1.What is Diabetes?

Diabetes is an old illness. It has affected mankind for many hundreds of years and is referred in old Sanskrit writing. It is a chronic metabolic disorder with high levels of sugar in the blood. The word “Diabetes” means siphon and “Mellitus” stands for sweet. Diabetes and Diabetes Mellitus are used interchangeably in day-to-day practice.

How does it happen?

A gland in the tummy named pancreas secretes a hormone called Insulin, which controls blood sugar. When we eat, glucose is absorbed from the stomach and enters in the blood. The glucose must enter into the cells to make energy and insulin helps glucose to enter the cells. Diabetes is the result of inability of the pancreas to produce normal amount Insulin or Insulin becoming ineffective to do its’ job.

Diabetes: Why me?

Frequently this question is asked, despite no family history how did I get Diabetes. Family history certainly is an important factor, but the fact is being Asian, we all have high-risk gene for Diabetes. Remember it is not your fault that you have Diabetes. You are just happened to be the person who got it. In India 4% of villagers and up to 10% of city dwellers have Diabetes. Recent studies showed all over the world the incidence of Diabetes is increasing and it is more so in Asians. Also we are getting Diabetes at an earlier age than people in the west (around 10 yr).

Who are at risk of Diabetes?

Family history of Diabetes is the major risk factor. If you have a family history and your blood sugar is normal, it is advisable to check for Diabetes every year. Sedentary life-style, obesity, smoking, excessive alcohol intake, high blood pressure and in case of women previous Diabetes in pregnancy or delivering big baby (birth weight more than 4Kg) are risk factors for Diabetes.

What are the symptoms of Diabetes?

In adults, at least at the beginning you may not have any symptom. When your blood sugar is above 180 mg%, sugar starts appearing in the urine. Sugar in the urine drags water and you pass a lot of urine and feel dry and thirsty. You may also feel tired and loose weight. Your appetite increases and peculiarly you may notice that you are loosing weight in spite of eating more. Chance of infection is higher if you have high sugar and also your healing from infection, cut or wound may be unusually delayed. Some people complain of poor eyesight.

How do we diagnose Diabetes?

The normal blood glucose in the morning before taking any food (fasting) is less than 110 mg%. There are three ways we diagnose Diabetes. Urine glucose is not reliable for diagnosis.

• Fasting blood glucose 126 or more is diagnostic of Diabetes; value in-between 110 to 125 is called borderline Diabetes.

• A random blood glucose sample taken anytime of the day more than 200mg% is also diagnostic of Diabetes. If there are no symptoms a repeat test is needed.

• In doubtful cases sample is taken after a glucose drink, called glucose tolerance test.

What is the difference between Glucose and Sugar?

We use the words glucose and sugar interchangeably but they are not same. The main component in sugar is glucose, around 85%. The rest are fructose, galactose, etc, which are sugar but not glucose. Now a days, we measure glucose in blood, so even if we tell blood sugar is such and such, we actually mean blood glucose.

What are the types of Diabetes?

There are two main types: type 1 or young onset and type 2 or adult onset Diabetes. In type 1 Diabetes pancreas does not produce Insulin and you cannot survive without Insulin. In type 2 Diabetes, pancreas does produce Insulin but it is insufficient and/or less effective. Diabetes can manifest for the first time in pregnancy, called gestational Diabetes.

What should I do when I am told, “you have Diabetes”?

First step when you see your blood sugar result is high is to recheck to confirm the diagnosis. The next and most important, although most difficult, step is to accept the diagnosis. Do not try to run away from the diagnosis, try to know the facts about Diabetes. Several sources of information are available, like health magazines, Internet, various health related journals, education programmes, etc.

• Eat meals and prescribed snacks at regular times each day.
• Avoid food, high in sugar content such as honey, jellies, candy, syrup and softdrinks.
• Eat appropriate number of calories
• Read all food labels carefully and avoid foods with sucrose or glucose high on the ingredient list
• Certain fruits like papaya, small plantain, apple etc. can be taken, provided your blood sugar sugar is under control. Avoid fruits with high sugar content like mango, jack fruit, sapota etc.
• Eat cereals like rice in limited quantities and increase vegetable content of meals.
• Do not skip meals or prescribed snacks. This is particularly important in those taking insulin injection

Can we prevent Diabetes?

If you have genetic risk for developing diabetes because of family history, you cannot do anything about that. Things you can do are healthy eating (i.e., eating vegetables and fruits, avoiding fast food), healthy life-style (regular exercise, avoidance of smoking, moderation of alcohol, etc) and keeping your weight in accordance to your height. Certain medicines are being used recently for preventing Diabetes in people who have borderline Diabetes.

What is Therapeutic Lifestyle changing (TLC)?

We have started realising for the last few years the curse of modernisation on our health. This is also referred as “TV and Couch syndrome” as we will be watching TV and taking chips and drinks (soft and hard!). Computer based work in different professions has worsened the scene. In this way more and more we are neglecting the need for being active, maintaining ideal body weight and eating healthy food.

Diabetes, heart problems, cancer and what not are on the rise, and are going to do so unless we start intervening. The term we are using now-a-days is TLC, which basically means to eat a healthy balanced food, avoid too much fast or fatty food, maintaining regular timing of food, maintaining ideal weight, regular exercise, health awareness, regular health checks, etc.

What is regional obesity?

The traditional definition of obesity includes a measure of height/weight and defined as Body Mass Index (BMI). Now with the advancement of science we are realising regional obesity is much more important for health. Here we measure the girth of waist and hip and express that as a ratio called Waist Hip Ratio (WHR). We describe this as a shape like an apple i.e., middle protrusion of the tummy, so called potbelly. For men less than 0.85 is normal WHR and for women it is less than 0.90.

What are the bad effects of regional obesity?

Regional obesity is associated with a cluster of metabolic problems such as Diabetes, high blood pressure, high cholesterol, arteriosclerosis (hardening of blood pipes) which all lead to problems with the heart (heart attack) and brain (stroke). Medically we call this as Syndrome X. The other concern is back pain; because of the potbelly the forward curvature of the lumbar spine increases and is one of the risk for disc problem and spondylitis.

What is the treatment?

First and most important step is to make us aware that regional obesity is bad not only for cosmetic reason but also for health. We need to eat the correct food (like eating plenty of vegetables and optimum fruits on daily basis), which obviously means to avoid high fat and calorie food as much as possible. We need to undertake some form of physical exercise every day for at least 30-45 min. Also we need to keep a regular eye on our BMI, WHR, blood pressure, cholesterol, blood sugar etc.

Is exercise a must for treatment of Diabetes? What type of exercise is advisable?

This is a very important aspect of treatment of Diabetes. It is very advised to do some form of regular exercise like brisk walking, jogging, swimming, running on a treadmill, etc.

You can take part in almost any exercise if your body permits. Exercise sometimes becomes monotonous, so we encourage sports like playing badminton, table tennis, etc. Sports help in continuing exercise with entertainment.

Do I need to walk only in the morning?

Medically walking in the morning or evening does not matter. You should not start exercising immediately after food. Also if you are going for morning walk, it is advisable to take a snack, i.e., tea and two non-sweet biscuits before a walk.

What are the benefits of exercise other than helping in Diabetes control?Exercise helps to keep you fit and active, strengthens the heart and lung, and improves muscle function and circulation. It helps in improving your weight control. Best advantage we believe is that exercise has a “feel good” factor.

What are Do’s and Don’ts of exercise?

Do’s:

1. Start gradually and exercise regularly.

2. Try to make it in the same time everyday.

3. Get involved in active sports like Badminton.

4. Try to eat something before you start.

Don’ts:

1. Do not exercise in empty stomach.

2. Avoid exercise soon after injecting Insulin.

3. Better not exercise if sugars are very uncontrolled.

Can I have drink when I have Diabetes?

Please see the alcohol section.

What about smoking?

Smoking makes your insulin less active, so should be stopped or minimised to the least. Otherwise also smoking is bad for heart and lungs. Also, as you will know smoking can cause cancer in different organs.

Can I control Diabetes with Diet only?

Diet is a very important aspect in the treatment of Diabetes particularly the timing of it. At the beginning you may be successful in controlling Diabetes with diet only, but unfortunately a time will come when only diet won’t be enough, you will require medicine. This time is different for different people, for somebody this can be a few months while for others it may be a few years. It is very important to try with diet first; this will help you to understand the principles of diet and will convince you the need for tablet/Insulin for good control of Diabetes.

Can I follow a strict diet chart?

A strict diet chart is something we are not advocating these days. A diet chart is not only monotonous but also difficult to follow day in and out. A strict chart restrains your freedom to eat and also impossible to follow when you are out for social or professional reasons. Rather than a diet chart you should have meal plan.

What are the principles of diabetic diet?

Healthy eating is the key to success for which you need to know what to eat, how much to eat and what not to eat.

To eat or not to eat is not the question, how to make the right decision about eating is the question

We recommend three meals (breakfast, lunch and dinner) and three snacks. You can space the snacks in between your meals according to your profession and life-style. There are six components in diet: Carbohydrate, fat, protein, mineral, vitamin and water. Restriction and distribution of carbohydrate throughout the day is important. The amount of calories in rice and wheat are the same, but protein content is high in wheat. Wheat has more fibre in comparison to rice.

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Dietary fibres are very important for people with Diabetes (food with high fibres such as bran, cereals, vegetables, fruits, brown bread, pulses like lentils, rajma, whole meal flour, etc), they make the absorption smoother and keep the bowel habit healthy. A mixed diet containing both rice and wheat is preferable.

Regular eating of salad and vegetables is good for nutritional balance. They are natural source of vitamins, minerals and fibres. If your weight is more than what it should be, you need to loose weight. Taking low caloric food and increasing food with high fibres can achieve this.

There is no bar to eat non-vegetarian food unless in special situation like kidney problem. Remember chicken and fish are better than red meat as the amount of saturated fat is less in them. If your cholesterol is high you better avoid yellow of egg and red meat

What should I take as snack?

You can make one of your own choices. A homemade sandwich will be the perfect one. You can take small amount of noodle, sprouts, a medium size apple or two non-sweet biscuits. Remember soft drinks have a very high sugar in it, so if you are fond of them take the diet one.

Will my blood sugars be normal if I do not eat?

No, it won’t. This is essential to realise, stopping eating is the worst possible thing to do when your sugar is not well controlled. Remember, whatever the blood sugar is, your body needs a balanced diet otherwise you will become malnourished and weak.

What if I skip meal?

Not a good idea at all, when you skip meals your blood sugar fluctuates and that is not good for control. Particularly in the teenagers, this is common and make sure you do not do this. Remember when you eat is as important as what you eat.

My job does not allow me to eat in fixed time, what should I do?

Most of the cases, this is an excuse for not being planned. You need to know how to organise your day. Days are changing and all of us are in much more stressful life than our forefathers. Competitions are increasing day by day but we need to look after ourselves so that we are in the best physical and mental state to be successful.

Do I need to stop eating out?

Certainly not, as long as you are not planning to eat out everyday! You need to know what is the right food and correct amount. Remember Alcohol has empty calorie and also with a drink we tend to eat more.

What to eat when I am not well?

If you cannot manage to eat your normal diet you need to match them with liquids. Please see the section on Sick day rule.

Can I have ice cream? Can I take artificial sweetener?

Occasionally yes, but do not make a habit of eating ice cream regularly. There are certain ice cream available now with no added sugar, but do not forget they have calories.

Certainly yes, artificial sweeteners are safe. Do not put them in cooking, they break down when heated. So they will not be sweet any more if you boil or fry them.

Can I eat fruit?

Yes, not only can, you should eat fruit regularly. This is a very old concept that in Diabetes you cannot eat fruit. You should know what fruit and how much you should eat. You should take 3 to 5 portions of fruit every day (One portion of food is 1 medium apple or 1 guava or 1 pear or 1 orange or 1 small banana or 12-15 grapes or 1 slice of pineapple or 1 small bowl of papaya, etc); you can choose what you like. It is better to avoid dry fruits as they have very high calories.

What are the food items I should avoid?

Foods to avoid – Direct sugar, jam, honey, and chocolate as they contain refined carbohydrate and blood sugar rises very quickly. Also it is better to avoid food with high saturated fat such as cheese, butter, ghee, solid cooking oils and hard margarine.

Do I need to take vitamin for Diabetes?

If you are eating a balanced diet, there is no proven rule for extra vitamin. Some people take them for mental satisfaction. Vitamin is not the treatment of uncontrolled Diabetes neither vitamin will help to control your Diabetes. If for some reason or other you are not able to take regular meal, i.e., you had an operation or you are unwell, you may take some vitamin for a short while.

Sample diet chart for vegetarian and non-vegetarian diet

These diet charts are only a rough guideline to your meal planning. Non vegeterarians can follow a veg menu also.