1. What are the dietary guidelines for diabetic patients?

• Eat meals and prescribed snacks at regular times each day.
• Avoid food, high in sugar content such as honey, jellies, candy, syrup and softdrinks.
• Eat appropriate number of calories
• Read all food labels carefully and avoid foods with sucrose or glucose high on the ingredient list
• Certain fruits like papaya, small plantain, apple etc. can be taken, provided your blood sugar sugar is under control. Avoid fruits with high sugar content like mango, jack fruit, sapota etc.
• Eat cereals like rice in limited quantities and increase vegetable content of meals.
• Do not skip meals or prescribed snacks. This is particularly important in those taking insulin injection.

2. What is the importance of exercise and weight reduction in diabetes ?

Regular daily exercise plays an important part in diabetes control. Exercise helps to :

• Utilize glucose effectively, which reduces the amount of insulin needed.
• Reduce weight; weight loss can improve your diabetes.
• Regular exercise program can prevent cardiovascular complications.
• Exercise relieves stress and tension and a well-exercised body feels good. The three key aspects in any exercise program are :

FIT: i.e. Frequency, Intensity and Timing.

• Exercise should be done frequently i.e. at least 5 times a week.
• It should be intense. Exercise should be intense enough to burn sufficient calories.
• Timing: Minimum 45 minutes to one hour walking is important for getting maximum benefit.

3. What are the common misconceptions regarding insulin therapy in diabetes?

A very common misconception about insulin is that once insulin is started, it has to be taken lifelong. This is not always true. Many patients with Type 2 diabetes require insulin treatment for a short period only. The following circumstances warrant insulin treatment.

a) When the blood sugar levels are very high, the chances of tablets working are less because of a condition called glucose toxicity. In this situation, if insulin treatment is started, blood sugar levels can be brought back to normal and then patients can be switched over to tablets.

b) Insulin is required in certain special situation like prior to and during surgery, in case of any serious infections, during emergencies like heart attacks, and during pregnancy. When tablets should not be taken. After this period one can resume tablets again.

4. What is hypoglycaemia (low sugar) and how do you manage it?

If your diabetes is being treated with insulin or oral medication, you may occasionally have symptoms of hypoglycaemia, (or low blood sugar). This might occur, if you ate less than usual, or missed meals altogether. Unusual amounts of exercise can also cause the blood sugars to dip. Common symptoms of hypoglycaemia include drowsiness, headache, slurred speech, confusion, excessive sweating, hunger and pounding of the heart. If hypoglycaemia occurs at night, patient may experience difficulty in sleeping, nightmares or an early morning headache. Hypoglycaemia should be promptly recognized and treated, as otherwise the patient can go on to a stage of coma. Mild hypoglycaemia can be managed by taking coffee with sugar a chocolate or even a snack. If it is not responding to these measures, the patient should be taken to a doctor or given glucose injections through a vein. Diabetic patients should always carry a card which gives details regarding his or her disease and treatment so that hypoglycaemia can be easily recognized and treated.

5. What is home blood glucose monitoring and what is its importance?

Continued blood sugar testing, by both you and your doctor, is essential in treating diabetes. The purpose of routine testing is to see how your treatment program is working and to see whether any changes should be made or not. You can test either a drop of blood from your fingertip or use urine samples. Testing blood is more accurate and may allow better control of your sugar levels. Testing glucose levels in the blood serves as useful check on diabetes and it also keeps you motivated to control your blood sugar better. Blood sugar testing at home using a blood glucose meter has now become easier and more convenient. If you cannot afford this, the next best is to urine sugar testing either with Benedicts solution or a test strip - the latter is easier and less messy.

6. How often should you test your blood sugar?

Early in the treatment, you may have to test daily, even twice or thrice a day. Later when the blood sugar has stabilized testing weekly twice would be sufficient. Tests can be done one day in the morning, next time after lunch and the next time after dinner. Not only is testing important, but you should also keep a chart of your sugar levels, which will be useful to your doctor to adjust your medication.

7. What is Glycosylated haemoglobin (HbA1c) and what is its relevance in diabetic treatment?

Glycosylated haemoglobin is a relatively new blood test, that will give you the average blood sugar levels over the past 2-3 months. This test has become the "gold standard" in the management of diabetes. Both the doctor and the patient should strive to bring Hba1c as close to 7% which is the value termed as good control. Good control will go a long way in preventing diabetic complications.

8. What are the likely future developments in diabetes management? ?

• Glucowatch: This is a new device to test your blood sugar levels even without pricking! This is still in the trial stage and is presently quite expensive.
• Newer insulin: Newer and faster acting insulin called insulin analogues have come which provides flexibility to the patient in relation to timing the meals.
• Pancreas transplantation: Improvements in pancreas and islet transplantation provide a great hope for Type 1 diabetic patients for achieving a total cure of diabetes.
• Nasal Insulin: Newer insulin delivery devices include nasal sprays which need not be injected. This insulin treatment is in the final stages of development.
• Newer drugs: Newer oral drugs are now becoming available which will help in reducing blood sugar levels better and more efficiently than existing compounds.

9. Can diabetes be prevented?

Yes. Diabetes can be prevented from developing in a susceptible person like those with a strong family history and those who are obese. This can be achieved by diet, exercise, weight reduction and stress management.