How do I know I have Diabetes?

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1 FREQUENTLY ASKED QUESTIONS The incidence of Diabetes is increasing all over the world including India. There are two main types: Type 1 or Insulin deficient or juvenile diabetes & Type 2 or Insulin resistant or adult onset Diabetes. In type 1 Diabetes pancreas does not produce Insulin and you cannot survive without Insulin. In type 2 Diabetes, pancreas does produce Insulin but it is insufficient and/or less effective. Public education is the key to control the epidemic of Diabetes. Here are the top 10 questions asked by the public and the answers. How do I know I have Diabetes? At the beginning there may not be any symptom. When blood sugar is above 180 mg%, sugar starts appearing in the urine. Sugar in the urine drags water and you pass a lot of urine and feel dry and thirsty. You may also feel tired and loose weight. Your appetite increases and peculiarly you may notice that you are loosing weight in spite of eating more. Chance of infection is higher if you have high sugar and also you re healing from infection, cut or wound may be unusually delayed. Some people complain of poor eyesight. Who are at risk of Diabetes? Being Indian is the biggest risk!! Family history of Diabetes, Sedentary life-style, obesity, smoking, excessive alcohol intake, high blood pressure and in case of women previous Diabetes in pregnancy or delivering big baby (birth weight more than 4Kg) are risk factors. Can I prevent Diabetes when my risk is high? If you have family history, you cannot do anything about that. Things in your hands are healthy eating (i.e., eating vegetables and fruits, avoiding fast food), healthy life-style (regular exercise, avoidance of smoking, moderation of alcohol, etc) and keeping your weight in accordance to your height ideal body weight. Certain medicines are being used recently for preventing Diabetes in people who have borderline Diabetes. I have nobody in my whole family with Diabetes, how did I get it then? Family history certainly is an important factor, but the fact is being Asian, we all have high-risk gene for Diabetes. Remember it is not your fault that you have Diabetes. You are just happened to be the person who got it. In India 4% of villagers and up to 15% of city dwellers have Diabetes. Not only have we had more Diabetes we are getting it at an earlier age than people in the west (around 10 yr). Can I have drink when I have Diabetes? Yes, you can. Alcohol is not banned in people with Diabetes. As always a little alcohol is pleasant but a lot is not, regardless of Diabetes and can damage the body badly. Remember Hypo (low blood sugar) can occur with alcohol and you should not skip meal after a drink with the fear of calorie in the drink. You need to know the medically allowed limit of alcohol. A small measure of Whisky, Rum, Vodka or Gin, a small glass of Beer or Wine is measured as one unit. The limit for men is 21 units and for women 14 units a week. It is better to space that rather than taking weekly quota on a day! Sweet wine or Soft drinks should be avoided as they have very high sugar content. Do I need to stop eating out? Can I have ice cream? Can I take artificial sweetener? Certainly not, as long as you are not planning to eat out everyday! You need to know what the right food is and correct amount. Occasionally yes, but do not make a habit of eating ice cream regularly. There are certain ice cream available now with no added sugar, but do not forget they have calories.

2 Certainly yes, artificial sweeteners are safe. Do not put them in cooking, they break down when heated. So they will not be sweet any more. Can I control Diabetes with Diet only? Diet is a very important aspect in the treatment of Diabetes particularly the timing of it. At the beginning you may be successful in controlling Diabetes with diet only, but unfortunately a time will come when only diet won t be enough, you will require medicine. This time is different for different people, for somebody this can be a few months while for others it may be a few years. It is very important to try with diet first; this will help you to understand the principles of diet and will convince you the need for treatment to control Diabetes. Once started, do I need to take tablet for life? This all depends on your Diabetes. If your Diabetes is very well controlled with a small dose of tablet, you may try only with diet. If that is fine, why not to control your Diabetes only with diet and life-style measures. But if you see, your control is not good with diet alone, you must accept that your body needs medicine and you should start again. Who with Diabetes needs Insulin? In type 1 Diabetes Insulin is a must for living. In type 2 Diabetes we advice Insulin in certain situations like pregnancy, during and after surgery, severe infection and for some reason or other when you are not able to eat. Obviously, when tablets do not work, you need Insulin for Diabetes control. Is there any job restriction for people with Diabetes? Diabetes should not be a selecting or refusing factor in employment arena. We need to make this clear to employers and employees. Driving is a problem if you are getting frequent hypo, as a rule people with Diabetes on Insulin are not given license to drive heavy vehicle and buses. Remember it is not your fault that you have Diabetes and there is no reason to hide it. Make sure that people around you know that you have Diabetes. Tell them about Hypo and what they should do in case you have a severe hypo.

3 Diet and Diabetes Good, Bad and Ugly of Diabetic Diet! Can I control Diabetes with Diet only? Diet is a very important aspect in the treatment of Diabetes particularly the timing of it. At the beginning you may be successful in controlling Diabetes with diet only, but unfortunately a time will come when only diet won t be enough, you will require medicine. This time is different for different people, for somebody this can be a few months while for others it may be a few years. It is very important to try with diet first; this will help you to understand the principles of diet and will convince you the need for tablet/insulin for good control of Diabetes. Can I follow a strict diet chart? A strict diet chart is something we are not advocating these days. A diet chart is not only monotonous but also difficult to follow day in and out. A strict chart restrains your freedom to eat and also impossible to follow when you are out for social or professional reasons. Rather than a diet chart you should have meal plan. What are the principles of diabetic diet? Healthy eating is the key to success for which you need to know what to eat, how much to eat and what not to eat. To eat or not to eat is not the question, how to make the right decision about eating is the question We recommend three meals (breakfast, lunch and dinner) and three snacks. You can space the snacks in between your meals according to your profession and life-style. There are six components in diet: Carbohydrate, fat, protein, mineral, vitamin and water. Restriction and distribution of carbohydrate throughout the day is important. The amount of calories in rice and wheat are the same, but protein content is high in wheat. Wheat has more fibre in comparison to rice. Dietary fibres are very important for people with Diabetes (food with high fibres such as bran, cereals, vegetables, fruits, brown bread, pulses like lentils, rajma, whole meal flour, etc), they make the absorption smoother and keep the bowel habit healthy. A mixed diet containing both rice and wheat is preferable. Regular eating of salad and vegetables is good for nutritional balance. They are natural source of vitamins, minerals and fibres. If your weight is more than what it should be, you need to loose weight. Taking low caloric food and increasing food with high fibres can achieve this. There is no bar to eat non-vegetarian food unless in special situation like kidney problem. Remember chicken and fish are better than red meat as the amount of saturated fat is less in them. If your cholesterol is high you better avoid yellow of egg and red meat What should I take as snack? You can make one of your own choices. A homemade sandwich will be the perfect one. You can take small amount of noodle, sprouts, a medium size apple or two non-sweet biscuits. Remember soft drinks have a very high sugar in it, so if you are fond of them take the diet one.

4 Will my blood sugars be normal if I do not eat? No, it won t. This is essential to realise, stopping eating is the worst possible thing to do when your sugar is not well controlled. Remember, whatever the blood sugar is, your body needs a balanced diet otherwise you will become malnourished and weak. What if I skip meal? Not a good idea at all, when you skip meals your blood sugar fluctuates and that is not good for control. Particularly in the teenagers, this is common and make sure you do not do this. Remember when you eat is as important as what you eat. My job does not allow me to eat in fixed time, what should I do? Most of the cases, this is an excuse for not being planned. You need to know how to organise your day. Days are changing and all of us are in much more stressful life than our forefathers. Competitions are increasing day by day but we need to look after ourselves so that we are in the best physical and mental state to be successful. Do I need to stop eating out? Certainly not, as long as you are not planning to eat out everyday! You need to know what the right food is and correct amount. Remember Alcohol has empty calorie and also with a drink we tend to eat more. What to eat when I am not well? If you cannot manage to eat your normal diet you need to match them with liquids. Please see the section on Sick day rule. Can I have ice cream? Can I take artificial sweetener? Occasionally yes, but do not make a habit of eating ice cream regularly. There are certain ice cream available now with no added sugar, but do not forget they have calories. Certainly yes, artificial sweeteners are safe. Do not put them in cooking, they break down when heated. So they will not be sweet any more if you boil or fry them. Can I eat fruit? Yes, not only can, you should eat fruit regularly. This is a very old concept that in Diabetes you cannot eat fruit. You should know what fruit and how much you should eat. You should take 1 portions of fruit every day. (One portion of fruit is 1 medium apple, 1 orange or 1 Musambi or a small bowl of papaya, pomegranate, or musk melon etc);. It is better to avoid dry fruits as they have very high calories. What are the food items I should avoid? Foods to avoid Direct sugar, jam, honey, and chocolate as they contain refined carbohydrate and blood sugar rises very quickly. Also it is better to avoid food with high saturated fat such as cheese, butter, ghee, solid cooking oils and hard margarine. Do I need to take vitamin for Diabetes? If you are eating a balanced diet, there is no proven rule for extra vitamin. Some people take them for mental satisfaction. Vitamin is not the treatment of uncontrolled Diabetes neither vitamin will help to control your Diabetes. If for some reason or other you are not able to take regular meal, i.e., you had an operation or you are unwell, you may take some vitamin for a short while.

5 Hypoglycaemia Hypo in people with Diabetes What is Hypo? Hypo is the short form of Hypoglycaemia meaning low sugar in the blood. This can be potentially dangerous and you need to understand very clearly how to recognise hypo, what to do in case you have hypo and how can you avoid that happening again. How would I feel in Hypo? The symptoms of hypo usually appear when your blood sugar is around 50 mg or less, obviously this varies from person to person. Initially you will feel sweaty, shaky, and hungry and heart thumping. Everybody may not get all the symptoms. If not corrected in time you may feel confused and drunk. With further lowering of blood sugar you may go into coma. How my friends will know I have Hypo? Your friends or family members may notice a few things when your sugar becomes low. Initially they may notice your change in behaviour, change in mood, pale face, slurring of speech, unstable gait. Situation may particularly be difficult sometime to differentiate from drunk. This is often a problem with traffic police; a sugar checking is the only way that time to make sure that you are suffering from a hypo. What my friends and family do then? They can give you a drink, may be fruit juice or biscuits and see you for some time till they find you normal and you feel ok. You should take sugar only if you are desperate. What should I do if I have Hypo? If you have glucometer with you better check your sugar. This will confirm the diagnosis because there are so many reasons in day to day life when we do not feel well. If you do not have a glucometer it will be better to eat something so that you can indirectly diagnose whether symptoms get corrected with eating or not. What to take for hypo? You can take different things for treating hypo. Some fruit, biscuits, bread, sandwich, and milk anything will do. If you are not too much symptomatic or sugar is not very low, it is better to avoid taking sugar simply because if you take too much sugar it will not only correct your hypo but also blood sugar will go very high. How can I prevent Hypo? Once you have corrected hypo the most important thing to do is to find out why your sugar dropped. Then only you can take action to prevent another hypo. The commonest cause of hypo is mismatch of food and treatment. If you have taken Insulin and delayed your meal or missed a snack, your sugar may drop. Remember if your Diabetes is very well controlled you are likely to get hypo if you miss snack, meal or delay meal. If you have taken less food for some reason or other, you have done unusual exercise and taken the same treatment your sugar may drop. Hypo also can happen when kidney is affected by Diabetes or thyroid is underactive, your doctor is the best person to help you out on this. Hypo with tablet and Insulin is different because tablets may remain active in the body for longer time, may be even for 48 hours. So you need observation in hospital.