Follow your physician's instructions and change your lifestyle to create a life that is full, happy, energetic and healthy

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1 Follow your physician's instructions and change your lifestyle to create a life that is full, happy, energetic and healthy C-14, Qutab Institutional Area, New Delhi Tel: , Fax: info@helpageindia.org. Website:

2 M I S S I O N To work for the cause and care of disadvantaged aged persons and to improve their quality of life. HelpAge India is thankful to the following experts for the preparation of this manuscript: Dr. Ashok Jhingan Chairman Delhi Diabetes Research Centre J-136, Rajouri Garden, New Delhi Series Editor Anupama Datta Director (Policy Research & Development) HelpAge India What is Diabetes? Diabetes mellitus, commonly referred to as diabetes, is a medical condition associated with abnormally high levels of glucose (or sugar) in the blood (hyperglycaemia). Glucose comes from the digestion of starchy foods such as bread, rice, potatoes, chapattis, sugar and other sweet foods and from the liver which makes glucose. Glucose is used by the body to make energy. Normally, blood glucose levels are tightly controlled by insulin, a chemical (hormone) that is produced by a gland near stomach called the pancreas. Insulin lowers the blood glucose level because it stimulates the body to make use of glucose. When the amount of glucose in the blood increases, for example, after eating food, insulin is released from the pancreas to normalize the glucose level. However, in patients with diabetes, the elevated glucose levels cannot be normalized either because of complete absence of insulin, or because insulin is insufficient, or in spite of sufficient insulin being produced, the body is resistant to it. This causes abnormally high levels of blood glucose, which ultimately leads to the presence of glucose in the urine (glucosuria). What are the common types of Diabetes? There are two main types of diabetes mellitus. These are known as type 1 and type 2 Diabetes. Type 1 diabetes: Type 1 diabetes mellitus used to be called insulin-dependent diabetes mellitus, or juvenile-onset diabetes mellitus, because it usually begins in childhood or adolescence. Type 1 diabetes occurs when the body's immune system attacks insulin-producing beta cells in the pancreas and destroys them. As a result there is absolutely no production of insulin in the body. These patients therefore rely completely on treatment with insulin for their survival. Approximately 5-10% of Diabetics have Type I Diabetes. It usually occurs in children or young adults, though it can also develop in older adults. This disorder increases the risk of cardiovascular disease, blindness (retinopathy), nerve damage(neuropathy) and kidney damage (nephropathy).

3 Type 2 diabetes: Type 2 diabetes mellitus is the most common form of diabetes. It used to be called non-insulin dependent diabetes mellitus or adult onset diabetes because it usually begins in adulthood. It develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). In most cases this is linked with being overweight and leading a sedentary lifestyle. If neglected, obesity-linked Pre-Diabetes can lead to the onset of Type 2 Diabetes. This type of diabetes usually appears in people over the age of 40, though, it often appears after the age of 25. However, recently, more children are being diagnosed with this condition, some as young as seven (early onset type 2 diabetes). Type 2 diabetes is the most common of the two main types and accounts for between 85-95% of all people with diabetes. This condition can only be managed, not reversed, for the rest of a person's life. Pre diabetes This is a condition that occurs when a person's blood glucose levels are higher than normal, but not high enough for a diagnosis of type 2 Diabetes. Before an individual develops Type 2 Diabetes, they are almost always Pre-Diabetic. Insulin Resistance and obesity are underlying causes of Pre-Diabetes, It is mostly seen in patients who have a strong family history of diabetes and are obese(overweight) or lead a sedentary lifestyle. Such people need regular screening for diabetes, preferably a Glucose Tolerance Test annually, along with strict diet control and lifestyle modification. Taking action to manage your blood glucose levels when you have Pre-Diabetes can prevent or delay Type 2 Diabetes from ever developing. Diabetes Mellitus is a life-long, chronic condition Type 1 diabetes usually begins in childhood or adolescence. The symptoms tend to occur suddenly after the onset of the disease and are usually more obvious than those of type 2. Type 2 diabetes usually begins in adulthood (mainly after years of age). It develops gradually in most cases and may be present for several years before it is detected. How serious is diabetes? The early symptoms of untreated diabetes mellitus are related to the elevated blood glucose levels. Excess glucose in the blood ultimately results in high levels of glucose being present in the urine (glucosuria). This leads to increased urination, especially in the night, which leads to dehydration and increased thirst. Other symptoms include extreme tiredness, weight loss, excessive hunger, blurred vision, itchy skin and repeated minor infections such as thrush and boils. If uncontrolled for many years, diabetes mellitus can lead to more serious health problems also called the complications of diabetes. These include: Blood vessel damage within the eye (retinopathy). This can start as blurring of vision and finally lead to blindness. Kidney disease (nephropathy) or kidney failure. Nerve damage (neuropathy) especially of the hands and feet, causing tingling, numbness, burning sensation in the feet or hands. Few patients have sensations of walking on sand or cottonwool and falling of chappals from the feet in advanced nerve damage. Affection of the nerves of the heart can lead to a silent / painless heart attack. Narrowing of the blood vessels due to fatty deposits (atherosclerosis). This increases the risk of heart attack, stroke and poor blood flow in the legs. Sexual problems due to the involvement of nerves. Who can get diabetes? Anyone can develop diabetes, but some people are more at risk than others. You are at greater risk for diabetes if you: Are over 45 years old. Are overweight. Have a family history of diabetes. Have high cholesterol and/or high blood pressure. Have had gestational diabetes during pregnancy. Have given birth to a baby that weighed more than 4 kg. Lead a sedentary lifestyle. Exercise less than 3 times a week. While you cannot change some of these factors, you can change others.

4 For example, you cannot change your age or ethnicity, but you can exercise more often. These kinds of changes will help reduce your risk of developing diabetes. What are the symptoms of diabetes? Diabetes often has no symptoms or warning signs. The only way to be sure is to have your blood tested for glucose (blood sugar). If symptoms do appear, they might include: Feeling tired Feeling irritable Urinating more than normal Being very thirsty Being very hungry Unexplained weight loss Some wound that is not healing Blurred vision Tingling, numbness or burning sensation in feet or hand If you are experiencing some of these symptoms or think that you might be at risk for diabetes, be sure to talk to your doctor about getting tested. How is diabetes treated? Treatment is aimed at controlling the elevated blood glucose without causing an abnormally low glucose level (hypoglycaemia). An important aspect of your treatment plan will involve eating a healthy diet (low fat, salt and sugar and high fibre). You should also monitor your blood glucose levels regularly as well as undergo routine timely screening to rule out complications. Type 2 diabetes mellitus is first treated with weight reduction, a healthy diet and regular exercise. In type 2 diabetes, if the above measures fail to control the elevated blood glucose, oral (by mouth) medicines are used to try to boost insulin production, improve the body's use of it, or reduce the speed at which glucose enters the blood. Treatment with insulin will be considered if these other medicines are insufficient or in the presence of complications. Treating high blood pressure and controlling the levels of fats (lipids) in the blood are also very important in patients with diabetes as they are at greater risk than the normal population of developing serious cardiovascular diseases. Although there is currently no cure for diabetes mellitus, it can be controlled successfully with an active treatment plan. New treatment options: 1. Insulin Pens: These pen devices are very successful these days due to easy and relatively painless injection of insulin and are very easy to carry around while traveling. 2. Insulin spray: This is another noble way of insulin delivery, where insulin can be inhaled in the form of a spray through aerosol inhalers, much like the inhalers used by asthmatic patients. 3. Insulin Pumps: The insulin pump is a pager-sized device that continuously delivers insulin in small amounts all through 24 hrs through a small painless cannula that is inserted under the skin. 4. Pancreas transplant & Islet cell transplant: Though these have been tried in the western countries, still their long-term results are awaited. 5. Stem cell therapy: This is again a new and promising therapy, and its success report is much awaited. Diabetes prevention Diabetes is a disease of lifestyle. So, change your lifestyle before diabetes changes you. Healthy eating and exercise habits are the best way to prevent diabetes. These are also great ways to help keep diabetes in control if you already have it. To eat healthy, pick foods that are nutrient-rich. This means that they have many vitamins, but not much fat or sugar. When it comes to foods that are high in sugar, like ice cream or cookies, make sure that you are not overeating. You can still eat these foods, but eat them in moderation. Exercising regularly, at least 5 times a week, is another way to lower your risk of developing diabetes. For example, you might go for walks, run, bike, swim, join a local sports

5 team or try a dance class. The key here is to start small and find something that you enjoy. Leading an active life not only is good for your sugars, but also for your heart and mind!! The mantra to a healthy life with diabetes is: Lose weight - Gain Life!! Eat right & Exercise!! Yoga and Meditation Yoga and meditation are also of great use in controlling your diabetes. While Yoga cannot cure diabetes, it can complement the lifestyle changes necessary to keep diabetic symptoms in check, and it can help you feel more in control of your health and well-being. Yoga exercises gently tone and shape the body, improve posture and flexibility, and contribute to feelings of wellbeing. Most Yoga exercises have a profound effect on improving circulation, especially to the extremities. Yoga exercises help keep the blood vessels elastic and yoga exercise combined with relaxation training, has been shown to reduce high blood pressure in some cases. After you've practiced for a while, you can add more vigorous exercises to your Yoga routine to give you the added benefits of some aerobic conditioning and increased muscle strength. Yoga exercises gently press on the body's glands and organs, resulting in positive effects for the digestive, endocrine and reproductive systems. By releasing muscle tension and teaching you how to relax at will, Yoga relaxation training helps reduce the harmful effects of physical and mental stress. Daily practice of meditation shows you a quiet, restful, stable part of yourself that supports everything you do, and teaches you how to draw on these inner resources for the strength and health that can be your choice. Side effects of diabetes treatment Medications used for the control of diabetes are usually considered safe, though a few rare side effects are worth mentioning. Some people can have drug allergy or rashes with some tablets that belong to the sulfa group. Some people suffer from gaseous distension, flatulence or stomach upset with metformin group of drugs. A serious side effect of medications used to control diabetes is hypoglycemia or low blood sugar as we call it in simple terms. It is a very important condition and so we must know a few important details about it as mentioned below. Hypoglycemia: A common side effect of diabetes medications Hypoglycemia can occur in people with diabetes who take certain medications to keep their blood glucose levels in control. Usually hypoglycemia is mild and can easily be treated by eating or drinking something with carbohydrates. But left untreated, hypoglycemia can lead to loss of consciousness. Causes of Hypoglycemia In people taking certain blood-glucose lowering medications, blood glucose can fall too low for a number of reasons: Meals or snacks that are too small, delayed, or skipped Excessive doses of insulin or some diabetes medications Increased activity or exercise Excessive drinking of alcohol Symptoms Symptoms of hypoglycemia include: Hunger Nervousness and shakiness Perspiration Sleepiness, confusion Difficulty in speaking Feeling anxious or weak Dizziness or light-headedness Hypoglycemia can also happen while you are sleeping. You might: Cry out or have nightmares Find that your pajamas or sheets are damp from perspiration Feel tired, irritable or confused when you wake up Prevention To help prevent hypoglycemia, you should keep in mind several things: Diabetes medications: Always take medications and insulin in the recommended doses and at the recommended times. Regular monitoring of blood sugars and adjustment of doses of your medications by your doctor can

6 really help in preventing your sugars from going too low. Meal plan: Eat regular meals, have enough food at each meal and try not to skip meals or snacks. Exercise: You should always have a snack or adjust your medication before a vigorous exercise. Discuss with your doctor about the type and duration of exercise best suited for you. Alcohol: Drinking, especially on an empty stomach, can cause hypoglycemia. So, if you want to drink, always have a snack or a meal at the same time. Treatment If you feel any symptoms or think your blood sugar is low, use a blood glucose meter to check your level. If it is 70 mg/dl or below, take glucose, candy, fruit, sugar honey or a cup of milk immediately to raise your blood glucose. After 15 minutes, check your blood glucose again to make sure that it is no longer too low. If it is still too low, have another serving. Repeat these steps until your blood glucose is at least 70. Then, if it will be an hour or more before your next meal, have a snack. If you take insulin or a diabetes m e d i c a t i o n t h a t c a n c a u s e hypoglycemia, always carry one of these quick-fix foods with you. Wearing a medical identification card about your diabetic status is also a good idea. Care of a person suffering from diabetes If you already have diabetes, you can lessen your chance of developing complications by keeping your blood sugar under control. Some ways to do this are to: Check your blood sugar often. Ask your doctor about a blood test called hemoglobin A1C. This tests how your normal blood sugars have been over the past 2 or 3 months. It is a kind of report card for your blood sugar. Follow your doctor's advice about oral medicines or insulin injections, diet and exercise. Monitor your cholesterols/ lipid profile. Increased lipids are bad for your heart and along with uncontrolled sugars can lead to major heart problems. Monitor your blood pressure. If your blood pressure is high, talk to your doctor about taking steps to control it. Have your doctor check your urine for protein to keep an eye on your kidney status. He can put you on certain kidney-protective medicines that save your kidneys from the effects of high blood sugars. Get your eyes checked routinely, at least once a year, to pick up diabetic eye changes. Ask for a retinal checkup which differs from a routine vision check that you normally do for your glasses. If picked up early, these changes are still reversible, but once severe changes develop, y o u m i g h t n e e d l a s e r treatment. Screen routinely for nerve a ffe c t i o n. C h e c k i n g fo r vibration thresholds in nerves of your feet can help you pick early sensory changes in nerves due to diabetes. Last but not the least, eat healthy and exercise regularly. These simple steps go a long way in making your life with diabetes much more comfortable and healthy. Coping with diabetes does not mean giving in to an illness mentality ; by following your physician's instructions and changing your lifestyle, you can create a life that is full, happy, energetic, healthy and balanced. Disclaimer: This booklet is not intended to be a substitute for professional medical advice. If in doubt, please consult your doctor and follow his/her instructions. All the statements have been made by the contributors in their individual capacity.