Understanding DiabetesDiabetes is a condition in which blood sugar levels rise in abnormal proportions. When food is eaten, the carbohydrates are processed and sugar is released into the blood. This leads to a temporary rise in blood sugar levels. The pancreas releases the hormone insulin which processes the sugar in the blood, thereby bringing the blood sugar levels to a normal range. Blood sugar levels vary throughout the day according to the fasting and post-meal states. A person is diagnosed with Diabetes when his or her body fails to process the blood sugar either due to insulin deficiency or due to insulin impairment..Type 1 Diabetes is an autoimmune condition where the beta cells in the pancreas fail to produce any insulin. This leads to an absolute deficiency of insulin. This condition is also known as juvenile Diabetes as it is commonly observed in children and adolescents. People withType 1 Diabetes require insulin injections to manage their blood sugar levels. A person is diagnosed with Type 2 Diabetes if there is little production of insulin in the body or the produced insulin is incapable of processing the sugar in the blood. People with Type 2 Diabetes are often prescribed oral anti-diabetic drugs along with diet, exercise for weight loss and lifestyle modifications to manage their blood sugar levels.Blood sugar targets in DiabetesThe target level of blood sugar depends upon the duration of Diabetes, age of the person and associated co-morbid conditions. For example, if a person is60 years old and has been living with Type 2 Diabetes for 10 years, has associated high blood pressure, highcholesterol and lipid levels and has a history of heart disease, in that case, the target HbAlc (a three-month average of blood sugar levels) should be dealt with flexibility. Such people would stay healthy without adverse events with HbA 1c of 7-7.5 per cent. Any young person with no associated comorbid conditions and a short duration of Diabetes should maintain HbAlc between 6.5 to 7 per cent.In younger people, the ideal fasting blood sugar levels should be less than 100 mg/dL and postprandial blood sugar levels should be 140-160 g/dL. In elderly people with comorbid conditions, fasting blood sugar levels should be maintained between100 and 110 mg/dL and blood sugar levels two hours after a meal should be maintained between 160 and 180 mg/dL. These criteria for maintaining the blood sugar level depend upon the kind of person having Diabetes.Frequency of monitoringIn case of intensifying the dosing of insulin, blood sugar monitoring should be done daily, at least three times a day before each meal for the adjustment for the doses. If a person is on twice-daily dose of premix insulin and his or her blood sugar levels are not stable, then the person should monitor his or her blood sugar levels three times,before each meal, to adjust the dose of the insulin. Once the insulin dose has been optimized and intensified, the blood sugar levels remain stable.Eventually, once the doses have stabilized, the person may reduce the frequency of the monitoring (after consultation with a diabetologist), by checking blood sugar levels three times daily on every third day in a week.If a person is on multiple doses of insulin (three short-acting or one long-acting insulin), in that case, they should check their blood sugar levels before each insulin shot and also at 3 a.m. to see whether the person has got nocturnal hypoglycaemia. Sometimes, a person with longstanding Diabetes may have hypoglycaemia unawareness. In that case, a blood sugar reading in the middle of the night is important to avoid hypoglycaemia unawareness. .Frequent monitoring may be required for a person in the ICU setup. If a person is a medical or a surgical ICU patient and is not able to take on IV fluid or RT (Ryle's Tube) feeding or is on insulin therapy for blood sugar control, then their blood sugar levels are monitored every two hours via a glucose meter.Dietary approach to Diabetes The approach of people with Diabetes towards the diet should be very simple. It should consist of small frequent meals with high fibre and no direct sugar. It is not that a person with Diabetes cannot consume rice, potatoes or fruits. A person may eateverything in moderation depending on his or her parameters and after consultation with a physician or a dietician. For example, a person with Diabetes can eat any kind of whole fruit in a day but the total amount of carbohydrates, protein and fat should be in proportion. Also, their saturated fat consumption should be less than 10 per cent.Advancement in glucose monitoringThere has been a rapid advancement in the monitoring of the blood sugar levels, right from the glucose meter to the invasive sensors like a continuous glucose monitoring system (CGMS), which can monitor blood sugar levels throughout the day for a long period. The glucose meters which are now available are calibrated with the plasma glucose and give the exact value as that of a test done in a laboratory.People using glucose monitoring devices should be taught and educated on how to interpret their blood sugar range and how to modify the dose of the insulin.Nowadays, many glucose meters and devices offer easy report sharing features with the treating physician.These may come with a common doctor-patient platform wherein the blood sugar values could be shared in real-time or can be shared viae-mail for a detailed examination. This helps the physician and other healthcare team members to provide immediate solutions to manage changes in blood sugar levels.Time-in-rangeA continuous glucose monitoring system shows the pattern of theNowadays, many glucose meters and devices offer easy report sharing features with the treating physician.These may come with a common doctor-patient platform wherein the blood sugar values could be shared in real-time or can be shared viae-mail for a detailed examination. This helps the physician and other healthcare team members to provide immediate solutions to manage changes in blood sugar levels.blood sugar levels; whether it is rising, falling or within the range in a 24-hour schedule. Time in range refers to the duration in which the blood sugar levels remained within the targeted range.Before CGMS, self-monitoring of blood was the only source of viewing blood sugar patterns. With the advent of the CGMS, it has become easier to see how many times in a day a person's blood sugar level falls within the range, below or above the range. The criterion is that more than 70 per cent of the reading should fall within the target range, between 70 and 180 mg/dL in a normal person with Diabetes (not pregnant women). If a person has 70 per cent or more readings in range then he or she is said to have good blood sugar control, in correlation with HbAlc.HbAl c and CGMS are complementary to each other. Where HAlc provides a picture of blood sugar control over three months, time-in-range provides a microscopic view of blood sugar control in a day. Time in range helps to know how many times a person had hyperglycaemia (high bloodsugar levels), hypoglycaemia (low blood\tcounter this, the current glucose meters are sugar levels) and normal blood sugar levels.equipped with different apps which people Accordingly, one can modify his or her diet, Benefits and shortcomingsOne of the shortcomings of time in range is that not everybody can use a glucose monitoring system due to its cost. To counter this, the current glucose meters are equipped with different apps which people could use to monitor sugar five or six times a day. These apps can be accessed using a computer or a phone and the data could betransferred and shared easily. CGMS also does not give the exact value as a glucose meter or test done by drawing blood from the veins. Some sensors do not indicate very low blood sugar levels and also some of the drugs may interfere with the sensor. CGMS is also not recommended in pregnant women and people with chronic kidney disease as they may not be able to get the correct reading.To concludeFor better management of Diabetes, regular monitoring of blood sugar levels is imperative. Blood sugar monitoring is an important tool in Diabetes management, even if a person is on oral drugs or insulin. Without monitoring, it would be difficult for a person to attain the target values of blood sugar and HbAlc. One should incorporate monitoring devices as a part and parcel of their Diabetes management strategy. Even if one is checking sugar levels once a day or three times a week, something is better than nothing. It might help one to keep blood sugar levels under control and avoid hypoglycaemia.