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5StepstoControlHighBloodSugar2007,Dr.AnjaliAroraISBN978-81-207-3243-8

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Title

Diabetesorhighbloodsugarisadiseasethatoccursifthereisadisorderincertainbodyfunctionsthatutilisecarbohydrates,fatsandproteinsinthefoodtoproduceenergy.Lackofahormonecalledinsulinorinadequateproductionofinsulinbythepancreasresultsinthisdisease.Insulinregulatestheamountofsugarintheblood.Animbalanceintheamountofinsulinproducedcanleadtotheonsetofdiabetesmellitus.

01.TestYourselfForDiabetes

Yes No HungerandThirst

Youareoftenverythirsty. Youfeelhungryallthetime.

Yes No HealthProblems

Youhaveanitchyskinorskinproblems. Youoftendevelopboils. Yourinjuriestakealongtimetoheal. Youoftengetlegpainandcramps.

Yes No UrinaryProblems

Youhavetopassurineoftenintheday. Yougetupatnighttopassurine. Youfrequentlydevelopurinaryinfections.

Yes No GeneralSymptoms

Thereisnumbnessoratinglingsensationinyourfeetorhands. Youhavelostweightrecentlywithoutmakinganeffort. Youfeeltiredandweak. Youareverynauseous.

Yes No OtherRiskFactors

Youhaveafamilyhistoryofdiabetes.

Youareoverweight.

The more times you answer yes to the above statements, the greater you are at the risk ofdevelopingdiabetesmellitus.

02.UnderstandDiabetesMellitus01.WhatIsDiabetes?

Diabetesmellitusmeans honey sweet.Diabetesoccurs due to the inability of thebody to convertfoodintoenergy.Itisaconditionwherewehavehighbloodsugar(glucose)levelsinourbody.Itisachronicdisease,whichcanbemanagedwellthroughproperguidance.

02.TheInsulinFactor

Normallyourbodyconvertsthefoodweeatintosugarorglucose,whichisusedfortheproductionof energy. This is done by the pancreas, an organ lying near the stomach. The pancreasmakes ahormone called insulin, which attaches itself to the receptors on the cell wall, thereby allowingglucose

toenterthecells.Itactsasthekey,unlockingthereceptorsforglucosetoenterthecells.Thecellsthenmetabolisetheglucosetogiveenergytothebody.

03.InsulinResistance

The pancreas makes enough insulin, but due to certain factors, the insulin is not effective intransferring glucose from the blood into the cells of the body. Such a disorder is referred to asinsulinresistance.

Factorsinvolvedcanbe:

Thenumberofreceptorsoneachcellbecomeslowerthannormal.

Insulinisnotabletoattachitselftothereceptor.

Insulinproducedmaybedefective.

Withthepassageoftime,thecapacityofthepancreastoproduceinsulindeclines.

04.TypesOfDiabetes

TypeIDiabetes

TypeIdiabetesisasevereformofdisease.It isanauto-immunedisease,whichmostlydevelopsinchildhoodorinadultsunder30yearsofage.(Auto-immuneiswhenthebodysimmunesystemstartsdestroying itself) Juvenile diabetes develops in childhood and must be treated with insulin. Itaccountsfor5-10%ofdiabeticsintheworld.Insidethepancreasarecellclustersknownasthe

isletsoflangerhans.Thereareseveraltypeofisletcellsincludingalphacellsandbetacells.Insulinisproducedbybetacells.On increaseof sugar in theblood, thesecellsmanufacture insulinand thenreleaseitintothebloodstream.Theroleofthesecellsistomonitorlevelsofbloodsugar.InpeoplewithType I diabetes, beta cells are attacked by the immune system and are destroyed slowly.Whatexactly causes the immune system to get affected is still based on a number of theories. Theunfortunate part is that, though this slowdestruction takes placeover a numberof years (5-7), thesymptoms of diabetes mellitus do not surface until about 80% of these beta cells are destroyed.Eventually,insulinproductioncomestoahaltasnobetacellsremain.

Isletsoflangerhans

TheoriesontheDevelopmentofTypeIDiabetes

Genetic Predisposition : Genetic predisposition determines entirely whether a person willdevelop immune reactivity against insulin producing -cells in the pancreas. Howeverenvironmental factorsand infectionscanhaveamajor impactonwhetherType-Idiabeteswillmanifest itself clinically. This occurs after 80-90% of the -cells have been destroyed. Theremnants of -cells are transported to the pancreatic draining lymphnode (PDLN),where theensuing auto immune is thought to be coordinated. Debris from the -cells is picked up byAntigen- Presenting Cells (APC) and displayed to immune cells called lymphocytes (L)promptingthemeithertokill-cellsortosignalfurtherimmunereponses.

InTypeIdiabetes,thebodylosestheabilitytomakeinsulin,astheimmunesystemdestroystheinsulin-producingcells.When insulin is not available, the glucose remains in the bloodstream and cannot be used asenergy.ApersonhavingTypeIdiabeteshastotakeinsulininjectionstostayalive.

VirusInfectionColdWeather

TheThriftyGeneTheory

This theorywasproposedbyJ.A.Neel in1962. Itsuggested thereasonas towhyIndianssufferedfrom a disproportionate high rate of Type II diabetes. According to him, Indians lived a huntergatherer existence for centuries. For their survival, they developed a genewhich allowed them tosurvive the cycles of feast and famine. Their metabolism was adequate in itself in both theseconditions,itutilisedthecaloriesefficiently.Withanunstablefoodsupply,theirsurvivalwasbetterastheycouldsomehowstoresurplusenergy(intheformoffat)duringthetimeoffeast.Thisfatwasprobably stored as abdominal fat and utilised during famines.Exposing this gene to abundance offoodcontinuouslyinthepresentenvironmentinalllikelihoodisprovingtobedetrimental.

DiabeticKetoacidosis

KetoacidosisdevelopsmainlyinpeoplewithTypeIdiabetes.Thisdiseaseistheresultofpersistentlyhighlevelsofbloodsugar(hyperglycaemia).Bloodsugarbuildsupinthebodyasyourcellscannotabsorbglucoseforenergy.Theglucosenotavailabletothebody,startsburningbodyfatasfuel,thusproducing waste products called ketones. This accumulation of ketones in the blood is known asketosis. When these ketone bodies are excreted in the urine the process is called ketonuria. Theincreaseofketones in thebodyoveracourseof somedays leads to fluidbeingdepleted from thebodyintheformofurine.ThisresultsindehydrationleadingtothepHofthebloodbecomingacidic.Theprocessofketoacidosissets in.Unrecognisedanduntreatedketoacidosiscan lead tocomaanddeath.

SymptomsofKetoacidosis

FrequenturinationGreatthirstNauseaandvomitingBlurredvisionDrowsinessanddisorientation

ToDetectKetoacidosis

Ifyourbloodsugarlevelsareover200mg/dlfortwoconsecutivetests,testyoururineforketones.Ketonesalsoknownasacetonescanbedetectedintheurinebytheacetonetest.

KetoacidosisandComa

Ifapersongoes intocomaduetoketoacidosis, it isaserioussituation.Mildketoacidosisdoesnotlead tocoma. It isonlywhen theketonebodiesarepresentaboveacertain level thatcomaoccurs.Anyofthesymptomsmentionedaboveandthepresenceofketonesintheurineareanindicationofadministeringinsulinwhenbloodsugarishigh.

TypeII

TypeIIdiabetesisoftencallednoninsulindependentdiabetesmellitus.Thistypeofdiabetesdevelopsinadulthood.Itdevelopsduetolessproductionofinsulinorineffectiveuseofinsulin.Thisformofdiabetesispresentin90-95%ofdiabeticsintheworld.WomenduringtheirpregnancycandevelopaformofTypeIIdiabetescalledgestationaldiabetes.40%ofwomenwithgestationaldiabetesduringpregnancydevelopTypeIIdiabeteswithinfouryears.

HumanFoetus

ImpairedGlucoseTolerance

Impairedglucosetoleranceisa termwhenbloodsugar levelsarehigher thannormal,butnothighenough to be diagnosed as diabetes mellitus. This impairment is indicated by a fasting glucosereadingrangingbetween100and130mg/dl.Thesymptomsrelatingtodiabetesmellitusarenormallyabsent.Ifapersonreduceshisriskfactors,hisimpairedglucosetolerancemayimprove.

Bloodsugarlevelthereforemaybecomenormalorstabilise.Somepeoplewithimpairedglucosetolerancemaygoontodevelopdiabetes.

05.FactorsCausingHighBloodSugar(Hyperglycaemia)

FactorsCausingHighBloodSugar(Hyperglycaemia)

Eating foodcontainingsimplesugarswhichare rapidlyabsorbedby thebody,e.g. sweets, icecreamsandpastries.Drinkingsweetenedbeveragessuchascarbonateddrinksandjuices.

Sedentarylifestylenotburningtheconsumedsugar,carbohydratesandotherproducts.Notenoughadministrationofinsulinorothermedication.Physicalstress(e.g.infections,flu).Psychologicalstress

06.FactorsCausingLowBloodSugar(Hypoglycaemia)

Skippingordelayingameal.Takingtoomuchofinsulinordiabeticmedication.Nottakingenoughcarbohydratesinameal.Suddenincreaseinexercise.

03.MeasureYourRiskMeasureYourRisk

Afewsimpletestscanhelpdeterminewhetheryouhavediabetes.

01.TheVenousSampleTest

This is done in the laboratory. It can be of four types: fasting (F), postprandial (PP), glycosylatedhaemoglobinandoralglucosetolerancetest(GTT).Exceptforpostprandial,alltheothertestsshouldbedone12hoursafteranovernightfast,withoutevenacupoftea.

Fasting:Thenormalfastingbloodsugarlevelislessthan100mg/dl.Ifyourreadingishigherthanthis,adiagnosisindicativeofdevelopingdiabetesismade.

Postprandial:The postprandial is conducted 2 hours after a heavymeal or after taking75gmofglucose.Areadingofover130mg/dlalongwithotherpositivetests,isindicativeofdiabetes.

GlycosylatedHaemoglobinTest:HbA1c isameasurement toassess the levelofyourbloodsugaroverthepast120days.AnHbA1creadingofover6.1%issuggestiveofdiabetes.

OralGlucoseToleranceTest:Afterfastingovernight,youaregivenwaterwith75gmsugar(inawater-sugar solution). Your blood glucose levels are tested over a 24-hour period. In a diabetic

person, blood glucose levels rise higher than normal and do not fall as quickly. A normal bloodglucosereading, twohoursafterdrinkingthesolution,shouldbe less than130mg/dl.Allreadingsbetweenzerototwohoursshouldbelessthan200mg/dl.Inadditiontothese,arandombloodsugarreadingcanbetakenanytime.Areadingofabove140mg/dlcanbeindicativeofdiabetes.

02.TheSingleStickBloodGlcoseTest

Thefingerisprickedwithaneedle.Thebloodsampleisplacedonastrip.Thestripisthenplacedintheslotoftheglucometermachine,whichassessesyourbloodsugarlevel.Thismethodistobeusedonly tomonitoryourbloodsugar levelsathome.It isnotcompletelyreliable,soavenoussampleshouldalsobeassessedinthelaboratoryasguidedbyyourdoctor.

03.UrineTest

Youmayalsobeadvisedbyyourdoctortogetaroutinesampleofurinetestedforalbumin,sugarandmicroalbuminurea.

04.ScreeningForDiabetes

Thisshouldbedoneat30yearsofage.Ifahistoryofheartattack,strokeordiabetesprevailsinthefamily, then a blood sugar test should be done along with a lipid profile at 20 years of age todeterminethepersonsbaselinelevel.Thetestscanberepeatedevery3yearsifnormal.Ifabnormalorborderline,testsshouldberepeatedannuallyorasyourdoctoradvises.

06.RiskFactorsForDevelopingTypeIIDiabetes

ApersonhavingaparentorsiblingwithTypeIIdiabetes.Ifapersonisoverweightorhashighbloodpressure,heorsheisatagreaterriskofdevelopingdiabetes.Apersonhavinghigh levelsofcholesteroland triglycerides isatagreater riskofdevelopingdiabetes.Withdiabetesandabnormalfatlevels,apersonincreasestheriskofheartdiseaseuptofourtimesincomparisonwiththegeneralpopulation.

Apersonhavingasedentarylifestylehasgreaterchancesofdevelopingdiabetes.Thisriskcanbereducedbyexercisingregularly.Awomandeliveringababyweighingover9lbs(approx.4kg)hasatendencytodevelopTypeIIdiabetes.If a persons blood sugar levels are regularly above normal then he or she is becoming aprediabeticandwillprobablybecomeadiabeticwithin10years.Continuousstressistodayknowntobeapredisposingfactorfordevelopingdiabetesmellitus.AfamilyhistoryofTypeIIdiabetes(particularlyinafirst-degreerelative)inpresenceofotherriskfactorscanprecipitatethedevelopmentofdiabetes.Ethnicgroups(AsianorAfro-Caribbean)aremorepronetodevelopdiabetes.Previous history of gestational diabetes or previous diagnosis of impaired glucose tolerance,canbothleadtothedevelopmentofdiabetesmellitus.

07.DiabetesMellitusAndObesity

Overweightandobesepeoplekeepproducingthehormoneinsulin,butitcannotactappropriately.Anobesepersonhavingahighcarbohydrateintakeputsastrainonthebodysglucosemetabolism.Also,obesity reduces the insulin receptorson the surfaceof thecells.As theuptakeof insulin is lessbyfewerreceptors,thebodyssensitivitytotheinsulinisreduced.Cells(mainlyfatormuscle)requiringglucose,cannotgetitfromtheblood.Thereisafamineinthemidstofplenty,resultingindiabetes.Inresponse to the high blood sugar present, the pancreas works more to produce more insulin.Eventually,thisconstantpumpingofthepancreasexhauststhepancreaticbetacells.Insulinsecretionfromthepancreasstartsbecominginadequateandoverweightpeoplebecomediabetic.

08.DiabetesMellitusAndLDLOxidation

Indiabetesmellitus,LDLisglycosylatedbytheprocessofglycosylation,i.e.attachmentofsugartoLDL-C. This modified LDL-C makes it stick to the arteries, thus enhancing the process ofatherosclerosisandheartdisease.

09.SecondaryDiabetes

Itcanoccurduetoanumberofcauses:

HormonalabnormalitiesInsulinreceptordisordersPancreaticdiseaseDruginduceddiabetesCorticosteroidadministrationGeneticsyndrome

DiseasedPancreas

Studies show that if there is even1% reduction inHbA1c (glycosylated haemoglobin) in diabeticsthen:

Theriskofmicrovascularcomplications(e.g.inkidney,eye)isreducedby37%.Theriskoffatalandnon-fatalheartattackisalsoreducedby14%.

10.DiabeticComplications

HighBloodSugar

Highbloodsugarlevelsoveraperiodoftimecanleadtomajorhealthproblems.

Bloodvesselscangetaffected,leadingtoheartattack,strokeandcirculatoryproblems.Frequent urinary infection is due to the presence of high sugar (not well controlled) whichresultsinthedamageofthekidneys.Kidney disease (nephropathy) may result, which often leads to end-stage renal disease andkidneyfailure.

TheKidneyMalfunction

Justasthekidneyslosetheirabilitytodischargewastes,theyalsolosetheirabilitytoretainproteinandsugar.Sugarandproteinaredetectedinurinetestsofteninlargeamounts.Bloodtestsdetecthighlevelsofurea,nitrogenandcreatininewhichindicatedamagedkidneys.

EffectsofKidneyMalfunction

IIf kidney damage (nephropathy) progresses, a person may have to undergo kidney dialysis.Kidneytransplantationmightalsobeanoption.Highuncontrolledbloodsugarcanalsoleadtoneuropathy.

Nerveproblems(neuropathy)mayoccur,causingapinsandneedlessensationinthehandsandlegs.Diabetesdamagingthenervescanalsoleadtoreducedpainorlossofsensationinthefeet.Skinsoresorulcersonthefeetcanbearesultofbadfootware.

Injuriesorinfectionsdonothealwell.Oftenaninjuryonthefootdoesnothealandcanleadto

gangrene.

DiabeticRetinopathy

Itcanresultduetosomediseaseordamagetothesmallbloodvesselsoftheretina.Eyeproblemsgetcomplicatedandcanresultinretinopathy,prematurecataractandglaucoma.Retinaistheareaoftheeye onwhich the image (picture ofwhatwe see) is formed by our lens system. Peoplewith longstandingdiabetesoftendevelopthisdisease.

DiabeticRetinopathyCausesDamagetoSmallBloodVesselsoftheRetina

SkinDisease

DiabeticDermopathy:Itisthecommonestkindofskindiseaseseenindiabetics.Skindevelopsbrownscarsovertheshinoflegs.Thisisduetoabnormalchangesinthesmallbloodvesselsoftheskin.Ifdiabetesisnotkeptundercontrol,theprocessofageinggetsfaster.

11.BloodGlucose,LipidsAndBloodPressureControl

Thisisapartofdiabeticcare.Itisimportanttoreachtargetlevelsmentionedbelow.Failuretodosowouldleadtoadeterioratedlifestyle.

BloodGlucoseControlandMicrovascularRisksInvolved

BloodLipidControlandRiskLevelswithDiabetes

Assessmentofbloodglucose,lipidsandbloodpressureshouldbedoneasfollows:

Glycosylatedhaemoglobinassayedbetweeneverytwotosixmonths.Bloodlipidprofiletobeassayedbetweeneverytwotosixmonths(Ifborderlineishigh).Bloodpressuremeasurementoneachconsultation.

(lowerriskbeing:

12.SomeMoreStatistics

Thereareover32milliondiabeticsinIndia.EveryeighthIndianisadiabetic.95%ofthesediabeticssufferfromdiabetesmellitusII.

AccordingtotheWorldHealthOrganisation,Indiaispredictedtobethediabeticcapitaloftheworldby2030,harbouring79milliondiabetics.

13.Food,HormonesAndBodyBalance

SomeFacts

Yourbodyhasalimitedcapacitytostorecarbohydrateandprotein.Yourmuscles and liver together cannot storemore than 1800 cals of carbohydrate.After thiscapacityisfilled,foodisconvertedintofat.Acontinuouslysustainedrhythmicformofexerciseforabout45minuteshelpsburnfat.Anyfoodconsumedaffectsyourinsulinandglucagonsecretions.When you eat carbohydrate in your food, your blood sugar level rises, stimulating insulinsecretion. This insulin gets the tryptophan serotonin mechanism working in the brain. Thefeelingofpleasureorfeelinggoodisaresultofthisserotoninproductioninthebrain.Arecentstudystatesthatdiabeticsconsuming50gmsofnaturalfibreintheirdailydiet,lowertheirglucoselevelby10%.Itwasseenthatahighfibredietalsohelpsdecreaseinsulinlevelsinthe blood. In patients of diabetes mellitus II, lipid levels also get lowered with the fibre.Consumptionofsolubleandinsolublefibrecontainingfruits,vegetablesandgrainsisbeneficial.Chromium, a trace mineral, plays an important role in insulin sensitivity. Its deficiency alsopromotesanimbalanceinglucosemetabolism.

For a goodbody-mindbalance it is important to have an even secretion of insulin.Roller coastersecretionleadstoexcessivemoodswings,hunger,stress,cholesterolandfatdeposits.

FoodsHelpfulinControllingBloodSugarLevels

All these products are supportive in controlling diabetes mellitus. A balanced diet, exercise andprescribedmedicationshouldnotbeneglected.

04.DiabetesAndLifestyleGeneralGuidelines

Avoidfatty,junk,friedandpreservedfoods.Tryandloseweightifyouareoverweight.Havemorehigh-fibrefoodsandcomplexcarbohydrates.Choosehealthysnacks.Takeyourprescribedmedicationregularly.Monitoryourbloodsugarregularly.

Glucometer

Beactive,butcheckwithyourdoctorbeforedoingstrenuousexercise.

Ifyoufollowaregulatedlifestyle,youcanindulgealittleoccasionally!Avoidalcohol.Ithasemptycalories.Ifnecessary,drinkinstrictmoderation.

Followanorganisedroutine.Eatthesameamountoffooddaily.Eatataboutthesametimedaily.Exerciseatthesametimedaily.

Takeyourmedicationatthesametimedaily.Avoidstress.Destressyourselfwithmassage,yogaormeditation.Dont miss a meal. If you travel frequently and have long eating gaps between meals, carrysweetsortoffeestoavoidhypoglycaemia.

MonitoringofBloodGlucoseLevel

Self-monitoringshouldbedonebyeverydiabeticwhoisconcernedaboutmanagingtheirdisease.Itisespeciallyrecommendedforanyoneusinginsulin,whetherhavingTypeIorTypeIIdiabetes.

Monitoringisimportantas...

Anidenticaldoseofinsulinwillbeabsorbeddifferentlyfromday-to-day.Italsodependsonfactorssuchasexercise,stress,typeoffoodtakenandanindividualsinsulinsensitivity.Hormonalchangesinawoman(e.g.puberty,themenstrualcycleandpregnancy)arealsofactorsinvolvedwithinsulinabsorption.Self-monitoringofinsulindosageisalsorecommendedwhenadifferent(new)typeofinsulin(company or dosage) is administered. Blood glucose monitoring is also recommended topatients on a oral hypoglycaemic drug. This is recommended to avoid hypoglycaemia (lowbloodsugar),especiallyifthediethasbeenlessorthepatienthasbeenvomitingandsufferingfromdiarrhoea.

DiabeticsandIllness

Itisimportanttokeepyourbloodsugarundercontrolwhenyouareill.

Drinklotofwater.

If you cannot eat your regular food, have sweetened lime juice, crackers or soup. You needcaloriestoavoidhypoglycaemia.Keeptakingyourdiabeticmedicinesasadvised.Monitoryourbloodsugar.Itmaystillbehigh,evenifyouarenoteatingregularmeals.Consultyourdoctorifyouhavevomitedorarehavingdiarrhoea.

InjuriesandFootCare

Donotwalkbarefoottoavoidfootinjury.Minorinjuries,cutsorinfectionsshouldimmediatelybeattendedto.Footcareisofextremeimportance.Afterhavingabathintepidwater,patyourfeetdrywithacleantowel,especiallybetweenthetoes.Checkyourfeetregularlyforanycutsorbruisesorroughcracksinwinter.Preventinfectionsbyapplyingantisepticcreamimmediately.Consultadoctorforanylingeringinfection.

Wearcleancottonorwoollensockswhicharecomfortableandnotskinirritants.Wearleatherorsportsshoeswhicharenottightfitted.Becarefulofshoebite.Donotusehotwaterbottlesorheatingpadsnearyourfeet.Avoid cutting your toe nails too close to the skin. File them straight slightly rounding thecorners.

DentalCare

Uncontrolleddiabetesincreasesyourriskofgumdisease,cariesanddevelopmentofmorecavities.Regulardentalcare(brushingorflossingtheteethaftereverymeal)isimportantinpeoplewithhighbloodsugar.Dentalcheckupsshouldbedoneasadvisedbyyourdentist.

05.Diet,ExerciseAndMedication01.Diet,ExerciseAndMedication

PeoplehavingdiabetesmellitusIIcancontroltheirdiseasewiththehelpofthefollowing.

DietExerciseWeightlossMedication

SomepeoplewithTypeIIdiabetesmayeventuallybecomeinsulindependent,butmostcanproduceenoughinsulintocontroltheirsugarlevelsiftheycanlookafterthemselves.

02.Diet

Thediabeticmealshouldconsistofhighfibre,lowfatandprotein.Fruitsandvegetablesarerichinminerals, vitamins and antioxidants and therefore should be consumed. Salads can also be freelytakenbydiabetics,butwithlimiteduseofoil.

Totalproteins:15-20%ofcaloriesrequired.

Fats:lessthan30%ofcaloriesrequired.

Carbohydrates:55-60%ofcaloriesrequired.

Fibre:25gmsperdayforwomen,40gmsperdayformen(approximately).

DietSchedule

Adiabeticmusthavethreemainmealsandtwosugar-freesnackseveryday.

A complex high-fibre carbohydrate diet is recommended for diabetics. Also known as starches,complex carbohydrates are slowly absorbed, thereby keeping blood sugar levels fairly stable.Examplesarewholewheatproducts,brownrice,beans,oats,vegetablesandfruits.

Toincreaseyourfibreintake,highfibrebreakfastcereal(withnosugar)canbeconsumed.Eatmorevegetables.Increasetheamountofbeans,peas,nutsandotherpulsesinyourdailydiet.

Gofor smallamountsof food. Ifoverweight, trycuttingdown thecaloriesyouconsume inaday.

03.SomeUsefulFoodTipsForDiabetics

Rice

Thecalorificvalueof rice isveryclose to cereals likewheat.Rice,unfortunatelyonconsumptionincreasesbloodsugarlevelsrapidly.Therefore,riceshouldbeconsumedinsmallquantities.Itisalsoimportanttoconsumericeincombinationwithoats,wholewheatbread,dals(lentils)andvegetables.Thehigh fibre content present in these foodshelpsprevent a rapid increase inblood sugar levels.Unpolishedorbrownriceisabetterdietaryoptionthanpolishedrice.

SugarandSweets

Sugarorsweetconsumptionisnotdirectlyrelatedtothedevelopmentofdiabetesmellitus.Inabilityof the body to produce insulin leads to diabetes when the body is unable to utilise sugar orcarbohydrate. On consuming sugar, in a person prone to diabetes mellitus, there is a substantialincrease in blood sugar levels leading to diabetes or aggravating the existing condition. Actually,excessive consumption of sweets leads toweight gain.Weight gain in combinationwith sedentaryhabits, family history of diabetes mellitus and stress are the precipitating factors for developingdiabetes.

FruitsandFruitJuices

Diabeticscanconsume fruitsbut in limitedquantity. Jamun, sweet lime,papaya,guava, strawberry,

apples, and oranges can be taken by diabetics as they have fibre and minerals. Also, these fruitsreleasebloodsugargraduallyinthebody.Banana,mango,chiku,grapes(thesweetfruits)aretobeeatenonceinawhileandthattooinsmallquantities.Fruitjuicesshouldnotbetakenbydiabeticsasinstantsugarisreleasedandthereisalsonobenefitoffibre.

HealthyCookingTechniques

Low-fatfoodcanbetasty,healthyandenjoyedbyyourwholefamilywhenyouusehealthycookingtechniquessuchasboiling,baking,stewingandroasting.

Microwave,broil,grill,stirfry,boil,barbecueorsteamfoodwithminimalsaltorfat.Cookonalowflame.Usenon-stickcookware.

Tryandhavelow-fatrecipes.Favourtheuseofmonounsaturatedfats(mustard,olive,rapeseedoils)andpolyunsaturatedfats(sunflowerandsaffloweroils)inplaceoftoomuchsaturatedfat(palmoil).Blendtwoormoreoilsforhealthycooking.

HealthyWaystoConsumeVegetables

Uselow-fatorfat-freesaladdressings.Cookorsteamvegetablesusingverylittlewater.Overcookingwillbreakdownthefibres.Seasonfoodwithchoppedonion,garlic,tomatoorlimejuice.

HealthyWaystoConsumeFruits

Consumerawfruits.Donotpeelfruitslikeapplesandpears.Eatsmallportionsandonlyconsumetheamountrequiredinyourdiet.Eatfruitsinsteadofdrinkingfruitjuice(whichgivesyouonlysugarandnofibre).

HealthyWaystoConsumeMilkandMilkProducts

Drinkskimmedornon-fatorlowfatmilk.Consumelow-fatorfatfreeyoghurt(curd).Makecottagecheeseoutoffat-freeorlow-fatmilk.

HealthyWaystoConsumeMeat

Eatmoreoffish.Cookchickenwithouttheskin.Buymeatwithlessfat.Trimoffextrafatasfaraspossible.Avoidfattymeatslikebacon,muttonandsausages.Haveeggwhite.

Flavouryourfoodwithlemonjuice,soyasauce,vinegarorherbs.Limit theuseofcondiments likemustard,ketchupandsaladdressing (theyarehigh in saltorsugar).

ArtificialSweeteners

Sugar substitutes are saccharin and aspartame. Saccharin is calorie free.Aspartame has negligiblecaloriesperserving.Theycanbeusedinsteadofsugar.Allartificialsweetenersshouldbeusedtotheminimum

04.Exercise

Testyourbloodsugarlevelsbeforeexercising.Ifyourbloodsugarlevelsarenottoohigh,haveasmallsnack15-20minutesbeforeexercising.Dont inject insulin into thatpartofyourbodywhichyouwillbeexercising. Itgets absorbedfasterfromthere.Whileexercising,watchoutforsignsofhypoglycaemia.

BenefitsofExerciseforDiabetics

Lessrestrictivediet:Exerciseburnscalories.Youcaneat reasonablywellandstillkeepyourbloodsugarandweightatahealthylevel.Less insulinrequired:Exercisehelps in increasing thebodys sensitivity to insulin andburnsglucosemoreefficiently.

Caloriesburntbyanindividualinhrwiththefollowingweight

DiabeticFoodPyramid

05.Medication

Aftergettingyourbloodsugarreports,consultyourdoctorforthetypeofmedicationyourequire.TypeIandTypeIIdiabeticsrequiredifferentkindsofmedication.Also,factorssuchaswhetheryouareobeseor thin, or haveothermedical problemsbesidesdiabeteswill decide thedosage and thegroupofmedicinestobetaken.

MedicationforDiabetesMellitus

Oralantidiabeticagentsareusedforpatientsofnoninsulindependentdiabetesmellitus(NIDDMII).These patients should be administered this medication after they have been put on a restrictivecarbohydratediet.Administrationofmedicationshouldbealongwithproperdietandexercise.

Biguanide(Metformin): It is themedicationofchoice today. Itsaction is toprimarily increase theperipheraluptakeofglucose.Inlargedoses,italsohelpstodecreasetheintestinalabsorptionofglucose.

Sulphonylureas (Gilbenclamide, Glimepiride and Glipizides): They produce hypoglycaemia bystimulating the release of insulin. They also help inhibit the release of glucose by the liver andincreasethesensitivityofperipheraltissuetoinsulin.

Thiazolidinediones(RoziglitazoneandPioglitazone):Theyhelpenhancesensitivitytoinsulinintheliver,adiposetissueandskeletalmuscle.

PostPrandialGlucoseRegulators(RepaglinideandNateglinide):Theyhelpstimulatethereleaseofinsulinfrompancreaticbetacells.

Alpha Glucosidal Inhibitors (Acarbose): When taken with a meal Acarbose reduces the postprandialglucosepeaksbyretardingtheglucoseuptakebytheintestine.Acarbosecanbeadministeredasamonotherapyorincombinationwithotherhypoglycaemics.

Insulins:Theyarepreparedasbovine,procineorhumaninsulin.Insulinpreparationsareclassifiedaccordingtotheirdurationofaction.Themorecommononesare:

ShortactinginsulinsIntermediateandlongactinginsulins

InsulinsarenormallyadministeredtopatientsofIDDM.TherecentconceptistoalsoputpatientsofNIDDMoninsulinastoavoidcomplicationsofdiabeteslater.

Alldiabeticmedicationscanhavesideeffects.NodiabeticmedicationwhetherforNIDDMorIDDMshouldbetakenoradministeredwithoutthedoctor sprescription.

06.SiteForInsulinInjection

Themostcommonsiteforaninsulininjectionistheabdomen.Thebackofupper

arms,theupperbuttocksorhipsandtheoutersideofthighsarealsousedasinsulininjectionsites.Thesesitesaregoodforinjectinginsulinbecause:

Theyhavealayeroffatjustbelowtheskintoabsorbtheinsulin.Not toomany nerves are present in that areamaking itmore comfortable compared to otherpartsofthebody.

07.EasilyAvailable

Reasonablypriced,easy-to-usehomeglucometersareavailable.Insulinpens,whichcanbecarriedinthepocket,areeasytoadministerandcauseminimumdiscomforttothepatient.Alsoavailableareinsulinpumps,whichcanbeinsertedundertheskin.

Diabeticjam,flour,chocolatesandicecreamsareavailableatmanyoutlets.

08.AdvancementsInTheTreatmentOfDiabetes

Diabetesisoneofthemostcommondiseasesaffectingpeopleworldwide.By2010,IndiaisexpectedtobecometheWorldsDiabeticCapital.IntheUnitedStates,ithasaffectedanestimated seventeenmillion people. Todaywe have come a longway since insulins discovery in

1921.

SmartMeters

Theyhelptoregulatefoodintake,exercise,medication,bloodglucosereadingsandweight,allwithpush-buttonease.

AlternateSiteTesting

Finger tips are the easiest site for drawing a sample for blood glucose testing. The new tester(freestyle)offerstheopportunitytodrawabloodsamplefromanalternatetestsite.

HomeTesting

Theglycatedhaemoglobintestisnowavailableasasingleusefingersticktestwithresultsavailablewithinminutes.

Whileafingerstickprovidesaglucoselevelforamomentin time, theglycatedhaemoglobinlevelreflectstheglucoselevelinthebodyforthemostrecenttwotothreemonthperiod.

Non-invasiveGlucoseMonitoring

Itisawell-establishedfactthatpeoplewithdiabeteswhocloselymonitorandregulatetheirglucoselevels have fewer complications from the disease. A recently developed device GlucoWatch G2Biographerwillmakeglucosemonitoringeasier.TheBiographer isaglucose-monitoringdevicethatlookslikeawatch.It iscompletelynon-invasiveandusesalowelectricalcurrenttopullfluidsthroughtheskin.Itthenmeasurestheglucoselevelinthefluid.

Thewatchcanbewornforupto13hoursandcantestglucoselevelsasoftenaseverytenminutes.This does not eliminate the need for standard fingersticks.Thehope is that devices like thesewilleventuallymakethemunnecessary.

The Biographer can also show people how their bodies react to specific situations like exercise,stress,meals,sleep,andmedications(allofwhichcanaffectglucoselevels).Thereisanalarmonthewatchthatcanbesettogooffifglucoselevelbecomestoohighortoolow.

InsulinPump

Themostrecentdevice,tobeintroduced,isawirelessinsulinpumpsystem.ThesystemiscalledtheMedtronic MiniMed Paradigm 512 Insulin Pump and Paradigm Link Blood Glucose Monitor. Itcomprises of a glucosemonitor, external insulin pump, and dose calculator thatwork together todeterminetheamountofinsulinneeded.

09.OnTheHorizon

There are many new treatments being studied to improve the lives of people who have diabetes.Insulinisbeingstudiedinnewformsincludinglongeractingdoses.Newmodesofdeliveryarealsobeingexaminedincluding

inhalers, skin patch, and oral insulin. Other medications under investigation hope to enhance thereleaseof insulinfromthepancreas inorder tobalanceglucose levels(byregulatingotherrelatedhormones),andtreatcomplicationsofdiabetes.

DiabeticSkinPatchTest

PancreasTransplant

Apancreas transplant is a surgery to implant a healthy pancreas from a donor into a patientwithdiabetes.Pancreastransplantsgivethepatientachancetobecomeindependentofinsulininjections.

PartialPancreasTransplantation

Whenapatientwithdiabetesreceivesakidneytransplantfromalivingrelative,itisusuallybeneficialtoperformapartialpancreastransplantatthesametime.Sincethetransplantedkidneywillbecomedamagedbydiabetesover the time, transplantingapartialpancreas from thesamedonorwillhelpcontrolbloodglucoselevelsandprotectthenewkidneyfromfurtherdamage.

BenefitsandRisksofPancreasTransplants

Pancreastransplantsaresafestinpeoplewhodonothaveheartorbloodvesseldisease.Thehealthieryouare,thebetteryoucanwithstandthephysicalstressofsurgery.Immunosuppressivedrugsare importantandhardon thebody.Peoplewhohave toundergoapancreatictransplantationshouldavoidthosewhohaveinfections,suchasacoldortheflu.Theyshouldnotbeimmunisedwithoutfirstcheckingwiththeirdoctor.Thesedrugscanalsodamagethekidneys.

AsuccessfulpancreastransplantcanbenefitaTypeIdiabeticpersoninatleastthreeways:

Someamountofdiabetes-relateddamagetothebodycanbecontrolled.Insulininjectionsarenolongerneededandthepersoncanenjoyaregulardiet.Apersoncanenjoygreateractivityandindependence.

PancreasTransplant

06.MythsAndFactFileMyth

Idonothaveahistoryofdiabetesinmyfamily.Iwillneverdevelopit.

Fact

Genetically you are less prone to developing diabetes. However, because of sedentary lifestyle,wrongeatinghabits,excessweightandstress,onecandevelopdiabetesmellitus.

Myth

Alcoholdoesnotaffectdiabeticsadversely.

Fact

Consumptionofalcoholcanworsenthedisease.Itcanalsoreactwiththegivendiabeticmedication.

Myth

Asadiabetic,Igettiredeasily,soIshouldrest.

Fact

Diabetes should be kept under control. All diabetics must be active and have a regular exerciseroutine.However,exercisemustnotbestrenuous.

Myth

Diabeticscannoteatanyfatorcarbohydrates.

Fact

Diabetics should have a minimal amount of fat and mostly keep to monounsaturated orpolyunsaturatedfats.Complexcarbohydrateswithlesscaloriesandmorefibrecanbetaken.

CopyrightTitle01. Test Yourself For Diabetes02. Understand Diabetes Mellitus03. Measure Your Risk04. Diabetes And Lifestyle05. Diet, Exercise And Medication06. Myths And Fact File