Jayrath was diagnosed with diabetes three years back. Still, he was overweight, he smoked and never took his diabetes treatment seriously.

He suffered from a silent heart attack. Like him, many people underestimate diabetes and get controlled by diabetes, instead of controlling it.

What happens in uncontrolled diabetes?

• People with diabetes are 2 – 4 times more likely to have a heart attack and stroke. Studies show that about 50 % of people with diabetes die of cardiovascular disease.
• Diabetic neuropathy [damage to the nerves] affects up to 50 % of diabetics. Combined with reduced blood flow and neuropathy in the feet, uncontrolled diabetes also increases the chance of foot ulcers, which may eventually lead to limb amputation.
• Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. Research shows that after 15 years of diabetes, approximately 2 % of people become blind and about 10 % develop severe visual impairment.
• Diabetes is among the leading causes of kidney failure and affects 10 – 20 % of diabetics.

How can one control diabetes?

Type-2 diabetes can be controlled with appropriate medications, regular monitoring and a healthy lifestyle. It is essential to visit the doctor regularly to evaluate the effectiveness of medicines.

Medications used in diabetes work on different mechanisms involved in glucose metabolism. For example, some oral medications lead to increased secretion of insulin from beta cells, some act on liver to minimise glucose production and some slow down the absorption of the starches one eats.

However, as type-2 diabetes is a progressive disorder, there is an increased destruction of the insulin-producing beta cells over time. This typically leads to the addition of medications every few years, and in most people, eventually results in the need for insulin therapy.

Incretin-based therapies today represent a new class of treatment for type-2 diabetes. People with type-2 diabetes lack a key incretin hormone, GLP-1 [Glucagon-like peptide 1], which is a natural hormone released from the intestine during digestion of food.

GLP-1 has the ability to lower HbA1c, systolic blood pressure, lipid levels and body weight without inducing hypoglycaemia. This offers a good alternative to people with type-2 diabetes to control diabetes and reduce their risk of complications.

However, note that, depending upon age, weight, and blood sugar levels, different people may need different medicines, which only an expert can decide.

Regular blood glucose monitoring helps the doctor understand how food, exercise and insulin or medicine affects your sugar levels. Along with self-monitoring of blood glucose level, one must also get the HbA1c [glycosylated haemoglobin] blood test done, every three months.

The higher the HbA1c, the greater is risk for developing complications. [In people with diabetes, HbA1c is aimed at less than 7 %.]

Along with glucose monitoring, a diabetic should also undergo the following tests to prevent complications: blood pressure monitoring, lipid profile, urine microalbuminuria, serum creatinine, eye fundus and foot examination.

While environmental factors like sedentary lifestyle, stress, increased obesity certainly play a major role in diabetes, it usually occurs more because of genetic susceptibility.

Various studies prove that Indians are genetically predisposed to diabetes at a younger age [at least 10 years earlier than our European counterparts].

Thus, do not wait for an emergency to start taking diabetes seriously. It is necessary to understand diabetes and its complications and take measures to prevent them. It may sound serious and tough, but controlling diabetes is pretty simple. With proper care and treatment, you can live a long and healthy life. There are many people with diabetes who are doing so.

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Most of the guidance on the topic consists of a generalised list of dos and don’ts [often given by well-meaning friends, relatives and other diabetics], which may not hold true for every diabetic. You are different from others and your body is unique too.

An experienced doctor understands this and will therefore customise your treatment for you based on the specific requirements of your body.

To be able to live a restriction-free life, diabetics need to make changes in three areas: diet, exercise and medication. It is within these areas that customisation becomes important.

Diet

Diet of a diabetic is a matter of great discussion with advice freely flowing in from all quarters. Naturally, a lot of it is based on misconceptions.

For instance, it is strongly suggested that diabetics should give up rice totally or stop eating potatoes. Some diabetics even stop having fruits completely, simply because someone told them to.

It is NOT necessary to make such drastic changes. A South Indian for instance, whose staple diet is rice, cannot suddenly eliminate it from his diet. And if he does, it will have detrimental effects on his health.

The traditional Indian diet comes real close to an ideal diet for diabetics, albeit with slight changes. If you follow this diet, you don’t really have to make any major change to your eating habits other than abstaining from eating simple sugars and reducing your fat intake.

Often, patients are put on ‘fixed’ diets—they have to take the same food in the same quantity daily. This does not work in the long run as patients do not comply with these strict and unnecessary restrictions for long.

Like normal healthy human beings, even diabetics require all their nutrients—carbohydrates, proteins, fats, minerals and vitamins, which they can get through a balanced diet. But many ‘prescribed’ diets leave out the carbs, which is wrong.

Of the total calories consumed by a diabetic, 60 – 70 per cent should be carbohydrate. Avoid carbohydrates only if they are in the form of simple sugars.

The emphasis should be on restricting your fat intake. So, eat more grilled, steamed or baked food instead of fried.

Cooking mediums matter too. Traditional cooking mediums like mustard oil, ghee and coconut oil are better than today’s refined oils because although they are rich in saturated fats, they also have a healthy ratio of essential fatty acids such as omega-6 and omega-3. Whichever the medium, make sure you use it sparingly.

You don’t have to starve yourself at a party or shy away from attending one because you have diabetes.

Opt for boiled, grilled or baked food if available and help yourself to generous servings of salads sans the dressing. Also, eat something before an event, so you don’t get hypoglycaemic in case the food gets delayed.

Often diabetics prefer to have beer thinking it’s a better option than hard liquors. Instead, it is advisable to take hard liquors like whisky, brandy, rum or gin rather than sweet wine or beer. Avoid drinking on an empty stomach though and do not drink more than 60ml per day.

Although fasting is not recommended, if you wish to do it for religious reasons, you may do so after discussing with your doctor.

Also, you can even eat sweets occasionally along with the main meal. Doing so, slows the absorption of pure sugars.

Exercise

Regular exercise is important as it increases the utilisation of glucose by the body, lowering your blood sugar levels.

However, not everyone may be able to exercise. For instance, many diabetics who are overweight suffer from osteoarthritis of the knees or may have corns and calluses of the feet. Walking is difficult in this situation. They require a modified exercise programme involving more of upper limb and trunk exercises.

Your aim when exercising should be to achieve 75 per cent target heart rate. However, if you have heart problems, 40 – 50 per cent may be good enough for you. Consult your diabetologist for the exercise regime that is most suitable for you.

Medication

In early stages, you can control your diabetes with the help of medication and not all diabetics need to be injected with insulin.

Insulin treatment is only given in advance cases and is not necessarily a life-long treatment. Further, not all diabetics are prescribed the same medicines, as some tablets may interfere with the person’s existing medication or ailment.

In some men, diabetic drugs can illicit an adverse reaction such as erectile dysfunction. Hence, even your medication needs to be customised to suit your lifestyle and health.

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