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              Special August 2009 Issue on Dealing with Diabetes Mellitus
Published by Development, Welfare & Research Foundation (DWRF) as part of its endeavors to improve quality
of life of people as they age. Postal Address: D 104 Anand Niketan, New Delhi 110021, India. Email Fax: 26196990. Editor: Dr. Mala Kapur Shankardass, Sociologist, Gerontologist, Health
& Development Social Scientist; Managing Trustee: DWARF – LTMI. Co-Editor: Kiran Puri, Director: DWRF-LTMI.
 FROM THE EDITOR’S DESK:                  Greetings! As part of our endeavors to make a difference towards improving
 quality of life of people we are happy to bring to you this special edition of our Newsletter on ‘Dealing with Diabetes
 Mellitus’, an extremely common disease that is reaching epidemic proportions owing to major increases in the incidence
 of obesity and the propensity for a sedentary life. The need for individuals, families and communities to familiarize
 themselves in dealing with diabetes is essential and we hope that this special edition will make the task easier for the
 lay person, especially those afflicted with the disease and also as an affected carer. Diabetes mellitus belongs to the
 category of ‘lifestyle’ diseases, which are putting the afflicted individual at greater risk to ill-health and becoming an
 obstacle to a longer and more fulfilling life, unless managed and taken care of. There are many practical ways to take
 care of diabetes which can provide better control for an individual and prevent complications. We would be happy to
 receive your response to our initiative of this newsletter and suggestions for further topics to be covered that impact
 quality of life of individuals, which we also cover by organizing discussion series to raise awareness from a self care
 and management perspective and provide a platform for interactions with experts by exchange of views.
                        Seeking your support, participation and goodwill, Yours’ Truly, Mala Kapur Shankardass

  UNDERSTANDING DIABETES                 It is a condition where an excess of glucose occurs in the blood. While glucose,
a form of sugar derived by the digestive system from food, is fuel for the body, but surplus of it creates problems. Diabetes
makes it harder for the body to get energy from food. In a non-diabetic person, a hormone called insulin helps glucose
to enter the body cells. In a diabetic person absence or deficiency of insulin or defective secretion of insulin does
not allow glucose to get into the cells and this increases the level of sugar in the blood, making it high, medically called
hyperglycaemia or high blood sugar/glucose. Over time elevated levels of glucose damages an individuals blood vessels,
kidneys, eyes, nerves, heart, brain and the feet leading to various complications, such as heart attack, stroke, circulation
problems, glaucoma, cataract, retinopathy, nephropathy and hypertension. If left untreated, diabetes is believed to lead an
individual to a state of ‘metabolic chaos’.
Diabetes can be controlled and managed through medication and treatment, but it cannot be cured, it lasts lifetime.
It can have co-morbid conditions such as hypertension, hyperlipidemia, vascular disease, fatty liver disease, which require
immediate medical attention and supervision. Dealing with diabetes often requires addressing barriers to treatment,
including stress, depression, and patient motivation.
  SIGNS AND SYMPTOMS              People with diabetes experience different symptoms with varied intensity from the
following: frequent urination, always being very hungry, increased appetite, feeling tired and weak, weight loss, skin
infections, itchy skin, slow healing of wounds/cuts, numbness or tingling in feet, blurred vision, excessive thirst. Some
people show no signs and know about their diabetic condition only after routine laboratory tests and medical examinations.
  CAUSES OF DIABETES            include besides heredity, obesity, lack of exercise, mental stress, repeated infections and
diabetogenic drugs, especially from the cortisone group, steroids.
   TYPES AND AGE RELATION                  The disease has no age barriers. Type 1, insulin-dependent diabetes mellitus
(IDDM), generally afflicts individuals early in life. It is also known as juvenile diabetes and genetic as well as environmental
factors contribute to its incidence. It progresses rapidly and individuals with IDDM have the risk of slipping into diabetic
coma. Type 2, non- insulin-dependent diabetes mellitus (NIDDM), is more common and usually afflicts individuals late in
life. Hereditary and genetic factors as well as obesity and stress are strongly associated with Type 2 diabetes but the
main cause is impaired action of insulin on the tissues. Other types are: secondary diabetes, gestational diabetes mellitus
(occurring during pregnancy) and malnutrition related diabetes mellitus, but their incidence is insignificant compared to
Type 1, accounting for 3 – 7% of all diabetes cases and Type 2, which accounts for over 90% of all diabetic cases.
  TYPE 2 DIABETES MELLITUS CAN BE AVOIDED                       by eating less and exercising more. Exercise and activity
provide an effective way to manage and control blood glucose. Check blood sugar level the first time you start exercising.
If you are diabetic consult the doctor before starting any exercise regimen. Checking the sugar levels, before and after
exercise would help you to understand how workout affects your glucose levels. Exercise lowers blood sugar levels, and
improves the body’s ability to use glucose. Sticking to an exercise regimen also greatly reduces the likelihood of developing
diabetes complications and co-morbid conditions.
 BE AWARE         if you are more than 20% over a healthy weight for your height and carry more weight around the
abdomen than on the hips and thighs. If the waist-to- hip ratio is higher than 0.8 you need to be cautious about blood
sugar and consult the doctor for guidance.
  TESTING BLOOD SUGAR Diabetes is diagnosed by measuring blood glucose, a simple procedure, which may
be self administered. Ideally it involves Glucose Tolerance Test (GTT) which requires measuring fasting plasma glucose
(FPG) and two-hour plasma glucose after intake of 75 gm of glucose dissolved in water. A normal and easily done practice
however is to measure fasting blood sugar levels and 2 hour later after eating a normal meal measure post-prandial (PP)
level. A diabetic person for checking diabetes control must undergo on quarterly basis glycosylated haemoglobin
(HbA1C) test, which measures the percentage of haemoglobin in the blood that has sugar stuck to it over a period of
around 2-3 months. Diabetes is under control if the HbA1C test shows a result of below 7%. If fasting and post meal
sugar levels are within normal range for 2-3 months, then HbA1C is likely to be less than 7%. Even a 1% drop in the
HbA1C level can reduce the risk of diabetes complications by nearly 20%. For diabetics, to avoid any health
complications, it is essential to maintain fasting blood glucose level at 100 mg/dL to 110 mg/dL and post –prandial
blood glucose level below 140 mg/dL.
 MANAGEMENT OF DIABETES              For Type 1 Diabetes Mellitus, Insulin therapy must be individualized and tailored by the doctor
 according to the patient’s need. Accurate record of sugar level must be kept and healthy diet and lifestyle to keep weight under
 control is essential. The Management of Type 2 Diabetes Mellitus depends on how elevated patient’s blood sugar is at time of
 diagnosis. Regular exercise and proper diet plan are required to be formulated and suggested for 3-6 months before patient is
 given drugs or insulin therapy.
                  Good management of Diabetes requires balancing food intake, exercise and medication.
 DIET MANAGEMENT TIPS                 A good knowledge of how the foods you eat affect your blood sugar becomes necessary.
 Consult the dietician for individualized meal plan according to your needs. Space your meals throughout the day, instead of
 eating heavy meals twice a day. Your 50-60% of daily calories should come from Carbohydrates, 12-20 % from proteins, and
 less than 30% from fats. Stopping or strictly restricting sugar intake becomes very important but sugar alone does not cause
 diabetes. Just because a particular food does not contain sugar does not mean that blood sugar levels will not rise after eating
 it. It is essential to eat a balanced diet with adequate amount of fibers sourced from fruits and vegetables with peel, whole
 grain atta and cereal and beans, brown rice instead of white rice and potatoes with skin on; cereals like wheat, jowar, bajra,
 ragi; pulses and legumes like beans, soy bean, peas, rajma, bengal gram, black red and green grams, lentils; milk and low
 fat curds, nuts like almonds, pistachios and peanuts, meat products like egg, fish, chicken and other meats. There should
 be sparing use of oil, butter and ghee; and occasional intake of alcohol.
 EXERCISE & HEALTHY LIFESTYLE TIPS                     Exercise reduces triglycerides and cholesterol levels in the blood, and
 helps decrease excess fat and increases body’s cell sensitivity to insulin, and also increases body’s muscle receptivity to
 insulin. Aerobic exercise, like brisk walk, bicycling, swimming, tennis, skipping rope, or dancing is recommended for 45-60
 minutes a day. Strength Training which helps build strong bones and muscles also lowers blood glucose and enables
 effective insulin action. Losing even a relatively small amount of weight and controlling it can make a real improvement in
 reducing the risk of diabetes and other related serious conditions. Ideal body weight can be measured by calculating your
 height in cms minus 100 (eg. 170 cm - 100 = 70 kg)
                                   Dr. Anoop Misra, Director & Head, Department of Diabetes and Metabolic Diseases,
                                                        Fortis Hospitals (Vasant Kunj and NOIDA), New Delhi and NOIDA;
                    Center for Diabetes, Obesity, and Cholesterol Disorders (C-DOC) and Diabetes Foundation (India)
                                                                   Recipient of Padma Shri 2007 and BC Roy Award 2006

Large amount of glucose in the blood makes the skin and teeth a breeding ground for
bacteria and fungi. High glucose causes dehydration, making the skin dry and itchy and
also damages gums. Prevent dry skin, take extra care of teeth, drink plenty of fluids and
inspect your body regularly for any wounds and infection. Nerve damage caused by high
blood sugar levels can cause loss of sensation and feeling in the feet. For a diabetic,
chances of cataract or glaucoma double compared to a non-diabetic and retinopathy may
cause blindness. Always consult the doctor in case of any problem.
 Early detection is the key to prevention and effective control of diabetes. Sugar levels
 must be checked regularly so as not to exceed normal levels. Controlling blood
 sugar levels on a regular basis prevents complications and contributes to leading a
 normal long life. By managing diabetes an individual can enjoy life to the fullest.
This Newsletter, for private circulation only, is based on research conducted by DWRF. We
acknowledge the support extended by Dr. Anoop Misra, Dr. Namita Bhatia, Diabetes Foundation
(India) and sponsorship from Bayer Health Care (Diabetes Care) for printing the newsletter. Join us
at DWRF in our endeavors through LTMI in bringing awareness on quality of life issues of people
as they age. We welcome financial assistance for wider reach out. All donations to Development,
Welfare and Research Foundation are exempted from tax under Section 80 G of Income Tax Act
1961. Contact us, whenever you feel the need to do a good deed.

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