India with more than 62 million diabetes patients has recently become the ‘Diabetes capital of the world’. The number is estimated to go up to 80 million by the year 2025. According to the Diabetes Foundation of India (DFI), Delhi alone has more than 30 lakh diabetics.
Diabetes shortens life expectancy by an average of 8 years (7.8 years for men and 8.4 years for women). The risk of premature death amongst diabetes patients is about twice that of non-diabetics.
The World Health Organization (WHO) defines diabetes as a chronic disease which occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces leading to increased concentration of glucose in the blood (hyperglycaemia).
Type I diabetes (childhood onset diabetes) is characterized by the lack of insulin production. Type II diabetes (adult onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity.
If you visit your doctor and he says, “your glucose levels are a little high.” or “you have insulin resistance.” or “you have pre-diabetes.”, take it seriously but do not panic. You have time to take simple corrective action.
How does this happen? Insulin, a hormone produced by the pancreas helps the body to use glucose for energy. Insulin resistance is the condition in which the body produces insulin but does not use it properly. When muscles, fat and liver cells do not respond properly to insulin, the pancreas tries to keep up the demand by producing more insulin, but eventually it cannot. Excess glucose builds-up in the blood setting the stage for pre-diabetes or diabetes.
Diabetes can cause damage to the heart, blood vessels, eyes, kidneys and nerves. It is therefore important to understand its classification and also most importantly its management. According to the American Diabetic Association (ADA), a person is categorized to be in the pre-diabetic range if their blood glucose levels are higher than the normal but not yet high enough to be diagnosed as diabetes.
An individual is pre-diabetic if he/she have any of the following:
- HbA1C levels of 5.7% -6.4%
- Fasting blood glucose of 100 mg/dl to 125mg/dl
- An Oral Glucose Tolerance Test (OGTT) 2 hour blood glucose of 140mg/dl to 199 mg/dl.
Source: American Diabetic Association
Studies reveal that 70% of the pre-diabetic cases eventually develop into diabetes. Nonetheless, the studies also show that a pre-diabetic can lower the risk of diabetes by 58% by:
- Losing 5- 10% of the starting body weight can prevent or delay diabetes or even reverse pre-diabetes.
- Exercising moderately.
Tips for pre-diabetic/diabetic patients:
Know ABC of diabetes:
a) A1C: The A1C is a blood test that measures your average blood sugar level over the past three months. Diabetics should aim for AIC levels below 7.
b) Blood pressure: It is important for diabetic people to get their blood pressure checked routinely with a goal to keep it below 140/90.
c) Cholesterol: Diabetes increases the risk of heart diseases and other related complications. The diabetes patients should aim to keep their total cholesterol levels below 200 mg/dl and their low density lipoprotein cholesterol levels (LDLC- the bad cholesterol) below 100 mg/dl.
Diet: Diabetics should consume a balanced diet with appropriate amounts and types of the three macro-nutrients (carbohydrates, proteins and fats).
- Carbohydrates: To control the blood sugar levels from rising rapidly, it is important to consume complex carbohydrates such as whole grains, fruits and vegetables, as they provide a low glycemic load. According to the metabolic balance® program, complex carbohydrates, along with sufficient proteins and fats, allow for a slower increase in insulin. As a result, one retains the feeling of being full over a longer period. In contrast, foods with a high glycemic load cause cravings. In terms of food, the high load of simple sugars in baked goods, sweet drinks, chocolates, snacks and fruits with a high glucose content stimulates a larger release of insulin that remains even after the sugars have being broken down, results in further hunger and cravings.
Along with these guidelines, diabetic people should also be careful about including artificial sweeteners in their diet. The American Diabetic Association (ADA) recommends checking the nutritional facts on the label when considering foods with low or reduced calorie sweeteners. Many of the food products containing these types of sweeteners have a higher amount of carbohydrates and calories as fats. So never consider them as a ‘free food’ without checking the label first. - Proteins:metabolic balance® recommends having three different types of protein (dairy, legumes,poultry, fish,etc) in a day, to maintain the availability of the essential amino acids for better metabolic balance.
- Fats: Consumption of foods rich in long chain n-3 fatty acids such as fatty fish and n-3 linolenic acid (ALA- alpha linolenic acid) found in plant foods such as flaxseeds have shown to have beneficial effects. Infact, maintaining an intake of foods with a low n-6 to n-3 ratio as recommended by studies has shown beneficial effects on the lipoproteins, in the prevention of heart disease and has many other positive health outcomes.
- Do not skip a meal: Another important thing related to diabetic diet is not to skip a meal, especially if you are taking diabetes medicine, because your blood sugar levels can go too low and you may get a hypoglycemic shock.
Exercise regularly: Diabetes patients should not ignore exercise. Regular exercise improves glycemic control, reduces the risk for cardiovascular diseases (CVDs) and their complications, improves overall wellness and prevents or delays the onset of type 2 diabetes mellitus (T2DM). Exercise is very helpfulin controlling glucose levels because of its insulin-like effect that enhances the uptake of glucose even in the presence of insulin deficiency.
Diabetes patients should try to be active almost every day, 60 minutes minimum. The exercise regime should be developed under medical supervision keeping in consideration diet, medication and complications related to diabetes. Whenever diabetes patients start a new exercise regime, they should check their blood glucose levels before, during and after the exercise. Moreover, these patients should not exercise right before they go to sleep because that can cause low blood glucose during the night.
Medication: Take your medicines as advised by your doctor. In case your sugar levels are still high above the normal, let your doctor know about it so that the medication can be adjusted accordingly.
Foot care: Diabetes can reduce the blood supply to your feet and cause a feeling known as peripheral neuropathy i.e. foot injuries which do not heal well and you may not notice if your foot is injured or sore.
Foot tips for diabetes patients:
- Here are a few tips that, if used, can help diabetes patients to keep their feet healthy.
- Check and wash your feet every day.
- Dry your feet well after bath and washing of feet, especially between the toes.
- Keep the skin soft and smooth. Use moisturizing cream if your skin is dry but avoid putting cream between the toes.
- Wear extra width, extra depth and well cushioned footwear. Always wear cotton or woolen socks.
- Trim your nails straight and avoid deep cutting as you may injure the skin around the nails.
- Never use hot water bottle or heat your feet electrically. Do not dip your feet in hot water.
- Avoid treating corns and calluses at home. Do not use corn cap available in the market for removal of corns and calluses.
- Exercise regularly as per the advice of your doctor.
- Never neglect any cuts, injury to skin, swelling, redness and infection of skin and nails. Take a prompt medical advice and avoid self-medication.
Be stress-free: Stress can raise your blood sugar levels. Learn ways to control your stress. Try deep breathing, yoga, gardening, taking a walk or meditating.
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Taranjeet Kaur
metabolic balance® coach & sr. nutritionist, AktivOrtho™
About AktivOrtho™ and metabolic balance®
AktivOrtho™ is India’s first-of-its-kind comprehensive centre for orthopaedic, neurological and gynaecological rehabilitation as well as sports medicine, pain management, prevention, medical training therapy (MTT) and weight management solutions located in New Delhi and Gurgaon.
metabolic balance®, a German-developed weight management and personalized nutrition program exclusive to AktivOrtho in India, has experienced tremendous success and changed the lives of more than 700,000 participants globally. It is a holistic approach to bring your body’s metabolism to a healthy balance and reaching your ideal weight. The program is developed according to an individual’s blood analysis, medical history, body measurements and food preferences.
Healthy nutrition, as recommended by metabolic balance®, will stabilize your body’s insulin level, maintain the natural feeling of fullness after a meal and balance your body’s metabolism.