Category: General

Calcium is required for all age groups to build and maintain strong bones. Calcium is essential for the heart, muscles and nerves to function properly. Calcium requirement varies with age and sex. Women younger than 50 years require 1000mg/day, 51 and above requires 1200mg /day. Men up to 70 years require 1000mg /day calcium and 71 and above requires 1200mg/day (National Osteoporosis Foundation). For proper absorption of calcium, our body needs vitamin D in the right amount. The daily requirement of Vitamin D for women and men under age 50 is 400-800IU/day, above age 50 and older require 800-1000 IU/day.
If our body fails to obtain adequate calcium from the food we eat, it is taken from our bones and gradually can lead to making our bones weak, porous and easier to break. A variety of foods contain calcium, if it is consumed in the right amount, it’s enough to meet daily calcium requirements. Common sources of calcium are milk & milk products (curd, cheese, yoghurt etc), Green Leafy Vegetables like drumstick leaves, spinach, kale, broccoli etc, fish with edible soft bone-like anchovy, sardines etc and nuts and seeds like almonds, pistachios and sesame seeds. Ragi is also a rich and cheap source of calcium. It is good to understand how much calcium is present in the food that you consume e.g 100 ml of milk contains 120 mg of calcium and 100 mg of ragi contains 340 mg of calcium. Caffeine present in coffee, tea and soft drinks may interfere and decrease calcium absorption, so use in moderation. Fish like tuna, mackerel, and sardines are a source of vitamin D also.

Author- Mrs. Rejitha

Bone development is a process that starts before birth and continues till the maximum amount of bone is developed. This is called peak bone mass. More than 90 % of the peak bone mass is achieved by age of 20 in boys and 18 in girls. However, bone continues to get deposited to reach peak bone mass till the late 20s. Even during this period, there is the bone formation and bone destruction, but the net effect is new bone formation. Higher bone mass is associated with adequate calcium and vitamin D intake, protein intake, physical activity, genetic factors and appropriate timing of puberty and adequacy of sex hormones.
After 30 years of age, the bone mass is maintained and as age progresses the bone destruction takes predominance over bone formation. In women, around the time of menopause, the level of estrogen reduces and there is rapid bone destruction. Adequate calcium and Vitamin D intake, protein intake, physical activity and adequate hormonal levels ensure better bone strength.
Chronic uncontrolled medical illness (e.g., diabetes, bronchial asthma), use of steroids, loss of sex hormones (ovariectomy or orchidectomy), chronic alcohol use and smoking can cause a more rapid loss of bone and lead to fractures.

Author- Dr. Mathew John

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone. Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are post-menopausal are at the highest risk. Currently, it has been estimated that more than 200 million people are suffering from osteoporosis. According to recent statistics from the International Osteoporosis Foundation, worldwide, 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime. Studies in India estimate that more than 50 million people have osteoporosis. Studies have shown that one-third of post-menopausal women in India have osteoporosis of the spine.
So, osteoporosis and osteoporotic fractures are very common the world over and in India.

Author- Dr. Deepa

Teeth are important. The absence of a tooth or multiple teeth can make common tasks such as chewing and speaking much more difficult. Some of the options available to replace missing tooth / teeth are removable partial / complete denture: It is a denture to replace partially / completely missing teeth, and the people using it can remove and reinsert it when required without any professional help. Next option is Fixed Bridge: It helps to replace the missing teeth permanently. The latest and advanced tooth replacing option is Dental Implants: They provide a permanent solution if you need to replace a single tooth, or multiple teeth, in different areas. It a surgical procedure in which a screw is placed and fused with the jawbone, onto that a crown is placed.

To help prevent damage to your teeth and gums, take diabetes and dental care seriously. Make a commitment to manage your sugar level and keep it as close to normal as possible. The better you control your blood sugars, the less likely you are to develop gum disease and other dental problems. Brush your teeth at least twice a day. Use a soft – bristled toothbrush and toothpaste that contains fluoride, and brush in an up and down motion. Avoid vigorous brushing which can irritate your gums. Get a new toothbrush at least every three months. Floss your teeth at least once a day. It helps to remove plaque between your teeth and under your gums. Schedule regular dental visits. Visit your dentist, once in every 6 months and do cleaning and dental checkups. Every time you visit your dentist, remind him that you have diabetes. Make sure your dentist has contact information for your doctor who helps you manage your diabetes. Look for early signs of gum disease like redness, swelling and bleeding gums to your dentist. Smoking increases the risk of serious diabetes complications, including gum disease and ultimately, loss of your teeth. Managing diabetes is a lifelong commitment, and that includes proper dental care. Your efforts will be rewarded with a lifetime of healthy teeth and gums.

There are a variety of treatments for gum disease depending on the stage of disease, how you may have responded to earlier treatments, and your overall health. Non-Surgical treatments for gum disease include dental cleaning. During this procedure, dentist will remove the deposits from the teeth. It is recommended to do once in every 6 months. Sometimes deep cleaning along the root surfaces is also required to remove deposits under the gums. In most initial cases, cleaning is all needed to treat gum diseases.
Surgery is needed when the tissue around the teeth is unhealthy and cannot be repaired with nonsurgical options. Of this, most common is Flap surgery where the gums are lifted back and the hardened deposits are removed. The gums are then placed back so that the tissue fits firmly around the tooth. This method reduces the size of space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow.
Painless Laser treatment for gum disease is the latest treatment option. In this a periodontist uses a laser to access and remove the inflamed gum tissue from around your tooth’s root causing minimal post-operative discomfort.

Since gum disease is strongly associated with diabetes, everyone with diabetes should have an annual dental checkup and cleaning of the teeth. The gum specialist will examine your gums and note any signs of inflammation after taking a proper medical history to identify conditions or risk factors. Your gums will be probed with a small ruler. This probing is a way to check for inflammation. It also measures small pockets (gap between tooth and gums) around the teeth. In a healthy mouth, the depth of these pockets is usually between 1 and 3 mm. This test for pocket depth is usually painless. They may also take an X-ray to see whether there is any disease of the tooth supporting the bone.

Many people aren’t aware that they have gum disease. If you notice a bit of blood when you brush your teeth, it is the first warning sign that you’ve got gum disease. You can find and treat the problem before it gets serious if you know what to look for. Red, swollen gums is one of the first signs that indicate that your gums need attention. Bleeding while brushing, flossing, or eating hard food is an indicator that needs immediate consultation with your dentist. In progressive stages of the disease, gums appear to be away from the teeth, causing the teeth to look longer than before. Pus between your gums and teeth with persistent bad breath is a typical presentation in advanced gum disease. If these problems are not addressed it can result in your tooth becoming loose eventually causing severe infection demanding extraction of the tooth.
In people who have already replaced part of natural dentition with artificial ones, a change in the way your teeth fit together when you bite or a change in the fit of dentures with occasional food impaction puts you at a risk of an already established progressive gum disease. This serious infection can lead to loss of remaining teeth.

Gum disease is very common in people with diabetes with almost 60% affected by it. If the blood glucose levels are uncontrolled, there is a higher risk of developing gum disease. Further increased glucose levels may cause bacterial infections in the teeth and gums. This inflammation of the gum is called periodontitis. This inflammation leads to weakening of the bone that supports the teeth and this leads to loosened teeth and ultimately the teeth may fall off. It is important to get glucose under control even in the early stages of diabetes. This will help reduce the risk of gum disease. Even if you develop gum disease, aggressive control of glucose can lead to faster healing of gum disease.
It is also important to realize that gum infections can lead to uncontrolled diabetes. So, in people with diabetes and uncontrolled glucose levels, a dental check up is required to see if the dental infection is responsible for the elevated glucose levels.

The most important treatments for diabetic kidney disease are tight control of blood glucose and blood pressure. People with type 2 diabetes who develop microalbuminuria (albumin in urine) or proteinuria (protein in urine) are usually also treated with medicines called angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs). The common ACE inhibitors are ramipril, lisinopril and captopril. The common ARBs are telmisartan, olmesartan, losartan and valsartan. These medicines are also used to control blood pressure. But even without high blood pressure, your doctor may prescribe an ACE inhibitor or ARB because these medicines reduce the amount of protein in the urine and can prevent or slow the progression of diabetic kidney disease.
Some of the newer class of diabetes medications also have role in prevention and treatment of diabetic kidney disease. These medicines known as SGLT2 inhibitors are primarily used to control blood sugars, but latest studies show they are useful in treatment of diabetic kidney disease. The common drugs in this group are empagliflozin, dapagliflozin and canagliflozin. Another class of medicines found to be useful in the prevention of diabetic kidney disease in GLP-1 receptor agonists. The common medicines in this group are Liraglutide and Dulaglutide. A new class of drug named Finerenone was recently approved for treating kidney disease in people with diabetes
Regular follow up with your specialist/endocrinologist is essential for adjusting the medications appropriately so that diabetic kidney disease can be prevented a well as treated optimally.

Author
Dr. Tittu Oommen