Diabetes is a chronic disease. It means once diabetic, you will always be a diabetic for whole of your life. The age of diagnosing type 2 diabetes has decreased these days. More and more people are being diagnosed to be type 2 diabetic in their 20’s or 30’s. So, they have to live with diabetes for a good 30-40 years. It’s a long journey.

There is no cure for diabetes. But if planned properly, it is quite manageable.

In the beginning you may feel scared, sad or even you may not believe that you are a diabetic!! You may not be feeling any symptoms.

Still, it is very important to take it seriously!! You need to balance out your food and exercise and take medicines prescribed by your doctor regularly. Thus, you can live a long and healthy life even with diabetes.

 

What is type 2 diabetes?

Whenever you eat food, it is digested into glucose ( a sugar). Glucose is an important source of energy for your body. But it can be used for energy only if your body is making enough insulin and using it well.

In type 2 diabetes, your body is making insulin, which is not sufficiently and body is not able to use it properly due to insulin resistance. So, glucose stays in blood, increasing its levels to above the normal. This can cause many problems.

 

Factors affecting blood glucose

A non diabetic person is able to maintain his blood sugar in a normal range irrespective of what he eats or how active he is. But a diabetic has to take care of his/her diet and activity, otherwise his/her blood sugar can fluctuate widely. So, most important thing is to know what factors affect blood sugar levels.

 

Factors which can increase blood sugar–

1. Too much food especially food rich in carbohydrates
2. Less physical activity
3. Under dosing of medicines
4. Forget taking your medicines or insulin
5. Consuming drugs like steroids
6. Acute illness like infections, pain, hospitalization or any stress (these situations produce hormones which cause rise in blood sugar)
7. Even during menstrual period, hormonal changes can increase it

 

Factors which can decrease your blood sugar–

1. Skipping meal or taking less meal than usual or delaying meals
2. Fasting as is common in India
3. Alcohol especially if snacks are not taken along with it
4. Over dosage of diabetic medication or insulin
5. More physical activity or exercise than usual

 

Managing your diabetes

We can guide you and help you managing your sugar. But in day to day life, controlling sugar mainly depends on you.

So, if you are living with diabetes, you have to follow these tips.

1. Follow a regular and fixed diet.

Your doctor/dietician will help you deciding what and how much you eat. With little planning, you can include your favourite foods. Some important tips-

1. Don’t delay or skip meals
2. Take a fixed amount of food at fixed time everyday
3. Avoid overeating
4. Include variety including vegetables, whole grains, fruits, non-fat dairy foods. Don’t eat too much of one type of food.
5. Space your meals equally throughout the day.
6. You may need to make changes in your diet, you still have flexibility.

 

 2. Be physically active which means you start exercising.

1. You should be involved in a moderate activity for at least 30 minutes a day for at least 5 days a week.
2. You can start slowly and increase it gradually.
3. If you are overweight or obese, you need to lose weight (at least 5-10% of your weight).
4. Don’t go for an exercise in a fasting state.
5. Examples of exercise-
   1. Aerobic activity like walking, biking, swimming
   2. Being active throughout the day like parking
      your car as far as possible, taking stairs instead of elevator
   3. Strength training like lifting weight
   4. Flexibility exercises like yoga and stretching

 

3. Regular blood sugar monitoring is very important.

1. Frequency of checking will depend on the levels of high sugar, whether you are taking insulin or not and on your sugar control. Your doctor will
   advise you accordingly.
2. Target blood sugar–
   1. Before meals- 80 – 130mg/dl
   2. 1-2 hour after meal- <180mg/dl
   3. HbA1c- <7%
3. There are two ways of keeping a check on your blood sugar

1. Self monitoring of blood sugar with a glucometer– This is a very important tool for keeping a check on your blood sugar in day to day life. Glucometers are small, portable and easy to use devices. A small drop of blood is required to do a test. Most of the glucometers will give a you a little different value than lab value (about 15-20%).But they are overall good tools for day to day management of diabetes.
2. Laboratory checking– It includes checking fasting and post prandial blood sugar and glycosylated haemoglobin (HbA1c).

1. Blood sugar– Though it gives a more accurate value for blood sugar, it cannot be used more frequently due to inconvenience of going to lab everytime and the long time taken to get the reports.
2. HbA1c– It gives us an idea about average blood sugar over the    past 3-6 months. It should be done every 3 months if blood sugar is not controll
   ed and once in 6 months if blood sugar is controlled.

 

4. Medicines-

1. Your doctor may prescribe you medicines to control your blood sugar. Many types of medicines are available.
2. Your doctor will prescribe you medicines depending on your symptoms, weight, sugar levels, associated diseases and financial status.
3. Be regular in taking medicines on fixed time.
4. If you have some side effects from medicines, talk to your doctor before        discontinuing your medicine.

 

5. Visit your doctor regularly and follow his advice.

1. Frequency of your visit to a doctor depends on what medication are you taking and whether your sugar levels are controlled or not. Here is a rough guide for frequency of visits, but you should follow your doctor’s advice-
   1. Every 3-4 months if you are on insulin
   2. Every 4-6 months if you are on tablets or diet control only
   3. More frequently if your sugar is not controlled (high sugar) on self monitoring, you have hypoglycemias (low sugar), some new symptoms have developed, or you have worsening of previous symptoms.

 

 2. You should provide following information to your doctor–

1. Your home sugar monitoring chart.
2. Any symptoms of low or high blood sugar.
3. Any change in your diet, exercise or medicines.
4. Any new illness/disease that you might have developed.
5. Symptoms related to the complications like eye (blurring of vision), kidney (swelling of hands, feet, face), neuropathy (numbness, tingling or pain of hands and feet), heart disease (chest pain, shortness of breath) or unusual weight gain.

 

6. Monitoring complications–

Diabetes can result in development of many complications like retinopathy (eye problem), neuropathy (nerve problem), nephropathy (kidney disease), dyslipidemia (high cholesterol), heart disease and stroke (paralysis). Your doctor will advise you on what to do and how frequently to get tests for these complications.

1. Blood pressure– Blood pressure should be got checked at every visit to the doctor. Generally, it should be maintained below 140/80. Your doctor may give you some medicine to lower it if it is high.
2. Cholesterol– Lipid profile should be tested annually or more frequently if deranged. Your doctor will give you some medicine if you have high c
   holesterol.
3. Eye disease ( Retinopathy)- Dilated eye testing should be done at least once a year by an eye specialist. It should be started at the time of diagnosis of type 2 diabetes and after 3-5 years of diagnosis of type 1 diabetes after puberty. If you already have diabetic eye disease, then your doctor may ask for a more frequent check up.
4. Kidney disease (Nephropathy)- Regular blood pressure checking is very important. Urine should be tested every year for proteins and creatinine clearance. Testing should be more frequent if abnormal. Kidney function should also be tested at least once a year.
5. Nerve disease (Neuropathy)- You should check your feet daily for any injury, cracks, redness or calluses. Report to your doctor immediately if you have any such problems.

 

7. Management during sickness –

Living with diabetes is a big challenge even on a normal day; it becomes even more difficult during sickness. When you are sick ( whether it’s a common cold, gastroenteritis or any other infection) your blood sugar is likely to go up. So you have to be extra careful about your diabetes. If you are sick, you should follow these instructions-

1. Drink lot of water and other fluids to avoid getting dehydrated (at least 1 cup every hour).
2. Eat or drink at least 30-50 gram of carbohydrate ev
   ery 3-4 hours.
3. Check your temperature regularly.
4. If you are using over-the-counter cold or cough medicine, check for sugar-free products.
5. Do not skip your diabetic medication. For severe infections your doctor may shift you to insulin.
6. Do not skip insulin, even if you can’t take solid food. You can take something with sugar to avoid having hypoglycemia.
7. Check your sugar levels frequently ( 4-6 times a day). Always keep a record of your blood sugar levels.
8. If your sugar is >240mg/dl you should also check f
   or urine ketones. Don’t forget to keep a record.
9. Stick to your usual meal plan, if possible.
10. Contact your doctor if-
    1. You have vomiting that prevents you from taking medicine/ food.
    2. You have vomiting/ diarrhea that persists for more than 2 hours.
    3. You have fever > 101 F.
    4. Your blood sugar is persistently high or l
       ow
    5. Your urine is moderately or highly positive for ketones.

8. Travelling with diabetes –

Travelling can disturb your diabetes care routine. You should not worry. You can travel safely and enjoy your trip even with diabetes. Here are some tips to follow while travelling-

1. Before you travel, consult your doctor and make sure your sugar is under control.
2. Always carry a doctor’s prescription stating that you always need to carry your medicines with you.
3. You may have to take some vaccines depending upon your destination.
4. Take a carry bag and put all your diabetes related stuff in it ( like medicines, insulin, sugar testing strips, needles, lancets, your ID, snacks and candy / glucose tablets). Ensure to take extra (twice of what would be needed) medicines,  (if you are on insulin) and glucometer supplies.
5. Try to follow your usual schedule – You may have to wait for your train/ flight for hours or you may be travelling in different time zones. So plan ahead. Try to stick to your usual daily routine. Carry some extra snacks with you.
6. While travelling, you may have hypoglycemia ( very low blood sugar) because you might have missed your meal or you had to walk a lot. Always carry glucose tablets ( hypotab) or candies with you.
7. When you are eating out, try to select healthy and balanced diet from the menu.Maintain your diabetic worksheet-

My Diabetes at a glance	Fasting Blood sugar (mg/dl)	Post prandial blood glucose (mg/dl	HbA1c (%)	Blood Pressure (mmHg)	LDL (mg/dl)	Smoking/ Tobacco use	Eye exam	Foot Exam	Urine albumin/ creatinine ratio (mg/g)
Goal	80-130	<160	<7%	<140/80	<100 or 70	Never	Normal	Normal	<30
How often to check	As per doctor	As per doctor	3 months	Every clinic visit	Once a year	Never use	Once a year	Once a year	Once a year
Date

Its not easy to hear that you are a diabetic. You may feel disbelief, shocked, angry, guilty, fearful, stressful or may have a sense of loss. These feelings are quite natural. Try talking out to your family members, friends or your doctor. They will help you in dealing with your feelings in a better way.

 

There are still a lot of things to learn about diabetes.You may not be able to make all the changes at once. Start with making small changes in your lifestyle. You may take some time to control the things. Be patient. Don’t hesitate to ask for help and support from your friends, family and healthcare team.

ALL THE BEST!!