To make our patient feel that they are not alone in this battle against diabetes, to empower them regarding Self-care and Management; and make them partners (active participants) in their own treatment with a motto ..."Let us Control Diabetes Together"

Living with Diabetes

Diabetes is a silent killer and a life long disease. It is associated with disabling & life threatening complications. After diagnosis of diabetes, the patient passes through a stage of denial, depression and frustration. At this stage psychological counseling regarding the disease is required esp. its life-long duration, non-curable nature, complications and treatment options. You have to be mentally prepared to take precautions and treatment for whole of your life and live comfortably with the disease. Always take help from your family, friends and doctor. You are not alone there are many others like you who have diabetes and are living a comfortable life. There is nothing to get panicky as with the help of healthy diet, regular exercise and latest medications every diabetic can lead a long, happy and healthy life.

"Awareness" is the only cure for Diabetes”

I suggest you to take small steps at one time and set small goals. You need to have a Strong Will Power, Motivation & Determination to achieve success. The following steps would definitely help you in wining the battle against diabetes and would help you in keeping your health better:

• Prevention of Diabetes: Diabetes prevention is as simple and basic as healthy eating, becoming physically active and losing a few extra pounds - and remember it's never too late to start. Get your blood glucose checked if you are >45 years of age or any age if you are overweight and have one or more additional risk factors for type 2 diabetes e.g. sedentary lifestyle or a family history of diabetes. Always remember that “Prevention is the Best Cure”.
• Positive Attitude: The most important step is to have a positive attitude and persistence of efforts to succeed over diabetes. Remember that leading a healthy life is in your own hands. Always believe in your self and put your sincere efforts in achieving your goal. Do not listen to or follow any advice from non-professionals e.g. giving up certain foods, using medicines etc. You should make your own decisions.
• Commitment: Stay Committed to your diabetes management. Monitor your blood glucose regularly. Always take your medication as advised by your doctor. Be an equal and active partner (along with doctor) in your own treatment.
• Healthy Diet: Always eat healthy, small & frequent (3 major with 2 small snacks in between) meals. Eat a Low Glycemic Index (Complex Carbohydrates) and High fiber diet i.e. whole grains, vegetables, beans etc. You should eat one fruit (approx. 200-250 gms) a day. Avoid Mango, Cheekoo, Banana and Grapes. Don't go for "fad" (Low Carb & Very Low Calorie) diets, instead go for long term 'healthy-eating plan'. Choose right kind of foods. Make simple & small changes in your eating behaviour, and follow them strictly e.g. remove fried food, cold drinks, cookies etc. from your side table or refrigerator.
• Regular Exercise: Always do regular exercise (at least 5 days/week) as per your need and fitness (cardiovascular) and strictly adhere to it. Adopt an active lifestyle. Exercise helps in controlling blood glucose, blood pressure and lipids. Research shows that both 'Aerobic Exercise' and 'Resistance Training' can help control Diabetes, but the Greatest Benefit comes from a 'Fitness Program" that includes both.
• Loose weight: Set Realistic Goals i.e. a loss of 5-10% in initial weight over 6 months. It has been proved by a number of studies that this much weight loss is both healthy as well as medically beneficial. You must reduce your calorie (food) intake by 500cals/day and also increase your physical activity. Current scientific opinion is that one should loose weight gradually and steadily i.e. 1-2 kg every month. You should lose weight only if you are overweight. Always keep your BMI < 25.
• Comprehensive Medical Check-up : It should be done at least once in a year and includes Complete medical examination, Complete blood count, Urine for R/M and Micro-albumin, KFT, LFT, Lipid profile, Chest X-ray, ECG and Eye (Fundus) examination. HbA1c should be performed every 3-6 months. Early Detection and Effective Treatment can prevent life-threatening Complications of Diabetes.
• Blood pressure and Lipid (Cholestrol) Control: Controlling your and BP (<140/80 mm of Hg) is as important as controlling Blood Glucose levels.
• Sickness: Do not stop taking your anti-diabetic medications during sickness. Always consult your doctor to get dose of your medications modified.
• Foot Care: Examine your feet daily for any cuts, blisters, sores or change of skin colour. Diabetic foot is the leading cause of non-traumatic amputations. Control risk factors for diabetic foot i.e. neuropathy, foot deformity, poorly controlled diabetes and cigarette smoking. Always use comfortable footwear that cover your feet. Never walk barefoot even indoors.
• Drink Responsibly: 45-60 ml per sitting, three times/week. Never drink empty stomach, as it can cause severe hypoglycemia.
• Quit Smoking: Smoking increases the risk for Neuropathy, Heart attack and Gangrene. No matter how long you've smoked, your health will improve after you quit.
• Handle Stress: Face it! Fight it! And Finish it! Learn relaxation techniques and coping skills to help you work through stressful period. Take sufficient rest and sleep, it helps to maintain the hormone level in your body. This can also be done with the help of yoga and meditation.
• Be prepared for emergencies: Becoming unconscious because of hypoglycemia is dangerous and can be fatal. Make preparations for your care ahead of time. Store glucose nearby and always carry sugar candies with you. Your friends /family members should know how to administer glucagon if needed.
• Always Keep a "Diabetes ID Card" with you which should have your complete diagnosis, list and dosages of various medications you are taking, any allergies you have and contact numbers of you doctor and relatives. It can give very important information during an emergency situation to save your life.

TAKE CHARGE NOW … for a BETTER TOMORROW !

As your age and the duration of diabetes increases, you may develop decreased sensation (Neuropathy) and decreased blood circulation (Peripheral Artery Disease) in the feet and are at an increased risk of developing foot infections, especially if you have poorly controlled diabetes. Foot ulcers and amputation are a major cause of morbidity & disability in diabetic patients, and carry an enormous physical & emotional cost. Early recognition & management of risk factors can prevent or at least delay the onset of these adverse complications by 80%. Amputation is one of the most important & avoidable long-term complications of diabetes. All diabetic patients are at high risk of developing foot problems esp. ulcers, infection and gangrene. Even a minor problem can have serious consequences if proper care is not taken. Every diabetic has come degree of foot problems like: Pain, Numbness, Cracked Feet, Calluses, Burning Feet Syndrome, Chronic Infection and Non-healing Ulcer.

The causes of diabetic foot are as follows:

• Decreased Blood Circulation (Ischemia)
• Decreased Sensation (Neuropathy)
• Infection

"Early Detection and Prompt Treatment can SAVE Your Feet"

"Take care of your feet as much as you care for your Face"

Thyroid disease is common in the general population (6.6%), and the prevalence increases with age. Screening for thyroid dysfunction is indicated in certain high-risk groups, such as neonates, elderly and diabetics (36%). It is more common in Type1 diabetics as compared to Type2. T1DM is an autoimmune disorder and is thus frequently associated with other autoimmune disorders including autoimmune thyroid disorders (e.g. Hashimoto’s thyroiditis, which leads to hypothyroidism) or sometimes become overactive (e.g. Graves’ disease, which leads to hyperthyroidism). Both Hashimoto’s and Graves’ will have positive blood tests for thyroid antibodies.

Hypothyroidism is far more common than hyperthyroidism, and can occur in both T2DM and T1DM. The symptoms develop slowly and include fatigue, dry/coarse skin & hair, cold intolerance, weight gain, hoarse voice and heavy or irregular menstrual periods. Blood levels of thyroid hormones (Free T3, Free T4) are low and levels of TSH are typically high. Blood glucose control is generally not changed, but blood cholesterol is high. Thyroid failure secondary to radioactive iodine therapy or thyroid surgery is also common. Rarely, pituitary or hypothalamic disorders can result in secondary hypothyroidism. Hormone replacement treatment in the form of L-Thyroxine (Eltroxin, Thyrox or Thyronorm) is the most recommended treatment.

Hyperthyroidism is much less common, with a female-to-male ratio of 9:1. Graves' disease is the most common cause and affects primarily young adults. Toxic multi-nodular goiters tend to affect the older age-groups. Symptoms of Hyperthyroidism develop over a short period of time. Symptoms include palpitations, tremors, insomnia, anxiety/ agitation, sweating, heat intolerance, weight loss, hair loss, and scant or absent menses. In older patients (>70 years of age), the typical symptoms may be absent. Blood levels of thyroid hormone are elevated and levels of TSH are depressed. The blood glucose levels also become high. In patients with Graves’ disease, the thyroid gland may become enlarged ("goiter"). There may be swelling of the muscles and tissues around the eyes, causing the eyes to bulge forward (“exophthalmos”).

“Thyroid disorder is quite common in diabetics, hence regular screening is essential”

Obesity is no more a sign a good health or prosperity. It is a chronic and a serious disease, which requires lifelong treatment like diabetes. It results from an interaction between ones genes and environment. It is on the rise worldwide and more so in India due to westernization or modernization. WHO considers obesity to be a global epidemic? As per WHO, there are nearly 300 million obese people all over the world, and many more are overweight. Obesity is the mother of all diseases and shortens your life. It is major risk factor for a number of medical diseases e.g. diabetes, hypertension, coronary artery disease, dyslipidemia, osteoporosis, arthritis, cholecystitis, and psychosocial problems. We have to manage obesity early and more aggressively. Loosing weight is one aspect; the more challenging part is maintaining the reduced weight. “Quick-Fix-Diets” and “Yo-Yo” dieting have only a short term effect on weight loss. We should always go for long-term and a more realistic weight management program. Obesity is central in causation of diabetes and is a major modifiable risk factor. Obesity has a negative impact on all the parameters of diabetes and a modest weight loss should be an important goal in the management of diabetes. Obesity should be treated as aggressively as diabetes, hypertension and dyslipidemia. As Indians have higher fat content and central obesity for same weight and BMI as compared to Caucasians, thus intervention for weight management should start at an early stage.

Diagnosis of Obesity for Indians (Indian Consensus Conference at Delhi, 2008):

BMI:  <=23 is Normal

          23-25 is Overweight

          >= 25 is Obesity

Class 1 (moderate to severe) obesity if BMI 25-30

Class 2 (morbid obesity) if BMI >30

Central Obesity: Waist circumference should be >80 cm for women and >90 cm for men

"Shorter the Waist Line, Longer the Life Line"

"LOOSE WEIGHT & GAIN LIFE"