Frequently Asked Questions

Diabetes is a chronic disorder due to decreased insulin secretion or defective insulin action or both which results in high blood sugar status.

1.What are the types of Diabetes?

Type 1 --- There is absolute insulin deficiency and they require insulin injection for survival.
                 Age in years usually <30 years
Type 2 --- There is decreased insulin secretion and defective insulin action.
                 Age Adults >30 years, they can be treated by oral drugs or insulin.

2.Symptoms of Diabetes?

3.How to diagnose Diabetes?

Fasting Plasma Glucose - >126 mg/dl,
Random Plasma Glucose - ≥200 mg/dl with symptoms (On two separate occasions),
Post prandial Plasma Glucose 2 hours after giving 75G glucose OGTT - >200mg/dl

4.What targets to be achieved in Diabetes?

FPG --- 70 to 130mg/dl
PPPG --- 135 to 180 mg/dl
HbA1c --- < 6.5%
B.P --- < 130/80mm Hg
L.D.L --- 80 mg/dl (Cholesterol)

5.What are the treatments for diabetes?

Type 1 Diabetes– only by giving insulin injection (Oral drugs are not effective)
Type 2 Diabetes– can be treated by giving oral drugs or insulin injection.

6.What are the complications if Diabetes is not controlled?

7.What is Glycosylated Hb (HbA1c)?

HbA1c indicates average blood sugar over a period of 2 to 3 months Normally in non Diabetics --- 5.7% In Diabetics HbA1c should be maintained at 6.5%

8.Whether Diabetes can be cured?

No, regular check up with Diabetologist is necessary to control blood sugar to prevent complications.

9.My Father / Mother has diabetes, whether will I get diabetes?

If both parents are suffering from Diabetes the chances are 40%. If one parent is suffering from Diabetes the chances are 25%.

10.Whether Diabetes spreads from me to my spouse?

No

11.Is it possible to lead normal life, like marriage etc, if one is detected with Diabetes Mellitus?

Yes

12.What are pre diabetic conditions?

Impaired fasting glucose tolerance – 100 to 125 mg /dl
Impaired glucose tolerance – 140 to 199 mg/ dl
Post Prandial Plasma Glucose - 140 to 199 mg / dl

1.How common is diabetes in world?

Diabetes is growing; prevalence of diabetes in the world is about 285 millions and is growing rapidly. In fact international diabetic federation has claimed pandemic status of diabetes and it is coming like a tsunami.

2.How common is diabetes in India?

It is estimated that India has around 50.8 million diabetic persons at present. It is suppose to double by 2025.

3.Is diabetes genetically transmitted?

It is true for type 2 diabetes and also type 2 Diabetes depends on diet and lifestyle.

4.Can diabetes be prevented?

It cannot be prevented for type 1 diabetes but it is estimated that 80% of type 2 diabetes can be prevented or postponed for several years.

5.How can I prevent getting diabetes?

Exercise, lifestyle management, diet and drugs to some extent prevent type 2 diabetes.

1.What is the importance of Diet?

Diet has a very important role in prevention of Diabetes and good control of blood sugar in person with diabetes. Diet and lifestyle changes are important to prevent conversions of pre-diabetes to Diabetes.

2.What diet is ideal for me?

Follow a diet which is just right in calories for your weight as advised by your doctor. Diet should maintain an ideal weight, (it should not add or lose your weight).

3.What is an ideal weight?

Ask your doctor for an ideal weight for height chart which gives your ideal weight.

4.I am overweight should I lose weight?

YES, it is good to maintain ideal weight. Overweight people develop insulin resistance which worsens diabetes or you find it difficult to achieve good blood glucose control.

5.How can I lose weight?

It is recommended that you consume adequate calories as advised by your doctor and exercise regularly for at least 30minutes for 5 days in a week. Once you lose weight try to maintain the ideal weight.

6.How much weight I should lose?

5 to 7% weight loss is ideal which helps in controlling blood sugar level.

7.Should I avoid sugars?

YES, eating food and eatables containing glucose, sucrose will increase your blood sugar immediately. Hence simple sugars act as emergency medication if you are in low sugar (hypoglycemia).

8.Can I drink fruit juices?

No, you can’t drink fruit juice but you can eat whole fruit in recommended quantity.

9.Can I drink tender coconut?

No

10.What vegetables and fruits can I consume?

You can consume vegetables rich in fiber such as green leafy vegetables cucumber, knol-khol, raddish etc and fruits like sweet lime orange, papaya, guava, apple and pears.

11.Insulin, Can I control my blood sugar by fasting?

NO, if you have high blood glucose and if you fast, your body tunes to adapt to fasting state by producing ketones which is very dangerous. If you are on insulin fasting or skipping a meal can result(put you into life threatening state)in low blood sugars which is dangerous.

12.What should I do when I feel hungry between meals?

Persons with diabetes should follow at least five to six meal and snack pattern. They should split the usual three day meals to five /six meal pattern without adding extra calories.

13.Should I restrict all the foods?

NO, there are certain foods like green leafy vegetables which can be consumed in plenty which are rich in fiber, minerals, vitamins and also adds to the antioxidant effect for the body.

14.Are meat and eggs harmful?

NO, Meat and Eggs can be consumed but in limited quantity. People with diabetes are prone for high cholesterol, hence meats and eggs will add to the cholesterol level. Fish is an ideal food which can be consumed liberally (method of cooking is also important).

15.Which vegetables are rich in carbohydrate?

All roots and tubers, such as potato, tapioca, colacasia, sweet potato etc, and beetroot are some foods rich in carbohydrate, which has to be taken into account for calorie counting.

Patients with Diabetes are more likely than others to have problems with their FEET. Recognizing and treating foot problems early can help diabetic patients avoid serious complications.Diabetic foot problems are a major cause for hospitalization in India.

All that you need is a pair of sensible hands and eyes. A healthy foot

1. Strong and flexible.
2.Supports the weight of the whole body.
3. Bones and joints help to absorb pressure from the body’s weight.
4.Skin and fat are first barrier to prevent infection.

Diabetes affects in three ways

1.Nerve damage-Neuropathy affects the nerve that supplies sensation to the feet. Thus decreasing the feeling of pain in the feet.
2.Hardening of the blood vessels i.e., defects in micro circulation leads to ulceration.
3.Infection-either superficial or deep and sometimes life threatening.

Common diabetes foot problems

Do’s…..

Don’t’s…..

1.What is Insulin?

Insulin is an important hormone produced naturally by beta cells of pancreas in our body.This hormone is very important in metabolism of glucose. It’s deficiency or defective action or both which cause diabetes.

2.Is there any ways of increasing Insulin production in Diabetes?

Drugs like sulfonylureas will increase Insulin production to some extent. Physical activity, Exercise and drugs like glitazones will make available Insulin in the body to act more efficiently.

3.When do patients of Diabetes have to take Insulin?

a) All patients of type 1 Diabetes.
b) All Diabetic women when they are pregnant and lactating.
c) In type 2 Diabetes when oral tablets are not efficiently controlling blood sugars. d) During medical emergencies like Diabetic keto acidosis, Infections and surgery.

4.Is Insulin once started has to be taken life long?

Treatment for Diabetes is lifelong. If sugars are not controlled with oral tablets then it is called oral drug failure. In such situations Insulin as to be taken continuously. If Insulin is started temporally during pregnancy or Infection or keto acidosis later it can be stopped.

5.If Insulin taken for long time will cause damage to my health?

This is not true. In fact if sugars are not controlled well, will cause damage to vital organs like kidney, heart, eyes. Taking Insulin and controlling sugars can prevent these problems.

6.Insulin injections are painful, Are insulin tablets available?

Earlier injections used to be very painful. Now with the advance of technology very fine needles are available, which will not cause pain. If insulin is given orally it will be destroyed in the stomach. Any how at present production of oral insulin preparations is in the experimental stages and is not commercially available.

7.My relative has diabetes for many years, but he is not taking insulin. I have diabetes     only for few years why I should take Insulin?

Each patient is different. Each patient responds differently to drugs. There are many factors which influence oral drug failure. Hence insulin when prescribed by your doctor should be taken.

8.Is it possible if I take Insulin injection once a day?

Majority of insulin’s available have to be taken more than once per day. But now newer insulin preparations called long acting analogs, which can be taken once a day are available, but are expensive.

9.Is Hypoglycemia more with insulin?

Patient on treatment either with tablets or insulin can experience Hypoglycemia. Sometimes during their treatment these episodes are not more with insulin.

10.Who will give me insulin injection?

You should not depend on doctors /nurses or any other person! Always try to be self reliant. You can learn self injections at any age. Once you start taking insulin you will realize how simple it is. These injections can be taken over abdomen, around outer aspects of thigh and upper aspect of arm, exact location and technique will be shown when we prescribe Insulin diagram of sites teach you Insulin administration.

11.Once I am on insulin, is it necessary to take tablets also.

Yes. Sometime you have to take tablets also along with insulin. These tablets will improve the action of insulin given.

a).Why should I exercise?

1).Exercise lowers your

2.Raises your Good cholesterol

3.It decreases insulin resistance

4.Lowers risk for heart disease and stroke

5.Keeps your heart and bones strong

6.Keeps your joints flexible

7.Helps to lose weight

8.Decreases your stress level

b).What kind of exercise  can help me?

1.Being extra active every day

2.Extra active every day

Aerobic Exercise -Brisk walking / Jogging, which makes your heart beat faster. Exercise 30 minutes a day at least 5 days a week is beneficial for health. 150 minutes per week is ideal for health.
Exercise with hand weights three times a week builds muscle mass which burns more calories so you lose weight. Stretching before exercise helps to increase flexibility, lowers stress and prevents muscle soreness.

3.What is the ideal time to exercise?

Exercise can be done any time of the day preferably early morning is a ideal time but Exercise can be split into two schedules in the morning and evening.

4.What precaution should I take before starting Exercise?

Stretching exercise is a must before you begin exercise.

5.Can Exercise lower my blood sugar?

Yes, exercise whether you lose weight or not can control blood sugar levels. Vigorous exercise can lower your blood sugar, so much that it may cause low sugar which is risky.

6.If I have high sugar can I exercise to lower my blood sugar?

No. If you have high sugar you might be having Ketones in urine which increases on exercise hence do not exercise until your doctor advice to do so.

7.If I have Diabetic complications like Eye problems and Kidney disease could I exercise?

You can exercise but avoid heavy weight lifting exercise if you have diabetic related problems. In case of numbness of limbs avoid weight bearing exercise but do Cycling and swimming exercise (Non-weight bearing exercise).

Dietary measures are an essential part of treatment in diabetes along with oral drug or insulin and regular exercise.

Importance of nutrition in the field of diabetes.

Nutrition plays an important role in achieving optimal serum lipid levels (cholesterol and triglycerides). The fundamental principle of dietary control in diabetes is to give the individual only the necessary calories according to the body’s daily requirement.The total calories advised will vary for each individual.
A diabetic nutrition plan is a balanced diet, which a normal person can follow for healthy living; However the nutrient intake has to be altered from individual to individual based on the age, sex, weight, height, physical activity, physiological needs and current dietary pattern accordingly, the diet is planned which helps to attain and maintains normal weight, controls and maintain blood glucose level and also gives a feeling of well-being and satisfaction.

To obtain adequate nutrition.

Carbohydrate foods are spread evenly throughout the day or may be varied according to the type of insulin used and the activity level of the individual (especially in TYPE 1)
These should provide about 55% of the total energy intake of which simple carbohydrates must be about 20% and complex carbohydrate should fulfill the remaining requirement.
Dietary fiber may be enhanced to an intake of about 25-30gm/day.
Fat level is limited to 30% of the total calories, which varies from individual to individual.Protein to 15% of total calorie.Management of hypoglycemia

Few instructions to be followed

1.While traveling

2.While you fall ill

Glycemic Index(GI)

Classifies foods or meals based on their potential to raise Blood glucose levels. It is expressed as a percentage of the response to a standard food or carbohydrate, usually white bread or pure glucose.

Glycemic Load(GL)

Glycemic load of a meal/ food is the product of the amount of available carbohydrate in that food/meal and the glycemic index of the food.

Glycemic index of selected south Indian breakfast meals

FREE FOODS = 20 CALORIES PER SERVING

Refined cereal products

Foods to be avoided

Recommended

Instructions