Blood sugar checksDiabetes is often termed a silent killer. Left untreated, its pervasive nature affects kidneys, nervous system, heart, blood vessels, eyes, liver, bones, gums and teeth. Diabetes can silently damage organs as not all blood glucose spikes are detected through blood sugar tests. This can lead to development of complications without the person’s knowledge. One way to avoid these complications is through blood sugar management.Blood sugar management involves checking both the fasting and post-meal sugars. Ideally, fasting should be kept under 126 mg/dL and post-meal sugars should be ideally below 200 ml/dl. A combination of factors together helps keep blood sugar levels under control. These are:•\tOral medication•\tInsulin therapy•\tDiet•\tExerciseWhat is equally important is general awareness timing and dosage of medicines. Along with diet and exercise, overall relaxation and a healthy mental state are also crucial to manage Diabetes. Diabetes self-management educationPeople with Diabetes, who were provided with Diabetes self-management education (DSME), have more likely to prevent the complications of Diabetes and delay the progression of the disease. Diabetes self-management education (DSME) includes imparting knowledge about the disease and its progression including the complications affecting the heart, eyes, kidneys, blood circulation and the nervous system. Any of these can be prevented or delayed by maintaining good sugar control along with healthy lifestyle behaviours. It is important to constantly work on improving self-care to have a healthier life. 5 care tips • Understand Diabetes by asking your doubts and queries to your doctor or a reliable resource. Knowledge about low blood sugars and how diet, exercise, and anti-diabetes therapy affects blood sugars is of utmost importance.• It is important to have a good doctor who can be your friend, mentor and who can guide you through this long journey of Diabetes management. • You should always listen to your doctors in terms of the medication. (Do not rely on the internet or advice from non-medical people. Always listen to your doctor and follow their advice without fail). • Never underestimate the power of a good diet and the importance of having good nutritional counselling, a good nutritionist to discuss your diet with periodically. Diet counselling should be routinely repeated several times in a year and it is always good to share your problems and clarify your doubts with your nutritionist. .Self-care strategies to improve blood sugar controlHealthy eating habits Eating mostly home-cooked food with more vegetables, nuts, avoiding junk food and eating on time can help reduce blood sugar fluctuations. Physically activityBesides being active, incorporating about 45 minutes of brisk walking every day will help burn more calories. Regular monitoring of blood sugar levelsBlood sugar levels must be monitored regularly to understand any highs and lows. Regular monitoring ensures that fluctuations are caught on time and medical help can be sought to correct them.Compliance with medicationsIt is important to take oral anti-diabetic medicines and administer insulin as prescribed by the doctor.Mental health careMental health is of equal importance and should not be neglected. Psychological stressors such as stress and anxiety could worsen blood sugar control. Taking care of mental health effectively helps in keeping the blood sugar levels in the normal range. Healthy coping skillsGood night sleep of about seven hours is very important in blood sugar management. Stress management plays a very important role in maintaining our health. Risk reduction behavioursQuitting smoking and tobacco use and reducing alcohol consumption is necessary to manage sugar levels.• You should always listen to your doctors in terms of the medication. (Do not rely on the internet or advice from non-medical people. Always listen to your doctor and follow their advice without fail). • Never underestimate the power of a good diet and the importance of having good nutritional counselling, a good nutritionist to discuss your diet with periodically. Diet counselling should be routinely repeated several times in a year and it is always good to share your problems and clarify your doubts with your nutritionist. • You have to be physically active as your health would permit. New medicationRybelsus which is a new drug is basically a blockbuster medicine which has changed many things. For the first time, an effective injectable preparation has been made available orally. the oral pills but sometimes more effective than injectable. Rybelsus (semaglutide molecule) tablet is available in 7 mg or 14 mg dosage. It is a prescription medicine used along with diet and exercise to improve blood sugar in adults with Type 2 Diabetes.Improving diet The basic preambles of a diabetic diet include reducing carbohydrates, increasing fibre and protein. This key is to understand which food groups are richer in fibre and rich in protein which people with Diabetes need to eat more. It is important to identify food groups which are carbs rich and those should be avoided. Learning to distinguish between complex carbs and simple carbs is also important. A nutritionist can help people with Diabetes understand which carbs to eat and which to avoid.Exercising safely and effectively Young people with Diabetes don’t have any problems exercising and I think the more they exercise the better. But elderly people with Diabetes for over ten years need to consult their Endocrinologist and physiotherapist so that can receive advice on what type, degree and extent of exercise based on their individual health parameters. It is always advisable to slowly incrementally increase physical activity or exercise level to an extent where it is tolerated well. I would say with exercise the mantra is “the more the better”.To concludeIt is important to be aware of the many complications of Diabetes. That is a starting point. Then it is important to screen for these complications periodically. Yearly check-up of the microvascular (small blood vessels problems) and microvascular (large blood vessels problems) complications is important. Small blood vessels problems include complications associated with retina, kidney, and nerves. Large blood vessels problems include complications associated with heart, the peripheral circulations and strokes. All these things need to be screened for and people need to be given a score sheet every year which helps people with Diabetes understand the risks for these problems, what the existing problems are and what needs to be taken care.Dr Tom Babu heads the Division of Diabetes & Endocrinology at Silverline Hospital. He is one among the few certified Diabetologists & Endocrinologists in Kochi (Kerala, India). Dr Tom Babu has an MBA from Paris (ENPC). He is affiliated with the Endocrine Society of India (ESI), Research Society of Study of Diabetes in India (RSSDI).