Living with Diabetes

People living with diabetes often wonder: How will my life change? Will I be able to lead a healthy, fulfilling life?
Fortunately, their fears are unfounded.“Almost all diabetics can lead a normal life,” says Dr Arun Patil of Sanjeevani Hospital and Ashraya Charitable Trust. “What is required is a three-pronged, target-oriented approach. Regular medication, a controlled diet and daily exercise.”

Control the sugar
Whether Type 1 or Type 2 – diabetes is all about controlling blood sugar as diabetics cannot produce the hormone insulin (Type 1) or they produce too little insulin and/or are unable to use the Insulin produced (Type 2). Short term effects include fatigue, increased hunger and thirst, frequent urination, and even coma in some cases. Long term complications range from heart and kidney disease to eye and foot problems to high blood pressure, as the sugar damages vital organs.

Taking medication on time
As excess blood sugar is harmful, adhering to the medication schedule is important.“It is not very difficult to have good sugar control with the available drugs. Studies have shown that good control of sugars significantly reduces the rate of complications in diabetics, specially eye and kidney problems,” says Dr Vijay Panikar, consultant diabetologist, Lilavati Hospital. While Type 1 patients may need daily injections, Type 2 patients usually take oral pills.“Type 1 patients (adults) need insulin shots three-five times a day,” says Dr Anil Bhoraskar, senior diabetologist, Raheja Hospital and Asian Heart Institute.“Blood glucose also needs to be monitored frequently to decide insulin dosage,” he adds.

Eating light, regular meals
If over-eating or eating energy-dense food causes blood sugar to rise, skipping meals causes it to plummet. That’s why an empty stomach is to be avoided at all costs as it may cause hypoglycemia. If untreated, this can lead to loss of consciousness. This condition is more often seen in Type 1, not only because to the nature of the disease, but also because many Type 1 diabetics are children.“What’s required is regularity in meal timings and adherence to a nutritional plan,” says Dr Bhoraskar.

Children need close parental supervision
Being a diabetic is specially hard on children. Taking daily injections and being forced to adhere to a low-sugar diet is a tough call even for adults.“Avoiding sweets, burgers, etc., is a major hurdle for children. Counselling is required or the child could feel deprived and develop psychological problems,” points out Dr Bhoraskar.

So diabetics need to give up sweets?
Not completely. However, sugar-rich foods can be consumed in tiny quantities by those whose diabetes is under control, but that too only in-between meals. And hear this: Foods containing jaggery and honey are sugary foods.“Patients think that jaggery or honey is not ‘sugar’, but they too are sugar-dense,” says Dr Patil.
There are restrictions on certain fruits, like mango for example. Dr Patil advises no more than say, half a mango, and that too several hours before a meal. Patients usually balk at these restrictions. Restrictions, which force them to eat regular, light, low-fat meals – forever! “Patients are ready to follow anything for 10-15 days but not when they hear that they have to do it for a life-time,”rues Dr Patil.
Lack of commitment is the problem. And the price to pay is heavy.“Diabetes is a silent killer. In the early stage, patients may not have major complaints, but the disease continues to relentlessly cause damage to vital organs and systems in the body,” says Dr Panikar.

Blood glucose is not the only aspect
“Diabetes management is not just control of blood glucose. Blood pressure, lipids like cholesterol and triglycerides and low HDL cholesterol – all have to be controlled to prevent long term complications,”continues Dr Panikar. He points out that 50-80% of diabetics have hypertension and that diabetics have higher rates of heart disease. Consumption of tobacco and alcohol adds to these risks.

Exercise
Exercise lowers all risk factors, including obesity.“Regular exercise for 40 min daily or at least five times a week is needed. Abdominal obesity is often a warning sign.The waist to hip ratio is a good clinical marker to judge the insulin resistance syndrome in type 2 diabetes,” says Dr Bhoraskar.
A diabetic is always walking on a tightrope.Too much exercise can lead blood sugar to drastically drop.That too should be avoided.
However, the key to managing diabetes is to more about the condition.

Varsha Lokhande is a shining example of someone who has managed her diabetes. Diagnosed in her early forties, she reduced her weight from 63 to 54 kgs within the year. Instead of taking two heavy meals a day she switched to four light meals and now walks for 45 minutes daily. She has never skipped her medication.“Awareness is the key, as also acceptance of the disease,” she says wisely.

(Published in The Times of India, Mumbai.)

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