Four pillars for leading a healthy life with diabetes are: a healthy diet, regular exercise, appropriate medication and diligent monitoring.

Eat six small meals instead of three large ones as eating smaller, frequent meals reduces the burden on the pancreas. It also helps keep the metabolism up to speed. For diabetics, both fasting and feasting are best avoided.

Aim for BMI [Body Mass Index] of less than 25. BMI is a crucial factor for diabetics. Lose weight if your BMI is more than 25. For non-diabetics or the insulin resistant too, BMI of less than 25 is ideal. However, if it is more than that, even if you lose up to 5 per cent – 10 per cent of your body weight, it will cut back your risk of developing type-2 diabetes by up to 50 per cent.

Zero tobacco. For a diabetic, smoking is an invitation to all sorts of health problems. It damages blood vessels, doubles your risk for heart disease and reduces your body’s ability to use insulin by 15 per cent.

One annual check-up. Since diabetes brings along a whole array of health complications, a total health check-up helps keep important parameters such as blood pressure and cholesterol in check, avoiding problems. It’s the best way to keep a tab on the status of your diabetes. Get tests once a year [at least]:

• Fasting lipid profile
• Dilated eye exam [where the doctor places drops in the eyes] to examine the retina [the inside of the eyes].
• A urine test for protein [called the microablumin test].
• Foot examination for altered sensation and decreased circulation.

Less than 120 mg/dl of fasting or pre-meal blood sugar levels. If you manage to maintain this level, you won’t have a worry.

You must eat at least five servings of vegetables and fruits every day.

Your postprandial capillary glucose levels should be less than 180 mg/dL. This is the sugar that is found in your blood two hours after the start of a meal.

Three-month average blood glucose levels, which can be monitored with the help of the HbA1c test. This test measures the amount of glycosylated haemoglobin [HbA1c] molecules in the blood. These molecules are formed when glucose sticks to haemoglobin. Hence, if you have more glucose in the blood, you will also have more HbA1c. This test is not the same as your regular test for blood glucose and experts find that it is more accurate in predicting the prognosis of the condition.

Less than seven per cent of HbA1c should be your aim. If your HbA1c is higher, it increases your risk for developing complications. If your HbA1c is more than 9 per cent at the time of diagnosis or over 7.5 per cent after being on oral anti-diabetic, ask your doctor about insulin.

Remember, less than 200mg/dL of total cholesterol should be your goal.

Two dental check-ups in a year. Visit your dentist once in six months for a thorough dental cleaning and exam. Oral problems are closely linked with diabetes and, in fact, those with diabetes are 3 – 4 times more likely to develop gum disease.

Aim for more than 40mg/dL of HDL if you are a man. HDL is the good, healthy cholesterol that protects you from heart disease, so the higher it is, the better. About 67 per cent of diabetic adults [type-2] suffer from at least one lipid abnormality. Low HDL levels, and high total cholesterol, LDL and triglycerides levels means a greater risk of heart disease.

Women should aim for more than 50mg/dL of HDL.

Less than 100 mg/dL of LDL or bad cholesterol. This is the cholesterol that your heart hates. Keep the levels down.

Aim to keep your triglyceride levels below 150 mg/dL.

Less than 80 mmHg of diastolic blood pressure [the bottom number in your reading]. About 70 per cent individuals with diabetes also suffer from high blood pressure. Having both conditions considerably increases your risk of developing micro- and macro-vascular complications associated with diabetes mellitus.

Get 30 minutes of exercise in a day. Physical activity moves sugar from blood into cells thus helping in lowering blood sugar levels. For the best health benefits, aim for 10,000 steps a day of a physical activity of moderate intensity. This is equivalent to 30 minutes of brisk walk per day.

Less than 130 mmHg of systolic blood pressure. When hypertension coexists with diabetes, the risk of heart diseases and stroke goes up by 75 per cent.

Less than 20 mg microalbuminuria. This is an indicator of presence of protein in the urine. Over 20 mg microalbuminuria in the urine is an early indicator of kidney trouble as a result of diabetes.

Either you control diabetes or it controls you. It is not a disorder that you can forget about and needs to be managed 24×7. These numbers will help do so with ease.

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The diabetes-weight connection

As weight increases, certain mechanisms prevent insulin from moving glucose [blood sugar] into cells where it can be used for energy. This is called insulin resistance. Thus glucose does not get transported despite having normal or even high levels of insulin. This becomes the forerunner for development of diabetes. Initially, pancreas overcomes the resistance by producing excess insulin. Over time, the pancreas becomes unable to produce enough insulin to overcome resistance resulting in an abnormal rise in blood sugar.

The ‘stay active’ principle

Being active is an important part of living a healthy lifestyle. This is true for people of all ages and especially true for people with or at risk for diabetes and those who are overweight. The key to weight control is balancing the energy [food] intake with how much energy our body burns [physical activity].

To lose weight, you must burn more calories than you eat. If you eat 100 calories a day more than your body needs, you will gain approximately five kilos in a year. You could lose the excess weight or keep it off by doing 30 minutes of moderate exercise daily.

When Prakash, a diabetic, went for his health check-up he was disappointed as his HbA1c was 9.5 per cent, indicating poor control of diabetes. Prakash was perplexed as he was regularly taking medicines and following an appropriate diet. To his surprise, the doctor diagnosed the main reason to be lack of exercise. Like Prakash, this is one of the biggest dilemmas most diabetics face.

Exercise is one of the four cornerstones of diabetes care [along with diet, medication, and monitoring]. It is not true that people with diabetes taking proper medication need not exercise and people who do regular exercise need not take medicine. All the four tools are essential.

Research by the Diabetes Prevention Program demonstrated that as little as 150 minutes per week of moderate exercise as part of a lifestyle intervention significantly decreased the progression of type-2 diabetes in patients with pre-existing impaired glucose tolerance.

Regular exercise is extremely beneficial to the body because:

• It makes insulin work better in the body, which helps regulate blood sugar levels.
• It improves cardiovascular function, increases fitness and physical working capacity and improves sense of well being. The improvement in lipid profile as well as reduction of hypertension is a major effect of exercise on cardiovascular risk factors.
• It also helps in reducing weight and aids in the loss of visceral fat—quite literally getting to the core of the metabolic syndrome.
• It helps relieve tension and stress, encourages relaxation, and improves mood.

It’s never too late

It is said that the journey of a thousand miles begins with a single step and exercise works the same way. Taking that first step can be hard, especially if you’ve been diagnosed with diabetes. But, remember—it’s never too late. You can always improve your level of fitness. There’s no need to join a gym or have a personal trainer to make exercise a part of your life.

Even simple things like parking your car further away and walking to your destination or taking the stairs instead of elevators have a huge benefit. Experts recommend about 30 minutes of regular exercise five times a week for maximum benefits.

There are three main types of exercises:

Aerobic exercises. These increase heart rate, work on muscles, and improve breathing rate. Walking, dancing, swimming, and playing various sports are some examples.

Strength training. This, if done several times a week, helps build strong bones and muscles and makes everyday chores like carrying groceries easier for you. With more muscle, you burn more calories, even at rest.

Flexibility exercises. Also called stretching, these help to keep your joints flexible and reduce your chances of injury during other activities. Gentle stretching for 5 – 10 minutes helps your body warm-up and get ready for other activities such as walking or swimming.

Before you start

To gain the benefits of increased physical activity and minimise potential risks, people with diabetes need to understand and evaluate risks and take steps to prevent problems. Here are some rules to follow.

• Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that can cause low blood sugar. Carry something readily available to eat and drink plenty of fluids while you work out. Stop exercising if you experience signs such as severe shortness of breath, dizziness or chest pain. Hypoglycaemia can occur during exercise or during the next 12 hours that follow and hence it is advised to eat something before you exercise.
• Check your feet for sores or blisters before and after exercise. Make sure that your workout shoes fit well and are comfortable. Wear soft, absorbent socks. If your feet are already compromised from poor circulation, choose an exercise such as swimming and yoga that will not put undue pressure on them.
• Carry your diabetes identification card along with you while going outside for exercise.
• Make sure you drink enough liquid before, during and after your session as dehydration can raise blood sugar.
• Consult your doctor before starting any exercise regime. This becomes even more important if you have any of these symptoms or conditions:
• If your blood glucose level over 250 mg/dl
• If you have any symptoms of cardiovascular problems
• If you have any evidence of retinopathy [eye problem], neuropathy [brain problem] or nephropathy [kidney problem]
• Any other ongoing health problems that might limit your ability to exercise.

Although exercise is essential for people with diabetes, but it cannot replace the requirement of diet management, monitoring and medications. Exercise is perhaps the best therapy for prevention of type-2 diabetes.

Thus, our goal for a long and healthy life should include a healthy diet, regular exercise, and maintaining normal weight. Whatever you choose, whichever exercise is right for you, make sure it’s something you enjoy.

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