COMPREHENSIVE AWARENESS

ON
DIABETES CARE

through

150
Frequently Asked Questions

MV Hospital for Diabetes (P) Ltd.

Royapuram
(ISO 9001 - 2000)
&
Diabetes Research Centre
COMPREHENSIVE AWARENESS
ON
DIABETES CARE

through

150
Frequently Asked Questions
First Edition : April 2008

ACKNOWLEDGEMENT
ALL THE DIABETOLOGY CONSULTANTS
&
DEPARTMENT OF DIABETES EDUCATION
MV HOSPITAL FOR DIABETES – ROYAPURAM

ARTIST : MR. ALEEM

 Dedicated to the memory of

our Founder Director & Mentor

(Late) Prof. Dr. M. Viswanathan

who continues to be

our beacon light

FOREWORD

The prevalence of diabetes is increasing worldwide

and according to WHO, the worst affected are the
developing countries. India, being a developing
nation is in the transitional phase, i.e., urbanization
is occurring rapidly along with changes in lifestyle
practices.

Patients with diabetes often have doubts and

questions related to diabetes. To address this issue
the M.V. Hospital for Diabetes, Royapuram, Chennai,
has prepared a book by compiling the frequently
asked questions about diabetes control and its
management, the role of diet in diabetes, healthy
lifestyle practices, etc.

Experts from the field of diabetology have

contributed to the content of the book in language
that can be easily understood. I hope that this book
will help people with diabetes to understand the
disorder better and help them to lead a healthy
life.

Dr. Vijay Viswanathan

Managing Director
 1
What is diabetes?

The hormone, Insulin, secreted from the

pancreas helps the cells in our body to
take up glucose for the production of
energy. Absence or deficiency of insulin
results in an increase in the level of
glucose in our blood. This condition is
called Diabetes Mellitus. It includes a
group of metabolic disorders like high
blood pressure and high cholesterol
levels.
 2
What are the symptoms of diabetes?

People with diabetes usually have

increased urination, increased thirst,
increased appetite, loss of weight,
frequent infections, frequent boils, a
burning sensation in feet, etc. However,
please note that nearly half of our
diabetic patients do not have symptoms.
High risk groups with a positive family
history of diabetes, obesity, hypertension
and pregnant women should be screened
for diabetes.
 3
Can diabetes be called a disease?

No. Diabetes is only a metabolic

disorder due to deficiency or defective
action of insulin. If adequate insulin is
provided a person can lead an absolutely
normal life. Infact Diabetes is a lifestyle
disorder.
 4
Are there different types of diabetes?

Yes, Diabetes is a spectrum of different

disorders. The two main types are
type 1 / Insulin Dependent / Juvenile
Diabetes Mellitus which is seen at a
younger age. These diabetics respond
only to insulin. Type 2, the most
prevalent type, also called Non Insulin
Dependent or Adult Onset Diabetes
Mellitus, responds to tablets. Diabetes
is also a part of other Endocrine
disorders like thyroid disorders. Most
of the time, diabetes is associated with
Hypothyroidism.
 5
What are the major aims in the treatment of
diabetes?

The most important aim of the

treatment of diabetes is to lead a normal
life avoiding all the complications of
diabetes.
 6
What are the Complications of Diabetes?

Diabetes can produce both acute &

chronic complications.
The acute complications of Diabetes
are those due to high blood sugar and
Ketone in the urine which are due to
infection, stress, stoppage of medication,
etc. The chronic complications of
Diabetes are Diabetic neuropathy
(involvement of the nerves), Diabetic
nephropathy (kidney disease), Diabetic
Retinopathy (involvement of the eyes).
Diabetes causes changes in blood vessels
which result in Heart disease, Strokes,
reduced blood supply to legs, etc.
 7
What is the normal blood sugar level?

The Normal blood glucose level is

Fasting blood sugar (FBS) : 80-110
mg/dl
Post Prandial blood sugar (PPBS) :
(1½ hrs. after the intake of food)
120-140 mg/dl
 8
How can I find out whether my diabetes is under
control?

To know whether your diabetes is under

control you have to frequently monitor
your blood glucose. The HbA1C is a
test which gives us an average control
of the blood sugar in the last 2 - 3
months.
 9
What is the youngest age at which diabetes has
been detected?

The youngest patient seen at our centre

is a two week old infant. Several of
our patients are below 5 years of age.
This is called infantile diabetes but it
is very rare.
 10
Is there any upper age limit for diabetes?

No. There is no upper age limit for

diabetes. The risk of developing diabetes
increases with age.
 11
What are the principles of diabetes treatment?

There are four basic principles of

diabetes treatment
1. A proper & balanced diet
2. Increased physical activity
3. Drugs - insulin & tablets
4. Patient Education about this
disorder
 12
Is diabetes more common among men or
women?

Till today there is no substantial data

to show that there is an increased
incidence of diabetes in either men
or women.
 13
What are the hormones secreted by the
pancreas?

The hormones secreted by the pancreas

are insulin, glucagon, somatostatin and
human pancreatic polypeptide. Insulin
is the only hormone which helps in
reducing the sugar levels in blood.
The other hormones increase blood
sugar. Thus, the opposite action of
these hormones help to balance blood
sugar.
 14
Do large babies indicate that their mother may
be a diabetic?

Babies who weigh more than 3.5kgs

at birth, are called large babies. It
can indicate the prediabetic state in
the mother. Metabolic changes in
carbohydrates, proteins and fat in the
pregnant mother cause excess growth
of the foetus resulting in increased
weight.
 15
Will children of diabetic parents develop diabetes if
they are born before the parents developed diabetes?

The familial tendency for diabetes

is inherited by generations through
genes. This will be transmitted to the
offspring irrespective of whether the
parents have developed diabetes. Hence,
the chances of the transmission of the
genetic factor to the offspring is the
same whether the parent is already a
diabetic or not.
 16
I developed DM at the age of 30 years and was
diagnosed as a Type 2 DM. But I have been
advised both insulin and oral drugs due to very
high blood sugar levels. Can I withdraw insulin
after good control of diabetes?
Types 2 diabetic patients usually
respond to oral drugs. Occasionally
the blood sugar becomes high due
to some intercurrent infection or
stress. Oral drugs alone may prove
ineffective. A small dose of insulin
helps to control blood sugar levels.
Under these circumstances, insulin can
be withdrawn in some patients after
sometime and control maintained with
diet and oral drugs.
 17
I am a diabetic. How will I know if my kidneys
are affected?

The symptoms of kidney disease like

swelling in legs, face, etc., occur only
in advanced kidney disease. At this
stage the damage to the kidney is large
enough and is irreversible. An important
test for the kidney is an estimation of
24 hrs urine. Normally only less than
100 mg of protein per day should be
excreted. Ideally a diabetic patient can
do this test once a year.
Other kidney function tests are blood
urea and creatinine.
 18
What is Micro-albuminuria?

Kidney disease in a diabetic can be

detected earlier, before the symptoms
appear. A slight increase in albumin in
the urine can be detected by 24 hours
urine protein testing. This is called
microalbuminuria. At this stage the
condition is reversible if treated.
 19
Can we store the blood test strips for more than
one year ?

The blood test strips can be stored

in a cool, dark place till the date of
expiry mentioned on the bottle. The
strips of some brands have to be used
within 3 months since the enzymes in
test strips slowly deteriorate. Please
read the instructions on the packet
carefully.
 20
I am a twelve year old diabetic. Can I have an
egg everyday?

The diet prescription for diabetes is

made according to individual needs.
For growing children the calorie
allowance will be more. An egg per
day is permissible provided it does
not cause drastic deviations from your
total calorie allowance.
 21
Should a patient taking insulin, eat a bed time
snack?

The aim of diabetes management

is blood glucose control without
significant hypoglycaemia. If a person
gets low sugar symptoms particularly
in the night, it may be due to either
a high insulin dose or less amount
of food consumption. In these types
of cases, the patient can take a bed
time snack. The patient needs to see
the doctor as well as a dietitian for a
proper evaluation of low blood sugar
or hypoglycaemia.
 22
Is Insulin available in the form of capsules or
tablets?

No, the oral form of Insulin is not

available at present. Being a protein,
it gets digested in the stomach if
taken orally. Research is going on in
order to produce oral forms of insulin.
Research is also going on in the field
of inhaled Insulin.
 23
If a diabetic is found unconsicous, what first aid
should be given before hospitalisation?
Unconsciousness may be due to very
high blood sugar (hyperglycaemia)
or low blood sugar (hypoglycaemia).
If a diabetic is found unconscious,
the first step is to rush him to a
clinic or hospital nearby where medical
attention is immediately available. An
estimation of blood sugar is to be done
immediately. Glucose or powdered sugar
could be placed at sides of the mouth
- (in between the cheek and the teeth)
if it is due to hypoglycaemia and the
patient will become conscious within
a few minutes. If it is a diabetic coma
(high blood sugar coma), I.V. fluids
and insulin will be needed. He or she
should be taken to a clinic or hospital
where medical attention can be given.
A self glucose monitor at home will
be useful to distinguish between high
or low blood sugar levels.
 24
What is the expected life span of a type 1
diabetic?

A well-controlled and monitored

diabetic can have a normal life
span. However, he has certain rules
to follow. Systematic life / strict
diet / regular insulin with necessary
adjustments made with the help of the
physician / seeking medical advice when
an infection (or) any other emergency
situation arises.
 25
Does Papaya fruit have any anti-diabetic
property?

This has not been proved. However

papaya is one of the fruits that a diabetic
patient is allowed to have (subject to
restriction of portion size).
 26
I am a newly detected diabetic. I am an occasional
drinker. Do I have to avoid alcohol?

An occasional drink, ie, 1-2 pegs

(1 peg = 30 ml) can be taken after
consulting the doctor.
 27
What is hypoglycaemia?

Hyploglycaemia means low blood sugar

that is below 60 mg/dl. Improper intake
of food, increased exercise, and physical
activity can cause hypoglycaemia.
Symptoms are excessive hunger,
sweating, palpitation and giddiness.
Hypoglycaemia is more common in
patients who take insulin.
 28
What are the routine blood tests recommended
for a diabetic and how often should we test our
bood?
In an ideal situation all diabetics should
test their blood sugar (fasting and 1½
hours after food) twice a week with
glucometers. However this is subject
to affordability. In type 1 diabetes
blood sugar levels fluctuate, so more
frequent glucose monitoring at home
is useful. Blood can be tested in the
laboratory once a month.
 29
How often should urine be tested?

Urine sugar testing can be useful to

decide the dose of tablets. It can be
done 2 hours after a meal. Urine sugar
testing can be done at home twice or
thrice a week.
 30
When should urine be tested?

The best time to test urine is two

hours after a meal. Blood sugar will
also be high at this time.
 31
What is the prevalence of diabetes in India?

In urban areas (cities & towns)

(in people who are above 20 yrs of
age) : 12 - 15%
In rural areas (Villages) : 2 - 5%
 32
Is it advisable to exercise immediately after an
insulin injection?

Never postpone a meal. Never exercise

after taking insulin without taking
food as there is always a risk of
hypoglycaemia.
 33
Is testing urine sugar alone sufficient for diagnosing
diabetes?

No. Urine testing alone is not sufficient

for diagnosing diabetes. For some
diabetics urine sugar may not be present
even when the blood sugar is high.
There is also a condition called renal
glycosuria where there may be sugar in
the urine with normal blood sugar.
 34
Do the tablets used for diabetes cause any
complications?

Oral drugs are not to be used in

individuals with severe derangements
of liver, kidney or heart functions; or
in pregnancy. At these times insulin
is recommended.
 35
What are the blood fats to be routinely tested in
a diabetic?

Serum cholesterol and serum triglyceride

should both be checked atleast once in
6 months. It is even better to check
the level of the good cholestrol (HDL)
and bad cholesterol (LDL).
 36
How is the heart affected in diabetes?

The process of the narrowing of the

arteries is known as Atherosclerosis.
It decreases the blood supply to the
heart and produces Ischaemic heart
disease and in severe cases Myocardial
infarction occurs (heart attack).
 37
Can a diabetic marry and have children?

Yes, People with diabetes can marry

and have children.
If you are a male diabetic person,
marriage causes no problem. In females,
because of pregnancy, it is a bit more
difficult. However, with the advancement
of modern methods of management,
i.e., pre-conceptual care and counseling,
continuous care during pregnancy,
etc., the results are very encouraging.
Most of our female diabetic patients
go through pregnancy successfully.
 38
Is smoking a taboo for the diabetic?

Smoking is definitely an aggravating

factor for diabetic complications. It leads
to lung cancer, Atherosclerosis, foot
problems, kidney and eye complications,
etc. So, yes it is a taboo not only for
diabetics but for everyone.
 39
Can a diabetic donate blood?

Yes, a well controlled diabetic is as

normal as anybody and can donate
blood provided that he/she does not
have any contagious illness.
 40
I am an athlete and I take part in major games.
Do I need to increase my food intake or reduce
my drugs at the time of my tournaments?

Exercise increases insulin release and

increases body response. So, at the
time of heavy exercise, it is better to
reduce the dose of insulin or tablets.
There is generally no need to alter the
diet pattern, except to take a snack two
hours before going in for the exercise
and a snack two to three hours after
the exercise.
 41
Can a diabetic travel and go on tours?

Of course. We encourage our patients

to lead a normal life in every way.
However the following points should
be kept in mind.
• Do not break the diet rules as far
as possible.
• Do take medicines regularly.
• Do carry a diabetic identity card
with you.
• Do consult your doctor before
going on a long trip especially
an overseas trip.
 42
Can a person have diabetes without symptoms?

Yes. Most symptoms of diabetes are

associated with severe diabetes. Very
often patients are asymptomatic. Most
people have vague symptoms. A lot of
personal variation is also there with
respect to their symptoms.
 43
Can a diabetic take up the “Keep Fit” exercises
telecast on T.V.?

“Keep Fit” exercises keep you fit but

before starting a strict regimen of
exercise do consult your physician for
a cardiac review.
 44
Should exercise be done even when there is pain
in the feet?

If the pain is mild or moderate, it is

due to neuropathy and exercises like
walking are recommended. If there
is severe pain or if the cause of the
pain is a wound or an abscess exercise
is not possible. In such situations
medical advice is required. People with
neuropathy must wear the right type
of sports shoe for exercise.
 45
Can an occasional fast be undertaken by a diabetic
during religious occasions?

Avoid fasting in diabetes. Fasting

demands glucose production from
the liver and tissues; It mobilises fat
from the fat deposits for energy. These
are undesirable changes in diabetes.
We advice our patients not to fast or
feast.
 46
Why is “tight control” of blood sugar essential
in pregnant diabetic women?

A carefully planned, well controlled

pregnancy will lead to a healthy mother
and child. In the first 3 to 6 weeks
after conception the organogenesis
occurs and requires tight control of
blood sugar and also optimal control
throughout the pregnancy.
 47
I am 50 yrs old and diagnosed as a diabetic. How
do I prevent complications?

Complications can be prevented by

a multifaceted approach. A regular
checkup of blood pressure, blood sugar,
weight, lipid profile, urine testing, etc.
should be done. Regular visits to your
physician are also mandatory.
 48
Both my elder brothers had diabetic eye
complications. I am a diabetic for the past 5 years.
Is there are any possibility for me to develop eye
complications?
These is a possibility of genetic
predisposition to the complications
of diabetes. Since the family history
is positive, you should take necessary
precautions, i.e., maintain strict blood
sugar control and have an annual eye
checkup.
 49
What are the classifications for blood pressure
control?

Optimal - 120/80 MM Hg

Normal - 130/85 MMHg

Pre hypertension -
130-140/85-90MM Hg

Hypertension Stage 1 -
140-150/90-99 MM Hg

Hypertension Stage 2 -
160-179/100-109 MM Hg

Hypertension Stage 3 -
>=180 / >=110MM Hg
 50
Is high blood pressure related to diabetes?

Both blood pressure and diabetes are

related by a mechanism called “Insulin
Resistance.” Moreover, the complications
of diabetes will be worsened further by
uncontrolled blood pressure.
 51
Is there any risk in undergoing surgery when
diabetes is not under good control?

Yes, If blood sugar is not under strict

control surgery can predispose the
person to various surgical complications
which may ultimately result in a failure
of the procedure. Poor blood glucose
control can lead to infection of the
surgical wound, delayed healing process
and prolonged hospital stay all of which
increase the economic burden on the
patient. Therefore it is essential to have
tight blood sugar control (preferably
with insulin) prior to surgery.
 52
My diabetes is under good control with regular
exercise and tablets. Can I relax my diet?

No. It is not advisable to relax the diet

as even a small amount of extra calories
taken daily for a long period can lead
to obesity or weight gain. These extra
calories also need an extra amount of
insulin production from the pancreas
to keep the blood sugar in the normal
range. This process overstrains the
pancreas and may lead to premature
failure of insulin producing cells.
 53
Is there any danger in a Type 1 diabetes patient
missing an insulin injection?

As we all know type 1 diabetic patients

don’t produce insulin, they need insulin
usually in the form of an injection.
They require insulin for the normal
daily metabolic activity. If a type
1 diabetic patient misses an insulin
injection he may develop high blood
sugar leading to diabetic ketoacidosis
due to the deficiency of insulin which
may lead to coma and death. Even when
they have fever and vomiting patients
are advised not to skip insulin, and to
meet a doctor at the earliest.
 54
Why do diabetic patients get foot problems?

Foot problems are common in diabetics

due to the following reasons.
i. Absence or diminished sensation in
the feet.
ii. Decreased blood supply to the
feet.
iii. Improper foot care (shoe bites,
cracks in feet, careless nail cutting,
etc.)
iv. Various deformities of the feet.
Once started these foot problems take
a long time to get cured.
So, “Prevention is better than cure.”
 55
Both my husband and I are diabetics. Our two
children aged 10 and 12 are very fond of sweets
and chocolates. Should we restrict their intake of
sweets at this age itself ?

The chances of developing diabetes for

children whose parents are both diabetic
is high. These “At Risk” children should
be advised regarding diet control and
regular physical activity. As sweets and
chocolates contain refined sugar and
high fat they provide higher calories,
which results in weight gain and obesity.
In these genetically predisposed children
the addition of obesity increases the
possibility of getting diabetes several
fold. So children have to be advised
to restrict sweet and chocolate
consumption.
 56
When I travel, can I stop my insulin injections
and use tablets on those days?

During the period of travel it is

advisable to check blood glucose
with a Glucometer and take insulin
injections according to blood sugar
levels. Taking tablets instead of insulin
is not advisable as it may lead to DKA
(Diabetic Ketoacidosis) in type 1
diabetic patients. In practical terms,
the patients can be advised to reduce
the dose of insulin by 2 units if the
travel duration is short. If the travel
duration is long it is advisable to
consult the doctor before starting the
journey.
 57
At your institute, you advise insulin for those who
are pregnant. During the first three months of
pregnancy I was only on tablets as my Gynaecologist
did not advise me to switch over to insulin.
Eventually I lost my baby. Is this because I was on
tablets during the initial part of my pregnancy?

Micarriages are more common in

diabetic women than nondiabetics.
Insulin is the most widely used and
ideal treatment for pregnant diabetics.
During pregnancy the patients should be
switched over to insulin. Preconception
counselling is also equally important.
The first three months of pregnancy
are crucial from the glycemic point
of view as the organ development is
completed in this period. So strict
glucose control with insulin is needed
during pregnancy in general and the
first trimester in particular.
 58
I am 55 years old and have had no diabetes so
far. I had a painful foot infection with a lot of
pus. It was operated upon recently. The doctor
did a number of investigations before that and
told me that I have severe diabetes. He has started
giving insulin injections also. Does diabetes start
all of a sudden? What is the remedy for it?

It is probable that your diabetes has

remained undetected for many years
Once the foot infection started, you
have come to know that you have
diabetes. In the presence of any sort
of infection and high blood sugar,
insulin is the best form of treatment.
Once the infection settles down you
can consult the doctor and change to
tablets if possible.
 59
Diabetes was detected during my second pregnancy.
The doctor has prescribed a small dose of insulin.
Will my diabetes disappear after delivery as it
developed only during pregnancy?

Pregnancy unmasks the hidden diabetes

in genetically prone individuals as it
stimulates the production of certain
hormones with the ultimate aim of
providing the foetus with enough energy
for its growth. In the majority of patients
diabetes disappears after pregnancy only
to reappear in subsequent pregnancies.
Minority of patients continue to be
diabetic after delivery although the
insulin requirement falls immediately
after delivery.
 60
Sometimes I find it very difficult to concentrate.
Is this due to diabetes?

Lack of concentration can’t be solely

attributed to diabetes. This can be
either be due to low blood glucose
(most common) or high blood glucose
(rarely).
 61
My son is a Type 1 diabetic and he is much shorter
and thinner than the other children in his class.
Is there any cause for worry or is it alright?
Children with type 1 diabetes are
usually thin. This is because persons
with high blood glucose lose much
of their sugar in the urine. Therefore
control of blood glucose in these types
of patients helps to regain near normal
weight. In otherwords weight loss in
a diabetic patient points towards poor
blood glucose control. You must pay
more attention to his diabetes. Meet
the doctor frequently and get proper
advice from the dietician regarding
balanced diet for a growing child.
 62
Is pig Insulin better than cattle insulin?

Insulin is a protein made up of smaller

units called amino acids. The human
insulin differs from pig insulin by
one amino acid and bovine insulin
by 3 amino acids. Due to the similar
structure of pig insulin to human
insulin, pig insulin is better than cattle
insulin. However animal insulin has
been almost completely replaced by
human insulin even in India.
 63
What do you mean by “unhealthy eating
habits?”

With the mushrooming of fast food

restaurants children are getting addicted
to high calorie food like pizzas, burgers,
soft drinks, etc. They could miss out on
a nutritionally balanced diet. This could
lead to children becoming overweight,
which may result in diabetes.
 64
I cannot see clearly at times. Is it due to
diabetes?

The causes of visual problems in

diabetes are
1. Low blood glucose
(most common)
2. Refractive errors caused by poor
blood glucose control.
3. Very high blood glucose.
4. Cataract.
5. It may also be due to diabetic
retinopathy.
It is advisable to order for glasses after
correction of blood glucose.
 65
I am a pregnant diabetic and I am on insulin.
I have been advised to do some walking. If I
walk will I get hypoglycaemia?
Walking improves the response of the
body to insulin. In pregnant women
insulin is the ideal choice to control
blood glucose. Walking is advisable in
case of pregnant women as it increases
the muscle tone. It is always better to
check the blood glucose prior to going
out for a walk. If the value is low the
patient can take 2 or 3 biscuits before
starting to walk.
 66
At what age should checkup for blood sugar be
started in a person with a strong family history
of diabetes?
In recent times more and more children
and adolescents are affected by diabetes.
Keeping this in view, biannual checkup
is advised in all high risk persons (those
with a strong family history of diabetes)
once they are more than 20-25 years
of age. Early checkup should be done
in patients who present with increased
hunger, urination and thirst.
 67
Can transplantation of the pancreas cure
diabetes?

Theoritically transplantation of the

pancreas can cure diabetes but no
convincing result has been obtained so
far. Moreover in the past the patient
who has received the transplant has
had to be on life long steroid therapy
which predisposes the patient to other
infections.
Pancreatic transplant has not yet been
done in India.
 68
Is it safe for a diabetic to have an abortion?

Abortion is not contraindicated in

diabetes. The blood glucose level should
be controlled prior to abortion in order
to prevent further complications.
 69
My parents are diabetics. My wife’s father is also
a diabetic. Will this affect my children?

Your children are at a high risk of

developing diabetes due to a very strong
family history. In recent times, various
studies have proved that diabetes can
be prevented or delayed by diet control
and regular exercise. So to prevent or
delay diabetes they should be advised to
control their diet, restrict their calorie
intake, increase their physical activity
and to lose weight.
A strong family history of diabetes puts
anyone at a great risk of developing
diabetes. However, there is great scope
for prevention of diabetes by certain
dietary measures, avoidance of excess
weight, etc. Both of you should practice
these measures to prevent diabetes.
 70
I am very fond of sweets. Can I prepare sweets
at home with artificial sweeteners?

Yes. You can. In the market there are

various artificial sweeteners available.
They provide either no calories or less
calories in comparison to table sugar.
Some can be used for add on purpose
(heat unstable sweeteners) and some
can be used for cooking (heat stable
sweeteners). They should be avoided in
pregnancy. Some branded confectionary
companies market sweets with artificial
sweeteners.
 71
Do stress and worry affect diabetes?

Yes. Stress (either mental or physical)

produces some hormones (Glucogon
Adrenaline, Noradrenaline, etc). These
hormones act in opposition to insulin
and increase the blood glucose level.
Due to increased stress of work and less
physical activity more and more people
are getting diabetes now-a-days.
 72
Can early kidney disease be prevented by intensive
insulin therapy?

Yes. Early kidney disease can be prevented

by intensive insulin therapy (IIT). IIT is
advisable to prevent long term diabetic
complications. But the main problem
with IIT is hypoglycaemia. So this
should be kept in mind while selecting
patients for IIT. The prevention of
early kidney disease aims at tight blood
glucose control and blood pressure
control. Salt and protein also have to
be restricted.
 73
How can we calculate the ideal body weight
(IBW)?

IBW = (Height (in cms) - 100) x 0.9kg.

Example :
If your height is 160 cms.
Your Ideal body weight is therefore:
(160-100) x 0.9
= 60 x 0.9 = 54 kgs.
 74
What are diabetogenic drugs?

These are a group of drugs which

increase the blood glucose and
predispose the patient to diabetes
or may cause an increased need for
insulin or tablets in those who are
already diabetic. The commonly used
diabetogenic medicines are steroids,
(used for asthma) contraceptive pills and
certain drugs that are used to decrease
swelling in the feet. Specific advice
should be sought if these drugs are to
be continued for a long duration.
 75
Is it possible for a complication to be reversed?

Complications of diabetes are due

to long standing hyperglycaemia and
the ensuing metabolic aberrations.
Complications can be prevented if
diabetes is well controlled. However
if the degree of the complication is
very severe good metabolic control
can only help in arresting further
deterioration of the complication. It
may not be possible to totally reverse
the changes already caused by sustained
hyperglycaemia.
 76
Is diabetes becoming a major problem in our country?

Indians are at a particularly high risk

of developing diabetes due to their
genetic susceptibility. Due to rapid
urbanization, increased stress at the
work place, high calorie diet, reduction
of physical activity, etc., the incidence
of diabetes is high. The magnitude of
this problem is likely to increase and
India may soon become the diabetic
capital of the world.
 77
What is Renal Glycosuria ?

This is a condition where one can find

sugar in urine whereas the blood sugar
is within normal limits.
In normal persons the kidney doesn’t
allow the sugar to come out in urine if
the blood sugar is within normal range.
But in Renal Glycosuria patients the
urine shows positive for glucose, even
if the blood glucose is normal.
 78
Can a diabetic take rice?

Yes, all diabetics can take rice. They

can take whatever cereals they want like
rice, wheat, ragi, bajra, etc., according
to the portion size prescribed by a
dietician.
 79
Can exercise be done on an empty stomach? Are
early mornings the best time for doing exercise?

Exercise can be done early in the

morning after a good sleep at night.
Exercise can be done on an empty
stomach provided that the patient
doesn’t go into hypoglycaemia. Patients
should not over exert themselves during
exercise. Exercises such as brisk walking,
swimming, cycling, jogging, etc., are
the best forms of exercise.
 80
What is ‘Brittle Diabetes ?’

Brittle diabetes is the name given to the

type of diabetes in which the glucose
level varies between a very high level
to a very low level especially among
people who are on insulin. Their
insulin dosage has to be monitored
frequently and they should be counseled
to a adhere to a strict diet and to do
suitable exercise.
 81
In children with diabetes, is it possible to control
their diabetes with tablets when they become adults?

No, children with diabetes are generally

type 1 diabetics who require insulin to
sustain their blood sugar levels as their
pancreas is unable to secrete insulin.
Their diabetes cannot be controlled
with tablets.
 82
What is an insulin pump and who would benefit
by it?

The insulin pump is a battery

operated device by which insulin
can be continuously injected at a
pre-determined rate. It minimises the
fluctuation in blood sugar. The insulin
infusion rate can be adjusted according
to the requirement of the patient. It
can be used among both type 1 and
type 2 diabetics in whom the sugar
level fluctation is very high. It avoids
the daily prick of the insulin. Cost
is one of the limiting factors for its
usage.
 83
Can a diabetic take sweets and increase the dose
of tablets?

No. Diabetics cannot take sweets as

it will suddenly increase the blood
glucose levels and increase in tablet
dose will result in fluctuation of blood
sugar. However sweets made up of
artificial sweeteners are permissible to
an extent.
 84
Can all vegetables be taken by a diabetic?

All vegetables can be taken by a diabetic

but the total amount of calories have
to be adjusted. Vegetables like potato,
tapioca, yam, etc., are a rich source of
carbohydrates. Hence if they are taken
other high carbohydrate sources like
rice will have to be restricted.
 85
How accurate are the blood glucose meters that
can be used at home by the patients?

Blood glucose meters are handy,

convenient and very useful in case
of an emergency. They give nearly
accurate readings when used properly.
Strips are to be kept properly according
to the instruction on the packet and
the instructions on coding should
be followed strictly. Please read the
instructions on the machine and strip
boxes carefully. In big institutions like
our hospital patients are taught how
to use meters.
 86
I use insulin injections regularly. At the site of
injection, I have loss of fat. How can I prevent this?

Loss of fat tissue, at the injection

site is known as “Lipoatrophy’’. The
exact cause is still unknown but it is
probably due to the antibodies formed
by the components of insulin. It can
be prevented by rotating the site of
the injections. Such incidents are less
with purer forms of insulin.
 87
What is Human insulin?

Human insulin is genetically developed

from bacteria or yeast cells. These are
the purer forms of insulin and are
similar to the insulin produced by
the body.
 88
I need insulin injections to control diabetes. The
doctor prescribes tablets also with the injection.
What is the need for this?

As the diabetes progresses over the

years insulin from the body decreases
gradually and subsequently not enough
insulin is available to maintain the
blood glucose at a desired level. Hence
insulin is exogeneously provided to
maintain the blood glucose and to
prevent further complications. Tablets
also need to be taken to decrease the
insulin requirements of the body.
 89
What is food fibre? How does it help in a
diabetic?

Food fibre is the part of the food

which cannot be digested and absorbed
from the intestine. It forms the bulk
of undigested food material.
Fibre helps in reducing blood glucose,
reduces fat absorption, provides gastric
motility and avoids constipation.
 90
Do any drugs cause increase in blood sugar and
upset the control of diabetes?

Some drugs like steroids, oral

contraceptive pills, certain diuretics,
antibiotics, etc, increase the blood
glucose to a certain extent. Hence these
drugs should be used judiciously and
blood glucose should be monitored
more frequently doing their use.
 91
Can oral hypoglycaemic agents (tablets) be completely
withdrawn after good control of diabetes?

In very few cases the oral hypoglycaemic

agents can be withdrawn completely for
a certain period of time. Patients can
maintain good glycemic control with
proper diet and adequate exercise. But
they have to be regularly monitored.
 92
When a diabetic gets fever or any other illness
should he discontinue treatment for diabetes? Can
he take the usual drugs for fever or any other
common illness?

Diabetics should continue the drugs

during their illness or fever. If the
dosage has to be adjusted please consult
your Physician.
 93
What is HbA1c test? How is it useful for a
diabetic?

HbA1c or glycosylated haemoglobin

gives an idea of the blood glucose
control during last 2 – 3 months.
It is the average blood glucose level
during this period. It is very useful
in monitoring the glucose level of the
patient.
 94
Why should diabetics take extra care of their
feet?

Diabetics should take extra care of

their feet because infection in the feet
is one of the most common causes of
hospitalisation and it is the costliest of
all the complications of diabetes. The
diabetic foot is one of the most common
causes for amputation which can be
prevented if proper care is taken. Due
to diabetic neuropathy the sensation of
pain in the legs is decreased and the
patient is unable to realise it when
there is injury to the feet.
 95
Can insulin injections be taken at the same site
repeatedly?

Insulin sites should be changed every

time and repeated injection at the
same site is to be prevented. It is
advisable to inject insulin over the
abdomen during the day time and in
the thighs during night. Insulin should
be pricked at a distance of ½ inch to
1 inch from the previous site.
 96
What precautions should one take when buying
insulin?

While buying insulin you should

i. check the expiry date.
ii. check whether insulin has been
stored properly (refrigerated).
iii. there shouldn’t be any particle
formation inside the insulin.
iv. check whether the form of insulin
is the same as that prescribed by
your doctor.
 97
How should a diabetic choose footwear?

While choosing footwear a diabetic

should check the following facts.
i. It shouldn’t be too tight. It is
advisable to wear a footwear which
is a bit loose.
ii. The insole should be soft and
the outsole has to be hard.
iii. Footwear should be continuously
checked to see whether there are
hard objects like stones inside
it.
iv. Buy the footwear only in the
evening.
 98
While on insulin, can a diabetic increase the dose
of insulin and take more food?

It is always best to continue the dosage

prescribed by the diabetologist. If the
blood sugar is high, you should contact
your doctor before increasing the dose
of insulin because increase in insulin
causes unexpected hypoglycaemia. So
it is not advisable to increase the dose
of insulin and to take more food.
 99
It is said that if one does not develop diabetes
before 60 years, he will never get it. Is it true?

Diabetes can develop at any age and

it is not true that it always develops
before the age of 60. The peak incidence
occurs between 20 and 50 years of age
but it can occur at any age. We have
seen diabetes in an individual at the
age of 104 years.
 100
Can diabetes be cured?

No. Diabetes cannot be cured. It can

only be controlled. In certain cases of
type 2 diabetics who are obese, weight
reduction can achieve a normal state
without the use of drugs. This is called
remission. In type 1 diabetics sometimes
insulin dose can be decreased or may
not be required - this is called the
honey moon period.
 101
Is it true that hypoglycaemia can cause brain
damage ?

Very rarely hypoglycaemia (low blood

sugar) can cause brain damage. It occurs
with the hypoglycaemia associated with
long periods of unconsciousness. There
is no evidence to suggest that repeated
hypoglycaemia leads to any permanent
damage to the brain.
 102
Can diabetes cause loss of memory ?

Diabetes by itself does not lead

to poor memory except during
hypoglycaemia.
 103
Can I drive after having put in eye drops for my
annual eye examination ?

It is advisable not to drive for 4-6 hours

after eye drops are put in. Eye drops
are put in the eye before screening.
to dilate the pupils. In bright light.
the pupils usually become small to
prevent getting dazzled. However this
is prevented by the eye drops. so you
will have a blurred vision till the effect
of the eye drops goes away.
 104
In diabetics, what are the chances of foot
amputation?

If proper foot care is taken, there is

less chance of foot amputation. The
chances of amputation in diabetics
increases if one smokes; if minor
foot infection is not taken care of; if
diabetes is not optimally controlled,
if one is unaware of foot problems; if
one does bare foot walking, etc. So,
it is advisable to contact a podiatrist
(foot specialist) immediately if you
have any foot problems.
 105
My doctor says - I have diabetic kidney disease -
but I have no symptoms, how is that?

Symptoms in diabetic kidney diseases

appear late in the course of the
progress of the disease. Usually the
kidney damage can be assessed well
in advance (before symptoms appear)
by doing tests like microalbuminuria
in the urine. Symptoms appear very
late in diabetic kidney disease. So
you should get your urine checked
for Microalbuminuria at regular
intervals.
 106
What are the factors that lead to type-2
Diabetes ?

Factors like obesity; sedentary life style;

family history of diabetes; smoking,
stress and genetic predisposition all
lead to type-2 diabetes.
 107
Are contraceptive pills safe for insulin dependent
diabetic patients?

Low dose oral contraceptive pills are

safe in diabetes but it can also decrease
glucose tolerance. However significant
adverse effects on glucose control are
very unusual. Concerns have been
raised regarding lipids, blood pressure,
macrovascular disease aggravation, etc.
So consult your doctor before starting
contraceptive pills.
 108
I have no symptoms - but my doctor says - I have
blood pressure - and that I should take tablets
for blood pressure. Why should I take blood
pressure tablets ?

Ideally blood pressure should be kept

under tight control - irrespective of
whether you have symptoms or not.
There is good evidence to show that
keeping the blood pressure within
normal range protects the heart, kidneys
and brain.
 109
My left leg was amputated because of diabetic
gangrene, now I have a lot of pain in my right foot
and calf muscles. Could it be due to insulin?

No; there is no reason for insulin to

produce pain in your leg. It can be due
to the fact that the blood supply to
your legs is insufficient and the pain
that you are getting in the foot and
calf muscles is a reflection of the poor
blood supply. If you are a smoker quit
the habit immediately and do consult
your doctor.
 110
Can early kidney disease be controlled?

Generally when proteins are excreted

in urine it indicates that your
kidneys are affected. Protein excretion
can be known by a test called as
Microalbuminuria. It is advisable
to do the Microalbuminuria test at
regular intervals. If Microalbuminuria
is present, in addition to good control
of diabetes and blood pressure, avoiding
daily intake of high amounts of protein
in the diet will also help. A class of
drugs called ACE inhibitors also help
to prevent futher kidney damage.
 111
I am a diabetic - can I wear contact lenses ?

Diabetes is not a contraindication for

contact lenses. Take advice from your
ophthalmologist. It is important to let
him know that you are a diabetic and
to follow the advice given particularly
to prevent damage to the eyes.
 112
Is it possible to avoid diabetic complications in
my life?, If so, how?

Yes, it is proven beyond doubt that

if you keep your blood sugar under
tight control you can postpone your
complications. It is advisable to start
insulin early in the course of the disease
if the blood sugar is not under control
with tablets.
 113
What are the symptoms that suggest that a complete
foot checkup should be done?

As a diabetic, you should not wait

for any symptoms to develop. It is
advisable to get your feet checked
once a year. However symptoms like
burning; pricking, numbness in the
foot; pain in calf muscles on walking;
the slipping away of chappals from the
foot; presence of callus (area of thick
skin on the sole), etc., indicate that
you need proper foot care.
 114
I am a girl aged 17 years. I have not yet attained
puberty. Is that because of diabetes?

It may not be because of diabetes alone

provided you have good glycaemic
control. Other causes of delayed puberty
like thyroid problems should also be
ruled out.
 115
When pregnant if I get hypoglycaemia, will my
baby (foetus) be affected?

No; your baby will not be affected by

your hypoglycaemia. If you get severe
hypoglycaemia, which is very rare in
pregnancy, your baby may also get
hypoglycaemia. However this is very
rare.
 116
My 10 year old son was recently diagnosed as
a diabetic. Can he start injecting insulin by
himself?
Yes, children above 8 years of age can
take injections themselves. We can
teach them injection techniques, sites
where injection is to be taken, rotation
of the sites, etc.
 117
I was diagnosed as diabetic during my pregnancy.
Can I breast feed my baby?

Yes, you can, provided you are using

insulin for blood sugar control and
not tablets.
 118
I am a diabetic for the last 10 years. I was on
tablets, now my doctor has prescribed insulin
also. Why should I take both?

After 10 years of diabetes, there may

not be enough Insulin in the body. So
tablets alone will not give good blood
sugar control. In such cases, insulin
should be taken along with tablets for
good control. You can always discuss
with your doctor whether insulin is
temporary or permanent for you.
 119
I am a diabetic and I am pregnant. Will diabetes
affect my baby?

As a woman it is your right to deliver

a baby. Diabetes will not affect your
baby if it is under good control. You
need to be more cautious during your
pregnancy and take insulin as advised
by your doctor.
Infact in a newly married diabetic it
is wise to start insulin even before
conception to ensure safety for the
baby. You need to adhere to your diet,
exercise and follow the insulin regimen
as per the guidance of a diabetologist.
You can always have a healthy baby
like any other normal woman.
 120
Can stress affect my blood sugar level? If yes
how?

Acute stress - physical or mental,

certainly affects blood glucose levels
both in type-1 and type-2 diabetes.
Long term stress may have substantial
and significant effects. During stress,
hormones such as cortisol and adrenaline
affect the glucose response to insulin.
Studies have shown that there is a
reduction of HbA1C with good stress
management.
 121
Can diabetes affect the sexual life of a person?

Yes, diabetes does affect the sexual life

of a person if he/she has high blood
sugar. If you keep your blood sugar
under tight control - your sexual life
will not be disturbed. Other causes
like smoking and certain medications
do affect the sexual life of a person.
 122
I am suffering from asthma and I am on a short
course of steroids. Will this affect my sugar levels?

Yes. Steroids do increase the blood

sugar. However inhaled steroids do not
cause much fluctuation in blood sugar
as compared to oral or intravenous
steroids. When you are on steroids your
requirement of diabetic medicines may
have to be increased. So consult your
diabetologist before starting steroids
so that the dose of medicine can be
adjusted accordingly.
 123
As a diabetic - what are the precautionary measures
that should be followed when I am sick?

During illness / infection - your blood

glucose can fluctuate frequently even
with the same dose of medicines
(tablets / insulin). So when you are
sick -
a. Test your blood sugar
frequently
b. Consult your doctor for adjusting
the medicines
c. Ensure adequate intake of fluids.
 124
Do large babies cause their mother to develop
diabetes?

No; It is the otherway around. During

pregnancy; even mild hyperglycaemia
may result in an overweight baby. In
any woman who has given birth to
an overweight baby diabetes should
be ruled out.
 125
Is weight loss a symptom of diabetes? If so...
how?

Weight loss is an important symptom

of diabetes. In hyperglycaemia a large
quantity of urine is passed which is
loaded with sugar resulting in weight
loss.
 126
I was symptomatically free at the time of diagnosis
how was it so..?

There may not be typical symptoms of

diabetes at the time of diagnosis. It is
so because the diabetes process starts
8 - 10 years before the diagnosis. To
diagnose diabetes at this stage a glucose
tolerance test (GTT) should be done.
However in the high risk population
it is advisable to do a GTT once a
year.
 127
Why does my blood sugar go up even when I eat
a meal with no sugar in it?

When a meal is taken with/without

sugar, it is digested to form energy
by liberating glucose, amino acids,
etc. These amino acids / glucose are
absorbed in the blood, which leads to
a rise in blood sugar.
 128
What is Ketone? My doctor said I have Ketones
in the blood. What does this mean?

When fat is used for energy ketones

are produced. The body uses fat for
energy when there is no insulin in the
body. In diabetes it indicates that you
have high blood sugar with relatively
less insulin. When you have ketones
in the urine you have to consult your
doctor.
 129
Does diabetes increase my risk of heart disease?

Yes, diabetes increases your risk of

heart disease. However the risk can be
reduced by keeping the blood sugar
and the blood pressure under control.
Moreover your cholesterol should be
under control and certain medicines
which protect the heart should be
taken. You can ask your doctor for
the same.
 130
What is dialysis?

Dialysis is a method of removing wastes

such as urea, creatinine from the blood
when the kidneys are unable to do so.
Dialysis is of two types - hemodialysis
and peritoneal dialysis.
 131
How can I reduce the risk of developing diabetic
eye disease?

Diabetic eye disease gets worse with

poor blood sugar control, high blood
pressure, dyslipidemia, smoking, etc.
You can reduce the risk of developing
diabetic eye disease with good blood
sugar control and by keeping BP,
cholesterol under control. If you smoke
you should stop immediately.
 132
Does alcohol affect painful neuropathy?

Alcohol by itself is not a sufficient

cause of neuropathy. In people with
diabetic neuropathy it may aggravate
the problem.
 133
I am a diabetic for the past 10 years. What are
the precautionary measures that are needed to
prevent foot ulcers?

Your risk of developing foot ulcers

increases as neuropathy sets in. The
best precautionary measure is to
prevent trauma to the foot by wearing
appropriate footwear. Further you
should inspect your foot daily before
going to bed. Avoid dry skin and get
screened annually for neuropathy, PVD
and other foot problems.
 134
Is a diabetic more prone to get skin infections?

Yes, boils and abscesses are commonly

seen in diabetics. Balanitis and
vulvovaginitis are more frequently
seen when the blood sugar is not under
control. However the infection can
be brought under control with good
glycaemic control.
 135
What should I do if I suddenly realise that I have
missed an insulin injection?

If you are a type-2 diabetic you can take

insulin with your next meal and the dose
may have to be reduced. If you are a
type-1 Diabetic then the dose of insulin
has to be taken immediately. However
the dose and the type of insulin will
depend upon the regimen which you
are presently on.
 136
How is yoga beneficial for a diabetic?

Yoga reduces insulin resistance; improves

glycaemic control, corrects dyslipidemia
and reduces blood pressure. Moreover
yoga reduces stress. Some useful asanas
are - Bhujangasana; Sahalabhasana;
etc.
 137
I am a 32 year old male. What should I do to
postpone the onset of diabetes?

There are modifiable risk factors for

diabetes like obesity, sedentary life
style, stress, etc. Diet and exercise are
recommended to postpone the onset of
diabetes. Moreover, certain medicines
like metformin, acarbose, etc., are also
useful in high risk groups to postpone
the onset of diabetes.
 138
Is there any way to increase the body weight of
a diabetic patient?

Good blood sugar control may

lead to some modest weight gain.
Some medicines like rosiglitazone,
pioglitazone, etc. which are used to
control blood sugar may increase weight
as an effect of the drug.
 139
Is there any cure for diabetes? I have heard that
Ayurvedic medicines can cure diabetes.

At the moment there is no cure for

diabetes. Ayurvedic medicine or any
other alternative medicine also does
not have a cure for diabetes. However
with the currently available expertise,
facilities and medicines it is possible to
control blood sugar to near normal.
 140
Is it possible to detect the risk of developing
diabetes? If so how?

Yes, the risk of developing diabetes in

an individual can easily be detected by
a test known as GTT. The prediabetic
stages - IGT, IFG can be detected by
GTT and we can act accordingly.
IGI : Impaired glucose intolerance
= 2hr value 140-199mg/dl
IFG : Impaired fasting glucose
Fasting value 110-125mg/dl
 141
What are the devices by which insulin can be
taken?

Insulin can be taken from vials by

syringes and by pens from different
companies. The recent and the most
advanced method is the insulin pump.
The insulin pump is the best method
of taking insulin in patients who are
not getting proper blood sugar control
with insulin injections. However the
cost is an important factor.
 142
Is inhaled insulin available in India?

No, inhaled insulin is not yet available

in India. It was available in the USA
but it was withdrawn from the market
for various reasons in Oct ’2007.
 143
What is a CGMS?

CGMS is a continuous glucose

monitoring system. With the help
of a hi-tech gadget the blood sugar
is monitored continuously. Various
gadgets are available in the international
market - like CGMS from Medtronics;
Glucowatch, etc.
 144
When is CGMS useful?

CGMS is useful for fine tuning the

blood sugar levels when the patient is
on an insulin pump. It is also useful to
detect hypoglycaemia of which we are
unaware, post prandial hyperglycaemia,
etc.
 145
What is Exenatide?

Exenatide is a new drug for diabetes. It

is a GLP1 Mimetic. It helps to control
blood sugar; gives a feeling of satiety
and delays gastric emptying.
 146
How is exenatide administered?

Exenatide is injectable. It is injected

subcutaneously like insulin.
 147
What are the latest drugs that have been launched
for diabetes?

The latest medicines in diabetic

management in India include
• Insulin pumps for insulin
administration.
• Exenatide (Byetta) is a drug for
diabetes which is to be injected
like insulin.
• DPP-4 inhibitors (tablets) which
are yet to be launched.
• Codeless glucometers are available
in the market.
• To monitor blood glucose
continuously CGMS is available
in India.
 148
When pregnant, if I inject insulin in my abdomen
will it effect my child?

No; not at all. The insulin needle is

very short and thin. There is no way
in which it will affect your child.
 149
How do I know if insulin is spoilt?

If premixed insulin / intermediate

acting insulin is spoiled it will have
precipitates adhering to the wall of
the bottle / pen fill. If short acting
insulin is spoilt its colour will change
to brown.
 150
What colour syringe should I use for insulin?

Insulin comes in two strengths 40 IU

& 100 IU in India. If you are using
40 IU insulin you have to use a red
colour syringe and if you are using
100 IU insulin you have to use a pink
colour syringe.
 re Than
MV Hospital for Diabetes (P) Ltd. Mo

(ISO 9001 - 2000)

CO M P U PR I N T : 281 1 67 68

& 50
Diabetes Research Centre Years of
Diabetes Care
Our South Chennai Unit MV CENTRE FOR DIABETES
(A Branch of MV Hospital for Diabetes (P) Ltd.)
No. 51, Second Floor, (Opp. to P.S. Higher Sec. School)
R.K. Mutt Road, Mylapore, Chennai 600 004.
Phone : 4210 2117, 2461 3716, 6585 0955/56, 2440 5107/08/09