Diabetes mellitus (DM) is a metabolic condition characterized by an increase in blood glucose levels due to insulin deficiency or poor quality insulin.
It causes damage, dysfunction or failure of vital organs like eyes, kidneys, nerves, blood vessels, heart etc.
Types And Definition Of Diabetes
There are two types of diabetes.
Type I diabetes manifests from childhood and is insulin dependent.
Type II DM is also called adult-onset diabetes or non-insulin dependent diabetes.
Type II diabetes can start at any age (after the age of 18), and in the long term sadly does not spare any organ in the body. It causes irreversible damage to the eyes, kidneys, blood vessels of the heart, brain kidneys and the lower limbs etc.
Once it is diagnosed the blood glucose must be brought down to normal by diet, exercise, and medication.
A fasting blood glucose less than 100 mg/dL and 2 hours post food less than 140 mg/dL is considered as normal
A fasting blood glucose more than 100 mg/dL and less than 125 mg/dL, and 2-hour post-food more than 140 mg/dL and less than 200 mg/ dL is considered as prediabetes or impaired glucose tolerance (IGT).
A fasting blood glucose of more than 126 mg/ dL and 2 hours post food more than 200 mg/dL is frank diabetes.
Understanding Hb1Ac
The hemoglobin (Hb) we refer to normally is the hemoglobin that is present in the red blood cells. This Hb carries oxygen to all parts of the body via the blood.
There is another type of Hb that humans have in their blood called HbA1c or glycosylated hemoglobin.
Whenever the blood glucose remains high, the HbA1c also steadily goes up in the blood. Scientists have taken this parameter (Hb A1c) to assess duration of diabetes or even the severity of diabetes, even to know how well the control of blood glucose is in a given person.
A HbA1c less than 5.7% is considered as non-diabetic and normal.
A value between 5.7% and 6.5% is considered prediabetic and more than 6.5% as diabetic.
There is a chart available in all labs to calculate the blood glucose corresponding to HbA1c. For example, a diabetic person on medication or diet should maintain his A1C levels less than 7%, which is equal to blood glucose level of about 154 mg/dL.
The HbA1c levels are normally estimated only once in 3 months, which represents the blood glucose levels corresponding to that period.
If you wish to know how good or bad your blood glucose was in the past 3 months, then check your A1c levels. For example, a value of 7% = 154 mg, 10% = 240 and so on.
Suppose a diabetic persons HbA1c is 9%, that means that a person’s average blood glucose is 212 mg/dL for the last 3 months.
In short, a diabetic person need not get his blood glucose checked very often. If he or she gets an A1c estimated once in 3 months, one can get the average blood glucose results from the chart.
If your blood glucose is well under control, the A1c level will be low. Good control is defined as an A1c value below 7%.
In other words, your diabetic control can be assessed by checking HbA1c levels once in three months.
My personal view is 40 to 50 % of patients with adult-onset DM can be controlled on by diet and exercise alone. The rest will need additional medication.
So diet and exercise play a major role in controlling blood glucose levels.
Diet
A detailed discussion of foods for diabetes you should and should not have has been discussed elsewhere in this blog.
All diabetics must avoid sugar and sugar products in many forms.
This includes sugar, sweets, jaggery, ice creams, cakes, chocolates, biscuits, sweet drinks, puddings etc.
In addition to this, they must also avoid white rice and rice products, white bread and pasta, full cream dairy products, raisins, fruit jams and products containing fats and cholesterol (such as red meat), all of which can increase blood fats and cholesterol causing cardiac events.
Having discussed what are the foods a diabetic should avoid, let us see what kind of foods a diabetic can have in his day to day life.
My Recommended Diet And Exercise For Diabetes
Early morning: One bowl of papaya fruit followed by 30 min of brisk walk/ jog/cycling/swimming or any kind of aerobic exercise
Breakfast: (8-8.30 am)
Some preparation from wheat rava: Upma 1 cup or 2-3 small rava idlis / 2 small rava dosa or one medium sized rava roti.
If you opt for cereals, then 50-gram wheat flakes with some dry fruits and one cup of skimmed milk.
Millets can be used in place of rava. Avoid rice products for breakfast. Coffee/tea without sugar and very little milk.
Midday: Around 11 am
0ne cup buttermilk/ or cup of tea/ coffee with no sugar very little milk.
Lunch: 1 pm to 1.30 pm:
One cup rava rice cooked (broken wheat, dhalia, wheat rice) with one cup dal or sambar + one cup greens / + one cup sprouts and some veg salad. You can increase veg salad and sprouts if you need.
One cup of buttermilk.
Evening tea: Around 5pm
Green tea + lime + honey 1 teaspoon. Followed by a second round of walk for 30 mins.
7 pm: One cup of veg/ non-veg soup (ideally homemade as most ready preparations contain excess salt or sugar)
Dinner 8 to 8.30 pm: 2 pulkas and side dish what you had for lunch.
If you wish to have a fruit at bedtime, certainly you can: one small Alaki banana or half apple or half pear
Avoid mangoes, jackfruit and pineapple as they have very high sugar content.
That’s it for the day. You may change the menu but try to stick to wheat products/ millets etc. Avoid rice or rice products (rice idli, dosa, poha (avalakki), roti, bisibele bath, chitranna etc.
With the above diet please continue with the exercise on regular basis.
Brisk walking for 30 minutes a day is great; more is even better. Twice daily/swimming/jogging/cycling etc can be included in your daily activity.
Diabetic patients on diet, exercise and on medication are prone to low sugar events, called hypoglycemia episodes. A diabetic should know how to identify these episodes. If you take your food on time it is rare. However, if you have untimely food then you will be prone to hypoglycemia.
What Is Hypoglycemia?
Blood glucose levels less than 60 mg/ dL is called as hypoglycemia.
These episodes are quite common in practice and are mainly due to untimely food habits, and also an excessive dose of anti-diabetic medications.
The symptoms of hypoglycemia include the following –
- Early symptoms are feeling very hungry, craving for food.
- This is followed by mild dizziness or imbalance.
- Then, certain nervous system symptoms like confusion, disorientation, irrelevant talks etc.
- Later, profuse sweating. If not identified at this stage and if effective measures are not taken, the patient may go into a state of coma followed by convulsions and rarely deaths.
Hence it is very important to identify hypoglycemic episode in the early stages.
A random glucose estimation at home by using glucometer will give the diagnosis.
If the blood glucose level is less than 80 mg/dL and the person is conscious, feed him with some food or give him 3-4 teaspoon of sugar, or some sweets or glucose powder.
If the patient is drowsy but responding then feed him with 2-3 spoons of glucose powder. If he responds well, then give him more glucose powder.
If the person is very drowsy and not responding at all, then do not feed him and take him to the nearest hospital where he will be given glucose intravenously (IV) with a very immediate response and recovers consciousness.
In these patients, further evaluation of blood sugars and adjusting the dose of medication is required. Never neglect a low sugar situation. It must be recognized early and suitable measures must be taken or it can be fatal at times.
Hypoglycemic episodes at night in sleep can be a very serious problem and can be fatal. If you wish to learn more, then take a look at another post of ours here.
Closing Remarks
Diabetes is a dreadful disease if you do not take charge of it. These simple methods should help.
- Diabetes – The Dreadful Disease. Dr BG Baliga Writes. - July 29, 2018
- Dr BG Baliga Writes – Getting Heart Healthy This World Heart Day! - September 28, 2017
- Can We Prevent A Heart Attack? Dr BG Baliga, Baliga Diagnostics, Writes. - April 15, 2017
why glucometer reading and lab reading differ sir ?
Thank you for your comment. There is always a little difference between the two because of the way they are analysed. The expected difference is around 8 to 10%.