Foods that lower blood sugar

When a person has diabetes, either their body does not produce enough insulin, or it cannot use the insulin correctly, so glucose accumulates in the blood. High levels of blood glucose can cause a range of symptoms, from exhaustion to heart disease.

One way to control blood sugar is to eat a healthful diet. Generally, foods and drinks that the body absorbs slowly are best because they do not cause spikes and dips in blood sugar.

The glycemic index (GI) measures the effects of specific foods on blood sugar levels. People looking to control their levels should pick foods with low or medium GI scores.

A person can also pair foods with low and high GI scores to ensure that a meal is balanced.

Below are some of the best foods for people looking to maintain healthy blood sugar levels.

1. Whole wheat or pumpernickel bread

Many kinds of bread are high in carbohydrates and quickly raise blood sugar levels. As a result many breads should be avoided.

However, pumpernickel bread and 100 percent stone-ground whole wheat bread have low GI scores, at 55 or less on the GI scale.

Pumpernickel and stone-ground whole wheat breads have lower GI scores than regular whole wheat bread because the ingredients go through less processing.

Processing removes the fibrous outer shells of grains and cereals. Fiber slows digestion and helps to stabilize blood sugar levels.

In a 2014 study, researchers reported that spelt and rye both caused low initial glycemic responses in rats. They also found that these ancient wheat types, as well as emmer and einkorn, suppressed genes that promote glucose metabolism

2. Most fruits

Except for pineapples and melons, most fruits have low GI scores of 55 or less.

This is because most fruits contain lots of water and fiber to balance out their naturally occurring sugar, which is called fructose.

However, as fruits ripen, their GI scores increase. Fruit juices also have very high GI scores because juicing removes the fibrous skins and seeds.

A large 2013 study found that people who consumed whole fruits, especially blueberries, grapes, and apples, had significantly lower risks of developing type 2 diabetes.

The researchers also reported that drinking fruit juice increased the risk of developing the condition.

3. Sweet potatoes and yams

Regular potatoes have a high GI score, but sweet potatoes and yams have low scores and are very nutritious.

Some research indicates that the flesh of the sweet potato contains more fiber than the skin, indicating that the whole vegetable could be beneficial for those with diabetes.

Reporting the findings of an animal study, the researchers also noted that sweet potato consumption may lower some markers of diabetes.

While there is still no conclusive evidence that sweet potatoes can help to stabilize or lower blood sugar levels in humans, they are undoubtedly a healthful, nutritious food with a low GI score.

People can substitute sweet potatoes or yams for potatoes in a variety of dishes, from fries to casseroles.

4. Oatmeal and oat bran

Oatmeal in a bowl — Oats contain B-glucans, which help maintain glycemic control.

Oats have a GI score of 55 or lower, making them less likely to cause spikes and dips in blood sugar levels.

Oats also contain B-glucans, which can do the following:

reduce glucose and insulin responses after meals
improve insulin sensitivity
help maintain glycemic control
reduce blood lipids (fats)

A 2015 review of 16 studies concluded that oats have a beneficial effect on glucose control and lipid profiles in people with type 2 diabetes. Determining the impact of oat consumption on type 1 diabetes requires more research.

Doctors still recommend that people with diabetes limit their consumption of oatmeal because 1 cup contains roughly 28 grams of carbohydrates.

5. Most nuts

Nuts are very rich in dietary fiber and have GI scores of 55 or less.

Nuts also contain high levels of plant proteins, unsaturated fatty acids, and other nutrients, including:

antioxidant vitamins
phytochemicals, such as flavonoids
minerals, including magnesium and potassium

A 2014 systemic review concluded that eating nuts could benefit people with diabetes.

As with other foods in this article, it is best to eat nuts that are as whole and unprocessed as possible. Nuts with coatings or flavorings have higher GI scores than plain nuts.

6. Legumes

Legumes, such as beans, peas, chickpeas, and lentils, have very low GI scores.

They are also a good source of nutrients that can help maintain healthy blood sugar levels. These nutrients include:

fiber
complex carbohydrates
protein

A 2012 study found that incorporating legumes into the diet improved glycemic control and lowered the risk of coronary heart disease in people with type 2 diabetes.

Avoid legume products that contain added sugars and simple starches, such as those in syrups, sauces, or marinades. These additions can significantly increase a product’s GI score.

7. Garlic

Garlic is a popular ingredient in traditional medicines for diabetes and a wide variety of other conditions.

The compounds in garlic may help reduce blood sugar by improving insulin sensitivity and secretion.

In a 2013 study, 60 people with type 2 diabetes and obesity took either metformin alone or a combination of metformin and garlic twice daily after meals for 12 weeks. People who took metformin and garlic saw a more significant reduction in their fasting and post-meal blood sugar levels.

People can eat garlic raw, add it to salads, or use it in cooked meals.

8. Cold-water fish

fish on a plate — Cod does not contain carbohydrates and may reduce the risk of developing type 2 diabetes.

Fish and other meats do not have GI scores because they do not contain carbohydrates.

However, cold-water fish may help manage or prevent diabetes better than other types of meat.

A 2014 study included data taken from 33,704 Norwegian women over a 5-year period. The researchers found that eating 75–100 grams of cod, saithe, haddock, or pollock daily reduced the risk of developing type 2 diabetes.

However, the researchers were uncertain whether the reduction in risk was a direct result of eating the fish or whether other healthful lifestyle factors, such as exercise, could have influenced the findings.

9. Yogurt

Eating plain yogurt daily may reduce the risk of type 2 diabetes.

Authors of a large 2014 meta-analysis concluded that yogurt may be the only dairy product that lowers the risk of developing the condition. They also noted that other dairy products do not seem to increase a person’s risk.

Researchers are still unsure why yogurt helps lower the risk of type 2 diabetes.

However, plain yogurt is generally a low-GI food. Most unsweetened yogurts have a GI score of 50 or less.

It is best to avoid sweetened or flavored yogurts, which often contain too much sugar for a person looking to lower their blood sugar levels. Greek-style yogurt can be a healthful alternative.

Other ways to lower blood sugar levels

Eating a healthful, well-balanced diet is key. Additional strategies to help lower or manage blood sugar levels include:

staying hydrated by drinking plenty of clear liquids
exercising regularly
eating small portions more frequently
not skipping meals
managing or reducing stress
maintaining a healthy body weight or losing weight, if necessary

People with diabetes may also need to take medications and measure their blood sugar regularly to reduce the risk of potentially dangerous symptoms and complications.

Speak with a doctor about how to incorporate a healthful diet into a diabetes care plan.

February 4, 2021

Eye Diseases in Africa

Blindness is a major public health problem in African because of the sheer number of people so afflicted. Economic survival is a struggle for the average, non-handicapped person in a developing country. The burden of blindness is therefore a major added frustration to the individual’s economic independence and social development.

Eye care delivery has not received much attention in many African countries. Although the need for eye care cannot be denied, it is competing for scarce resources with more compelling problems like high maternal and infant mortality and acute medical and surgical problems.c Ophthalmologists are few and tality and acute medical and surgical problems. Ophthamologists are few and the traditional hospital-based curative ophthalmic practice is expensive to run.

By and large, ophthalmologists, optometrists and hospitals are situated in big cities and towns while more than 80% of the population lives in rural areas and villages.The majority of the population is therefore underserved or not served at all. For every patient who attends the hospital, there are probably 4-5 needy patients who have not visited the doctor because they are too poor, too far from the hospital or just ignorant of what can be done. Besides, taboos and sociocultural attitudes often discourage patients from using existing modern facilities. Consequently, diseases are usually seen at an advanced stage. These factors, contributing to late presentation, together with inadequate facilities lead to a pool of curably blind as is seen in the cataract backlog in Africa.

The eye diseases seen in Africa are often no different from those encountered in Europe; most of them are treatable or preventable, but their neglect has a devastating effect on vision.

Cataracts are very commonly seen in Africa, accounting for approximately 50% of all cases of blindness. They may be congenital in origin; often due to intrauterine infection like rubella, or metabolic diseases in the child like galactosaemia. Cataracts may also complicate injuries to the eye; but more commonly they are seen in the elderly.

Senile cataracts are known to occur at an earlier age in the tropics, and recent work suggests that severe diarrheoal diseases early in life may be a contributory factor. It will be interesting to see in a few year’s time the effect of oral rehydration therapy on the prevalence of cataracts. The surgical treatment of cataracts is very rewarding, but advantage of this fact is often not taken, due mainly to inadequate facilities and ignorance. Mobile eye units being operated by various non-governmental organizations are now unable to afford the cost of corrective glasses, as is often the case, the improvement in vision is often adequate to enable him to look after himself and move around, thereby ceasing to be a burden on family and friends. Although more cataract operations are now being done, contact lenses and intraocular lens implantations, which have become routine in developed countries, are not usually available in Africa.

Infections of the external eye are very common, notably among which are trachoma, conjuctivitis of the newborn, epidemic haemorrhagic keratocon-junctivitis, corneal ulcers, measles, Keratoconjunctivitis and leprosy. The infection may spread to the inner eye and lead to loss of the eyre. Eye infections may be responsible for up to 25% of all cases of blindness in Africa.

February 3, 2021

Bandage Contact Lenses

The Case for Bandage Soft Contact Lenses

A primer on the use of these therapeutic lenses to serve and protect the corneas of our patients.

By Susan Gromacki, O.D., M.S., F.A.A.O.

The concept of a protective eye bandage originated in the first century A.D., when Celsus reportedly applied a honey-soaked linen to the site of a pterygium removal to prevent symblepharon development.^1,2 Bandage soft contact lenses were first used in the 1970s following the development of hydroxyethyl methacrylate (HEMA) by Otto Wichterle.² With the recent advances in material technology, today’s bandage contact lenses provide the same benefits as their predecessors—but with enhanced convenience, improved healing and increased corneal health.

Bandage Lens Basics
By definition, a bandage contact lens protects the cornea. Many different lens types can be utilized to accomplish this goal (see tables 1 and 2); however, because of their high oxygen permeability and FDA approval for extended wear, silicone hydrogel soft contact lenses are currently most practitioners’ first choice.

Bandage lenses protect the cornea not only from potential exterior sources of injury, but also from a patient’s own eyelids. The shearing effect created by the lids during the blink can inhibit re-epithelialization and cause pain. Use of a bandage lens facilitates corneal healing in a pain-free environment.

Depending on the patient’s ocular condition, he or she may wear their therapeutic lenses for a period of days to years. They may be utilized for daily or extended wear (see table 2). Because there is generally an underlying disease process precipitating the need for a therapeutic lens, extra caution must be taken to clean and disinfect the lens after wear, keeping in mind that silicone hydrogel lenses tend to deposit lipids more readily than HEMA lenses (see image 1). That said, the addition of a digital rubbing step is necessary for lenses that are used more than once.

It is critical to perform frequent follow-ups for bandage contact lens patients. One reason is that a bandage lens fit, by design, demonstrates less movement than a traditional soft lens fit. The theory is to provide increased patient comfort while preventing the healing epithelial cells from sloughing off due to any mechanical trauma of the lens itself.³ In addition, it is important for the practitioner to be vigilant regarding the detection of signs of microbial keratitis. The compromised cornea—especially when wearing lenses in an extended wear modality—is at particular risk for infection.⁴

Indications
Bandage contact lenses are indicated for many different reasons, including: protecting the eyes, increasing comfort, facilitating healing and sealing wound leaks. We’ll explore these indications, and others, in more detail in the following paragraphs.

• Protection. Corneal protection is needed in the case of several conditions, including: entropion, trichiasis, tarsal scars, recurrent corneal erosion, post-surgical ptosis and surgical sutures or exposed suture knots.

Recurrent erosions are a typical sequella of epithelial basement membrane (basal lamina) trauma or are secondary to anterior basement membrane dystrophy, anterior basement membrane degeneration or stromal dystrophy. A bandage contact lens is the second line of treatment, after hyperosmotic drops and/or ointment fail.^2,5 An added benefit is the enhanced vision provided by the smooth refracting surface of the contact lens, as opposed to an irregular anterior corneal surface.5 Hypertonic saline drops should continue to be utilized concurrently with the lenses.

• Pain relief. The mitigation of corneal pain is another important indication for therapeutic contact lenses. The conditions most in need of this therapy include bullous keratopathy; epithelial erosion and abrasion; filamentary keratitis; and postoperative penetrating keratoplasty.

In bullous keratopathy, endothelial failure results in corneal edema, which in turn creates epithelial blisters that rupture, causing pain, foreign body sensation, and photophobia. A bandage contact lens reinforces the damaged tissues and protects the nerve endings from the abrasive actions of the eyelids. Patients who are awaiting a conjunctival flap or cornea transplant may be fitted with therapeutic lenses for up to 30 days at a time.²
Until recently, pressure patching was the standard of care for treating large epithelial abrasions (see figure 2). With this treatment, the caveat was to refrain from patching contact lens wearers or injuries caused by presumed vegetative matter or false fingernails. The utilization of a bandage contact lens provides protection and healing for all three of these conditions, and it has now supplanted patching as the standard of care. The authors of the Wills Eye Manual caution, however, that prophylactic topical antibiotics should be used concurrently and that daily follow-up care is mandatory.⁶

The other advantage of bandage contact lenses over patching is the ability to continue to install topical ophthalmic medications. This is particularly important after a corneal abrasion, erosion, or corneal refractive surgery, which necessitate the frequent installation of antibiotics and/or artificial tears. Some reports caution against the installation of cycloplegic agents (which reduce the pain associated with a corneal abrasion/erosion or after corneal refractive surgery) in bandage CL wearers. The dilating drops can cause the bandage lenses to dry out and become less comfortable, especially overnight, with the end result a potentially decreased healing response.⁷ On the other hand, bandage contact lenses can be utilized—by design—as vehicles for drug delivery, but the exact way to ensure a consistent dosage is still under investigation.

• Healing. The use of bandage contact lenses to facilitate healing is particularly necessary for the following conditions: chronic epithelial defects, corneal ulcer, neurotrophic keratitis, neuroparalytic keratitis, chemical burns and basement membrane disease.

They also enhance healing following corneal surgery, particularly refractive surgery. They protect the cornea from exposure or from the irritation caused by rubbing the eye as the corneal wounds are healing. Therapeutic bandage contact lenses are a mainstay after photorefractive keratectomy (PRK) procedures, in which the removal of the epithelium leaves an open wound that takes about one week to heal (see figure 3). They are also valuable for the following procedures: laser-assisted in situ keratomileusis (LASIK), laser-assisted subepithelial keratomileusis (LASEK), Epi-LASIK, penetrating keratoplasty (PK) and phototherapeutic keratectomy (PTK), lamellar grafts and corneal flaps.

• Sealing. The lenses also may aid in sealing leaky wounds. Serving as a splint or sealant, the lenses can be beneficial after cataract, penetrating keratoplasty or glaucoma filtering surgery.

• Maintenance of corneal hydration. The role of bandage contact lenses in dry eye is controversial. For patients who need to continually instill lubricating drops into their eyes, particularly after refractive surgery, the benefits of using a bandage lens can be great. Other patients who benefit are those who have significant lagophthalmos and subsequent corneal exposure. However, contact lenses are generally contraindicated for dry eye.⁷

• Structural stability and protection in piggyback lens fitting. Many patients benefit from the utilization of a soft and rigid lens concurrently. The rigid lens provides crisp vision, particularly for irregular corneas, and the soft bandage lens protects the cornea, preventing irritation and abrasions. Examples include elevation differences in the host/graft junction, keratoconus and in the presence of scar tissue.

Contraindications

Each clinician must assess his patient’s condition carefully to determine whether a bandage contact lens is warranted. Interestingly, many of the conditions that require bandage contact lenses (dry eye, infection, inflammation, etc.) contraindicate lens wear in general. In addition, therapeutic contact lenses should not be used in patients who are unwilling or unable to comply with the necessary treatment and follow-up.

Dr. Gromacki is a diplomate in the Cornea, Contact Lens and Refractive Technologies Section of the American Academy of Optometry. She is Chief Research Optometrist at Keller Army Community Hospital, West Point, New York.

1. Arrington GE. A history of ophthalmology. MD Publishers, New York, New York, 1959.
2. Weiner BM. Therapeutic bandage lenses. In: Silbert JA, ed. Anterior Segment Complications of Contact Lens Wear. Churchill Livingstone, New York, New York, 1994; 455-471.
3. Aquavella JV. Chronic corneal edema. Am J Ophthalmol 1973;(76):201-207.
4. Thoft RA, Mobilia EF. Complications with therapeutic extended wear soft contact lenses. Int Ophthalmol Clin. 1981;(21):197.
5. Chan WE, Weissman BA. Therapeutic contact lenses. In: Bennett ES, Weismann BA, (eds). Clinical Contact Lens Practice, Lippincott Williams & Wilkins: New York, New York, 2005: 619-628.
6. Ehlers JP and Shah CP, eds. The Wills Eye Manual Fifth Edition, Wolters Kluwer Health, New York, New York, 2008:15-16.
7. Russell GE. Bandage lenses: new opportunities in practice. Contact Lens Spectrum. 2004(6).
8. Tyler Thompson TT. Tyler’s Quarterly 2011;28(3):32-52.
9. White P. 2011 Contact Lenses and Solutions Summary. In: Contact Lens Spectrum (suppl) 2011;27(7):14.

February 2, 2021

Ocular Trauma

^{Eye Injuries}

Eye Trauma

Eye trauma refers to damage caused by a direct blow to the eye. The trauma may affect not only the eye, but the surrounding area, including adjacent tissue and bone structure.

There are many different forms of trauma, varying in severity from minor injury to medical emergencies. Even in cases where trauma seems minor, every eye injury should be given medical attention.

What Causes Eye Trauma?

When the eye is hit with blunt force, it suddenly compresses and retracts. This can cause blood to collect underneath the hit area, which leads to many of the common symptoms of eye trauma.

Symptoms of Eye Trauma

Symptoms of eye trauma may include:

Pain
Trouble seeing
Cuts to the eyelid
One eye not moving as well
One eye sticks out
Blood in the clear part of the eye
Unusual pupil size or shape
Something embedded in the eye
Something under the eyelid that cannot be easily removed

Treatments for Eye Trauma

Every eye injury should be given medical attention; do not touch, rub or try to remove any object in the eye. If the eye has been cut or there is an object in the eye, rest a protective shield – such as a paper cup – on the bone around your eye. Make sure there is no pressure on the eye itself. Seek immediate, professional medical attention.

In minor cases of trauma, such as a black eye from a sports injury, applying cold to the affected area can help bring swelling down, and allow the affected area to heal faster. However, even in cases where trauma seems minor, every eye injury should be given medical attention.

The best way to avoid eye trauma is to prevent it by using protective eyewear while doing things that may put them at risk. Activities include home repair, yard work, cleaning, cooking, and playing sports. In most cases of injury, people report not properly protecting their eyes – which shows that proper precautions may prevent an eye injury.