SPECIAL SUPPLEMENT TUESDAY 15 MAY 2018

PAGE | 2 PAGES | 4-5

State-of-the-art surgical therapy for Cardio- Vascular diseases at Al-Ahli Hospital

Public HealthPHCC

advises on healthy fasting

ACTING MANAGING EDITORMohammed Salim Mohamed

SUPPLEMENT COORDINATORAhmed Eltigani Idris

CHAIRMAN Sheikh Thani bin Abdullah Al Thani

EDITOR-IN-CHIEFDr. Khalid Mubarak Al-Shafi

DESIGNAbraham Augusthy

SPONSORS

MAIN SPONSOR

PM opens Muaither and Al Wajba Health and Wellness Centers

The Prime Minister and Interior Minister H E Sheikh Abdullah bin Nasser bin Khalifa Al Thani inau-gurated the new Muaither and Al Wajba Health and Wellness

Centers yesterday.The Prime Minister and Interior Min-

ister toured the new health centers where he was briefed about the medical services available for the patients and the various specialized clinics and affiliated facilities.

The Prime Minister and Interior Min-ister was accompanied by Minister of Public Health H E Dr. Hanan Mohamed Al Kuwari, President of the Public Works Authority (Ashghal) Eng. Saad bin Ahmed Al Mohannadi and senior officials from the Ministry of Public Health and the Primary Health Care Corporation.

The two new state-of-the-art facilities will each support up to 50,000 registered patients, bringing high quality, convenient care even closer to the community. They will each deliver a range of services including women’s wellness clinics, maternity and well-baby clinics, vaccination clinics, smoking cessation clinics and a specialised travel clinic providing vaccinations and health advice.

Both health centres will also house modern laboratories, pharmacies, radiology units, dental clinics and physiotherapy services as well as dedicated health and wellness centers. These centers provide patients with access to a swimming pool, gym and health coaches and offer the support and guidance needed to help them improve their health.

Commenting on the significance of the opening of the new centres in ensuring the best possible primary healthcare for the people of Qatar, Her Excellency Dr Hanan Al Kuwari said: “Primary care’s role is key to supporting healthier lifestyles in Qatar and this expansion of our health facilities will help raise the quality, safety and effi-ciency of the care we provide to our patients. It is not just about buildings -the services provided are state-of-the-art and well-coordinated. They range from pre-ventative wellness programs to advanced evidence-based treatment.”

In March of this year, the Ministry of Public Health launched the new National Health Strategy, which stressed the impor-tance of increasing the availability of care care closer to people’s homes. The new facilities at Muaither and Al Wajba mark the latest milestone in the journey in sets out to significantly expand the number of new health centres opening their doors to the public within their own communities.

Dr Mariam Abdul Malik, Managing Director at PHCC, said: “The recently

opened health centres provide health and wellbeing services with a commitment to delivering care closer to our communities. Geographically, we aim to ensure that we are not only providing excellence in service but that this is accessible in all areas across Qatar. “

She continued: “Our family-focused prevention programs have been shown to effectively reduce a range of negative behavioural health outcomes and therefore achieve a significant public health impact. We want to bring health care closer to our communities and the new health centres will not only play a vital role in improving the health and wellbeing of our patients but will also provide leadership in education and preventative measures in health care, helping to support the delivery of the Qatar National Vision 2030 under the leadership of His Highness Sheikh Tamim bin Hamad Al Thani, the Amir of Qatar.”

To date, there are 25 health centres across Qatar and during the past two years PHCC has opened LeaBaib, Al Thumama, Rawdat Al Khail and Umm Salal Health centres with two more due to open in 2018 located in Qatar Uni-versity and Al Waab.

The two new state-of-the-art facilities will each support up to 50,000 registered patients, bringing high quality, convenient care even closer to the community.

Prime Minister and Interior Minister H E Sheikh Abdullah bin Nasser bin Khalifa Al Thani touring the new Muaither and Al Wajba Health and Wellness Centers.

Public Health

TUESDAY 15 MAY 2018

2

PHCC advises on healthy fasting

The lifestyle of Muslims changes in the Holy month of Ramadan, and it is an opportunity for the person observing the fast to adopt a new healthy lifestyle, which will help contributing to weight

loss and control blood sugar levels.The Primary Health Care Corporation (PHCC)

has stressed in this regard and said that fasting has many psychological, social and physical ben-efits for the human being, besides its spiritual part. It is a month of training for the soul and the body to keep patience, committed and restrained by leaving some bad eating habits that harm health.

The person who observing fasting is able to follow some recommendations in this holy month. The individual will again many medical benefits associated with fasting, the most important of which are related to nutrition.

Ramadan is an opportunity for the fasting

Muslim to reconsider some of bad eating habits, from eating fatty foods in particular, and focus on specific types of foods, most of which contain large amount of calories. This will enhance the healthy benefits which protects the person observe fast from many diseases, as the fast to renew the activities of all organs of the body and reduce the level of lipids in the blood.

However, it is important to follow a healthy and balanced diet throughout the year, not just during the month of Ramadan. This diet system should depends on the following:

Healthy and integrated food, which includes different types of foods, in order the person observing fast to get all essential nutrients of the food that body needs. Also among important things that the person observing fast should follow is to eat slowly and not speed up.

Drink enough water between Iftar (refers to the evening meal for breaking fasting) and Sahour to supply the body with liquids during the day.

Avoid drinking soft drinks during Iftar and Sahour because it negatively affects the digestion process and fill the stomach with

sugar, in addition to the lack of these types of drinks for nutritional value and its impact on weight increase.

Exercise in the evening (for 30 minutes) after eating any meal in two hours.

It is advisable to have Iftar in two stages, and start to eat some of the dates and drinking water and then eat the soup, which helps control the amount of food eaten by the person observe fasting. The second stage, it is recommended to be after the completion of Taraweeh Prayers, and this meal contains the main dish.

The routine life of individuals with diabetes change in the holy month of Ramadan because of fasting.

Before Ramadan they were follow a particular diet schedule and taking prescribed doses of the medicines on time. But fast during Ramadan changes their routine including number of meals and timing for having food and doing other daily activities.

Diabetic patients should be careful during Ramadan because of these changes.

Primary Health Care Corpo-ration (PHCC) has given some necessary tips that a diabetic patient must adhere in Ramadan. The tips include con-sulting a physician before fasting , to check the person’s health condition, get proper advice, detail information about the risks he might have in case of fasting, and how to avoid them.

The diabetic patient should conduct sugar tests several times in a day and keep records of the results with testing times

to show his doctor. As per the PHCC advice, main course of meal should be divided in to Iftar and Suhour and the patients should take light meals between them.

A diabetic patient should not do very hard work or psychical exercises which causes fatigue while fasting during day time. He can do psychical exercise at night for two or three hours.

The PHCC warned fasting diabetic patients that if the sugar level reached 70–80 he/she should break the fast even if the Iftar time is very close.

It is also important to drink plenty of fluids such as water, soups and fresh juices time to time at night and try to avoid canned juices and beverages containing sugar.

The individual should avoid excessive use of sugar, sugar containing food items, sweets, and fats. Salt in food should be also avoided specially in Suhour meal because it increases the need of water to the body.

Diabetic patients should eat foods made of fiber nutrition like fresh beans, vegetables and

fruits because it helps reduce the high sugar level in blood in addition to avoiding consti-pation and give a feeling to the patients that he is full.

The patients should avoid eating too much spicy foods in Suhour otherwise he will need plenty of water. And excessive use of carbohydrates such as rice and pasta should be also avoided.

Regarding medications, doses and timing, it is necessary to consult a physician to fix appropriate time of medicines as there are medicines which are not recommended to take them at Suhour and usually the doctor reduces the dose of med-icines with Suhour by half.

There are several risks that a diabetic patient may expe-rience while fasting. The patient should be careful in case of steep fall of sugar level in blood, an increase in acidity in blood and dehydration.

The PHCC stressed that the diabetic patient should not hes-itate in breaking the fast when they have the symptoms of low sugar level in the blood.

Necessary health tips for diabetic patients

Fasting has many psychological, social and physical benefits for the human being, besides its spiritual part. It is a month of training for the soul and the body to keep patience, committed and restrained by leaving some bad eating habits that harm health.

PHCC underlines Suhoor meal’s importanceS

ome individuals observing fast avoid the Suhoor meal, and they are satisfied with the Iftar (refers

to the evening meal for breaking (fasting) . They avoid this meal, due to the miscon-ception that they can reduce weight.

This is a wrong practice because this meal has special importance for the body and help the person to continue fasting for the next day without tiredness, exhaustion and hunger, and help to resist hunger and thirst.

“During Ramadan, we have to choose proper food, stay away from food items that make you feel full, and deprived of eating other foods,” said Nutrition Spe-cialist at PHCC, Mouda Al Hajri. “We must choose a healthy Iftar meal, with nutri-tious soups and sufficient

amounts of water, and keep away from heavy food on the stomach, and must eat small meals, “ she said.

Al Hajri said that “it is important” in the Suhoor meal to drink more water and it is better half hour before eating Suhoor meal and not drink it while eating.

She said the Suhoor meal must be a complete diet con-taining necessary carbohy-drate required for the body, including bread made of whole wheat, cheese and milk, a little olive oil, food rich of healthy fat and vege-tables, and a glass of milk.

It is better to take fruits without peeling specially those fruits rich with fiber like peaches and apples, which gives feeling of full. Banana, dates and honey are natural sources of sugar which would not convert into fat and supply sugar to the body.

She suggested to keep away from juices because they contain sugar, filling the stomach uselessly, as a result the fasting person feels hungry after a while.

Sweets are not harmful in Suhoor meal for those who do not have diabetes, or overweight, but it should be in small quantity, and to be taken after eating other foods.

Al Hajri advised the people with normal weight to eat Al Kanafah, Al Manaqish and Al Karwassan (famous Arabic sweets) once a week in Suhoor. She asked indi-viduals who fast to avoid car-bonated drinks which cause unnecessary fat to the body without giving any nutrition. She said that half avocado could be taken, because it is rich in saturated fat in addition to a handful of dry fruits without roasting.

Public Health

TUESDAY 15 MAY 2018

3

QNA

Minister of Public Health H E Dr Hanan Mohamed Al Kuwari has underlined the

important role of primary health care as the basis of the health system and the first point of contact with the patient and his family, affirming that the State of Qatar attaches great impor-tance to primary health care sector and its quality.

Speaking after the inaugu-ration of the new Muaither and Al Wajba Health and Wellness Centers yesterday, the Minister said the expansion of health facilities comes within the context of the ministry’s plan to improve the patient’s access to health care at the right time and place and to enhance his safety.

She pointed out that this is not only limited to expanding health facilities but also includes continuous devel-opment of quality services pro-vided to ensure that the needs of the patient are met with the best quality standards.

Muaither and Al Wajba Health and Wellness Centers are one of the most modern health centers and one of the unique health centers, as they contain health and wellness services. The health centers provide compre-hensive health services through family medicine clinics, which includes treatment of non-com-municable diseases, follow-up of pregnant women and postpartum, healthy women, healthy children and periodic immunizations.

Among the provided services at the centers are the Psycho-logical Support Clinic, in addition to a prenuptial clinic, dental clinics, ophthalmology and optics clinic, ENT clinic, derma-tology clinic, health educator for children and women health, therapeutic Nutrition Clinic and Physiotherapy services. The centers also have laboratory, pharmacy, radiography and ultrasound sections. The centers have wellness services that focus on health promotion, where they have a gym, a swimming pool, sauna, steam and massage services, as well as specialized clinics that are equipped with the latest equipment.

Managing Director of Primary Health Care Corporation (PHCC), Dr Maraim Abdulmalik, said that the new health centers opened by the PHCC recently would meet the increasing needs of the primary health care services in the country, taking

into account the geographical distribution and population density of each geographic area.

She added that this geo-graphical distribution contributes to enabling the patient to have fast access to primary health care services of higher quality. This is

what the PHCC has committed to it since its launch of the national strategy for primary health care, she said.

The PHCC Managing Director pointed out that prevention and health promotion’s programs adopted in primary care centers and focused on individuals and families would contribute signif-icantly to improving the health outcomes in Qatar, leading to the building of a healthy society.

Director of Al Wajba Health Center, Dr Meshaal Al Misaifri, esti-mated that the center will accommodate between 10,000 and 15,000 visitors during the first year. This number will reach more than 50,000 in two to three years from now, he said.

Talking to reporters during a tour of the facilities of the center, he said that the center extends health services to the people in Al Wajba area, as well as provide central medical services for those transferred to it from other centers.

Managing Director of Primary Health Care Corporation (PHCC), Dr Maraim Abdulmalik, said that the new health centers opened by the PHCC recently would meet the increasing needs of the primary health care services in the country, taking into account the geographical distribution and population density of each geographic area. This geographical distribution contributes to enabling the patient to have fast access to primary health care services of higher quality. This is what the PHCC has committed to it since its launch of the national strategy for primary health care, she said.

Health Minister highlights important role of primary health care

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Public Health

TUESDAY 15 MAY 2018

6

Autism is a wide range or spectrum of brain disorders that is usually noticed in young children. Autism is also referred to as Autism

Spectrum Disorder or ASD. Autism decreases the individual’s ability to com-municate and relate emotionally to others. This disability may range from mild to severe. Autism occurs about four to five times more often in boys than girls.

Autism is a disorder, not a disease. There are many brain disorders that fall into the autism category such as autistic disorder, childhood disintegrative dis-order, pervasive developmental dis-order-not otherwise specified, and Asperger syndrome. “Spectrum” in autism spectrum disorder refers to the wide range of symptoms, skills, and severity of the disorder. The three most common disorders on the autism spectrum are autism, Asperger’s syn-drome, and pervasive developmental disorder- not otherwise specified.

Autism can develop at various ages. Some infants may show early signs of autism while others may develop nor-mally until 15 to 30 months.

SYMPTOMS

The following are common symptoms of autism, but non-autistic children may display some of these behaviours:

� Rocking, spinning, or other repeated movements� Avoiding physical contact� Avoiding eye contact� Delayed speech development� Repetitive speaking of words or short phrases� Inability to cope with small changes in a daily routine� Limited or no interactions with peers

SIGNS OF AUTISM IN BABIES

Early warning signs and symptoms of autism are recognizable. If parents or doctors are able to diagnosis autism as an infant, treatment can greatly improve a baby’s brain. Signs of autism usually appear between 12 and 18 months, but parents should still be on the lookout for common autism symptoms. Early symptoms may be interpreted as signs of a well-behaved baby because they are quiet, independent, and undemanding.

The behaviours associated with autism in babies:

� Will not make eye contact� Will not respond to parent’s voice�Will not babble (baby talk) or point by 1 year of age� Will not respond to their name� Will not smile or laugh in response to others behaviorAs some autistic children reach age

2, they may regress or lose language skills. Others may simply have no words by 16 months or no two-word phrases by 2 years of age. Children may only speak the same words repeatedly or they may repeat what they hear verbatim. Other signs of autism are organising toys in certain ways, as opposed to playing with them. They may also refrain from engaging in make-believe play or engaging with other children. Two-year-olds with autism may also be unable to recognise other people’s feelings or facial expressions.

Other autism spectrum disorder symptoms are physical problems such

as poor coordination while running or climbing, poor hand control, consti-pation, and poor sleeping. Some children develop seizures. Pica, or the tendency to eat items that are not food, is common in children and adults with autism.

EARLY SCREENING FOR ASD

Because autism spectrum disorders range from mild to severe, many children are not diagnosed early. Diag-nosing autism may be difficult because there are no medical tests, such as blood tests, that can diagnose children. Therefore, treatments may be delayed for years. Autism can sometimes be detected in children 18 months or younger. Many paediatric doctors can diagnosis children by age 2.

Developmental screening for children is an efficient test to tell if they are learning basic skills when they should. During this exam a doctor might ask the parent some questions or talk and play with the child to see how he/she learns, speaks, behaves, and moves. All children should be screened during their 9, 18 and 24 month well-child doctor visits. Older children are often screened if they seem to fall behind age-related developmental levels.

DIAGNOSIS

Speech Problems: During develop-mental screening, a doctor will observe how the baby reacts to the parent’s voice, smile, and other stimuli and may ask a few questions about the child’s reactions. The Communication and Symbolic Behavior Scale may also be used to evaluate a child’s communi-cation level and help decide if seeking professional care is necessary. Other

tests that determine hearing, speech development, and behaviours may be completed to help distinguish autism from other developmental problems.

Poor Social Skills: A major part of the diagnosis of autism is determining social skills. Some features of many children with autism are their inability to look another person in the eye, even the eyes of their parents. Children with autism often focus on objects and do so intently, virtually ignoring other people or other stimuli for long time periods. If children with autism do communicate, it is often robot-like without facial expressions or gestures. Ages and Stages Questionnaires can be helpful in eval-uating a child’s communication, gross motor, fine motor, problem-solving, and personal adaptive skills.

Evaluation: Although there is no medical test for autism, a

comprehensive diagnostic evaluation can help diagnosis a child with autism. This evaluation may include looking at the child’s behaviour and development and interviewing parents. Hearing and vision screenings, genetic testing, and neurological testing may also be involved in a comprehensive diagnostic evaluation. Most clinicians accept the three criteria for diagnosis: 1. Impair-ments in social interactions, 2. Impair-ments in communication, and 3. A restricted and repetitive range of interests, behaviours, and activities

ASPERGER’S SYNDROME

Asperger’s syndrome is a “high-functioning” type of autism spectrum disorder. Symptoms of high-functioning autism may include lack of eye contact, awkwardness in social situations, missing social cues, or not showing many emotions. Children may also have normal or superior intelligence but have difficulty in relating to people and making friends. They also tend to focus on specialized tasks.

AUTISM TREATMENT

Behavioural therapy: Treatment of autism is available. Behavioural therapy programs are available from several sources and they are designed to aid people in talking, communicating effec-tively, interacting with others, and avoiding negative or antisocial behav-iours. Behavioural therapy uses positive reinforcement, self-help, and social skills training to improve behaviour and communication.

Education: Treatment involves edu-cating the child with ASD. Parents are advised to check with doctors to determine what programs best fit their child.

Medication: Although there is no

medical treatment for autism, there are treatments for some autism symptoms. You and your child’s paediatrician should discuss medical therapy before it is administered to be sure the benefits outweigh any risks. Close observation is required to monitor the child’s response to any medication.

Sensory Integration: Children with autism spectrum disorder may be extremely sensitive to various sensory stimuli such as sounds, lights, textures, taste, and odours. Some children may become agitated by touching, hearing, or seeing specific things such as a bell, blinking lights, touching something cold, tasting certain foods, or smelling a spe-cific odour like a disinfectant. Some children can be trained to adapt and thus improve behaviour. Sensory integration therapy assesses the way an individual’s brain processes sensory input. A sensory integration-trained occupational or physical therapist will evaluate the autistic child in order to create a plan that matches sensory stimulation with physical movement, which can improve how the brain processes and organizes sensory information.

AUTISM & ASSISTIVE TECHNOLOGY

Technology has recently given some children with severe autism (patients with autism who are nonverbal) ways to communicate. Assistive technology is any product, item, or piece of equipment that is used by a person with a disability to perform tasks, improve functional capabilities, and become more independent. The assistive tech-nology may be a computer tablet, a com-puter, or even a phone app with pro-grams especially designed to engage children with autism. For students with severe communication difficulties a device with a speech-generating app or a speech generating device may be highly effective.

AUTISM AND DIET

A balanced diet, along with some vitamin supplementation, is advised by clinicians for children with autism spectrum disorders. It is important to have a good diet as some patients show good improvement in symptoms when eating such a diet. Some patients with autism suffer from constipation and others may develop a habit of eating items like dirt or paper. A proper diet may help reduce these autism symptoms.

Children with autism may be sud-denly set off by a change in schedule, a noise, or anything else that irritates them. Relaxation techniques such as deep pressure massage or weighted clothing may soothe agitation in autistic children during a meltdown.

WHAT CAUSES AUTISM?

Researchers still do not know exactly what causes autism spectrum disorders. They do know that autism features abnormalities in brain structure or function. Researchers also suggest that some toxins or drugs may play a role. For example, valproic acid, thalidomide, and infection exposure during preg-nancy increases autism risk in the infant.

Autism spectrum disorders do not necessarily mean your child cannot lead an independent and useful life. People with early treatment and mild-to-mod-erate symptoms can even graduate from college or graduate schools. Others with below-average abilities may still be able to do specialized jobs and live independ-ently or in group homes. The key to autism treatment is early recognition of the signs and symptoms of autism spectrum disorders in infants and young children. The following are tips for fam-ilies with autistic children:

� Their senses are out of sync- ordinary sights, sounds, tastes, and touches are perceived differently

� Give clear, simple directions� They interpret language literally

— idioms, puns, nuances, inferences, metaphors, and sarcasm may not make sense

� Be on alert for body language cues� Visual support may help in daily

tasks� Help them socially interact� Identify what triggers their meltdowns� Be patient and love them unconditionally

www.medicinenet.com

What is Autism Spectrum Disorder?

Public Health

TUESDAY 15 MAY 2018

7

There are many different ways blood sugar (glucose levels in the blood) can be affected and cause problems with sugar control in people with

diabetes. Each person reacts differently to various items that influence blood sugars. There are some compounds individuals with diabetes may want to examine to see how they influence their own blood sugar levels.

UPSWING: CAFFEINE: Blood sugar levels can rise after

drinking coffee, black tea, and some energy drinks due to the presence of caffeine. There are other compounds that may alter blood glucose levels and methods people with diabetes can use to see what compounds and actions influence their own blood sugar levels.

UPSWING: SUGAR-FREE FOODSA number of foods claim to be

“sugar-free,” but these foods raise blood sugar levels because many of them contain carbohydrates in starches, fats, and even fiber. Foods with high levels of carbohydrates are likely to raise blood sugar levels very high, and even-tually may cause organ damage over time in people with diabetes.

UPSWING: CHINESE FOODFoods high in fat can cause blood

sugar to stay higher for longer periods of time. Pizza, French fries, and most fried foods are high in carbohydrates and fat. It’s a good idea to check your blood sugar about two hours after you eat such foods to see how your blood sugar levels are affected.

UPSWING: A BAD COLDDehydration can elevate your blood

sugar so it is wise to stay well hydrated.

If you are sick, diarrhoea and vomiting for more than two hours, or illness longer than a few days may alter your blood sugar. Moreover, blood sugar rises as your body tries to fight any type of illness. Medications such as antibiotics and decongestants may alter your blood sugar.

UPSWING: JOB STRESSStress may cause your body to

release hormones that can cause rises in your blood sugar. Although this is more common in people with type 2 diabetes, practice relaxation techniques with deep breathing and exercise, if possible, to reduce stress.

UPSWING: BAGELSAre bagels better than bread? The

answer is that bagels are better at increasing sugar levels in the blood than bread because bagels are packed with carbohydrates and calories.

UPSWING: SPORTS DRINKSAlthough the main design for sports

drinks is to help individuals replenish fluids quickly, many of them contain large amounts of sugar. For moderate workouts of less than an hour, plain water should do to replenish your fluids. For more intense workouts, a sports drink may be appropriate, but people with diabetes should check with their doctor to see which particular sports drinks would be best for them to use.

UPSWING: DRIED FRUITSAlthough fruit is a healthy choice

for most individuals, people with dia-betes should be aware dried fruits contain a large amount of carbohy-drates in a small serving size. For example, two tablespoons of dried raisins, cranberries, or cherries have

the same amount of carbohydrates as a small piece of fresh fruit. Three dried dates contain 15g of carbohydrates so eating a handful or two of dried fruits may cause high spikes in blood glucose levels in many individuals.

UPSWING: STEROIDS AND WATER PILLSSteroids, commonly used to treat

rashes, arthritis, asthma, and other medical conditions, can cause blood sugar levels to rise. Diuretics (water pills) may raise blood sugar levels, while anti-depressants may either raise or lower them.

LOWER: HOUSEHOLD CHORESNormal activities such as mowing

the lawn or cleaning the house count as moderate physical activity for a person with diabetes (and for other people, too!). This type of activity may help lower the blood sugar in a person with diabetes. People with diabetes should participate in mild to moderate physical activity because the activity may lower blood glucose and increase overall fitness.

LOWER: YOGURTProbiotic foods may help people

with diabetes by improving digestion. Yogurt, for example, is reported to

contain “healthy” bacteria that may help protect against gastrointestinal problems. The best yogurt choice is plain yogurt or “light yogurt” with no added sugar or fruit.

LOWER: VEGAN DIETPeople with diabetes who switched

to a vegan diet (no meat or animal products such as dairy or egg con-sumed) or entirely plant–based diet, according to some researchers, had a much better blood sugar control and required less insulin. Although the mechanism is not entirely clear, whole grains, fiber, and beans may function by slowing down carbohydrate digestion, thereby producing sugars at a lower rate. People with diabetes should check with their doctor before they make any major changes to their diet.

PROMISING: CINNAMONSome studies suggest sprinkling

your food with cinnamon may lower blood sugar in individuals with type II diabetes. Study investigators suggest cinnamon can add flavour without adding salt, carbohydrates, or calories. Moreover, cinnamon may improve the body’s ability to use insulin. People with d i a b e t e s s h o u l d d i s c u s s

use of cinnamon with their health care professional before making any dietary changes.

CAUTION: SLEEPRegular testing of your blood sugar

is important to determine how it fluc-tuates during a typical 24-hour period. Blood sugar can fall low during sleep for some people with type I diabetes; these people may benefit from a small snack just before bedtime. For other people, blood sugar can rise in the morning even before eating breakfast – this is due in part to changes in hor-mones or a drop in insulin levels. A good way to determine how your body uti-lizes glucose is to use a continuous blood glucose monitor on occasion.

ROLLERCOASTER: EXERCISEMost clinicians agree that physical

activity almost always can improve an individual’s health, whether they have diabetes or have normal blood glucose levels. Unfortunately, when people with diabetes do intense or endurance type exercises, their blood sugars may spike up and then drop for as long as 24 hours. People with diabetes should check their blood sugar before, during, and after exercises to be sure their blood sugar levels don’t go too high or too low.

ROLLERCOASTER: HEATBeing overly hot or sweating makes

your blood sugar more difficult to control. Going in and out of air condi-tioning can have a roller coaster-like effect on your blood glucose levels. Staying in air-conditioned environ-ments during the heat of the day and drinking plenty of water to avoid dehy-dration is a good way to avoid heat–related problems in controlling your blood sugar. In addition, people with diabetes should know that their med-ications, the glucose meter, and test strips could be affected by high heat such as the type of heat that can occur in a hot car or on a windowsill in the sun. Keep these items at room temperature.

www.medicinenet.com

Travel is a wonderful way to discover new places and cul-tures. Having diabetes shouldn’t stop you from expe-riencing new places. With

these tips, you can stay healthy and safe on your adventures far from home!

SEE YOUR DOCTOR FIRST

Having diabetes means you should plan ahead before you travel. Be sure to see your doctor before you leave. Get a check-up and make sure your diabetes is in control. If you need immunizations for your destination get them at least one month before departure. This way, if the shots make you sick, you’ll have time to recover.

You’ll need two important items from your doctor: A letter and prescrip-tions. The letter should explain in detail what you need to manage your diabetes while you’re away, such as taking dia-betes pills or insulin shots. It should also list insulin, syringes, and other medica-tions or devices you used, along with allergies or food sensitivities.

Your doctor should also prescribe any insulin, diabetes medications, and syringes you will need; you should have more than enough to last throughout your trip.

What your doctor’s letter should list� The insulin you use� The syringes you use� Other medications you use� Your allergies� Your food sensitivities

CARRY-ON LUGGAGE

Always take your medications and medical supplies with you; never pack them in checked luggage. Medication should also be clearly labelled. Keep a carry-on bag with you at all times with needed items, such as:

� Insulin and syringes needed for your trip

� Blood and urine testing supplies� All oral medications � Any other medical supplies.� Your ID

AIRPORT SECURITY

If your trip involves air travel, it’s ok to put your glucose meter, insulin, or insulin pump through the X-ray machine. However, you can always ask to have your carry-on items hand-inspected if you have concerns.

In order to bring syringes or insulin delivery systems on an aeroplane, you must have a vial of insulin presented with a professional, preprinted phar-maceutical label that clearly identifies the medication. Bring the original insulin box with the label displayed on it.

MAINTAIN BLOOD SUGAR DURING FLIGHTS

It’s important to eat correctly when you travel and airlines offer meals low in sugar, fat, or cholesterol. Contact your airline and make your meal request at least 48 hours in advance of your flight.

If you take insulin, wait to take your shot until right before you eat, when the food is already in front of you. If you are traveling alone, because of elevated

anxiety of some plane passengers, it may be useful to inform airline personnel and the person sitting next to you that you are diabetic and will need to take a med-ication shot before you eat. Having a pre-packaged snack with you will prevent low blood sugar, in case your food takes a while to be served or if your order is incorrect.

Also, remember aeroplane cabins are pressurized, meaning before you use a syringe in flight, you will need to remove and replace the plunger to allow pressure equalization.

MIND THE TIME ZONES

Traveling across time zones may affect the timing and amount of your insulin doses. If you are traveling eastward, you lose time and thus your day is shorter and you may need less insulin. When you travel westward you gain time, making your day longer and possibly requiring more insulin. Your doctor can recommend any adjust-ments you may need to make in your insulin regimen.

Keep your watch set to the time of your travel origin to help you to remember when to take your insulin. Reset your watch to local time the morning after you arrive. Check your blood sugar level when you land, it may be hard to tell if you are jet lagged or have low blood sugar.

CHECK YOUR BLOOD SUGAR

You will need to check your blood glucose more often when traveling (at least every 4 to 6 hours). In addition, when you travel you may be more active than usual which could lead to low blood sugar levels.

STAY HYDRATED

Hydration is important when trav-elling, so make sure you carry plenty of water with you. Air travel can be dehy-drating so avoid too much coffee, tea, or other beverages with caffeine as these have diuretic properties and can con-tribute to dehydration. Limit sugary drinks such as soda, lemonade, or fruit

punch. Be sure to also avoid drinking tap water overseas, including ice cubes.

PROTECT YOUR MEDICINE

It’s important to plan ahead on how to store your medical supplies, especially insulin. While insulin does not need to be refrigerated, it can lose strength if exposed to extreme heat or cold.

Don’t store insulin in the glove com-partment or trunk of a car, and keep it out of a backpack or cycle bag that can get hot in direct sunlight. Never freeze insulin, and make sure pills are kept dry because moisture can damage them. If you are travelling in very hot or cold temperatures, plan ahead to protect your insulin. There are travel packs you can buy that will keep your insulin at proper temperatures.

COMMUNICATE WITH OTHERS

If you are travelling with others, make sure they know the signs of hypoglycemia. Keep your glucose tablets or gels easily accessible in case you experience hypoglycemia, which may occur unexpectedly when traveling. If you are traveling abroad to a country where they speak a different language, learn how to say, “I have diabetes,” and “Sugar or orange juice, please,” and any other phrases you think you will need. You can also write down phrases on a piece of paper and use it when in need. There are online programs and apps that can help you figure out the correct phrases and pronunciation so you are prepared before you depart.

DIABETES AND DIET

Bring snacks wherever you go, whether you’re hiking or sightseeing never assume food will be available. Keep your blood sugar in check by always being mindful of what you eat and drink when traveling. Be careful of unfamiliar food that may make your dia-betes difficult to control or may upset your stomach. Ask for ingredients of unfamiliar foods, if you can.

Diabetes and travel: Tips for better control

Different ways to manage blood glucose levels

Public Health

TUESDAY 15 MAY 2018

8

Patients with chronic medical conditions such as diabetes, hypertension, heart and kidney diseases, as well as conditions like epilepsy, require daily medication to effectively manage their condition and prevent complications. For many patients, we can make a simple adjustment so they can take their medication between the evening meal of Iftar and the morning meal of Suhoor.

Advice for chronic patients before fastingConsult with your doctor before changing medication timings

With Ramadan approaching, Hamad Medical C o r p o r a t i o n

(HMC) is urging patients with chronic medical conditions, such as diabetes and hyper-tension, to speak with their doctor before beginning a fast.

Patients who take daily medication can safely adjust the schedule, but making changes without a doctor’s advice can lead to serious complications. Specialists from across the healthcare pro-vider’s network of hospitals say it is imperative that patients seek professional advice before making any changes to their diet and med-ication regimes.

Dr Moza Al Hail, Executive Director of Pharmacy at HMC says that some patients need only a simple adjustment to their medication schedule while others require a more complex solution.

“Patients with chronic medical conditions such as diabetes, hypertension, heart and kidney diseases, as well as conditions like epilepsy, require daily medication to effectively manage their con-dition and prevent complica-tions. For many patients, we can make a simple adjustment so they can take their medi-cation between the evening meal of Iftar (sunset) and the morning meal of Suhoor (dawn). For medications taken multiple times during the day, recommended strategies include choosing long-acting formulations or changing dosing regimens to once or twice daily,” said Dr Al Hail.

Dr Amr Mohammed Elmoheen, Consultant of Emergency Medicine at Hamad General Hospital, said that although patients who take daily medication can safely adjust the schedule, but making changes without a doctor’s advice can lead to serious complications. He also urges patients with irritable bowel syndrome (IBS) and other chronic digestive and stomach conditions to take preventative measures by avoiding large meals, spices

and fried and fatty foods, which may trigger symptoms.

“ W i t h R a m a d a n approaching, we are receiving requests from patients seeking advice about how they can adapt the timing and dosage of their medicine during the fasting period. It is important for patients to talk to their doctor before making any modifications as changes can affect the medicine’s efficacy and the appearance of side effects. Doctors and pharma-cists work with patients to help prevent or minimize these effects,” said Dr Elmoheen.

Manal Musallam, Director of Diabetes Education at the National Diabetes Center at Hamad General Hospital, says diabetics who choose to fast need to be aware of the potential health risks. She urges patients who plan to fast to talk with their doctors as early as possible, saying that while many diabetics can safely fast, modifications to diet, exercise, and medication routines are often required.

“Type 2 diabetics who have poorly managed blood glucose levels, elderly patients with Type 1 or Type 2 diabetes who take insulin, pregnant women who take insulin, and breastfeeding mothers who have Type 1 or Type 2 diabetes are generally advised not to fast. Patients with long-term diabetes complications, such as kidney failure or heart disease, are also advised not to fast. Your doctor can help determine if it is possible for you to safely fast,” said Musallam.

She says it is important for patients with diabetes to monitor their blood glucose levels regularly and to drink adequate fluids during non-fasting hours. She recom-mends water over juice and sugary beverages or options that include stimulants, such as coffee and caffeinated soft drinks. She also advises that patients with diabetes should ensure they eat the Suhoor meal and while she recom-mends resting before Iftar, she says sleeping during this period should be avoided as some patients may be at risk for hypoglycemia.

“Patients with diabetes should speak with their doctor

or health educator about when and how often they should check their blood glucose levels. As a general rule, a reading of 80-180 mg/dl post meal is considered normal and it is advisable to eat the Suhoor meal as late as possible. We also advise patients to refrain from strenuous workouts during Ramadan, particularly during the few hours before the sunset meal as this is when they are at risk for low blood sugar. Low-intensity activity is encouraged and performing prayers should be considered as part of the daily exercise program,” added Musallam.

Dr Amar Salam, Senior Consultant Cardiologist and Head of the Cardiology Department at Al Khor Hos-pital, said while it is necessary for heart patients to speak with their doctor before under-taking a fast, especially for patients who take medication, there is usually no negative effect for most cardiac patients.

“While fasting is not rec-ommended for some heart patients, including those who have recently had a heart attack or heart surgery, and patients who have narrowing or inflammation of the aortic valve, research indicates that fasting is good for the heart. Fasting not only lowers one’s risk for coronary artery disease and diabetes, but it can also cause significant changes in a person’s blood cholesterol levels, increasing HDL-C, the ‘good’ cholesterol by 30 to 40

percent. However, it is important for patients to consult with their doctor, especially patients who take medication and will require timing and dosage modifica-tions, and potentially an alter-native medication,” says Dr Salam.

Dr Salam, who is also Associate Professor, College of Medicine, Qatar University, adds that heart patients are advised to eat small portions during meals and to avoid fatty, salty, and sugary foods and large quantities of bev-erages. He suggests patients who drink caffeinated bev-erages ease into Ramadan by reducing their consumption of tea, coffee, and other caf-feinated beverages prior to Ramadan. He says going without caffeine for long periods of time during Ramadan can cause with-drawal symptoms such as

migraines and can be a shock to the system.

Dr Salwa Abuyaqoub, a Senior Consultant for Obstetrics and Gynecology at Women’s Hospital, stressed the importance of pregnant women speaking with their doctor before deciding to fast. She says that many pregnant women are able to safely fast, but there are exceptions. “While many pregnant women can safely fast, it is not medi-cally advisable for women who have pregnancy compli-cations such as diabetes and high blood pressure to fast.

“If your doctor gives you permission to fast, take care to consume a healthy and bal-anced diet and drink sufficient amounts of water during non-fasting hours. Each year we see an increase in the number of pregnant women visiting our Emergency Departments

during Ramadan due to fasting, and specifically dehy-dration,” says Dr Abuyaqoub.

HMC is asking patients who are unable to attend their appointment, or can see a change in their schedules as a result of their Ramadan-related commitments, to call Nesma’ak at 16060 so the appointment can be rebooked. This will also allow the appointment slot to be assigned to another patient.

Also a website dedicated for ‘Ramadan Health’ by the the Ministry of Public Health, HMC and Primary Health Care Corporation continue to provide information on common health issues that may be of particular interest during Ramadan, including managing diabetes while fasting, ensuring that people stay hydrated, tips for healthy eating as well as a range of other topics.

FAZEENA SALEEM

THE PENINSULA