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Tweak your life-style
Compared to a few decades ago, there has been an exponential rise in the prevalence of diabetes amongst Indians. From about 4% of the urban population 30 years ago, almost 16% is now diabetic. The numbers are scary: over 60 million suffer from diabetes and over 75 million from pre-diabetes. Worse, diabetes- related complications are higher in India than anywhere in the world and are a prime contributor to heart and kidney disease, blindness, nerve damage and even amputation. If you or your family member has been diagnosed with diabetes, there are ways to stay on top of it. Read on to find the three- legged protection plan to combat diabetes.
Food for Thought
A complete change in your diet may not cure diabetes. But along with medicines, it is crucial to managing the condition. Choice of diet and mealtimes are significant for diabetics. The idea is to prevent blood sugar from spiking. This calls for choosing foods that are low cal and avoiding refined, high- glycaemic foods, plus opting for small, frequent meals. The first line treatment of diabetes is Medical Nutrition Therapy. Remember though that while the right diet is important, you will still need medication to manage this chronic condition. Diabetics should keep the following in mind.
Ensure a balanced intake
Eat three meals and three snacks every day. Your total intake should be approximately 1500 calories. It should primarily comprise of complex carbohydrates and fibre-rich foods such as fruits, vegetables, chapattis, brown rice, grains, etc. Make sure you avoid simple sugars as in sweets, cakes, cookies, etc. Your fat intake should be minimised and salt should be restricted as well.
Monitor body weight
Most type 2 diabetics are overweight. Hypersecretion of insulin (to match the spiking blood sugar levels) causes weight gain. Weight loss improves insulin sensitivity and glucose utilisation. Five to 10 kg weight loss should be targeted an year.
Low sugars (hypoglycaemia) are as bad, if not worse, than high blood sugars. Diet in the form of complex carbohydrates supplemented with fruits prevents hypoglycaemia, while promoting weight loss, says Dr Binayak Sinha, consultant endocrinologist, AMRI Hospitals, Kolkata.
New research opens up new vistas for diabetes management. Modern drugs and monitoring devices can help you conquer diabetes.
Modern drugs are more potent and precise in action and the last decade has seen the launch of ‘designer’ insulins that have changed the landscape. There are short-acting (lyspro, aspart, glulisine), ultrashort (buccal spray) and long-acting glargine, detemir, degludec) ones, that reduce the variability of blood sugar, weight gain and hypoglycaemia- the most undesirable side-effects of insulin.
Pure insulin (not animal-derived and fast, medium and slow-acting) provide better sugar control. Also, gone are the days of painful syringes. With modern insulin pens, delivery has become less painful and easier. Plus, pumps that deliver insulin continuously into the body (almost mimicking the pancreas) result in excellent blood sugar control.
Finally, there are smart and patch insulin pumps that sense and deliver insulin-on-demand.
Other new-age drugs
Novel incretin- based therapies have a long- term potential to reverse pancreatic cell failure and promote their regeneration. These drugs work by activating the incretin hormonal system in the human gut, stimulating insulin production and inhibiting glucagon (anti-insulin) production from the pancreas in response to food in the stomach. Starch blockers, called alphaglucosidase inhibitors (oral drugs), slow the digestion of starch in the small intestine. These are ideal for Indians who consume a lot of carbs.
Accurate, convenient and easy-to-use glucose meters have revolutionised diabetes management. They encourage a good control over diet (you can see results almost immediately!). Also tests like HbA1c (glycosylated haemoglobin) measurements gives the average blood glucose reading over the past 120 days. It helps the physician to review the treatment and gauge patient compliance with lifestyle modifications, according to Dr Shashank R. Joshi, senior consultant endocrinologist, Lilavati Hospital, Mumbai and president, Indian Association of Diabetes.
Studies indicate that overweight or obese people are at a significantly higher risk of developing diabetes. This is because extra weight induces resistance to the effects of insulin, a key hormone that metabolises glucose, while exercise helps insulin to work effectively. We give you the lowdown on managing diabetes through exercise.
How exercise helps
Physical activity increases the rate at which glucose in the blood is taken up by the muscle cells. This happens as the cellular transport vehicle for glucose (GLUT-4) increases in efficiency. This results in improved sensitivity of the cells to insulin, lowering of blood glucose, BP and cholesterol levels as well as reduction of harmful body fat and weight loss. Exercise also improves the efficiency of blood circulation and tones up blood vessels, especially in the arms and legs, that are targets of diabetes- related complications. Additionally, it improves cardiovascular fitness and reduces stress. Sustained and adequate physical activity has an overall effect on the body of diabetic patients which no drug or a combination of drugs can match. And the effect starts from day one!
How much of it is ideal
Most guidelines suggest moderate- intensity physical activity. This should elicit a moderate, noticeable increase in depth and rate of breathing, while still allowing you to talk comfortably. Those with type 2 diabetes need at least 60 minutes of physical activity daily. Try to include the following tips given by Dr Anoop Misra, chairman, Fortis Centre of Excellence for Diabetes, Obesity and Metabolic Disease, New Delhi.
- Aerobic exercise for 30 minutes. Choose from brisk walking, cycling, treadmill at a speed of 5.5- 6 kmph, swimming or games like badminton, tennis, etc.
- Fifteen minutes of walking or similar exercise incorporated through the day like walking for five minutes before lunch, short walks every couple of hours when at work is bound to help.
- Ten to fifteen minutes of resistance exercise targeting major muscle groups of the upper arms and legs with small weights. Evidence shows that supervised resistance training over a period of three months leads to a significant improvement in blood glucose values, lipid profile and decrease in abdominal fat in patients with type 2 diabetes.
- Additional physical activity (such as household chores) built in your daily schedule beyond 60 minutes a day can be helpful in maintaining a healthy blood glucose profile.
Tweak lifestyle to stay safe
Lifestyle measures have a key role to play in both controlling and preventing diabetes.”As a nation, we are becoming more and more obese and this is resulting in shooting up of type 2 diabetics,” says Dr Sinha. According to him, maintaining a healthy weight and body mass index, making sure that you take medicines at the prescribed dose and time, following your diet and exercise routine and going in for regular check-ups to rule out other diabetes-related complications are key to tackling diabetes.