What is Diabetes?

India is the country with the most people with diabetes, with a current figure of 50.8 million, followed by China with 43.2 million * Diabetes is a condition which occurs as a result of problems with the production and supply of insulin in the body. Most of the food we eat is turned into glucose, a form of sugar. We use glucose as a source of energy to provide power for our muscles and other tissues. Our bodies transport glucose in our blood to muscles and tissues. In order for our muscles and other tissues to absorb glucose from our blood, we need a hormone called insulin. Without insulin, our bodies cannot obtain the necessary energy from our food. Insulin is made in a gland behind the stomach called the pancreas. It is released by cells called beta cells in the pancreas. Insulin allows the entry of sugar from the blood into the cells and thus becomes necessary for the body to be able to use glucose for energy. When we eat food, the body breaks down all of the sugars and starches into glucose, which is then used for energy. When a person has diabetes, either their pancreas does not produce the insulin they need, or the body cannot use its natural insulin effectively. Thus, in diabetes when the glucose builds up in the blood instead of going into cells, it can cause following problems: the cells may be starved for energy and over time, high blood glucose levels may cause damage to eyes, kidneys, nerves or heart. Diabetes Symptoms:

Frequent urination Excessive thirst Extreme hunger Unusual weight loss Increased fatigue Irritability Blurry vision

* International Diabetes Federation, Press Release, Oct 19, 2009

Type 1 Diabetes
Type 1 diabetes is sometimes called insulin-dependent, immune-mediated or juvenile-onset diabetes. It is caused by an auto-immune reaction where the body's defence system attacks the insulin-producing cells. The reason why this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease can affect people of any age, but usually occurs in children or young adults. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. Type 1 diabetes is usually diagnosed in children or young adults, although it can occur at any age. Approximately 5-10 % of all people with diabetes are diagnosed with Type 1. The onset of type 1 diabetes is often sudden and can include the following symptoms:

Abnormal thirst and a dry mouth Frequent urination Extreme tiredness/lack of energy Sudden weight loss

Slow-healing wounds Recurrent infections Blurred vision

Type 1 diabetes occurs when the body's immune system destroys the beta cells found in the pancreas-the cells that create insulin. As a result, the body makes very little or no insulin of its own. A person with type 1 diabetes supplies their body with insulin in one of the following ways:

Insulin pump Insulin pen Insulin injections with a syringe

Insulin therapy along with following a healthy meal-plan, regular physical activity and frequent blood glucose testing are important in the management of type 1 diabetes.

Importance of Blood Glucose Control

Controlling your blood glucose level is a very important part of managing diabetes. Regularly testing your blood glucose helps measure the effectiveness of your meal plan, physical activity and medications. Self-monitoring of blood glucose (SMBG) is an important & integral component of modern therapy for diabetes mellitus. SMBG has been recommended for people with diabetes in order to achieve a target level of glycemic control and thus achieve their HbA1c target. The goal of SMBG is to achieve target HbA1c by regularly monitoring blood glucose levels at different time intervals so as to check short term glycemic changes and enable maintenance of a more constant glucose level. By self-monitoring your blood glucose one can measure how the body handles different types of food, exercise, medication, stress and illness. Your blood glucose result may prompt you to eat a snack, take more insulin or go for a walk. Self-monitoring can also alert you to a blood glucose level that is too high or too low, which requires special treatment. The results of self-monitoring can help guide you and your healthcare team to adjust the many parts of your therapy. To self-test your blood glucose, you need a blood glucose meter, a test strip and a lancing device. Then, follow these basic steps: 1

Wash and dry your hands. Using warm water may help increase the blood flow to your fingertips. Follow the instructions included with your lancing device to get a drop of blood which normally include shaking your hands below the wrist or gently squeezing your finger a few times to help. Apply the blood drop to the test strip as directed. Wait a few seconds to view your results. Dispose of the lancet and test strip in the proper manner.

While testing from the tip of a finger is most common, it is possible to use Alternate Site Testing ( AST ). Other methods of testing and monitoring look at your blood glucose in the long-term. An HbA1c (also known as glycated haemoglobin or A1c) test gives you a picture of your average blood glucose control for the past 2 to 3 months.

Joslin Diabetes Center. Blood glucose monitoring: your tool for diabetes control. Available at: http://www.joslin.org/managing_your_diabetes_650.asp . Accessed January 10, 2010.
1

American Diabetes Association. A1C test, Available http://www.diabetes.org/living-with-diabetes/treatment-andcare/blood-glucose-control/a1c/Accessed May 06, 2010
2

Diet Chart
Counting Carbohydrates Counting carbohydrates in the foods you eat can help you control your blood glucose. This is because carbohydrates raise your blood glucose more than any other nutrient. The balance between the amount of carbohydrates you eat and insulin determines how much your blood glucose level goes up after meals. This means you need to know what foods have carbohydrates and how many carbohydrate servings to eat to keep your blood glucose within the target range.
DIET CHART FOR ILLUSTRATION PURPOSES ONLY FOOD ITEM SERVING SIZE 1CU=15G M CARB CALORIE(KCAL S) PROTEIN(GM S) FAT(GMS ) CARB(CHO )

Main Course Wheat Flour Chapati Tuar Dal (plain) Paneer Palak Jeera Aloo Plain steamed rice Breakfast Idli 1 idli(72.5gm ) 1(200gm) 130 1(100gm) 1 idli 115.65 3.7 1.51 21.81 1(90gm flour) 1 katori 1 serving 1 serving 1katori 1/3 chapati 1 katori 1 serving 1serving 3/4 katori 240 7.2 0.6 48

100.5 407 209 86.25

6.69 8.3 1.3 1.7

0.51 36.3 15.1 0.12

17.28 11.6 17.1 19.55

Masala Dosa Upma Banana Others Chilli Chicken Cheese Burger Cheese

Qtr dosa 1katori 43.5gm

400 210 116

8 55 1.2

12 9 0.3

65 26 27.2

1 serving 1 sandwich 1slice 1/2 1/2

307.4 310 280

44.16 15 11

7.65 12 13

15.62 35 29

pan pizza French fries(Small ) Coca Cola (Medium) 68gm 39gm 210 3 10 26

480ml

179ml

150

40

The Diabetes foundation (India) has recommended new dietary guidelines for Indians. The new guidelines for Indian Diabetics contains dietary recommendations based on several factors like calculation of Ideal body weight, Calorie needs as per body weight , no. of servings for different food groups/types for different calorie needs. It covers food for all regional diabetics. It also covers Breakfast, Lunch, Snacks, Dinner for Diabetics in India. It covers foods of various types viz, Cereals, Salads, Meat, Leafy Vegetables, Pulses, Beans, Chapatis, Rava Idli, Curd, Coffee, Dosa, Butter milk and many more. The chart below was sourced from Livemint.com and is prepared as per recommendations from Diabetes Foundation (India).

Click to enlarge Note: 1lb = 0.45359237 kg 100 lb = 45.359237 kg 106 lb = 48.08079122 kg 1CU = 1Carb Unit
Reference : http://clinical.diabetesjournals.org/content/23/3/123.full last accessed 21 Apr 2010

Managing Diabetes
As is already known, controlling blood glucose is important for avoiding hypoglycemia and hyperglycemia-blood glucose lows and highs.

Hyperglycemia
Hyperglycemia, or high blood glucose, occurs when levels rise above your recommended range. A healthcare professional managing diabetes will help determine the proper healthy blood glucose range. High blood glucose can be caused by many things, including:

Eating too much food

Little or no physical activity Not taking medications Stress, infection or illness Bad or spoiled insulin

High blood glucose can cause serious problems and is a major cause of long-term diabetes complications. Some warning signs of high blood glucose include:

Tiredness or fatigue Increased thirst Frequent urination Blurred vision Dry mouth or skin Slow-healing cuts and sores Unexplained weight loss

It is important to keep blood glucose level within the recommended target range set by the treating doctor. Checking blood glucose often may help avoid hyperglycemia. High blood glucose levels can damage many parts of the body, including eyes, heart and toes.

Hypoglycemia
Hypoglycemia occurs when blood glucose level drops too low. The body responds to low blood glucose levels with warning signs that may be different in each person. Some warning signs of low blood glucose are feeling:

Weak Shaky Irritable or confused

Low blood glucose may occur if meal or snack is delayed or missed, after vigorous physical activity, or if too much insulin is given. In a person without diabetes, the pancreas will stop producing insulin if the blood glucose level falls below normal. In a person with diabetes, the insulin they inject or pump keeps working, even when the blood glucose level is low. Low blood glucose may be caused by the following:

Not following the meal plan Too much exercise or exercising for a long time without eating a snack Too much medication or a change in the time one takes medication Stress Side effects from other medications Alcohol intake, especially without food

Regular testing may help avoid hypoglycemia. Low blood glucose can happen very quickly, so one should be prepared to act fast to correct it. If untreated, hypoglycemia can cause serious effects, such as seizures or unconsciousness. By keeping blood glucose level in the target range decided by

treating physician, one can delay or prevent long-term complications. The good news is that along with treating doctor, one can easily be able to lessen the impact of diabetes complications on life. This section lists some of the more common diabetes-related complications, their symptoms and treatments, and some steps doctor may recommend to help reduce risk.

Foot Complications
Proper foot care should be an important part of a diabetic's daily routine. High blood glucose levels can damage the blood vessels that carry oxygen and nutrients to the legs and feet. This can lead to nerve damage, poor circulation, infections and foot deformities. Diabetes is often associated with foot problems and amputation. Not including those caused by accidents or trauma, more than 60% of lower-limb amputations performed each year are on people with diabetes. What to Look For The American Diabetes Association recommends all individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions. People with one or more high-risk foot conditions should be evaluated more frequently for the development of additional risk factors. People with neuropathy should have a visual inspection of their feet at every visit with a health care professional. Doctor visit is required in case one experiences any of the following symptoms:

Pain or less sensitivity in the leg or foot Cuts or breaks in the skin Ingrown nails Changes in the shape of foot Corns or calluses

Healthy Diabetic Foot-Care Habits By keeping blood glucose level within the range recommended by doctor and paying special attention to feet every day, one can be able to prevent long-term complications. For healthy toes and feet, following these simple steps helps:

Check feet regularly - look for redness, sores, swelling etc. Wear comfortable shoes that fit Wash your feet daily with soap and lukewarm water Moisturize feet daily to avoid dry skin Trim toenails straight across and not too short Get medical advice early if one notices any change or problem

Centers for complications Control and Prevention. National diabetes fact sheet, 2007. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Preventive foot care in people with diabetes (Technical Review). Diabetes Care 21:2161 - 2177, 1998. Available at http://care.diabetesjournals.org/content/27/suppl_1/s63.full National Institute of Diabetes and digestive and Kidney Complications. Prevent diabetes problems: keep your feet and skin healthy." Available at: http://diabetes.niddk.nih.gov/dm/pubs/complications_feet/.