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HOW TO LIVE WITH DIABETES
Compiled by Dr. A. Nigam,
M.B.B.S., M.D.(Medicine),
Specialist Physician
E Mail: [email protected]
Al Hudaibah Medical Center, Ras Al Khaimah, UAE
(Published in Friday magazine of Gulf News 14 Nov 2003 issue)
Normally whenever a doctor treats any patient, his duty is limited to diagnose and treat the ailment. Diabetes
mellitus is the perhaps, the only disease where the Physician has got an added responsibility of educating the
patient as well.
1. INTRODUCTION
In Diabetics, the body does not produce enough insulin. This results in a high level of glucose in the blood due to
poor utilisation of glucose while vital organs starve for insulin and suffer slow damage.
There are two main types of diabetes mellitus:
a. Type 1, (earlier referred as insulin dependent diabetes mellitus, IDDM or sometimes juvenile-onset
Diabetes Mellitus). People with this type of Diabetes Mellitus make little or no insulin in their body, and
need regular insulin injections to manage the problem.
b. Type 2, (earlier referred as non-insulin dependent diabetes mellitus, NIDDM, or sometimes adult-onset
Diabetes Mellitus). This is the most common form of diabetes mellitus, and is strongly associated with
obesity. In this, a combination of factors play their role. Type 2 Diabetes Mellitus is a group of disorders
usually characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased
glucose production.
Sometimes Diabetes is due to drugs or other medical conditions, which is called Secondary diabetes mellitus,
Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously
diagnosed diabetes exhibit high blood glucose levels during pregnancy. Gestational diabetes affects 3-10% of
pregnancies, depending on the population studied. No specific cause has been identified, but it is believed that the
hormones produced during pregnancy reduce a woman's sensitivity to insulin, resulting in high blood sugar levels.
Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during
pregnancy. Diagnostic tests detect high levels of glucose in blood samples.
Babies born to mothers with gestational diabetes are at increased risk of complications, primarily growth
abnormalities and chemical imbalances such as low blood sugar. Gestational diabetes is a reversible condition and
women who have adequate control of glucose levels can effectively decrease the associated risks and give birth to
healthy babies.
Women with gestational diabetes are at high risk of developing type 2 diabetes mellitus after pregnancy, while
their offspring are prone to developing childhood obesity, with type 2 diabetes later in life. Most patients are
treated only with diet modification and moderate exercise but some need insulin therapy.
2. CAUSES OF DIABETES
According to some rough estimates about 2% of world’s population is Diabetic but in UAE about 25% adult
population is Diabetic and there may be many unreported cases. About 5% of patients are below 10 years of age.
Following are the factors which influence the development of disease.
The causes may vary depending upon the type of diabetes mellitus. Some of them are:
¾ Genetic - this plays a part in all types of Diabetes.
¾ Obesity, which is the most common cause of Type 2 or NIDDM
¾ Sedentary lifestyle
¾ Unhealthy dietary patterns
¾ Viral infections have been blamed as a cause of Diabetes and considerable research is taking place today
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into this aspect of disorder.
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3. SYMPTOMS OF DIABETES
The most important thing to remember is that Diabetes may be without any symptoms and sometimes may be
detected only during routine check up.
The symptoms also depend on the type of diabetes mellitus and also how long the problem has been untreated.
The signs and symptoms are also related to the blood sugar levels. These include:
Increased thirst and hunger
Frequent urination and increased amounts of urine excreted
Weight loss (only in Type 1 or IDDM) (Often with good appetite)
Fatigue
Nausea and vomiting
Blurred vision
Skin infections, especially fungal or more serious bacterial infections
Delayed healing of wounds, abscess formation & Dental infections
Urinary infections
Coma, which only happens if the diabetes is out of control
Ketoacidosis may occur in Type 1. (More about Ketoacidosis is discussed under Complications)
Some Diabetic males develop sexual dysfunction due to retrograde ejaculation.
4. MECHANISM OF DIABETES:
Diabetes is a disorder that prevents the tissue of body from utilisation of a particular type of food carbohydrate as
a result they accumulate in the blood in the form of glucose and then passed in urine. This occurs because of
insulin deficiency. Insulin is normally secreted inside our body by Pancreas and released into the blood whenever
blood sugar tries to go up (e.g. after eating any food) so sugar levels are maintained within normal range by proper
release of insulin in the blood. However in a diabetic, the failure of insulin release doesn't allow glucose to enter
the cell for energy and utilisation so the glucose increases in the blood while body cells starve for glucose. This, in
long term, slowly causes diabetic complications by damage to the various organs.
Few patients have misconception that they have sugar only in urine and not in blood or vice versa. This is due to
lack of proper understanding of mechanism of Diabetes.
Actually the normal level of glucose in blood is 60 -110 mg% and the kidneys can withstand a rise of up to 170 or
180 mg % but when blood sugar values are more man that there is spilling of sugar in urine.
Diabetic complications can affect almost every part of body especially kidneys, heart, brain, eyes and foot.
Therefore once some one is diagnosed as Diabetic, he has to suddenly learn a lot about diet, exercise and
necessary checks to avoid and delay these complications. Many of them soon become experts.
5. MANAGEMENT:
Patients must understand that with the treatment point of view Diabetics can be classified into 3 categories.
a) Patients, whose disease can be controlled with proper diet control and exercise only.
b) Patients, whose disease needs to be controlled by diet, exercise plus oral MEDICATIONS.
c) Patients, who must take insulin in addition to diet and exercise (with or without oral MEDICATIONS.)
Treatment is usually by one or a combination of the following:
i.
DIET and EXERCISE: The diabetic diet is designed to meet the nutritional requirements, to maintain
normal blood sugar levels and at the same time to help in weight reduction if you are overweight. It is
also important to eat meals at regular time intervals, especially if insulin or oral hypoglycaemics are used.
It is an important component of diabetes therapy.
Exercise utilizes blood sugar and makes the body more sensitive to insulin. Exercise must be on regular
basis otherwise will cause wide fluctuation of blood glucose.
ii.
ORAL HYPOGLYCAEMIC AGENTS OR TABLETS: There are various types of tablets available to
control Diabetes. Your doctor will decide what is best for you and also any special precautions, if any.
iii.
INSULINS: All patients do not need insulin. Your doctor will select appropriate insulin for you and will
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train you the technique of self-administration, if necessary.
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6. SOME VERY IMPORTANT GUIDELINES FOR DIABETICS.
a) Do you know that you should always carry glucose with you, if you are a Diabetic, controlled on insulin
or oral tablets esp. from Sulphonylurea group.
b) Are you in habit of carrying “DIABETIC CARD” in your pocket especially during travel. Never try to
hide from your family/boss/supervisor/colleagues that you are a diabetic. Rather you must inform them
that if you are found to be behaving in an abnormal manner or found drowsy/unconscious, they must
immediately put some glucose or sugar in your mouth and arrange immediate medical help.
c) A diabetic must avoid smoking. Smoking is injurious to health to any one but much more to a diabetic.
The risk of Heart attacks & strokes is many times more in such patients.
d) All Diabetics must avoid smoking and alcohol.
e) If you are a female of child bearing age and you wish to become pregnant, You must stop oral
antidiabetic drugs & change to Insulin injections under supervision of a physician.
f) Patient should try to learn self-monitoring of Blood Glucose by Glucometer.
g) You should not accept a change in number of your eye glasses unless your diabetes is under good control
for a 4-6 weeks period. Also achieving a good control of blood sugar in a Diabetic habitual of high blood
sugar may make him feel that has vision has deteriorated because of the change in the refractive index of
the lens inside the eye, which changes with blood glucose concentration.
h) Every 3 to 4 months get your Glycosylated Haemoglobin (HB A1c) checked. Glycosylated Haemoglobin
reflects average blood glucose value of preceding 3-4 months and is excellent test for determining overall
Diabetic Control. Value below 7% shows good control.
i) If you also suffer from high blood pressure then you must be aggressively treated for high blood pressure
as early as possible. The goal should be to maintain it below 130/80 at all times.
j) All the Diabetics must check their Lipid Profile (Total Cholestrol, Triglycerides, HDL Cholestrol & LDL
Cholestrol) regularly. Almost all the diabetics usually have high LDL and must take proper medication
for that under Physician’s guidance. Daibetics should try to maintain LDL below 78 mg%
7. HYPOGLYCAEMIA [LOW BLOOD SUGAR]
HYPOGLYCAEMIA is the most important phenomenon, which all those diabetics who are either on insulin or on
antidiabetic tablets must know. Hypo means low & glycaemia means sugar i.e. low blood glucose. Some times the
level of glucose in blood falls below normal. If the patient is alert and has been told about signs & symptoms of
hypoglycaemia, he can himself recognise it in the beginning only and treat it by taking glucose, sugar orally (even
honey, sandwich, biscuits etc. work well for mild hypoglycaemia). However if patient fails to recognise it early,
he may eventually become unconscious and then will need hospitalisation and intravenous glucose.
1) Symptoms: Patient will usually feel hungry in the beginning. This is usually followed by sweating, tremors of
hands, weakness, palpitation and headache, which are important warning symptoms. Later, patient feels
giddiness and may even become unconscious. Even at this stage an attempt should be mage to give some
sugar or glucose by mouth if patient can swallow. After the episode patient must contact his treating
physician. He will either change the dosage of antidiabetic drug or readjust meals or discuss changes in life
style. There are some other factors as well, which your physician can analyse.
2) Causes of Hypoglycaemia
a) Accidental overdose of insulin or antidiabetic tablets.
b) Forgetting to take meals at proper time.
c) Sudden unaccustomed vigorous exercise or physical activity like playing football, tennis or cycling etc.
These physical activities will cause burning of glucose because of increased energy requirement. If
patient has taken his usual amount of tablets of insulin this will become overdose because glucose has
already been burnt during exercise.
This factor is more commonly observed in diabetic children on insulin. This doesn’t mean that diabetics
should not do exercise etc. but whatever they wish to do, they must do on a regular basis so as their
doctor can control their diabetes for a particular type of life style. Also if accidentally there is occasional
need for sudden physical activity, they can undertake that but must remain alert for hypoglycaemia &
recheck that keep glucose with them at all times.
d)
All the diabetic patients must not skip their meals because some brands of insulin and most oral
antidiabetic medications remain effective for 24 hours or more. If a patient whose Diabetes is controlled
on tablets decides to skip the meal along with the tablet, the remaining effect of previous dose taken may
still cause hypoglycaemia. There should not be even long gaps between the meals. Regular breakfast,
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lunch & dinner is must for all the diabetic patients on medications or on insulin.
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WHENEVER HYPOGLYCAEMIA IS SUSPECTED PATIENT SHOULD IMMEDIATELY TAKE SOME
GLUCOSE OR SUGAR & CONTACT HIS PHYSICIAN AT FIRST OPPORTUNITY.
1) Once a patient suspects that he is having symptoms of hypoglycaemia he shouldn’t try to postpone taking
glucose. He should not fear that taking glucose may harm him.
2) All diabetic must carry a diabetic card like this (on reverse of the card patient’s contact details)
Name………………………………
Address…………………………….
……………………………………..
Tel (House/office)…………………
Mobile (friend/relative)……………
I am a DIABETIC and take
medications. If I am found behaving
strangely but I am conscious, give me
some sugar or juice slowly. If I am
unconscious, take me to a Physician or
hospital. I AM NOT INTOXICATED.
HYPERGLYCAEMIC COMA: Very high blood sugar can also make the patient unconscious or drowsy. This
must be treated only in hospital. If it is not clear that whether it is HYPOGLYCAEMIA OR
HYPERGLYCAEMIA, Patient must be given sugar or glucose orally if he can swallow while shifting him to the
hospital. No harm will be done if glucose is given to a patient with high blood glucose, But vice–versa is not true
and hence under no circumstances insulin should be given to an UNCONSCIOUS PATIENT UNLESS YOU
ARE SURE THAT BLOOD GLUCOSE IS HIGH.
TIP – To a diabetic patient who has been found unconscious, you can give sugar or glucose, but leave the decision
of insulin administration for the doctor, unless you are absolutely sure that blood glucose is very high (by testing
blood glucose).
8. COMPLICATIONS:
Most of the complications do not have any satisfactory treatment. So all the diabetics must try to prevent them or
at least delay the onset by many years through proper control of Diabetes.
Diabetes affects almost all the organs of the body. Most of the complications are slow in onset and appear after
many years depending upon quality of Diabetic control.
A. EYE - Retinopathy, a disease in the retina of the eye that can cause blindness.
B. KIDNEYS - Nephropathy, a kidney disease, that can lead to kidney failure.
C. BLOOD VESSELS - Atherosclerosis, hardening or blockage of arteries, that can lead to heart attack and
stroke. It can also cause poor circulation in the legs and feet.
D. NERVES - Peripheral neuropathy, or damage to the nerves in the limbs, which can cause numbness and
pain in the hands and feet. This, along with poor circulation, can result in serious foot and leg infections
that may require amputation.
E. SEXUAL DYSFUNCTION - The affection of nerves apart from causing problem of sensation can also
cause impotence which in many persons is psychologically disturbing. Impotence is usually a late
complication.
F. Autonomic neuropathy, which may cause problems with digestion, diarrhoea, impotence, a fast heartbeat
or tachycardia and low blood pressure.
G. SKIN INFECTIONS - Especially fungal infections such as ringworm, jock itch, and athlete’s foot. Other
bacterial infections are also common and can be life threatening.
H. Vaginal infections, as high levels of sugar encourage the growth of yeast.
I. Urinary tract infections.
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9. DIABETIC FOOT CARE:
In diabetics, an untreated cut, corn, callus, or blister can progress quickly to a skin infection that can spread deeper
into the tissues. The combination of infection and poor circulation can quickly progress to gangrene, in which
skin in the affected area begins to die. The skin first becomes cold, then turns blue, and eventually turns black and
soggy. If the infection progresses deeper into the tissues, it can penetrate the bones, leading to osteomyelitis, a
serious inflammation of the bone marrow. Both gangrene and osteomyelitis result in amputation of the affected
limb.
Prevention of foot complications
a. Feet should be washed daily with lukewarm water and kept free from infection.
b. A moisturizing lotion may be used, but should not be applied between toes because it can promote the
growth of bacteria and fungal infections. Ingrown toenails, corns, calluses, and other foot problems
should be treated promptly by a podiatrist. Self-treatment with commercial preparations is discouraged.
c. Proper-fitting shoes is another important consideration. Shoes should have cushioned soles and uppers,
and should be made of soft, breathable materials, such as canvas or leather.
d. New shoes should be broken in gradually and worn for short periods of time until they become soft
enough to avoid causing blisters.
e. Diabetics should avoid going barefoot outdoors to prevent the risk for cuts and infections.
f. They should not wear sandals, thongs, or open-toed shoes because these expose them to injury, provide
poor support, and may cause excessive friction and skin lesions.
g. Cotton and wool stockings are preferable to synthetic fabrics because they are breathable and provide
better cushioning. Garters and tight-fitting elastic-topped socks inhibit circulation and should not be
worn.
h. Diabetics should avoid crossing their legs when sitting because this reduces blood circulation in the legs
and feet.
10. HEALTHY EATING CAN HELP YOU TO CONTROL YOUR DIABETES BETTER.
Good dietary habits and adequate activities along with medications are important for good diabetes control. Good
diabetes control means keeping your blood sugar level as close to normal (non- diabetic level) as possible.
This leaflet can help you to plan your own meals until you see a dietitian in our hospital, who will give you more
information on your own diet
General guidelines
1. Avoid all kinds of sugary foods and drinks.
2. Have regular meals each day and try to eat plenty of salad before each meal. It is better to have small
and frequent meals (at least 5 meals a day). It is not advisable to have large meals with long gaps in
between meals.
3. Choose cereals and grains that are high in fiber and low in fat such as steamed brown rice, oatmeal, and
whole wheat bread more often.
4. Enjoy 2 servings of fruits each day (1 serving of fruit = 1 small orange or ½ banana)
5. Eat at least 2 servings of green leafy vegetables per day.
6. Choose lean meat, skinless poultry & fish, low fat & non- fat dairy products, less than 3- 4 eggs per
week.
7. Cut down on oils and salt in cooking.
8. Avoid alcohol intake especially if you are overweight or on sulphonylurea.
9. Keep active and enjoy daily activities such as walking, cycling and other aerobic exercises.
10. Achieve and maintain a reasonable body weight. (BMI between 19 to 25)
B.M.I. is Body Mass Index and is calculated as weight in Kilograms divided by height square in meters.
BMI = W/H2 where W= weight in Kg. H=Height in meters
Then… what can I eat ?
The key is to eat balanced meals based on unrefined and high fibre cereals. And you can also include
some free foods in your diet. Don’t forget to cut back on sugars and fats!!!
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TRY TO AVOID THESE
(A) Too Much Sugar
Sugar, glucose, jam, honey, Sweets, chocolate, ice- cream, Condensed milk, chocolate milk, Mangoes,
Grapes, Dates, Fruit pies, cakes, cookies, Soft drinks, fruit juice, Beer, sweet wines
(B) Too Much Fat
Fatty meat, salami, sausages, luncheon meat, Chips, pastries and deep fried foods
Instant noodles & cup noodles, Salad dressing, cream, non- dairy creamer, coconut cream
Oil, butter,
(C) Smoking & Alcohol
EAT IN MODERATION
Cereals: rice, brown rice, pasta, noodles preferably wholemeal bread
Fruits: 2 servings per day
Starchy vegetables: carrots, potatoes, corn
Skinless poultry, lean meat & Fish
Non fat or low fat dairy products such as skim milk, yoghurt( low fat), low fat cheese, cottage cheese
Soya beans, red beans, kidney beans & lentils
2- 3 eggs per week
FREE FOODS
All kinds of green leafy vegetables such as Spinach, Watercress, Lettuce, Broccoli, Brussel sprouts,
onions, peppers, cucumber, celery, cabbage, green beans
Clear soup, plain tea or coffee, “Diet” or sugar- free soft drinks, plain water or mineral water.
Low fat salad dressing, vinegar, herbs and spices, lemon, ginger, garlic, vinegar, pepper
Sugar free candies, low fat popcorn, agar with artificial sweetener.
11. TO TAKE GOOD CARE OF YOUR DIABETES FOR LIFE, BE SURE TO FOLLOW THESE
SEVEN PRINCIPLES:
1. Find Out What Type of Diabetes You Have.
2. Get Regular Care for Your Diabetes.
3. Learn How to Control Your Diabetes.
4. Treat High Blood Sugar.
5. Monitor Your Blood Sugar Level. (Also Glycoselated Haemoglobin – Hb A1c- 3 to 4 times a year)
6. Diagnose and Prevent Long-Term Diabetic Problems.
7. Get Checked for Diabetic Complications and Treat Them.
12. SOME USEFUL WEBSITES FOR DIABETICS.
a) http://www.recipesource.com/special-diets/diabetic/
Recipes for Diabetics (A searchable database
of over 850 delectable diabetic treats from Recipe Source (formerly SOAR). The site also welcomes new
recipe submissions for your favourite diabetic dishes.)
b) http://www.diabetic-diet-and-recipes.com: Another good website about Diabetic diet and recipes.
c) http://www.healthtalk.com/den/toc/basics : Details about Diabetes Basics: Who, what, when, why and
how. Excellent website for general diabetic education. One can also subscribe to free Diabetic Education
Network newsletter by e-mail.
d) http://www.life-with-diabetes.com : Another good website for Diabetic education. Good information
about treatment, life style and diet. Other useful links also available.
e) http://www.diabetes.org Website of American Diabetes Association.
f) http://www.childrenwithdiabetes.com : The on-line community for kids, families and adults with
diabetes.
g) http://www.diabetes.org.uk : Diabetes UK is the leading charity working for people with diabetes.
h) http://www.diabetes-self-mgmt.com : Whether you've just been diagnosed with diabetes or have had it for
years, you'll find a wealth of information in the online edition of Diabetes Self-Management to help you
live a healthier, happier life.
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