Diabetes Treatment

Pertaining to the complications associated with diabetes, its management and control plays a very important role. The ABC of diabetes management can be described as:

Aim for the target:

When you get yourself treated for diabetes, your health care provider will assign the target level of control that you should aim for. You targets should be set for:

• blood sugar levels
• lipid levels
• blood pressure
• body weight

Good diabetes control implies that the blood glucose throughout 24 hours, on each day, is at the target level determined for you. In simple terms, the blood glucose levels should be as close to these levels as is possible without exposing you to a risk of a severe attack of hypoglycemia or even to minor recurrent attacks of low blood glucose. Apart from your blood sugar levels, the blood lipids (fats), your blood pressure and your body weight should be well controlled and should be at an acceptable level. Refer the following table for optimum control.

Click here to view the target range of parameters used to assess diabetes.

Ideal Body Weight:

Management of body weight is a very important component of diabetes management and treatment. The indicators of weight status of an individual are Body Mass Index and Waist- Hip ratio.

Body Mass Index (BMI):

Body Mass Index is defined as a ratio of weight and height. Its value indicates a direct correlation with disease and death, irrespective of age and gender. A higher BMI is associated with an increased risk of diabetes, heart disease, stroke, osteo- arthritis, high blood pressure and certain types of cancers.

How to calculate my BMI:

Follow the following steps to calculate your BMI:

• Take your height in meter.
• Take your weight in kilograms.
• Calculate your BMI using the following formula:

BMI= Weight (in kilograms)/ Height (in meter) x Height (in meter)
One should aim to come in the category of good to fair BMI in order to prevent the risk of diabetes and its complications.

Be Physically active:

Researches have shown that physical activity in diabetes can:

• lower your blood glucose and your blood pressure
• lower your bad cholesterol (LDL cholesterol) and raise your good cholesterol (HDL Cholesterol)
• improve your body’s ability to use insulin
• lower your risk for heart disease and stroke
• keep your heart and bones strong
• keep your joints flexible 
• help you lose weight
• reduce your body fat
• give you more energy
• reduce your stress levels

Aim for at- least 30 minutes of physical activity everyday. Follow healthy lifestyle tips to be extra physically active.

Control your diet

Diet plays a significant role in controlling the diabetes. A diabetic diet may be used alone or else in combination with insulin doses or with oral hypoglycemic drugs. Main objective of the diabetic diet is to maintain ideal body weight, by providing adequate nutrition along with normal blood sugar levels in blood. The diet plan for a diabetic is based on height, weight, age, gender, physical activity and nature of diabetes. While planning diet, it is important to consider complications such as high blood pressure, high cholesterol levels as well as presence of any other ailment such as a kidney disorder or a history of heart disease. Diabetic diet works on the principle of carbohydrate exchange system, wherein the type of carbohydrates and their nature is taken into consideration in order to ascertain that the required amount of carbohydrates are taken without putting an extra glucose load on the body.
The general guidelines for a diabetic diet are:

• The basic rule for diabetics is to have a 6- meal pattern diet. That is, small meals at frequent intervals are required.
• Balance the number of servings of carbohydrates with the help of exchange system. Ask your dietician to chart out a diet for you according to the exchange system.
• Space carbohydrates equally through out the day
• Make healthy choice
• Eat plenty of whole grains like whole wheat, maize, barley and other millets.
• A diet high in both soluble and insoluble fiber is beneficial in controlling blood sugar levels. Include more of whole grains instead of refined cereals, green leafy vegetables, other green vegetables in your diet to make it fiber- rich.
• Eat breakfast everyday. Try having an early breakfast
• Do not skip your meals
• Include more of low glycemic index foods in your diet
• Eat a variety of foods each day. Choose foods from all major food groups
• Eat at least 5-7 different colored vegetables a day
• Take 4-5 almonds or walnuts along with 2 figs and a handful of raisins everyday - they contain essential fatty acids and various vitamins and minerals necessary for good health.
• Food items like lemon, mint, coriander, cinnamon, methi dana are good for every day’s consumption. Use spices like elaichi, dal chini (cinnamon), mint, dhania, lemon juice, vinegar, garlic, tamarind and tomatoes to enhance taste.
• Use less salt in cooking and at the table. Do not sprinkle salt on salads, curd or raita.
• Read dietary labels on the packed food.
• Consume at least eight glasses of water everyday
• Good fat also provides similar calories and thus does not mean “unlimited consumption”.
• Use variety of oils: Change your cooking oil every three months. Use a combination of mustard oil, olive oil and corn oil, curdy oil, rice bran oil, sunflower oil and sesame oil
• Avoid nibbling in between your meal timings
• Use of artificial sweeteners is allowed in limited quantity but they are not allowed in pregnancy and lactation.

Glycemic Index:

The glycemic index ranks foods on how they affect our blood glucose levels. This index measures how much your blood glucose increases in the two or three hours after eating. The higher the number, the greater the blood sugar response. A low GI food means it will cause a small rise, while a high GI food will trigger a dramatic spike. A GI is 70 or more is high, a GI of 56 to 69 inclusive is medium, and a GI of 55 or less is low. To have a better control on diabetes, choose maximum foods that have low glycemic index
Glycemic Index of various food items:

Dietary modifications in special situations:

• Diabetic Nephropathy: Avoid too much of animal proteins and salt in your diet. Ask your dietician to chart out a protein and salt restricted diet for you.
• Hypertension: Avoid too much of salt. Do not sprinkle salt on salads, curds or fruit. Avoid high salt foods such as bakery items, papad, namkeen, chutney etc.
• Dyslipidemia: Avoid fried foods, fast foods and foods prepared in saturated fats such as ghee and butter. Use mustard oil in moderation for cooking. Increase fiber content of the diet.
• Infections and acute illness: Avoid fasting and try to meet up the calorie requirements pertaining to the type of illness. Consult your dietician for a long term infection or illness management.
• Do without stress: Stress makes our sugar levels raise. Long term illness (which is also a factor to add up stress) or psychological stress can lead to complications of diabetes. Try to combat stress in order to keep your sugar levels under control.Tips to manage stress:
• Care for your feet:

Follow medication regime

Your healthcare provider will manage your blood sugar levels either with the oral medications (known as oral hypoglycemic agents) or by insulin injections. There are now several medications available to treat diabetes. Most are taken in pill form. Different diabetes pills do different things:

• Help the pancreas make more insulin
• Help the body's cells use insulin more efficiently
• Work with both the pancreas and the cells to control blood sugar levels
• Slows down the digestion of carbohydrates in the food we eat causing the rise of glucose in the blood following a meal to be less.

You should a strict medication regime in order to control your blood sugar levels.

Go for regular health check- ups

Regular health check- ups are an important component of diabetes management program. A diabetic should follow the schedule of health check- ups set by the health care professional in order to control the blood sugar levels and prevent the complications of diabetes.

Following regime should be broadly followed in health check- ups:
Self Monitoring of Blood Glucose: Individualized regime as charted by health care professional. Strict regime to be followed in pregnancy and illness.
Clinical Examination: At least every three months
Lipids, eye check- up, kidney function tests, ECG (for those above 40 years of age): Annual checkup

HbA1c every 3- 6 months:

Glycated hemoglobin test (HbA1c) is an important parameter to give an overall picture of diabetes control over a period of last three months. Your HbA1c levels should be <7% at any given point of time in order to prevent the complications of diabetes.

Indulge yourself in diabetes awareness and education:

Education programs and self help groups keep you updated and motivated to work towards the targets. Join a diabetes help group or management program to keep yourself up- to- date on the newer advances as well as better control.

Kill the urge for smoking or alcohol intake:

Alcohol intake not only fluctuates your sugar levels, it also exacerbates neuropathy, dyslipidemia, obesity and hypertension. Say no to smoking and alcohol.