November 14 is World Diabetes Day.
According to the Madras Diabetes Research Foundation, in India, the number of diabetics rose from 50.8 million in 2010 to 62.4 million in 2011. So millions of Indians cope with diabetes on a daily basis and, while some of these diabetic patients may require medications, all will need to make changes in their lifestyle. Though the changes in diet and activity may vary from person to person, planning and routine are essential to successfully managing the diabetic condition.
Living with diabetes becomes stress-free once a systematic approach to taking medications, dietary restrictions, regular physical activity and blood glucose monitoring is established. Controlling diabetes is often a lifetime task that requires a combination of personal determination, medical assistance, friends and family, support groups and online tools.
Medications: Diabetes treatment may require a combination of medications.
- They work by acting as Insulin substitutes (e.g. Insulin Detemir), increasing insulin production (e.g. glibenclamide) or reducing sugar released by the liver to more adequately use the body’s lower-than-normally available insulin (e.g. Metformin).
- All medications have a specific regimen, in terms of time and dose, tailored to a patient’s needs which should be followed strictly.
- Many diabetes medications have been linked to harmful side-effects and hence a patient (under specialist supervision) could consider alternative medical treatments such as herbal drugs, acupuncture or home remedies.
- Indian scientists are researching an anti-diabetic oral vaccine.
Dietary Changes: Modifying food habits is important to control blood sugar levels as well as other existing or potential health conditions such as obesity, high blood pressure and high cholesterol. Here are a few tips for a step-by-step process for long-lasting benefits:
- Understand your current eating habits
- Start by recording eating habits – what, how much and when eaten
- Identify portion sizes e.g. teaspoon (5ml) vs. tablespoon (15ml); grams vs. cup (150grams rice = 1 cup; 150grams dal = ¾ cup)
- Begin with small changes in the diet that help you determine the “right” amount of carbohydrates
- Portion control plus medication(s) often effectively keep blood glucose levels in the normal range
- Involve family and friends to plan meals and identify food substitutes
- Adapt or suggest diabetic friendly recipes so that you can have the same meals as family and friends
- Example: Suggest/request whole grain bread instead of white bread, roti rather than naan, herbs for additional flavour rather than high-salt and sugar condiments such as ketchup
- Consult a nutritionist who will draw up a personalized diet plan for you based on additional dietary and lifestyle restrictions
- Example: vegetarian vs. non-vegetarian; options for on-the-go lifestyle
- Besides carbohydrates, fat and salt intake should be reduced
- To manage or reduce possibility of high cholesterol or blood pressure
- In the case of school-going children, the school should be informed about the child’s diabetic condition
- May require special treatment such as extra breaks for medications and additional meals
Regular Physical Activity: Exercise is key to controlling blood glucose levels.
- 30-60 min daily physical activity is recommended
- Testing blood glucose before and after exercise will help to develop a customized workout
- Some general guidelines are:
- Exercise 1-3 hours after meals
- Testing before exercise
- Blood glucose level should be at least 90 mg/dL
- Eat a small snack before exercising, if blood glucose level < 90mg/dL (may cause hypoglycaemia)
- Avoid exercise if blood glucose level > 240 mg/dL (may cause ketosis)
- Before initiating a new or modified physical activity routine
- Consult your doctor or fitness expert about the type of physical activity needed to manage diabetes
- Request friends and family for help to jump-start and/or maintain regular activity
- Increase physical activity by being more active throughout the day
- Example: Take the stairs instead of using elevators or walk instead of driving to the neighbourhood store
Weight Management: Modifications in diet and physical activity to maintain blood glucose levels have an added bonus of reducing the weight of an overweight or obese patient. This in turn reduces the risk of high blood pressure, high cholesterol, heart disease and stroke in such patients.
Monitoring Blood Glucose and Diabetic Complications: Diabetes testing is important for real-time information regarding the status of your condition.
- Organize your work and home activities to allow time-appropriate tests
- Daily, multiple blood glucose check-ups
- Self-testing, at home, can be done with easy-to-use devices
- Set reminders for tests during the day or lab appointments
- Follow your doctor’s instructions for test frequency and target ranges
- A fasting test plus tests after medications, meals and exercise are recommended
- Test before sleeping, blood glucose levels should be between 100-140mg/dL at bedtime
- Medication dosage may need adjusting based on major changes in eating, sleeping or exercise habits as well as illness and stress
- A quarterly A1c test is recommended to determine long-term changes in blood glucose levels
- Regular blood pressure and blood cholesterol check-ups: Hypertension and high blood cholesterol are often complications of diabetes
- Regular eye check-ups: Diabetic retinopathy is a complication of diabetes
- Optic nerve damage leads to paralysis of eye movement muscles resulting in double vision
- Check your feet often: Diabetic foot damage is a serious complication
- Diabetes restricts blood supply to the feet and a loss of feeling that reduces injury awareness as well as healing capacity of the injuries. Serious foot infection causes gangrene and eventually, amputation
Other times to plan for the diabetic condition
- Before travelling, make adequate preparations for diet, medicines, insurance and doctor’s permission to carry insulin, syringes or other injection devices.
- Before and during pregnancy, understand the higher risks of complications including stillbirth, premature birth or a large baby. Follow the special instructions and additional tests required for a safe pregnancy and childbirth.
Rewards beyond Diabetes Control: Managing diabetes is a reward in itself but there are other benefits as well.
- Controlling the diabetic condition significantly reduces the risk of developing high blood pressure, high cholesterol, heart diseases, stroke, kidney failure and eye damage.
The key message here is that a personalized balance between (reduced) carbohydrate intake, insulin and (increased) physical activity is required to maintain healthy blood glucose (sugar) levels and live in harmony with diabetes.
Learn more about living with diabetes at: