1. FIVE CONCEPTS OF LIVING HEALTHY WITH DIABETES Dr Zinobia Madan, PhD, MAMS, FIMSA, FICN, Founder & Managing Director, ClinOma HealthcareDiabetes management requires awareness. If you are a diabetic, it is essential for you toknow what makes your blood sugar level rise and fall — and how to control these day-to-day factors.A diagnosis of diabetes puts you at a crossroads of your health. You may pretend that theblood result is a medical error or you may look at a diagnosis of diabetes as a wake-up calland make healthy changes to improve your life. The present article is intended to help adiabetic understand that this disease is manageable and treatable with practice of the fivebasic concepts that can help you live healthy. These include : daily exercise, testing yourblood glucose, healthy nutrition, scheduled medications and support of family and friends.Diabetes mellitus is a chronic condition, but people with diabetes can lead a full life whilekeeping their diabetes under control. Lifestyle modifications are an essential component ofany diabetes management plan. Lifestyle modifications can be a very effective way to keepdiabetes in control. Improved blood sugar control can slow the progression of long-termcomplications. Multiple small changes can lead to improvements in diabetes control,including a decreased need for oral hypoglycaemic medications and insulin.Diabetes requires a lifelong management plan, and persons with diabetes have a central rolein this plan. Lifestyle modifications are an opportunity for diabetics to take charge of theirhealth. Therefore, it is important to learn as much as possible about diabetes and to take anactive role in making decisions about healthcare and treatment.Being Active :Whether you are a diabetes or not, at least thirty minutes of daily exercise, 4 to 5 times a weeksuch as brisk walking will enhance your metabolism and improve your overall health &mental outlook. During exercise, drink plenty of fluids and stay hydrated.If your blood sugar level is over 300 mg/dl, if you are sick, short of breath, have ketones inyour urine or are experiencing any tingling, pain or numbness in your legs, you must avoidexercise. Exercising regularly will provide you innumerable benefits : helping in weight
2. reduction by burning calories, improving blood sugar control and thereby helping in reductionof dose of insulin and oral hypoglycemic medications, reducing risk of bone loss, heartdisease and stroke. Exercising also causes lowering of blood pressure, increase in the goodcholesterol (HDL) and decrease in the bad cholesterol (LDL) and triglycerides which are allimportant parameters beneficial for the heart. Exercise including weight bearing activities andstrength-training activities help strengthen bones and muscles, and help increase flexibilityand movement. Exercise helps decrease stress and improves sleep patterns.These precautions encourage patients to stay safe and ensure that exercise is productive. • Wear well-fitting, protective footwear. • Drink adequate liquids before, during, and after exercise to prevent dehydration, which can upset blood sugar levels.Diabetics who use insulin should also : • Measure blood sugar before, during, and after exercise to determine their bodys typical response to exercise. If the pre-exercise blood sugar reading is 250 mg/dL or higher, exercise should be postponed until the level is under control. • Choose an insulin injection site away from exercising muscles (for example, avoid the legs if running) • Keeping rapidly absorbed carbohydrates on hand (glucose tablets, hard candies, or juice). • Eat a snack 15 to 30 minutes before exercise, and again every 30 minutes during exercise. • Eat a source of slowly absorbed carbohydrates immediately after exercise. This will counter a post-exercise drop in blood sugar levels.Type of exercise — Gentle aerobic exercises, which increase the heart rate for a sustainedperiod of time, are often the best choice for diabetics. Examples of aerobic exercise includewalking, cycling, swimming, or rowing. Diabetics with well-controlled blood sugar levels andno complications can usually participate in most of the common types of exercises.Choose exercise that is enjoyable and can be performed comfortably, making it easier to staymotivated and stick with a program over time. People who are accustomed to a sedentarylifestyle may find it particularly challenging to start and continue with an exercise program.People with diabetic eye complications may be advised to avoid high-impact activities andstrenuous weight-lifting, which can increase blood pressure and cause bleeding in the eye.People with neurologic complications (peripheral neuropathy) are usually advised to avoidtraumatic weight-bearing exercises such as running, which can lead to foot ulcers and stressfractures although this depends on the severity of the nerve damage.Intensity — Exercise does not have to be intense to be beneficial. Persons who want toincrease the intensity of exercise should do so gradually, and should stop if he or sheexperience worrisome symptoms, such as chest discomfort or nausea.Duration — A reasonable exercise session consists of 10 minutes of stretching and warm-up,followed by 20 minutes of gentle aerobic exercise. Eventually, you may wish to exercise for
3. more than 30 minutes at a time. You should increase the duration of exercise gradually.Timing — People who take insulin should try to exercise at the same time of the day. Thispractice can help to maintain predictable blood sugar levels.Frequency — Most of the benefits of exercise for people with diabetes require a regular, long-term exercise program. Patients should commit to exercising 30 minutes a day most days ofthe week.Blood Glucose testing :The next basic concept is blood glucose testing. Just like a road map directs you toward yourdestination, your blood glucose log is a map of your diabetes journey. Use your glucosetesting results to see the impact of food and activity to help you attain healthy glucose goals.In order to determine whether or not someone has diabetes, the American DiabetesAssociation (ADA) recommends Fasting Plasma Glucose (FPG) testing. A FPG level below100 mg/dl is normal, between 100 and 125 mg/dl is referred to as impaired glucose toleranceand signals pre-diabetes and FPG of 126 mg/dl or more is diabetes.A person may have type 2 diabetes without knowing it. Often diabetes goes undiagnosed formany years because its symptoms seem so harmless. People who are high risk must checkwith a physician for diagnosis. They might have some or none of the following symptoms:increased thirst, urination or tiredness, slow healing wounds, and pain/tingling in limbs.People with diabetes can play an important role in medical care, and self glucose monitoringis an opportunity to take control of their own health. Self-care is the key, as daily care canprevent most complications.Nutrition is the third basic concept as well as the most challenging.Eating right is a key step to preventing and controlling diabetes. Your nutritional needs are thesame as everyone else—no special foods or complicated diets are necessary. But if the wayyou eat has been less than healthy, you may need to learn some better eating habits. Eat awell-balanced diet that is high in fiber, low in saturated fat and low in concentrated sweets. Aconsistent diet that includes roughly the same number of calories at about the same times ofthe day helps for better control of diabetes with medication or insulin. Some suggestionsinclude eating a wide variety of foods, choose foods high in fiber, eat multiple meals – portioncontrol is key. The key to a diabetes diet is eating in moderation, sticking to regularmealtimes, and eating a variety of fruits, vegetables, and whole grains.Eating right for diabetes comes down to three things: • What you eat. Your diet makes a huge difference!! You should eat lots of veggies, cut back on refined carbohydrates and sugary drinks, and choose healthy fats over
4. unhealthy fats. • When you eat. You need to keep regular meal and snack time schedules as this affects your blood sugar levels and will help you to control your diabetes. • How much you eat. Portion sizes matter. Even if you eat very healthy meals, if you eat too much you will gain weight, which is a factor in diabetes.Glycemic Index (GI) – an important dimension in diet of diabetics.Recent studies from Harvard School of Public Health indicate that the risks of diseases suchas type 2 diabetes and coronary heart disease are strongly related to the glycemic index of theoverall diet.Not all carbohydrate foods are created equal, in fact they behave quite differently in ourbodies. The glycemic index or GI describes this difference by ranking carbohydratesaccording to their effect on our blood glucose levels. Choosing low GI carbohydrates - theones that produce only small fluctuations in our blood glucose and insulin levels - is thesecret to long-term health reducing your risk of heart disease and diabetes and is the key tosustainable weight loss. • Eating a lot of high GI foods can be detrimental to your health because it pushes your body to extremes. This is especially true if you are overweight and sedentary. Switching to eating mainly low GI carbohydrates that slowly trickle glucose into your blood stream keeps your energy levels balanced and means you will feel fuller for longer between meals.• Low GI diets help people lose and manage weight• Low GI diets increase the bodys sensitivity to insulin• Low GI carbs improve diabetes management• Low GI carbs reduce the risk of heart disease• Low GI carbs improve blood cholesterol levels• Low GI carbs reduce hunger and keep you fuller for longer• Low GI carbs prolong physical endurance• High GI carbs help re-fuel carbohydrate stores after exerciseTips on switching to a Low GI Diet for a diabetic :o Use breakfast cereals based on oats, barley and brano Use breads with wholegrains instead of maidao Reduce the amount of potatoes you eato Enjoy all other types of fruit and vegetables, particularly those with a lower GIindex.o Enjoy pasta, noodles preferably of whole wheato Eat plenty of salad vegetables with a vinaigrette dressing
5. A diabetes diet is simply a healthy eating plan that is high in nutrients, low in fat, andmoderate in calories. It is a healthy diet for anyone!It is extremely important for a diabetic patient to coordinate his /her meals and medication.Too little food in comparison to your diabetes medications — especially insulin — may resultin dangerously low blood sugar (hypoglycemia). Too much food may cause your blood sugarlevel to climb too high (hyperglycemia). The diabetologist / physician/ nutritionist can helpstrike the right balance.Alcohol and Type 2 diabetes :If you are on insulin, or certain oral diabetes medications, such as a sulfonylureas thatstimulate the pancreas to produce more insulin, drinking alcohol can cause a dangerous lowblood sugar because your liver has to work to remove the alcohol from your blood instead ofits main job to regulate your blood sugar.Safe drinking guidelines: • Consult your physician and follow his/her advice — alcohol can worsen diabetes complications. • Monitor your blood sugar before, during, and after drinking alcohol. Remember to check before going to bed. • Never drink alcohol on an empty stomach — food slows down the absorption of alcohol into the blood stream. • Avoid binge drinking — The American Diabetes Association suggests men have no more than two drinks a day, and women one, the same guidelines as for those without diabetes. • Be prepared — Always carry along glucose tablets or another source of sugar. • Dont mix alcohol and exercise — physical activity and alcohol will increase your chances of getting a low blood sugar. • The symptoms of too much alcohol and low blood sugar can be very similar, i.e. sleepiness, dizziness, and disorientation. You dont want others to mistakenly confuse hypoglycemia for drunkenness.Quitting smoking :
6. Quitting smoking is one of the most important things a diabetic can do to improve his /herhealth. Smokers with diabetes have an increased risk of the following: • Death, especially from heart attacks and strokes • High LDL ("bad") cholesterol levels • Worsened blood sugar controlled, compared to non-smokers • Nerve damage from diabetes • Kidney disease leading to dialysis • Foot ulcer and amputation of toes, feet or legs caused by peripheral vascular diseaseDiabetics who quit smoking can decrease their risks.Medications can be a crucial adjunct to maintaining a healthy blood glucose level so followthe directions for each medication and take it at the prescribed times. If the instructions are totake it before meals, do that regularly.The day-to-day management of blood sugar levels can be complicated. The daily regimenmay include oral medications and/or insulin, frequent blood sugar monitoring, and carefullyplanned meals and snacks.People with diabetes may need to take several medications throughout the day. Medications tolower high blood pressure, lower cholesterol levels, and low-dose aspirin may be used tomanage and prevent complications. Each prescription should be taken exactly as directed on adaily basis. If the medication schedule is complex, a pill organizer or a diary / written outlinemay be helpful in remembering to take specific medications at specific times.Support of family and friends cannot be overlooked for its importance. We all need to knowthat we are not alone in this journey. Dealing with diabetes is an ongoing challenge, but dailyexercise, regular glucose testing, healthy nutrition, timely medication and consistentemotional support can help you live a long and healthy life.Importance of Self Care :Diabetes daily care includes: blood sugar monitoring, meal planning, exercise, and takingyour medications regularly. Also, take care of your feet and wash with warm water and mildsoap everyday, and remember do not soak. Check closely for scratches, cracks and redness ordry skin. Never do “home surgery” on your feet, ask for help from a physician if you haveany concerns.People with diabetes also need to control their stress levels. Stressful events are a reality oflife and they can never be eliminated completely. As such stress management is necessary forleading a happy and healthy life. It also leads to better management of diabetes. Thestrategies to manage stress include exercise and relaxation techniques, yoga, meditation,social supports, and in severe cases, consultations with professional psychotherapists.
7. No matter what kind of diabetes you have, Type 1 or Type 2, in the long term it could lead toeffects on other organs of your body and also complications. To prevent these complications,the goal should be to learn the ABC’s of diabetes. The “A” stands for the A1C or hemoglobinA1C test, which measures average blood glucose over the previous 3 months. “B” is forblood pressure, and “C” is for cholesterol. People with diabetes should attain as near asnormal blood sugar, blood pressure and cholesterol levels. Also, you should follow up with aphysician regularly for health maintenance check-ups. All patients with diabetes should betreated appropriately with risk factor modifications.Diabetes and obesity are two major health issues that are on a rapid rise today. Set some goalsfor yourself, make some lifestyle changes, and take control. Diabetes is on the rise, yet mostcases of diabetes are preventable with healthy lifestyle changes. Some can even be wellmanaged and controlled with the right lifestyle and medications. The bottom line is that youhave more control over your health than you think. If you’re concerned about diabetes, youcan make a difference by eating a healthy diet, keeping your weight in check, gettingexercise, controlling your stress and taking your medications as advised. All these lifestyleand therapeutic measures will ultimately help you keep your blood sugar level within yourtarget range and can help you live a long and healthy life.The article is authored by Dr Zinobia Madan, PhD, MAMS, FIMSA, FICN, Founder &Managing Director of ClinOma Healthcare. Dr Zinobia has contributed significantly to newintroduction of healthcare and nutrition products, clinical research, and held seniorpositions in healthcare & Pharma industry including Medical Director of Abbott. AtClinOma Healthcare, which is her own conceptualised vision on lifestyle management,advise is provided on appropriate dietary habits, fitness and exercise, yoga and relatedlifestyle modalities, for which she is supported by a qualified team including aphysiotherapist / fitness expert, a yoga expert and allied healthcare professionals.Email : email@example.comContact : +919820606934