Self care and management in Diabetes

LIFESTYLE MANAGEMENT

Nutrition, exercise, inhibition of tobacco and good mental health are the key areas of lifestyle management in diabetes.

 

DIET MANAGEMENT

  Diet is the sheet-anchor in the treatment of diabetes. A well-planned diet plays a vital role in keeping the blood sugar and lipids within normal limits.
Research studies have shown that nutrition management is associated with a decrease in HbA1c of 1% in type 1 diabetes and 1-2% in type 2 diabetes, depending on the duration of the diabetic condition.



 

1.    What to eat in diabetes?

  Here’s the audio-visual link for the explanation of the Indian version of the diabetes plate:

VIDEO 2:  https://www.youtube.com/watch?v=G9SKBext1Lc

 

2.    How to manage the meal timings throughout the day in diabetes?

Eating 4 to 6 small meals a day is the general recommendation for managing blood glucose levels in diabetes. https://www.ricphi.org/files/userfiles/2021/08/31/files/sc7.jpgConsuming same amount of carbohydrates at the same time every day helps to keep blood sugar levels closer to normal. It also reduces triglycerides (a type of fat in the body). However, dividing the food intake into small meals should be based on individual preferences and the use of insulin in the case of those taking insulin from outside. Fasting and feasting should be strictly avoided.

For more information, click the video link:

Here’s the audio-visual link explaining how often and how much a diabetic person should eat in a day:

VIDEO 1: https://www.youtube.com/watch?v=Rr68jndbaaw

 

3.    Are all carbohydrates bad? How to measure the quality of carbohydrates?

Not all carbohydrates are bad. There are good quality and bad quality carbohydrates in our food. It is challenging to remove carbohydrates completely from our diet as most of our foods have them. But we can manage the intake of the quality of the carbohydrates for reasonable blood sugar control. The quality of the carbohydrates is measured by Glycemic Index. Glycemic Index measures the speed at which carbohydrates pass through the digestion process in our body and release glucose in the blood.

Foods with a high glycemic index increase our blood glucose levels rapidly and are not advisable for patients with diabetes. Simple carbohydrates (processed sugars or glucose) that we get from refined sugar, honey, jaggery, candies, refined maida, white rice, potatoes, or any such processed foods are of the high glycemic index category. They increase blood glucose levels upon consumption.




Figure 2: What is Glycemic Index?


Food rich in complex carbohydrates or fibres such as whole grains, whole fruits and vegetables, unprocessed whole pulses have low to medium

Here’s the audio-visual link explaining the quality of carbohydrates

VIDEO 3: https://www.youtube.com/watch?v=d_MxbosA4uk

glycemic index. They release glucose slowly in the blood and, as a result, normalize the blood glucose levels.

Note: To understand more on Glycemic index and other indices to measure quality of carbohydrates, enrol for level 2 and 3 of the courses, ‘Basics of Diabetes Management’.

 MYTH BUSTERS  

1.  Myth: People with diabetes should avoid eating fruits.

Fact: Diabetics can eat a small portion of fruit in a day.
Fruits are loaded with vitamins, minerals and fibre, just like vegetables. It should be a part of the daily diet of the person with diabetes. However, fruit contains carbohydrate, so it can be eaten in exchange for other sources of carbohydrate in your meal, such as starches, grains, or dairy.  It is advisable to eat whole fruit and not in the form of juice.

2.     Myth: People with diabetes should eat only wheat and not rice.

Fact: Both wheat and rice increase blood glucose levels to a similar extent and should be consumed in moderation.
Both wheat and rice have an almost similar glycaemic index and raise blood sugar to a similar extent. Therefore, it should not matter whether one takes wheat or rice, as long as the total quantity is restricted. However, many diabetics feel it more convenient to count and reduce the number of chapattis they eat than to measure the amount of rice they consume.

 

3.     Myth: All bitter foods help to control blood glucose levels.

Fact: Bitterness cannot cut the sugar in your blood. Blood sugar levels are predominantly dependent on the quantity and quality of carbohydrates consumed.
Few studies on certain functional foods like fenugreek have shown a mild effect on glucose levels. These foods can be used as an additional element for management. Still, they can not replace the medications and insulin prescribed by the doctor.

 

4.     Myth: Home remedies like turmeric, cinnamon, jowar or barley
water, jamun, hibiscus powder, etc., are beneficial and can be replaced with medications.

Fact: The traditional remedies may provide an additional benefit but should not replace medications for diabetes as prescribed by the doctor.
The beneficial effects of these are generally mild. They can be more effective in some people with diabetes than in others. There is a disadvantage in trying some of these traditional remedies, as long as the glucose level is carefully monitored and conventional medications are taken. There is not sufficient evidence for a few remedies, and one should not rely on them alone. These traditional and unprescribed remedies should not be used as a replacement for medications for diabetes.

 

5.    Myth: Honey or jaggery is a healthier option over refined sugar for people with diabetes

Fact: Refined sugar, honey, jaggery and brown sugar belongs to the sugar family and equally spikes blood sugar levels.
There is strong evidence that any form of simple sugar is strongly associated with high blood sugar levels. Refined sugar, jaggery, honey and brown sugar belongs to the sugar family of foods. It contains only simple carbohydrates that result in a sudden rise in blood sugar. Any of these are not recommended for people with diabetes.
 

 

4.    Why do we need to avoid alcohol in diabetes?

  On the contrary, long-term consumption may lead to an increase in blood glucose levels. Finally, alcohol consumption can worsen diabetes-related medical complications, such as disturbances in fat metabolism, nerve damage, and eye disease.

 

PHYSICAL ACTIVITY

Exercise has got an insulin-like effect on blood glucose levels. It is one of the most important elements of self- care management in diabetes.


1.    Is physical activity different from exercise?

Physical activity is any movement of the body that requires energy. This includes any physical movement you perform throughout the day except sitting still or lying down.
Exercise is a planned, structured physical activity intended to provide health benefits. However, not all physical activities are considered exercise.
Research suggests that all physical activity positively contributes to health and wellness. Therefore, exercises are structured to improve strength, endurance, flexibility, body composition and cardiometabolic fitness.


2.    Why is exercise important for people with diabetes?

Regular physical activity is important in both type 1 and type 2 diabetes for overall health and wellness. Exercise can lower your blood glucose through the following ways;

1. Physical activity enhances insulin sensitivity therefore muscle cells can take available insulin to take up glucose during and after exercise.

2. During muscle contraction, cells can take up glucose and use it for energy with or without the presence of insulin.
This is how exercise can help lower blood glucose in the short term. And when you are active on a regular basis, it can also lower your HbA1c.Daily exercise, or at least not allowing more than 2 days to elapse between exercise sessions, is recommended to enhance insulin action.  

NO SMOKING OR TOBACCO USAGE

 

MENTAL HEALTH

SELF MONITOING OF BLOOD GLUCOSE LEVELS

How often should we check our blood glucose levels at home?

An instrument called a glucometer is used to check blood glucose levels at home. The frequency of glucose monitoring at home is individualized. It depends on the following conditions:
a.    All patients who wish to achieve better control of diabetes should check their blood glucose levels if any change in their daily routine.
b.    All people with diabetes on insulin
c.    Brittle diabetes
d.    Those who get recurrent episodes of hypoglycemia
e.    Whenever there is a need for tight control of blood sugar levels, particularly in conditions like pregnancy, acute illness or health complications.

MANAGEMENT OF COMPLICATIONS

 

How to treat hypoglycemia? (Rule of 15)

Depending on various factors, blood glucose sugar levels vary up or down. Low blood glucose level or hypoglycemia is when one’s blood sugar falls low enough than the normal range i.e., 70mg/dL.

From milder to most severe common symptoms are listed below:

●    Feeling shaky
●    Being nervous/anxious
●    Confusion
●    Feeling dizzy
●    Tingling/numbness in the lips, tongue or cheeks
●    Blurred vision

Treatment - The “15-15 Rule”
Eat/drink 15 grams of carbohydrate (1 table spoon of sugar or glucose) to raise blood sugar and check it after 15 minutes. If it’s still below 70 mg/dL, have another serving.
Repeat this step until blood glucose level is at least 70mg/dL.
Using this step-wise approach one can help prevent high blood glucose levels caused by eating as much as they can while in low blood glucose level.

Please note young children usually need less than 15 grams of carbohydrate to fix low blood glucose levels. Infants’ may need only 6 grams, toddlers may need 8 grams and small children may need 10 grams.
The choice of carbohydrate is very important. Complex carbohydrates or foods containing fats along with carbs (chocolates and biscuits) should be avoided as they interfere in the absorption of glucose.

How often should we visit our doctor?

Visiting a doctor helps to understand how one’s diabetes is controlled whether any complications are starting or getting worse.





Checklist of the few symptoms

1.    Are you often thirsty?
2.    Do you produce urine frequently?
3.    Are you worried about urinary smell?
4.    Do you feel numbness of your extremities?
5.    Do you have oedema in your legs?
6.    Do you have cramps in your legs?
7.    Are you insensitive to the pain of a small wound or burn?
8.    Do you feel light headed?
9.    Is your vision blurry?
10.    Do you have frequent episodes of hypoglycemia?


People with type 1 diabetes and under insulin therapy must see their doctor at least once in 3 or 4 months.
Others who manage their diabetes by eating healthy foods, living an active lifestyle and taking regular medications as prescribed should visit atleast once in 4 to 6 months.

However, if one’s having uncontrolled blood glucose level must visit doctor more often as advised by doctor.
To know more on complications of diabetes, kindly refer to Chapter 6- Complications in Diabetes.