An Awareness Initiative by

Understanding
Diabetes

Dr. R.B. Pandit

MD(BOM), FICP, FICN
FICA(USA), FCCP(USA)
 Diabetes Care
If you have diabetes no need to get panic. Few alterations to your
lifestyle can enable you to continue to lead a full and healthy life. All you
need to do is 3 things :
1.Take care of your diet, Exercise, Lifestyle & Stress (DELs)
2.Keep your blood sugar level under control
3.Avoid diabetes related complications

Checking your HbA1c and blood sugar level regularly is very important.

Set your own blood sugar level goal after consulting your doctor. You may not reach the goal right
away, but your every bit of lowering helps and goes a long way in diabetes care.

To control your blood sugar you need to manage 5 things - Diet, Exercise, Lifestyle, stress &
Medication

Diet:If diagnosed with Diabetes, your diet is going to play a key role. Contrary to what people
believe, you donot have to give up all your favourite foods and feel deprived. You may have to eat
some foods in moderation. It is important to understand the impact that certain foods can have
on your blood sugar and made the necessary adjustments accordingly.
You should plan your meals by selecting foods from 5 food groups namely, fruits, vegetables, dairy,
carbohydrate and protein. It is always better to ask for a nutritionists advice to know how many
food you can eat from every food group for good glycemic control.

Exercise : An exercise regime plays a key role in managing blood sugar level. When you exercise -
your cells use insulin more efciently to take up the glucose hence lowering blood sugar , It
triggers another response that enables the cells to take up glucose even without insulin.
It is important to exercise safely. If your blood sugar level is high your doctor may recommend a
graduated exercise plan. He can also suggest adjustment in your medication/insulin dose based
on exercise/ activity taken by you. Drink plenty of water as de-hydration can affect your blood
sugar.

Lifestyle: A sedentary lifestyle is one of the key factors for diabetes and related diseases like
hypertension, high cholesterol etc. Your daily routine, sleep hours, time to hit the bed and getting
up, choice of food, cooking process you follow and cooking oil and quantity of oil, tobacco & alcohol
intake, working hour & work stress you carry - are major factors to make a healthy lifestyle for
you.

Stress : Stress does not affect us just emotionally or mentally, it also has a clear physical effect
as it aggravates and increases the risk of diabetes and related complications. Stress and anxiety
can also affect your ability to relax and get proper sleep, contributing to further complications in
diabetes. Stress increases HbA1c level by combining hemoglobin with A1c. As a matter of fact,
people with diabetes may become anxious over a variety of things. On the other hand, people living
with continuous anxiety and stress have very high probability of developing diabetes. Thus stress
is the key factor which needs to be managed.

Medication : If the right diet, exercise, lifestyle & stress fail to control your blood sugar level, your
doctor may recommend medication. This may be oral tablets, insulin or a combination.

A little mindfulness about your lifestyle will go a long way in keeping you healthy. People diagnosed
with diabetes can continue to lead a full and healthy life provided they have full control on their
diet, exercise, stress and they take proper medication as advised by doctor.

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Understanding Diabetes
What is Diabetes
Diabetes is known as "diabetes mellitus". It
is a common condition and is characterized
by abnormally high blood sugar levels.
Diabetes essentially changes the way your
body uses food. Diabetes is not a disease
but is a disorder. Diabetes is the common
term for several metabolic disorders in
which the body no longer produces insulin
or able to use the insulin produced. Insulin
is a hormone that is needed to convert
sugar, starches and other food into energy
needed for daily life.
The cause of diabetes continues to be a mystery, although both genetics and
environmental factors such as obesity and lack of exercise appear to play roles.

Diabetes essentially changes the way your body uses food.

Diabetes is not a disease but is a disorder.

Types of Diabetes
There are three main types of diabetes:
Type 1 diabetes. Type 2 diabetes. Gestational diabetes

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 Diseases or chemicals that damage or destroy the pancreas can also cause diabetes.
Examples include pancreatitis, pancreatic cancer, and hemochromatosis - a disorder in
which excessive amounts of iron accumulate in the pancreas and other organs. Other
specic types include diabetes due to genetic defects, drug induced diabetes etc
Type 1 diabetes
Type 1 diabetes is an autoimmune disease in which the body destroys insulin-producing
beta cells in the pancreas. Without insulin, the body starves to death. Type 1 diabetes is
a lifelong condition that is treated with insulin. Insulin must be given each day and
multiple injections a day (3+1, minimum 3 short acting and 1 long acting) are required to
help maintain blood glucose control.
Ttype 1 diabetes most often affects people
under 20 years of age. It was previously called
juvenile-onset diabetes or Insulin-Dependent
Diabetes Mellitus (IDDM). Treatment involves
daily insulin injections, in conjunction with
healthy eating and regular exercise. 5-10% of
those with diabetes have type 1 diabetes.
Usually patients are young and lean.
The cause of type 1 diabetes is still unknown,
although many have speculated that it is a
combination of genetic predisposition and
environmental factors such as viruses that
serve as the catalyst for the disease's onset.

Type 2 diabetes
Type 2 diabetes is a term for several disorders with different causes and degrees of
severity. It is the most common type of diabetes. Often, people with type 2 diabetes can
still make their own insulin in the pancreas, but the insulin that is produced is not used as
effectively by the body.
Type 2 diabetes often improves as a result of weight loss, a healthy diet and exercise. With
the progression of the disease, some people
may have to take oral medication(s) or insulin
injections. Type 2 diabetes is much more
common than type 1 diabetes. It occurs in 90 -
95% of people with diabetes .It usually occurs in
people who are over 40, overweight, and have a
family history of the disease although it is also
becoming more common in younger people,
particularly adolescents. Although the cause of
type 2 diabetes is unknown, there are some risk
factors that can predispose some people to
this condition. The symptoms of type 2 diabetes
are same as type 1 diabetes.One may also experience slow healing cuts and bruises,
recurring gum or bladder infections, or tingling in their hands or feet.
.Gestational Diabetes Mellitus (GDM)
Gestational diabetes is another common type of diabetes. It is a temporary condition that
occurs during pregnancy.
Extra demands on the pancreas cause some women to develop diabetes during
pregnancy. Often, it goes away after delivery. But, later in life, diabetes may return.
Gestational diabetes affects 2% to 4% of all pregnancies, with an increased risk of
developing diabetes for both the mother and the child. The risk of type 2 diabetes
returning is greater if the mother has given birth to a baby that weighed over 4 kg (9 lbs)
at birth.

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Symptoms of Diabetes
þ Frequent urination
þ Extreme thirst and/or hunger
þ Sudden Weight loss
þ Lack of concentration
þ Fatigue & tiredness
þ Numbness
þ Slow healing
þ Blurred Vision
þ Increased infections
þ Sexual Problems
þ Dry & itchy skin
þ No Symptoms

People with type 2 Diabetes may have no symptoms for nearly 5 - 7 years after high
glucose levels develop- even when there are no symptoms, they may experience vague
symptoms like tiredness, muscle pain, headache, anxiety etc. And therefore, one must
keep a close watch on HbA1c level.

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 Complications of Diabetes
iDiabetes is a chronic disease condition that can cause many serious complications. Numbness
and tingling in your feet or hands (neuropathy), kidney failure (nephropathy) and vision problems
(retinopathy) which can lead to blindness, are the most well-known complications. Following are
the complications which a diabetic person may develop anytime. Poor control of diabetes can lead
to an increased risk of:

à Heart disease
à High blood pressure
à Stroke
à Nerve disease
à Kidney and bladder failure
à Gum disease
à Diabetic retinopathy, Cataract, Glaucoma etc
à Foot and leg infections
à Sexual Dysfunction
à Complications of pregnancy
à Hearing impairment
à Skin conditions
à Alzheimer's disease etc.

Uncontrolled diabetes can even lead to biochemical imbalances that can cause acute
life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic)
coma.

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Who are at Risk
People all over the world get diabetes. The numbers vary from place to place and
among ethnic groups. The risk of getting diabetes increases by who you are, how you
live and where you live. Chances are if you have a family history of diabetes, you may
get it and you may pass the disease on to your children.
Type 1 diabetes can develop at any age, but it most often strikes younger people (under 20
years of age) who are of slim build and especially children at the beginning of puberty.
Whereas, Type 2 diabetes most often affects overweight individuals over 40 years old who
have a low level of physical activity and wrong diet.

Risk factors of Diabetes include:

þ People with sedentary lifestyle
þ People with stress
þ Ethnic background or race / Asian Indian Phenotype
þ Having a parent with type 1 diabetes
þ Age (being over 4O years old)
þ Being overweight or obese (Adiposity factor)
þ Having a family history of diabetes
þ Having given birth to a large baby (over 4 kg or 9 lbs)
þ People with pre diabetes (Impaired glucose tolerance) or the metabolic syndrome-two
þ People with diseases that are closely related to type 2 diabetes
þ People with High Blood pressure
þ Abnormal Lipid Prole

India - Diabetes Capital

India leads the world with largest number of diabetic subjects earning the dubious
distinction of being termed the "diabetes capital of the world". With the proven
statistics INDIA IS SAID TO BE THE DIABETES CAPITAL OF WORLD. The number of
people with diabetes in India currently more than 62 million is expected to cross 100
million mark by 2030. Surprisingly, 35%
diabetic People are not even aware that
they have diabetes.
“
World Health Organisation (WHO)
estimates that nearly 200 million people
all over the world suffer from diabetes and
this number is likely to double in the
coming years. In India, there are nearly 62
million diabetics. One million Indians die
every year due to diabetes-related
complications. Others suffer whole life
with a variety of disEase. The high number
of cases among Indians has been
attributed to genetic factors and Asian
Indian Phenotype Adiposity factor.

Understanding Diabetes w w w. w e l l t h y l i f e . i n 6
 Asian Indian Phenotype

Subcutaneous Fat

Abdominal
Muscle Layer

Intra Abdominal Fat

Indian Phenotype
Adiposity

‘Asian Indian Phenotype' refers to certain unique clinical & bio

chemical abnormalities in Indians which includes increased insulin resistance, greater
abdominal adiposity, that is higher waist circumference despite lower Body Mass Index,
lower adiponectin and higher high sensitive C- reactive protein levels. This phenotype
makes Asian Indians more prone to diabetes and premature coronary artery disease.
Being overweight increases the chances of developing the common type of diabetes, type
2 diabetes.
At comparable levels of total body fat, intra abdominal fat and subcutaneous abdominal
fat, Asian Indians have signicantly larger adipocytes compared to Europids and is
correlated with insulin resistance and adiponectin levels. The proclivity for increased
visceral fat and insulin resistance is evident even among children aged 8 to 11 years.
When energy excess induces obesity, Asian Indians rapidly exhaust the storage capacity
of their supercial subcutaneous adipose tissue compartment and accumulate fat in the
deep subcutaneous tissue and especially the visceral fat depots, before whites do.
Due to this Asian Indians develop metabolic syndrome and diabetes at BMI <25 kg/m2,
which is generally considered normal among whites

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Understanding HbA1c
HbA1c refers to glycated haemoglobin (A1c), which identies average plasma glucose
concentration.

A1C is glucose attached to hemoglobin, a protein found in red blood cells that
transports oxygen from the lungs to other parts of the body. Hemoglobin is
composed of four globins(protein) chains, two beta (b) and two alpha (a) chains. A1C
is hemoglobin that has been glycosylated, or modied by the addition of glucose. The
term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein
within red blood cells that carries oxygen throughout your body, joins with glucose in
the blood, becoming 'glycated'.

By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall

picture of what our average blood sugar levels have been over a period of
weeks/months. For people with diabetes this is important as the higher the HbA1c,
the greater the risk of developing diabetes-related complications.

HbA1c Readings
4.5 to 5.7 : Excellent Control
5.7 to 6.5 : Prediabetic
6.5 & Above : Diabetic
8.0 and above : Diabetic & Critical

Understanding Diabetes w w w. w e l l t h y l i f e . i n 8
 Diet for Diabetes
Diet is the term which generally has a very negative connotation. For people with diabetes, it
means forgoing favourite food stuffs and taking only porridges/kanji, dry chapatti, biscuits,
bitter tasting foods every day. People feel they have committed a sin and it is a punishment for
their indulgence. So they follow these diets without a choice.

The good news is that a person with diabetes can enjoy one's food as any other individual.
There is nothing called a diabetic diet. The principle of dieting for people with diabetes is a
healthy change and is good for every adult in the family. Therefore adopting healthy diet habits
need not be considered as an act of deprivation of the tasty foodstuffs. The ideal diet for
people with diabetes lays emphasis on having a healthy and balanced meal. The family's diet
could be modied similarly for nutritional benets.

All varieties of cereals, dhal/whole grams, vegetables, fruits should be incorporated in the
daily menu. A thali/ plate should preferably include a cereal, dhal or lean meat, vegetables and
milk products. Amount of oil used in food preparations should be minimal and a combination of
different varieties of oil is better. It is necessary to include one fruit daily as a snack. It is also
important to avoid sugar and sweets since they are high in calories, carbohydrate and fats
which can lead to rise in blood glucose. Skipping or delaying meals can cause glucose levels to
go out of control. So having food at regular intervals consisting of 3 main meals and 1-2
snacks in-between will help to prevent this.
By following these guidelines, people with diabetes can lead a healthy life by

Attaining and maintaining recommended metabolic outcomes including Blood Glucose,

Lipids and Blood pressure

Improving health by promoting healthy food choices and physical activity.

Achieving and maintaining reasonable body weight

Preventing and treating chronic complications of Diabetes

Other family members can also follow these dietary principles to lead a healthy life.

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7 Mantra for Prevention & Care of Diabetes
þ Go for regular checkups

þ Take prescribed medicines

þ Stay Active

þ Eat Healthy

þ Maintain a Healthy Weight / BMI

þ Avoid tobacco & limit alcohol

þ Know your risk & take action

Have you checked yours ?

Get yourself checked before it is too late.

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Understanding Diabetes w w w. w e l l t h y l i f e . i n
 FAQ

Q. I have just been recently diagnosed, what should I do?

Whether you have been diagnosed with type 1 or type 2 diabetes, you can live a long and
healthy life by eating healthy, being physically active, and taking medications (if
prescribed) to keep your blood glucose (sugar) in your target range. Do not decide your
food on your own and take medicine as the only care. You need to keep a balance of food,
exercise & medicine (if prescribed) which any other health person should do. Keep
checking your sugar level on a regular basis. Keep an eye on your weight.

Q. Can diabetes be cured?

No. Diabetes cannot be cured. It can only be controlled. In certain cases of type 2
diabetics who are obese, weight reduction can achieve a normal state without use of
drugs.

Q. Why is diabetes becoming a problem in our country?

Indians have signicantly high rates of diabetes when compared to other ethnic groups
such as Europeans, Africans and the like. This is attributed to high genetic susceptibility
and rapid change in life style. Recent studies have shown that the prevalence of diabetes
in India is as high as 12 to 18% of the adult population especially in urban areas. The
magnitude of the problem is likely to increase. Diabetes occurs at a younger age in India.

Q. Can a person have diabetes without symptoms?

Yes. The common symptoms of diabetes are excessive thirst, excessive hunger and
frequent urination. The person may also feel weak and exhausted. These symptoms are
associated with severe diabetes. Very often many people do not have these
characteristic symptoms even when the blood sugar levels are in the diabetic range.
Many have vague symptoms and complain of body pain and lassitude, etc. Hence, it is
difcult to detect diabetes by means of typical symptoms alone. A lot of personal
variations are seen with respect to symptoms of diabetes.

Q. Is diabetes more common among men or women?

In most population it is not very different. Women seem to have higher prevalence in
certain population due to increased obesity. Today in India, diabetes is found almost
equally in men and women.

Q. Can I lead a normal life with diabetes?

Yes. This is a disorder either due to defective action or deciency of insulin. It is life style
disorder. When the blood sugar is kept under control, a diabetic can have a healthy,
normal life.

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Disclaimer : The content given here is purely informative & educational in nature and should not be
construed as medical advice. Kindly use the content only in consultation with a certied medical or
healthcare professional.