relatives. they can do it. When we serve large numbers of policy holders, in one or two areas there could be something wanting. We will always be receptive to correct the same, if it is brought to our notice. 24×7 One of our services meant for our policy holders’ welfare is not fully utilized. It is the medical advice being given through Toll Free number about which a write up was given in our earlier issues. This Medical advice will go a long way in assisting you when you have common ailments like cough, cold, etc.

In case if there is any short coming in this service, as a Chairman, I will be thankful to receive your suggestions so that it can be set right. As you could read, we have acquired many feathers in our cap which you can be proud of. Looking forward to write to you in the next issue. Always at your service, V. Jagannathan Chairman-cum-Managing Director 485 S Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255 STAR Health  In these days of spiraling medical costs the customer has to plan judiciously to ens protection – more so if the disease is a major one. s a major one. Star Health is Critical introduce “Star which Plus” Section II is theproud to Illness SectionCriticare offers lump-sum payment of the sum insured if insurance policy which provides any of the defined SectionsDiseases. The Major diseases covered ar person is diagnosed with protection under two Major – reimbursement for hospitalization and lump-sum compensation on diagnosis of specified Critical Illnesses. First Diagnosis of Cancer, Chronic expenses The hospitalization Section provides for payment of Kidney Disease, Brain Tumour Undergoing Major organ transplant for the ncurred on diseases / illness / accidental injuries. The minimum first time (Major Organ means Heart, Liv period of hospitalization is 24 hours. In respect of specific day-care Occurrence of any of the following for the first timetreatments this minimum period of stay in the hospital is waived. Cerebro-Vascular Stroke causing Hemiplegia Section II is the Critical Illness Section which offers lump-sum Acute Myocardial Infarction is diagnosed with payment of the sum insured if the Insured person resulting in Left Ventricular Ejection Fraction of 126 mg/dL and Post prandial blood sugar >200mg/dL 2.

Impaired glucose tolerance (IGT) Fasting blood sugar >100 mg / dL and post prandial >140 mg/ dL 3. Impaired fasting glucose (IFG) Fasting blood sugar >100 mg/dL and post prandial < 140 mg/ dL 4. Only impaired glucose tolerance Fasting blood sugar 140 mg/dL 5. Glycosyslated Haemoglobin (HBA1C) > 6 There is an ample chance for people in categories 2 to 5 to get back to normal metabolic state by taking enough initiative in controlling the diet, regular dynamic exercise, reduction in body weight and life style modifications.

This can be termed as primary prevention of diabetes mellitus and hence the related complications especially cardiovascular. Few may require added low dose diabetic drugs to achieve normal glucose metabolic state. ATHEROSCLEROSIS AND DIABETES: Atherosclerosis is the major reason for diffuse vascular disease especially coronary artery disease and Cerebro vascular disease and peripheral vascular disease by affecting inner layer of the vascular wall by lipid accumulation – oxidized LDL cholesterol – that leads to a condition called atherosclerosis.

There is progressive vascular occlusions ultimately interfering with blood supply to heart muscle. Associated factors like smoking, obesity, sedentary habit, hypertension high triglycerides, low HDL cholesterol and high LDL Cholesterol contribute STAR Health 1 Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255 to the tempo and progression of the disease process. Increased oxidatative stress due to multiple reasons aggravate the tempo of the disease much earlier in life and affect the prime youth of millions of young women and men.

Women especially loose benefit of premanopausal age protection from atherosclerotic heart disease HYPERTENSION: High blood pressure (HTN) is one among the important risk factors in diabetic subjects. Hypertension prevalence in diabetic population is almost twice as compared to non diabetic populations (general populations) nearly 50% diabetics have hypertension. The UKPD and other studies proved beyond doubt that the long term target BP control in diabetics results in significant reduction in all diabetics related micro vascular and macrovascular complications.

The international consensus has set the target for lowering the BP to 130/80mmHg or still lower especially in diabetics with kidney involvement and with high urinary protein excretion – proteinuria RENAL DISEASE: Kidney disease is a common and often severe complication of diabetes. Approximately 35% patients of new patients beginning dialysis therapy have Type-II diabetes and the leading cause for mortality is cardiovascular disease in end stage renal disease.

The kidney functions in diabetics therefore must be appropriately monitored at regular intervals, so that effective interventions especially at microalbuminuria stage can be introduced, early in the course of renal disease. Even though direct measure GFR (glomerular filtration rate) is the most reliable estimate of the amount of residual kidney function, micro and macroalbuminuria and rising serum creatinine level should alert the ongoing reno vascular disease at rapid tempo and the necessity for aggressive multiprong therapy.

DIABETIC DYSLIPIDEMIA (ALTERED CHOLESTEROL METABOLISM): This emphasizes the specific pattern of elevated low density cholesterol, small, LDL(c) particles and low high density cholesterol (HDL) and elevated triglyceride levels seen in diabetics. Growing evidence STAR Health 1 suggests the all the components of the lipid triad are independently atherogenic and increase the tempo of vascular disease. DIABETIC CARDIOMYOPATHY Yet another cardiac involvement seen in chronic diabetic patients though infrequently seen is significant decrease in cardiac pumping function, at times, alarmingly low cardiac muscle efficiency.

There is no obstruction in the large epicardial coronary arteries by coronary angiography or at post-mortem specimen examination. There is a consensus among researchers who took deep interest in this aspect of cardiac disease that the uncontrolled blood sugar level seems to be nucleus to the pathogenesis of Diabetic cardiomyopathy. Hence primary goal should be prevention of diabetes mellitus, especially in those individuals with impaired glucose tolerance, leave alone overt diabetes mellitus.

It needs appropriate risk assessment taking into account the major risk factors like cigarette smoking, elevated blood pressure and abnormal serum lipids(fast), excess body weight especially abdominal obesity, less physical activity, which play a significant role as components towards onset of complications and its tempo. Further, periodical checking for microalbuminuria estimation of serum creatinine and graded Exercise test ECG, may help to identify target organ involvement early and detection of occult vascular disease to take necessary treatment.

Strict control of fasting blood sugar and post prandial blood sugar, to keep HBA1C glycosylated hemoglobin less than 7, by regular physical exercise, diet control and drugs will pay rich dividend to overcome micro/ macro vascular complications which in turn manifest as heart attack, stroke and renal failure. Diabetes is a disease that can be controlled to ensure a good quality of life. It requires a detailed and committed modification in life style with follow up. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255

MD, FRCP(Glas), DTM & H (Lon), DGUM (Lon) Consultant, Infectious Diseases – Apollo Hospitals Director – Boosters Immune & Travel Clinic Dr. V. Ramasubramanian, The Bane of Diabetics Infections and Diabetes Mellitus [DM] and depressed function of the white blood cells as evidenced in diabetes contributes to the increased risk. A recent study has shown that patients with DM are at an increased risk of lower respiratory tract infection [RTI], urinary tract infection [UTI], and skin and mucous membrane infections.

WE shall now deal with each of these briefly: Urinary Tract Infections Diabetics suffer from an increased incidence of bacteria in the urine which is usually asymptomatic. Diabetes also increases the risk of complications including kidney infections and abscess formation. Treatment may require a prolonged course of antibiotics. B y the year 2025, India is predicted to have the most number of people with diabetes mellitus in the world. It is and will continue to be a major public health issue .

The complications associated with erratic blood sugar control are of concern not only to Drs but also the general population It is believed and proven that diabetics are at a greater risk for infections and their complications. It has also been shown through a number of well planned studies that effective control of sugars is critical to reducing the burden of infections in the very ill. The eradication of infectious agents involves the natural immune response. Dysfunction in the blood supply Dental infection The association between diabetes and dental infections is well recognized.

Gum infections are common and quite difficult to treat. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255 STAR Health 1 Respiratory Tract Infection DM is an underlying and important risk factor for suffering community acquired pneumonias. These infections are also associated with increased severity and a greater incidence of recurrence. Tuberculosis occurs 4 to 11 times more frequently in patients with diabetes and tends to be more aggressive involving both lungs. The chance for development of multi-drug resistant tuberculosis remains higher in these patients.

Dental infection The association between diabetes and dental infections is well recognized. Gum infections are common and quite difficult to treat. Skin and soft tissue infection Skin and soft tissue infections are more common in diabetes, presenting as cellulitis and /or carbuncles etc.. Patients with poorly controlled sugars show higher degree of oral thrush infection and superficial fungal infections. Diabetic foot infections and ulcers occur due to the combined involvement of the peripheral nerves that lead to the loss of protective sensation and poor blood supply secondary to long standing diabetes.

Prolonged antibiotic treatment with aggressive surgical removal of dead tissue can prevent the loss of the foot. Unusual Infections Uncommon fungal infections, like ‘mucormycosis’, that can affect the sinuses ,brain or lungs in uncontrolled diabetics, is often fatal. The sinus infection presents as a swelling and redness of the cheek and would warrant immediate surgery and follow up with antifungal drugs. Severe ear infection called ‘malignant otitis externa’ needs intravenous antibiotics. Gall bladder infection can be severe and predominantly affects elderly diabetic men.

Psoas abscesses, affecting the back muscles and bone, need drainage and broad-spectrum antibiotic therapy. How to prevent infections in diabetes? control of sugars in chronic diabetics. All these infections occur due to poor The following guidelines should be followed to minimize chances of infection ? Regular follow ups and good control of sugar levels ? Practice careful foot care. ? In addition to wearing shoes and socks to avoid minor bumps and scrapes, the feet should be examined daily for any blisters, cuts, scrapes, sores or other skin problems that could allow an infection to develop. ? Meticulous foot and skin care is eeded to and urgent attention given to minor cuts and scrapes to ensure they do not turn into ulcerating and wide spread infections ? Good urinary hygiene, especially for women STAR Health 1 Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255 Dr. V. MOHAN, M. D. , FRCP (London, Edinburgh & Glasgow), Ph. D. , D. Sc. , FNASc. Chairman & Chief Diabetologist Dr. Mohan’s Diabetes Specialities Centre, Chennai PREVENT DIABETIC KIDNEY DISEASE D iabetic nephropathy (DN) is one of the common vascular complications of diabetes, which leads to progressive loss of kidney function.

DN is a leading cause of end-stage renal disease (ESRD) accounting for one third to one half of all kidney failure cases seen at various centres. The frequency of ESRD is nearly 30 percent in Type 1 (insulin dependent) diabetic individuals and ranges from 4 to 20 percent in Type 2 (non insulin dependent) diabetic individuals. Type 2 diabetic individuals with kidney complications also face an increased risk of death from cardiovascular disease which in fact is a common cause of death in these individuals than the kidney disease itself. Stages of Diabetic Nephropathy Diabetic nephropathy usually progresses slowly through several stages.

In Stage 1, there is hyperfiltration of urine but no leakage of albumin or protein. In Stage 2, leakage of tiny amounts of protein or albumin is present, this stage is called – stage of Microalbuminuria. In Stage 3 or Macroproteinuria stage, increasing proteinuria occurs leading to loss of large amounts of protein, causing ‘nephrotic syndrome’ a condition in which fluid retention and swelling due to low amounts of protein in the blood is observed. In Stage 4, the kidneys become less able to remove ‘poisons’ from the blood resulting in raising levels of various chemicals such as urea and creatinine.

This is known as ‘Chronic Renal Failure’. Stage 5 is known as ‘End Stage Renal Disease’ (ESRD) and in this stage, the urine output decreases, serum creatinine level becomes very high and there is an imminent need for renal replacement therapy (RRT). Microalbuminuria in the range of 30–299 mg/24 hour has been shown to be the earliest detectable and treatable stage of diabetic nephropathy and is STAR Health 1 Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255 Dr. M. VARALAKSHMI ? Dr. RANJIT UNNIKRISHNAN ? Dr. V. MOHAN Dr.

Mohan’s Diabetes Specialities Centre & Madras Diabetes Research Foundation, Gopalapuram, Chennai also a significant marker for cardiovascular diseases in both diabetic and non-diabetic subjects. Patients with microalbuminuria are more likely to progress to clinical albuminuria/overt nephropathy (? 300 mg/24 h) and decreasing GFR over a period of years. Once macroproteinuria occurs, the risk for ESRD is high. In parallel with these changes, there is rise in blood pressure, which may begin even before the development of microalbuminuria but usually occurs during the early microalbuminuric phase. Risk factors for diabetic kidney disease:

Luckily not everyone with ‘long standing diabetes‘ gets nephropathy. Infact, over 50% of diabetic patients will never develop kidney disease even if their blood sugars are poorly controlled. The risk factors for diabetic nephropathy are shown in table below. RISK FACTORS FOR DIABETIC NEPHROPATHY NON-MODIFIABLE ? Ethnic susceptibility ? Genetic predisposition ? Male gender ? Duration of diabetes MODIFIABLE ? Poor glycaemic control ? Elevated blood pressure ? High cholesterol ? High dietary protein intake ? Smoking Symptoms During the early stages of diabetic nephropathy, there are usually no symptoms.

As the condition progresses, individuals with diabetic nephropathy may present with swelling (edema) of the feet and legs and later throughout the body, increase in blood pressure, larger amounts of protein leaking into the urine (macroproteinuria) and elevated levels of fats (cholesterol and triglyceride) in blood. Once the kidneys are more severely damaged, blood sugar levels may drop because the kidneys retain insulin in the body and a stage of “burnt out diabetes” may occur. In late stages, patients become severely anemic, breathless and serum potassium levels may rise necessitating urgent dialysis.

Screening for diabetic nephropathy Screening for nephropathy at its earlier stage of microalbuminuria, is important because it is reversible at this stage. Type 2 diabetic individuals should be screened at the time of diagnosis and yearly thereafter even if test is normal. If microalbuminuria or later stages of nephropathy are present, the test should be repeated bimonthly in order to classify the level of albumin in the urine. Frequent measurements are recommended as albumin levels vary up to 40% from one day to another. STAR Health 1 Thereafter, it is recommended to screen for microalbuminuria on a yearly basis.

Starting with atleast 5 years after diabetes is diagnosed. Management and Prevention of diabetic nephropathy Control of blood sugar is one of the most important factors in the prevention of nephropathy in both Type 1 and Type 2 diabetic individuals. Intensive management of blood sugar to achieve near-normal levels significantly reduces the progression of diabetic nephropathy. Aiming for Glycosylated Hemoblobin ( HbA1c) levels (which provides a weighted average of the blood glucose level for the previous 3 months) of less than 7 % appears to be effective in preventing diabetic kidney disease.

In patients with established diabetic nephropathy, control of hypertension is perhaps the most important factor, to reduce rate of progression of the renal disease.. Aggressive antihypertensive intervention will greatly decrease the rate of fall of GFR and significantly increase the median life expectancy in Type 1 patients with a decrease in mortality from 95% to 45 % and a need for dialysis and transplantation from 73% to Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255 31%. In general, people with diabetes should aim for blood pressure

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