Diabetes ManagementDo you have diabetes?

Is any of your close family member or friend is diabetic?

Are you sure you are not on the path of becoming a diabetic within next ten years?

As many as twenty-five percent type 2 diabetics are unaware about their diabetes.

India is currently called the diabetes capital of the world.

Currently, it is estimated that 65.1 million Indians are suffering from it, which was 50.8 million in 2010.

The numbers are expected to double by 2030, reaching up to 87 million.

Every third person seems to suffer from it to some degree. If not clinically diabetic, many are on 

the verge of becoming one.

According to the Global Burden of Disease study, 3,46,000 Indians died in 2015 due to diabetes-related complications.

These statistics are scary and you should take it seriously.

Even after reaching to such an epidemic proportion people generally, lack awareness about it.

Having some knowledge and awareness could help you to take better care of yourself.

Let us start from the basics

What is Diabetes?

Diabetes is a chronic disease.

A person is either unable to produce enough insulin or the sensitivity of the insulin towards the cells is diminished.

This results in the increase in blood sugar levels which can cause serious damage to all the vital organs and nerves and blood vessels of the body.

What is a pancreas and why it is important?

The pancreas is a six-inch long organ that sits behind the stomach.It releases vital hormones into the digestive system.

Normally when the blood sugar of the body exceeds normal range, the beta cells of the pancreas release insulin into the bloodstream.

Insulin takes all the excess blood sugar either to the cells to be used for energy or transport it to the fat cells to be stored as fat.

Types of diabetes

Basically, Diabetes is of two types

Type 1 Diabetes (Juvenile-onset):

It is an autoimmune disorder in which the immunity system attacks the beta cell of the Pancreas.

This causes either the complete destruction of the beta cell or leaves very few cells remaining. The body produces very little to no insulin.This results in sugar building up in the blood and unable to be used by the body.This is not a very common form of diabetes.

The actual cause as to why the immune system attacks body’s own organ is still not clear.Generally, it develops in childhood or adolescence. They have to depend on insulin shots for the rest of their life.

Type 2 Diabetes (Maturity-onset):

This type of diabetes occurs when the cells of the body do not respond to the insulin hormone. 

Even in the presence of insulin, the cells are unable to take up sugar for energy. This insensitivity towards the insulin causes the sugar to remain in the blood while the cells of the body starve.About 90% diabetics are type 2.

Complications related to Diabetes

1 Kidney damage (Nephropathy): Over a long period of time, if the blood sugar levels are high, the blood vessels of the kidney are damaged and the kidney is unable to filter the blood properly.

Due to this some protein spills into the urine instead of blood. Without a proper treatment, the kidney could fail. The person then has to be put on dialysis.

High blood sugar can also damage the nerves which give the signal when the bladder is full. You will not feel the pressure when the bladder will be full. This pressure could damage the kidney.

2 Eye Damage (Diabetic Retinopathy): Diabetes is a leading cause of blindness. Over long duration, the small blood vessels, that nourishes the retina, are damaged due to diabetes. This stage is called background retinopathy.

As the condition progresses the blood vessels become blocked. This leads to lack of oxygen in some areas of the retina which can cause the death of some parts of the retina.

This may cause blurred vision or complete loss of vision.

This can affect one in every twenty diabetics.

3 Foot Problem: People who suffer from diabetes for more than five or six years and constantly have high blood sugar levels will suffer from some loss of sensitivity in their feet.

This happens because long time elevated blood sugar can injure and eventually damage the sensory nerve in the feet.

Even the nerves which control the shape of your feet will get damaged, resulting in the deformed shape of the feet.

Furthermore, damage to the nerves that stimulate perspiration will get damaged causing the skin of your feet to become dry. This will slow the healing due to any external injuries and infectious bacterias could enter through cracks.

This can lead to gangrene and in extreme cases, a part of the foot will be amputated (medical lingo for cutting off your foot) to prevent further spreading of infection up the leg.

And it goes without saying, what a devastating experience it can be.

4 Diabetic Ketoacidosis: - Diabetic Ketoacidosis (DKA) mainly affects type 1 diabetics. But people with prolonged type 2 diabetes, whose beta cell are damaged and are able to produce very little to insulin, may also be at risk.

This condition happens when the blood sugar rises dramatically and there is no insulin in the body to bring those levels down.

As there is no insulin present the body is unable to burn these excess sugar (to be more technical-glucose). Thus, the body will start burning large amounts of fat. The burning of fat will result in by-product called ketones. 

When there is a high concentration of ketones in the blood, the blood will turn acidic. The body will try to eliminate the excess ketones through urine which could lead to severe dehydration. 

This condition can be life-threatening if went untreated for hours.

5 Gastroparesis: - The high blood sugar can damage the nerve which controls the movement of the food through the digestive tract ( Vagus nerve).

This causes the muscles of the stomach and intestines to work abnormally.

The movement of food, through the stomach, can either slow down or completely stop.It can worsen your management of blood sugar by making the digestion of food unpredictable.

This can cause your medication for blood sugar to start working when the food is still in the stomach thus causing low blood sugar.

This will be followed by the food finally entering the blood circulation when the effect of the medication is reduced causing the rise of blood sugar.

Bacterial overgrowth is another problem to worry about. If the food remains longer in the stomach it can cause fermentation leading to the growth of bacterias.

6 Heart disease: - Heart disease is the most common cause of death for the majority of people having diabetes.

Diabetics are five times more likely to die of heart disease than non-diabetics. 

High sugar in the blood causes the oxidation of LDL cholesterol (bad cholesterol) and makes them stick to the walls of blood vessels.

This causes the formation of plaque, which makes the blood vessels thick leading to a condition called atherosclerosis. It can restrict the blood flow to the heart.

7 Alzheimer's disease: As the body becomes more insulin resistant, the body will compensate by producing more insulin. People with type 2 diabetes produce excess insulin. This excess insulin can get to the brain and affect the brain cells by increasing the levels of a protein called Tau protein, which is also seen in Alzheimer’s patients. As more and more studies are conducted, the link between type 2 diabetes and Alzheimer's is becoming stronger.These are just so are just a few effects you will face if you do not take diabetes seriously.

People with type 2 diabetes produce excess insulin. This excess insulin can get to the brain and affect the brain cells by increasing the levels of a protein called Tau protein, which is also seen in Alzheimer’s patients. As more and more studies are conducted, the link between type 2 diabetes and Alzheimer's is becoming stronger.These are just so are just a few effects you will face if you do not take diabetes seriously.

As more and more studies are conducted, the link between type 2 diabetes and Alzheimer's is becoming stronger.These are just so are just a few effects you will face if you do not take diabetes seriously.

These are just so are just a few effects you will face if you do not take diabetes seriously.

Why is it important to be well informed about Diabetes?

Most people remain ignorant about diabetes and take it like other diseases where a prescription from a doctor will take care of it.

If you treat it as such, you will not be able to control your blood sugar properly. This could inevitably lead to any of the above-mentioned complications. 

Every diabetic should try to equip themselves with as much knowledge about diabetes as they can. 

Your doctor can give you the medicine and advice but you are the one who has to follow through. Once a month doctor appointment will not prevent you from the damages. Even a few hours of elevated blood sugar levels can cause a lot of harm.

You should monitor your blood sugar four to five times a day, at least once or twice a week, to get a proper understanding of the fluctuations in your blood sugar levels. It can be frustrating at times and you feel like it is too much of a hassle for you but it is important.

Along with the medications, your food habits will have a great impact on your diabetes.Your dietary habits will decide how good your control is on your blood sugar levels.

But be aware, there are some commonly thought health foods that are actually going to cause havoc to your blood sugar levels.

As you already know that your body is insulin resistant that means your body is unable to handle glucose. So you should always stay away from such foods.

Below are the so-called health foods that are going to raise your blood glucose levels which your body will not be able to tolerate.

Fruit juices:  One of the most common belief is that fruit juices are very good for your health.

You may get advice like “ Since you are diabetic you should be having the juice without adding any sugar.” These are what you may call, a well-meaning but ill-informed advice.

When you extract the juice from any fruit you leave out all the fibers present in that fruit. Without the fibers, the sugar present in the fruit gets easily absorbed. Thereby, raising the blood sugar.

Do not convert your fruits into sugar water; always go for the fruit.

The so-called light food (Poha, Upma, Dosa): These so-called light foods are going to be a burden on your blood sugar levels.

This is such a stupid thing to say that eating poha upma or dosa cooked in very little oil is good for you. Even many dietitians recommend it to their diabetic clients.

The carbohydrate present in this foods is going to get absorbed very fast. This is going to raise your blood sugar faster when you already lack the ability to use it.

Always remember the food that feels light in your mouth, are going to be a burden for your diabetic body. This means that the more effort you have to put in chewing the food the slower it is going to release glucose into the blood. Like fibrous vegetables.

Brown Bread: Everybody knows that white bread are unhealthy and we should always go for brown bread.

This is another big lie you are made to believe. Not all brown bread are actually hundred percent wheat bread.

They are simply marketed as a healthy alternative to white bread, which many of us buy into.

The flour used are refined and processed to such an extent that all the nutrients are stripped away. What remains is something equivalent to white bread.

The researchers found that the glycemic index of brown bread is nearly same as white bread. That means they will raise your blood sugar as quickly as white bread.

(Glycemic Index is simply the measure of how fast the blood sugar is raised by that particular food.)

Fruits and vegetables you should and should not include in your diet to control your blood sugar.

You should always go for fresh and whole fruits. Do not eat canned and processed fruits or juices. 

Fruits and vegetables are important in our diet as they are rich sources of vitamins and minerals. 

They also contain many phytochemicals like Quercetin, Anthocyanin which are shown to protect us from many chronic diseases. They are also a rich source of both soluble and insoluble fibers.

But there are certain fruits and vegetables you should not eat because they are high in sugar and will raise your blood sugar levels.

Fruits you should avoid-

Avoid all the fruits that high in sugar. Some high sugar fruits are Mango, Chikoo, Custard apple (Sitafal), Banana, Lychee, Grapes, Guava, Pomegranate (Anaar),

Watermelons should also be avoided. Even though they are low in sugar but the sugar present is highly diluted and will raise your blood sugar faster.

Basically, any fruit that tastes sweet are rich in glucose and should be avoided.

Fruits you can have- Papaya, Orange, pineapple, Raspberry, Strawberry, Avocado, Gooseberry (Amla), Coconut water and coconut meat, Olive, Kiwi.

Vegetables you should avoid- Beetroot, Corn, potato, Carrot, Peas, Tomatoes (limit the quantity).

Vegetables you should have- Cabbage, cauliflower, Eggplant (Baingan), Broccoli, Asparagus, Bell Pepper (Shimla Mirch), all green leafy vegetables, Cucumber, Mushroom, Okra (Bhindi), String beans. French beans.

Why is Exercise a must for Diabetics?

After you take care of your diet, the next important step to improve your diabetes is regular strenuous exercise.

The benefits of exercise are so great for diabetics that, you will be foolish not to start working out. 

But remember just doing a morning walk will not be enough to reap all the benefits that exercise can provide. Weight training is important for you as this alone can improve your muscle density.

Women should not be scared of weight training; thinking that it will make you muscular like men. It does not happen as women lack testosterone (male hormone) which is the primary reason why men are able to grow more muscles than women. Weight training is going to strengthen and tone your body.

So for both men and women, the better body composition (more muscles and less fat) you have the better will be your insulin sensitivity. 

Strenuous exercise itself can lower your blood sugar level by driving those sugar to the muscle cells to burn as fuel. There is a direct relation between exercise and brain development. Dr. John Ratey, in his book Spark, has covered this topic in great details.

The more physically active you are the more mentally stronger you will be. 

Always remember that any kind of exercise you choose it should be challenging for your body. And it should leave you panting and sweating at the end of the session.

Conclusion

"Taking care of diabetes is really just an ongoing series of small sacrifices, costs, mental efforts, and time commitments." - Gary Scheiner, MS, CDE 

Diabetes is a chronic disease and it is going to be with for the rest of your life. There will be a constant struggle between you and your diabetes, that who controls who.

I agree, at times it may be very frustrating to see other people taking things for granted, which you have to think twice before doing. Like eating out with your family without worrying about whether the food is going to raise your blood sugar or not.

There will always be a threat of going into hypoglycemia (low blood sugar) if you took your medication and forgot to eat after that or could not find food at that time. 

All this may paint a dark picture in front of you but remember all is not lost.

The treatment and medication are constantly evolving and better treatments are coming up. This has greatly reduced a lot of the risk which earlier would have been inevitable. 

There is a new research going on developing completely new pancreas or beta cells. This can completely cure diabetes, it will no longer be a lifelong sword hanging above your head.

But till such advancements will come you have to take care of yourself. Create a community or join a community of diabetics and motivate each other. Share your struggles with others and listen to their problems.

Let this be an opportunity to find new friends and relations. The life has given you lemons you better make lemonade out of it.

Photo Source: https://en.wikipedia.org/wiki/Diabetes_management#/media/File:Glukometr_OT.jpg


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