Diabetes - the desi versionSixty-eight million Indians have Diabetes! As this number is fast growing, India has gained the unenviable reputation of being referred to as the Diabetes capital of the world. This number is expected to double by 2040. Another 77 million people are suspected to be prediabetic. Fifty per cent of people who have Diabetes in India remain undiagnosed bringing Diabetes related deaths in India each year to over 1 million.Increasing numbers of people with Diabetes indicates a lack of awareness regarding its causes, symptoms and management. It is of utmost importance to understand Diabetes in order to disperse of its myths, misinformation and misconception like Diabetes only occurs later in life and is caused by eating too many sweets. Many people try untested and unproven treatments, leading to problems later on. If you know Diabetes only then can you say 'NO' to Diabetes. Early diagnosis and treatment can arrest the spread of this epidemic.This article will help you understand the whys and how's of Diabetes. Armed with this knowledge, you will be able to take control of your life and defeat Diabetes.Diabetes explainedGaining knowledge about Diabetes is a means to check and verify your knowledge about Diabetes. Understanding the underlying facets of Diabetes is crucial to successfully manage it. People with Diabetes should check their knowledge about Diabetes and its complications, correct any misinformation and using this knowledge in their daily life can prevent or manage the adverse outcomes tied with Diabetes.Here is a list of simple questions that will help you check your awareness about Diabetes and aid you in understanding Diabetes. Do take time to answer the questions on your own first. You can crosscheck your answers with the in-depth answers provided below. The more questions you can answer correctly, the higher is your awareness about Diabetes!. How do I know I have Diabetes?. How many types of Diabetes are there?. How and when should I check my blood glucose levels? .. Is there any symptom to indicate high or low blood glucose levels?. What happens if Diabetes is untreated?. Is there a perfect diabetic diet?. Which exercises are ideal to control Diabetes?. Which is better - injection or pills - to manage Diabetes?. Should I use gadgets for my insulin treatment?. Should I tell people I have Diabetes?. Can Diabetes be cured?The Diabetes Health team has sought to explain why these questions matter and knowing their answers is crucial to your continued well-being.How do I know I have Diabetes?As we all know that Diabetes is correctly diagnosed through a blood test. But did .you know that there are four different methods through which blood is tested to detect Diabetes? These methods are:Fasting blood glucose requires blood to be taken in the morning, on an empty stomach. A level of 126 mg/dL or above, on more than one occasion, indicates Diabetes.Random glucose blood test can be done anytime during the day, without fasting. A glucose level of 200 mg/dL and above may suggest Diabetes.Note: If a casual glucose level equals to 200mg/dL then you may be asked to do an oral glucose tolerance test.Oral glucose tolerance test (OGTT) assesses how well your body breaks down glucose. You need to fast for 8 hours before the test is carried out. Also, you cannot eat anything during the test. You will be asked to take a liquid containing 75 g of glucose, following which blood samples will collected after one, two or three hours (if needed) after ingesting the solution. The results are as follows:. Normal response: If your two-hour glucose level is less than 140 mg/dL and all values between 0 and 2 hours are less than 200 mg/dL.. Diabetes: You will be diagnosed with Diabetes when two diagnostic tests done on different days show that the blood glucose level is high. This implies that either the two-hour level is greater than 200 mg/dL or the fasting blood glucose level is greater than 126 mg/dL.HbA1c checks your blood glucose levels over the past three months. A value > 6.5 per cent confirms the diagnosis of Diabetes. In addition, it also indicates that you have been suffering from high blood glucose levels for the past three months.How many types of Diabetes are there?There are two main types of Diabetes Mellitus:Type 1 Diabetes is a condition in which the body's own cells destroy the beta cells (responsible for insulin production) of the pancreas, as a result of which the body is devoid of insulin. In such cases, the only treatment option is taking insulin injections. This type of Diabetes is usually seen in young adults and children. Having a family member with Type 1 Diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing Type 1 DiabetesType 2 Diabetes is a condition that begins with insulin resistance (the cells fail to respond to normal levels of insulin). As the disease progresses there is deficiency of insulin to meet the body's requirement.Family history of Diabetes, being overweight, unhealthy diet, physical inactivity, high blood pressure and ethnicity increases the risk of onset of Diabetes.Gestational Diabetes is seen in pregnancy. The pregnant women experience high blood glucose levels often in the second and third trimester of pregnancy. The sugar levels usually return to normal after a delivery, however, it puts the mother as well as the baby at high risk of developing Diabetes later in life. Pregnant women who are overweight, have been diagnosed with impaired glucose tolerance, have a family history of Diabetes, previously diagnosed with gestational Diabetes increases the risk of developing gestational Diabetes.How and when should I check my blood glucose levels?Blood glucose monitoring can help you understand the link between blood glucose, food, exercise and insulin. Regular testing and recording of your blood glucose level can reinforce your healthy lifestyle choices as well as inform you of your response to other choices and influences..What targets should you aim for?Normal blood glucose levels are between 72-140 mg/dL.If you do not have Diabetes, then your normal target range should be:. Fasting: <100 mg/dL. Before meals: <110 mg/dL. Two hours after a meal: <140 mg/dL. Hba1c: <5.7 per centIf you have Type 1 Diabetes, your target range should be. Before meals: 72-106 mg/dL. Two hours after a meal: 72-145 mg/dLIf you have Type 2 Diabetes, your target range should be. Before meals: 106-145 mg/dL. Two hours after a meal: 145-180 mg/dL. Hba1c: <7 per centNote: Target ranges may differ depending on age, duration of Diabetes, medication and existing medical problems. Do discuss your individual target range with your doctor. .Home monitoringThere are a variety of easy-to-use home monitors which patients can use to test their blood glucose levels. If you are managing Diabetes with the help of a home monitor, be sure to learn what results are too high and too low for you. Consult with your health care provider to learn what to do when your results are outside the desired target range..In the pathology laboratoryFasting blood glucose, random glucose blood test, oral glucose tolerance test and HbA1c conducted in the pathology laboratory are recommended to monitor blood glucose levels..Is there any symptom to indicate high or low blood glucose levels?Hyperglycaemia (high blood glucose level; blood glucose level >200mg/dL)Hyperglycaemia occurs when there is insufficient insulin or oral Diabetes medication. This may occur because insulin has not been injected properly or expired insulin has been used or meal plans have been ignored or physical inactivity.Symptoms of hyperglycaemia include blurred vision, dry and itchy skin, weight loss, increase in appetite and thirst. If untreated, hyperglycaemia can cause toxic acids (ketones) to build up in your blood and urine.Hypoglycaemia (low blood glucose is defined as a blood glucose level <70 mg/dL)Hypoglycaemia is caused by missing a meal or insufficient intake of food, increased physical activity, intake of alcoholic beverages and unnecessary high medication. Severe hypoglycaemia can cause loss of consciousness, convulsions and can be life-threatening if not treated promptly. Consuming glucose provides relief from symptoms of hypoglycaemia. Eating or drinking 15 grams of a fast-acting carbohydrate like three tablespoon glucose powder or three to four glucose tablets or four to six pieces of hard candy or 1/2 cup fruit juice is recommended to manage hypoglycaemia. Administering a glucagon injection or getting admitted to a hospital may be required in case of severe hypoglycaemia.Hypoglycaemia can be prevented by eating on time, checking blood glucose level before, during and after your exercise workout, regular check-ups with your diabetologist and taking extra care with regards to medication and diet during illness.You need to visit the doctor at the earliest if your blood glucose levels are:. <70 mg/dL you are suffering from the low blood glucose (hypoglycaemia). >200 mg/dL indicates that you are suffering from high blood glucose levels (hyperglycaemia)If you have trouble keeping your blood glucose within the desired range, schedule an appointment with your doctor. They will guide you better on what modifications you need to make to your medications, diet and exercise. What happens if Diabetes is left untreated?If Diabetes is left untreated, it could lead to some serious health complications like:Heart diseases. Nerve damage (neuropathy). Kidney damage (diabetic nephropathy) or kidney failure. Damage to the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Clouding of the normally clear lens of your eye (cataract). Feet problems caused by damaged nerves or poor blood flow that can lead to serious infections, and in some severe cases, amputation. Bone and joint problems. Skin problems, including bacterial infections, fungal infections and non- healing woundsTeeth and gum infections If blood glucose rises high enough or for a prolonged period of time, it can lead to two serious conditions:Diabetic ketoacidosis - Diabetic ketoacidosis develops when you don't have enough insulin in your body. Your blood glucose level rises and your body begins to break down fat for energy. This process produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually "spill over" into the urine. Left untreated, diabetic ketoacidosis can lead to a diabetic coma and be life-threatening.Hyperglycaemic hyperosmolar syndrome - This condition occurs when people produce insulin, but it doesn't work properly. Because insulin is present but not working properly, the body can't use either glucose or fat for energy. Glucose is then spilled into the urine, causing increased urination. Left untreated, diabetic hyperglycaemic hyperosmolar syndrome can lead to life- threatening dehydration and a coma..A check list of test that help diagnose complications associated with Diabetes. A-1-C blood glucose test (indicates average blood glucose levels over the last 3 months). Blood pressure and weight check (at every office visit). Lipid profile test which measures cholesterols in your blood (once a year). An ECG is also recommended. This helps rule out heart disease.. Liver function tests (LFT):. Urine for microalbuminuria: detects early kidney disease (once a year). Blood urea, serum creatinine: detects early kidney disease (once a year)• Complete foot exam to check for calluses, reduced blood flow and loss of feeling in your feet (a complete exam once a year, a brief foot exam during every visit). Eye check-up: diagnose early diabetic retinopathy by checking the health of the blood vessels inside your eye (once a year).Is there a perfect diabetic diet?Eating a well balanced diet with a variety of foods at each meal can help you create a Diabetes friendly diet which works for you.For example, there is no limit on vegetables and green salads you can consume. These foods are filling, nutritious, and raise blood glucose very little. Also, be sure to include moderate amounts of low-fat protein.Proteins help to control hunger between meals.It is important to limit your intake of fat, especially animal fat. Fat does not raise blood glucose, but can make you overweight. Excess body weight can raise blood glucose. A high-fat diet also increases your risk of heart disease.It is necessary to limit your alcohol intake. Drink alcohol only with your health care provider's approval. Never drink alcohol on an empty stomach as it can interfere with some Diabetes medications and insulin and put you at risk for low sugar levels.A low-sodium diet may help to control your blood pressure. Be aware of foods with high sodium content such as canned goods, cured or pickled foods and seasonings (soy sauce, garlic salt). The American Heart Association recommends having less than 2300 mg of sodium total per day.Which exercises are ideal to control Diabetes?Many kinds of physical activity can help you take care of your Diabetes. Even small amounts of physical activity can help.Doctors suggest that you aim for 30-60 minutes of moderate to vigorous physical activity most days of the week. Children and adolescents with Type 2 Diabetes who are 10-17 years old should aim for 60 minutes of moderate to vigorous activity every day.Aerobic Exercise - uses large muscles, makes your heart beat faster, and makes you breathe harder. Doing moderate to vigorous aerobic exercise for 30 to 60 minutes a day most days of the week provides many benefits. You can even split up these minutes into several parts.Strength training - is a light to moderate physical activity that builds muscle and keeps your bones healthy. When you have more muscle and less fat, you'll burn more calories because muscle burns more calories than fat, even between exercise sessions. Burning more calories can help you lose and keep off weight. You can do strength training with hand weights, elastic bands, or weight machines two to three times a week. Start with a light weight and slowly increase the size of your weights as your muscles become stronger.Stretching Exercises - are a light to moderate physical activity. For example, yoga is a type of stretching that focuses on your breathing and helps you relax. Your health care team can suggest whether yoga is right for you. Even if you have problems moving or balancing, certain types of yoga can help. When you stretch, you increase your flexibility, lower your stress, and help prevent sore muscles.Note: Your health care team can help you decide the best time of day for you to do physical activity based on your daily schedule, healthy eating plan, and Diabetes medicines. If you have Type 1 Diabetes, try not to do vigorous physical activity when you have ketones in your blood or urine. If you are physically active when you have ketones in your blood or urine, your blood glucose levels may go even higher. Light or moderate physical activity can help lower blood glucose if you have Type 2 Diabetes and you don't have ketones. Ketones are rare in people with Type 2 Diabetes. Ask your health care team whether you should be physically active when your blood glucose levels are high..Which is better - injection or pills - to manage Diabetes?Some medications reduce the amount of sugar produced by the body; some improve sensitivity to insulin; and some stimulate the pancreas to produce as much insulin as possible. Eventually, when the oral medications (combined with diet and exercise) are unable to do the job, insulin is added to the treatment. Switching to insulin doesn't mean you've done anything wrong, or that your earlier treatments have failed. Type 2 Diabetes is a progressive disease, and it usually requires a progression of treatments to keep it under control. When you go on insulin, you absolutely have to know what you're doing. Giving yourself either too much or too little insulin can be very dangerous. Fortunately, with modern- day blood glucose monitors and carb counting, most people learn how to adjust their insulin dose very easily.The benefit is that insulin lowers blood glucose directly by causing the body's cells to absorb glucose from the bloodstream, oral medications work indirectly. Also, the side effects caused by oral medications are more in number compared to insulin. Even people who are very reluctant to start taking insulin quickly learn to make it part of their routine, You can do this! It's not as bad as you think. And it is absolutely essential for the maintenance of your good health. .Should I use gadgets for my insulin treatment?There is a vast array of Diabetes technology products available including insulin pumps, insulin pens, blood glucose meters and continuous glucose monitoring devices with new features such as colourful touch screens, smartphone integration and easy information sharing.You may experience fear of what can go wrong. You have to realize that new technology is not perfect and neither is the person using it. Be prepared to do some troubleshooting and understand that Diabetes management is often a series of trial and error. There will be times that despite your best efforts, things will go wrong. The key is to be prepared, always have back-up supplies, and learn from your experiencesWhen using any new technology, your motivation is experiencing better blood glucose control and ultimately fewer complications. You can accomplish this by incorporating the new technology as just another step in the Diabetes routine, take breaks if the management is overwhelming and talk to others using the technology to gain knowledge and get support. In conclusion, when using new technology keep an open mind, get the training you need, try the device and know that you can always return to insulin shots if it's not working with your lifestyle. On the other hand, it may help tremendously and make you a healthier person..Should I tell people I have Diabetes?For most people, it's a new way of life and it affects relationships in all areas as much as it affects eating and physical activity.Diabetes management requires strict adherence to a self-care regimen, including blood glucose testing, medication, diet and exercise. This often challenges people with Diabetes and those who care for them, potentially affecting interpersonal relationships and indirectly affecting glucose control.People with Diabetes should ideally let their family; friends and colleagues know about their diagnosis. They should also explain signs and symptoms of hypoglycaemia so as to avoid life threatening lowering of blood glucose levels. It is important for your diagnosis to be known especially if you require to undergo an emergency medical procedure. In such an instance, your friends and family knowing your medical history and what medication you are on can be potentially lifesaving. Family and friends can help people with Diabetes follow their prescribed diet. Your family and friends play an important role to help you stay strong emotionally which is the key to keeping stress and blood glucose levels under control where they belong.Is there a cure for Diabetes?There is no cure for Diabetes. Neither Type 1 (juvenile onset or insulin-requiring) Diabetes nor Type 2 (adult-onset) Diabetes ever goes away. If the patient were to gain weight back or scale back on their physical activity program, high blood glucose levels would return. If they were to overeat at a meal, their blood glucose probably would continue to go higher than someone without Diabetes. Also, the decreased insulin production and/or increased insulin resistance that led to the initial Diabetes diagnosis will gradually intensify over the years and during periods of stress. In time, the patient who could maintain normal blood glucose with diet and exercise alone may discover that he or she needs to add oral Diabetes medications - or perhaps even insulin injections - to keep blood glucose in a healthy range.The good news for a Type 1 and Type 2 patient is that if insulin, medication, weight loss, physical activity and changes in eating result in normal blood glucose that means their Diabetes is well controlled and their risk of developing Diabetes complications is much lower. But it doesn't mean that their Diabetes has gone away.RECORD ALL YOUR READINGSAction steps if you take insulin:Keep a daily record of your blood glucose levels. the times of day you take insulin. the amount and type of insulin you take. what types of physical activity you do and for how long. when and what you eat. whether you have ketones in your blood or urine. when you are sickAction steps if you don't take insulin:. Keep a daily record of your blood glucose levels. the times of day you take your medicines. what types of physical activity you do and for how long.Bariatric surgeryweight loss surgery makes a big difference to people with Type 2 Diabetes. For some people, blood glucose levels get back to normal a few days after surgery, which implies that the person may require less medication or none at all. Nearly all individuals who have bariatric surgery show improvement in their diabetic state.While bariatric surgery certainly has some risk, the long-term risk of continued Diabetes (which is often inadequately treated with medication) typically outweighs the risk of a surgical procedure for most patients. Each patient's individual risks for surgery, though, should be evaluated in the context of the duration and severity of their Diabetes as well as their other obesity- related health problems. The best way to keep the weight off after surgery is to stick to your diet and exercise. You will have to work closely with your Diabetes health care team to that you can enjoy the benefits of the surgery, else you may land up gaining weight and being back to where you started from.Low calorie dietStudies have shown that substantial weight loss can be achieved through low calorie diet. A study published in Diabetes Care showed that Type 2 Diabetes is potentially reversible via an 8-week, very low-calorie diet followed by careful weight management for up to 6 months. The fact that a low-calorie diet can reverse Diabetes is something we've known a long time. The key issue here is not whether weight loss can actually reverse Diabetes or put it into remission but the durability of the effect. It's a proof-of-principle study showing that if you lose weight through a diet, there's a good chance your Diabetes will go into remission. But by the same note, if you put the weight back on, your Diabetes is going to come back. Many more trials are being conducted to check the durability of this principle. But the fact remains that despite the weight loss and your Diabetes going in remission, you have to work extra hard to maintain your diet and exercise, else you will bounce back to your original condition..To concludeIt is very common to feel sad, overwhelmed or angry when you are living with Diabetes. Managing your Diabetes, making changes and fitting the demands of Diabetes into your lifestyle can be challenging at times.But you must remember that effective Diabetes management can only be achieved through working closely with your Diabetes health care team. Although they are there to support you, you are the key player as the decision you make will affect you in the long-term. It is not an easy task at the same time it's not impossible. You have to make conscious efforts to make healthy food choices, keep your weight within a healthy range, exercise every day and take medicines even if you feel good. It's a lot to do, but it's worth it! Taking care of yourself and your Diabetes can help you feel good today and in the future.
