A to Z of Diabetes

[A] – A1C Test :
A1C test measures the amount of glucose that sticks to your red blood cells to know how high your blood glucose levels have been in last 2-3 months. It is also called hemoglobin A1C (HbA1C) or glycosylated hemoglobin.

• A1c test value of around 7% or less indicates that your diabetes is well controlled.
• At the time of diagnosis if HbA1c is more than 9, or at any time despite of 2 or 3 OAD’s (Oral Tablets), HbA1c is more than 8.5, insulin may be needed

Remember…..
Even a small reduction in your A1c value is vital in reducing the risk of developing any diabetes related complications
Recommended Tip…
One can check A1C twice in a year at a minimum, or more frequently as recommended by your doctor.
Please Note….
A1C tests cannot keep track of your day-to-day blood glucose levels thus it cannot replace the self monitoring of blood glucose levels by glucose meters for those who require it.

[B] – Blood Pressure :
High Blood pressure also called as ‘Hypertension’. Blood pressure is the force of blood flow inside your blood vessels. As many as 2 out of 3 adults with diabetes have high blood pressure.

1. High blood pressure is considered to be a silent problem as you will not know you have it unless your doctor checks your blood pressure.
2. Both high glucose levels and high blood pressure increases your risk of diabetes related problems like heart attack, stroke, and eye and kidney disease.
3. You will be able to lower your risk for diabetes related problems by keeping your blood pressure below 130/80 mmHg.

Remember…
Consult your doctor to find the right anti hypertensive treatment as treatment varies from person to person. You can keep a check on your blood pressure by having it checked at every doctor visit
Recommended Tip…
Some of the lifestyle changes to lower your blood pressure are eating less salt and less fat diet, avoiding alcohol, quit smoking, and being physically active.

[C] – Complications :
Chronic Complications related to diabetes develop over time due to the presence of high glucose levels present in the blood for a long time.

1. Uncontrolled diabetes can cause many serious compli-cations like heart attacks, stroke, eye problems, kidney damage, nerve damage and foot ulcers.
2. Many of the complications of diabetes usually develop silently and gradually over time, so even if people with diabetes aren’t having any signs of complications, it is better to have regular check-ups in order to have good health with diabetes.
3. Some symptoms given by the body

For Heart Disease & Stroke: Chest pain (angina) or shortness of breath, dizziness or light headache, shoulder or stomach pain, fast heartbeat.
Kidney damage: swelling (edema) in the feet and legs.
Nerve Damage: Tingling, burning, numbness, tightness, shooting or stabbing pain in the hands, feet or other parts of your body, especially at night.

Remember…..

The Sooner these complications are spotted, the more early it can be treated and prevented from getting worse.

Your doctor may ask you to see a specialist to help you with your specific complication.

Many of these complications can be prevented or minimized with a combination of regular medical checkups and proper blood glucose monitoring.

[D] – Devices :
Devices used in diabetes management includes glucometers for detecting blood glucose levels and different types of insulin delivery devices like syringes, pens and pumps.

Glucometers – They are small computerized instruments that can keep a track of your day-to-day blood glucose levels.
Ask your doctor to show you the correct way to use your glucose meter

Insulin injection syringes – They are light in weight, disposable and
have fixed micro fine needles.

Insulin pen – It is a most convenient way of administering insulin since they combine the insulin container and the syringe into a single unit. Insulin pens cause minimal pain due to the finest and shortest disposable insulin needles.

Two Types of Insulin Pens – Reusable Insulin pen are durable pens, which can be used by a person for many years and for various types of insulin. In reusable pen person with diabetes must load an insulin cartridge prior to use.
Prefilled Insulin device is ready to use, and eliminate the step of loading insulin into the delivery device.

Insulin pump – A small device attached to your belt or placed in pocket to deliver insulin infusion 24 hours/day through a catheter placed under the sin.

[E] – Eye :
Eye problems in people with uncontrolled diabetes can cause vision loss or blindness. The longer you have diabetes, the more likely you are at the risk of having eye problems.

1. Uncontrolled diabetes leads to eye problems like Diabetic retinopathy, Cataracts and Glaucoma which can cause vision loss or blindness.
2. Some of the eye problem symptoms are…. Blurry or double vision, rings, flashing lights, blank spots, Dark or floating spots and pain or pressure in one or both of your eyes

Remember….
Strict blood sugar and blood pressure control and regular medical eye care can help you to preserve your vision.

Recommended Tip…
Once a year, consult your eye doctor for an eye fundus examination even if your eyes are not bothering you Don’t worry…. If you still develop a major eye problem, there are treatments that often work well if you begin them right away.

Recommended Tip…
Once a year, consult your eye doctor for an eye fundus examination even if your eyes are not bothering you Don’t worry…. If you still develop a major eye problem, there are treatments that often work well if you begin them right away.

[F] – Feet :
Feet problems are diabetes related complications occurring because of nerve damage & poor blood flow due to uncontrolled diabetes.

1. In diabetes, even ordinary feet problems can get very serious finally leading to foot or leg amputation but most of them can be prevented by simple foot care.
2. Some common feet problems are… Loss of feeling in your feet, foot injuries, changes in the shape of your feet and formation of calluses.

Remember…
Look at your feet every day to check for cuts, bruises, swelling, cracks, sores, blisters, redness and skin that seem hot or cold .If it is difficult to see, use a mirror or ask a family member to check for you. Make sure your doctor checks your feet at each checkup.

Recommended Tip…

1. Wash your feet every day with mild soap and warm water, Dry your feet well especially between your toes, Always wear socks and well fitting shoes (neither tight nor loose) to avoid blisters and injury.
2. Cut your toenails once a week never cut corns and calluses. Never walk barefoot, Wear shoes that fit well. Gestational Diabetes is one of the common health complications in pregnant women. If not treated, it can increase the risk of health problems to the mother and fetus.

[G] – Gestational Diabetes :

1. Pregnant women who never had diabetes before but who have high blood glucose levels during pregnancy are said to have gestational diabetes. Women with gestational diabetes may not notice any symptoms so it is important to meet your doctors regularly and follow their advice.
2. Don’t worry… Most women with gestational diabetes have healthy pregnancies and healthy babies by following the treatment plan set up by their doctor and/or dietician.
3. Women with gestational diabetes, whose sugar levels are well controlled, often carry their baby to term without any problems. It needs a planned meal and scheduled physical activity. Regular glucose testing and insulin injections maybe required.
4. You may need to take insulin if modifying your diet as advised by doctors and getting regular exercise does not keep your blood sugar in the target range. Insulin can help you to control your blood sugar. Remember, keeping sugar levels in target range is the best way to prevent problems from gestational diabetes, such as a baby who grows too large or a baby who is born with low blood sugar.

Recommended Tip…
Keeping daily records of your blood sugar numbers, physical activities, and everything you eat and drink can help your doctor to track how well your treatment plan is working.

[H] – Hypoglycemia

Hypoglycemia occurs when blood glucose drops below normal levels. This can happen even when you’re doing all that you can to manage your diabetes.

1. Mismatches of the timing of diabetes medicine to a person’s daily schedule of meals and activities could result in hypoglycemia.
2. Symptoms of hypogly-cemia vary from person to person. Its major symptoms are shakiness, dizziness, sweating, hunger, headache, sudden mood changes and tingling sensations.

Remember…
Always have something with you to treat low blood glucose such as 1\2.

[I] – Insulin :

Insulin is a natural hormone our body creates and needs. Insulin is secreted from pancreas and it functions like a key, unlocking the cells and enabling glucose to enter the cells.” You need insulin 1) To help your body cope with high blood glucose after meals 2) To control your blood glucose between meals

1. Many people with diabetes are prescribed insulin, either because their bodies do not produce insulin (type 1 diabetes) or do not use insulin properly (type 2 diabetes).
2. Insulin cannot yet be given in tablet form as the stomach digests it. Thus, it must be injected under your skin for it to get into your blood.
3. Main types of Insulin are…
   • Rapid-acting insulins can be injected up to 15 minutes before you eat, during your meal, or after your meal.
   • Short-acting insulins are usually taken 30-45 minutes before a meal.
   • Medium and long-acting insulin effect lasts for several hours and also keeps blood glucose under control between meals.
   • Pre mixed insulin contain both short or rapid and long acting insulin.

Remember…

If you have type 2 diabetes and your HbA1c is increasing despite your best efforts, insulin may be the next step in treating your diabetes. Your insulin dose will change throughout your life, depending on what you eat, illness, work etc. Your doctor will help you find the right type of insulin based on for your health needs and your lifestyle.

[J] – Juvenile diabetes :
Juvenile diabetes or type 1 diabetes usually happens in children and young adults. Usually patients are young and lean. It is an autoimmune disease in which the body destroys insulin-producing beta cells in the pancreas.
Without insulin, the body starves to death. Symptoms of type 1 diabetes occur mostly when more than 90% of cells have been destroyed. It is a lifelong condition that is treated with insulin. If not treated properly, it can cause serious diabetes complications like vision problems, kidney & nerve damage.

Remember…
Type 1 diabetes can also develop at any age and its cause remains unknown. It’s certainly not caused by eating sweets or too much sugar

Major symptoms are….
Feeling very hungry, thirsty and tired, having blurred eyesight, tingling in the feet, losing weight without trying and urinating often

Remember….
If you have type 1 diabetes, you will have to take insulin every day. Take your insulin doses exactly as prescribed and don’t stop taking insulin

Recommended Tips :
Carry glucose tablets for hypoglycemia sometimes caused due to too much insulin intake. Attend regular checkups as recommended by your doctor to prevent diabetes related complications.

[K] – Kidney :

Kidney disease is due to uncontrolled diabetes which damages the tiny blood vessels of your kidneys. About 1 in 3 peoples with diabetes suffer from it.

1. Not all people with diabetes suffer from kidney disease. Its major risk factors are family genes, high blood glucose levels and high blood pressure.
2. Kidney disease slowly develops over many years. Its symptoms include fluid buildup, loss of sleep, poor appetite, weakness, and difficulty concentrating.

Remember…
To lower the chances of kidney disease, people with diabetes should keep tight control on their glucose levels and high blood pressure. Everyone with diabetes should have at least an annual checkup, which should include a urine test for proteins called ‘Microalbumi-nuria test’.

Recommended Tips:
Consume less salt. Consult your doctor whether you need to be on any special kidney friendly diet. If advised by your doctor, make sure to visit a Nephrologist.

[L] – Lipid Profile :

Lipid profile is vital to be checked as people with diabetes are more prone to having unhealthy cholesterol, which increases the risk for heart disease.

1. They are blood tests to measure lipid levels i.e. total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides.
2. ‘Bad’ cholesterol or LDL-C tends to form plaques in arteries, and ‘Good’ cholesterol or HDL-C helps to clear out dangerous plaques before they break off to cause a heart attack or stroke

Remember…

• Optimal ‘Bad’ cholesterol or LDL-C should be below 100 mg/dl and less than 70 mg/dl in people with heart disease
• Optimal ‘Good’ cholesterol or HDL-C should be above 40 mg/dl (above 50 mg/dl for women).
• Talk to your doctor about how often you should have your lipid profile checked and what should be your target range to maintain a healthy lipid profile

Recommendation Tips :

• Exercise regularly to maintain a healthy weight,
• Eat a low-fat, low-cholesterol diet with plenty of fresh vegetables, whole grains, and fruits

[M] Meal Planning :

Meal Planning encourages balanced eating by guiding you how much and what kinds of food you can choose to eat at meals and snacks time.

1. A diet appropriate for people with diabetes is same as a good, healthy eating routine that is applicable for any person. People with diabetes can eat most of the foods which are healthy, but one might have to change the quantity, frequency and duration of eating. Right meal planning can help in controlling your blood glucose levels, maintaining a healthy weight and preventing diabetes related complications’
2. Fiber can keep your blood glucose from going high after a meal because it slows down the speed at which the food is digested. Eat foods made of whole grain products instead of refined such as whole wheat flour instead of Maida, Brown rice instead of white
3. Eat 6 small meals instead of three big meals.. It’s important to be aware of the carbohydrates in foods, so you can learn to balance carbohydrate intake, activity levels, and medication to achieve the best possible control of your diabetes. Try to eat at the same time each day, don’t skip meals, don’t overeat, eat right amounts of food slowly and drink water or sugar-free drinks
4. Choose food prepared with little added fat, oil, salt, or sugar rice. Eat plenty of vegetables and fruit- at least 5 servings a day. Add greens, sprouts or crushed vegetables in your parathas, puri, idli or dosa. Your doctor and/or dietitian can help you create a personalized meal plan’
5. You can include servings of fish, lean meats, low-fat cheeses or eggs, whole grain pulses. Have a glass of milk and a piece of fruit or a ½ cup fruit salad to complete your meal

[N] – Nerve Damage :

Nerve damage due to diabetes is called as diabetic neuropathy. Uncontrolled diabetes for a long time can slowly damage your nerves throughout the body.

1. About half of all people with diabetes suffer from some form of nerve damage i.e. Peripheral, Autonomic”, Proximal and Focal neuropathy.
2. Some people with nerve damage have no symptoms, but for others, the first sign is often tingling, numbness, or pain in the feet.

Remember…

• Good diabetes control and regular medical care can prevent, minimize or delay this nerve damage.

Recommended Tips :

• Stay active to improve your blood flow to your legs and feet
• Consult doctor if you have any problems in your hands, feet, legs, stomach and bladder.
• Don’t worry….

[O] – Oral Hygiene :

If you still develop some nerve damage, there are treatments for neuropathy that often work well if you begin them right away

Oral hygiene is essential for people with diabetes because they face a higher risk of oral health problems due to poorly controlled blood sugars.

1. Oral health problems can also cause blood sugar to rise and make diabetes harder to control
2. In diabetes, there is a higher risk of oral problems i.e. dry mouth, gum inflammation, poor healing of oral tissues, oral thrush and burning mouth

Remember…    

Managing your diabetes well and taking good care of your teeth and gums can help prevent oral problems

Recommendation Tips :

Have your teeth and gums cleaned and checked by your dentist twice a year, Use dental floss at least once a day, Brush your teeth after every meal.

Use a soft-bristled toothbrush, If you use dentures then clean them daily and quit smoking

[P] – Pancreas :

Pancreas is made up of special cells, called beta cells which secretes insulin and regulates the amount of glucose in the blood.

1. Failure of the pancreas to produce or secrete insulin in sufficient quanti­ties results in diabetes mellitus
2. In type 1 diabetes as the beta cells are destroyed, the pancreas produces little or no insulin.

Without enough insulin, glucose builds up in the bloodstream.

Remember…

People with type 1 diabetes need insulin injections to use glucose from meals.

• In type 2 diabetes, the body is unable to use the insulin produced by the pancreas due to which high levels of glucose gets build up in the blood

[Q] – Quit Smoking :

Remember….

People with type 2 diabetes need diabetes medication or insulin injections or combination of both to help their bodies use glucose for energy.

Quit Smoking to have a better control on your diabetes as blood glucose levels rises up due to smoking. Smoking and diabetes together greatly increases the risk of diabetes related problems.

1. People with diabetes who smoke are three times at a higher risk to die of heart attack and stroke than people with diabetes who do not smoke
2. Blood pressure and blood cholesterol levels rises when a person suffering from diabetes smokes
3. Smoking increases your risk of diabetes related complications like serious eye problems, kidney problems, and nerve problems
4. Smoking damages the blood vessels of the diabetic people which makes harder for their body to heal. So, the risk of getting infected also increases.

When you quit smoking, you have….

Less chances of heart attacks, stroke and other diabetes related problems, Positive effects on your blood pressure, blood glucose and cholesterol levels

[R] – Regular Exercise :

Regular exercise and being physically active will help you feel better and help you avoid many health problems.

1. Regular exercise not only helps in better blood sugar control but also preventing and controlling hypertension, heart diseases, obesity and many others diseases.
2. Try to be active almost every day. Try to get about 30 minutes of exercise a day, at least 5 times a week.

Choose any physical activity that you enjoy the most like dancing, walking, gardening etc.

Remember…

• Consult your doctor before starting any exercise and about how much should you eat before you exercise.
• Begin with a few minutes of activity each day. Add a few extra minutes as you get stronger.
• During exercise, if you feel pain, slowdown or stop until the pain goes away.
• If you have high blood pressure or eye problems, some exercises like weight-lifting may not be safe.

Recommended Tip :

When you exercise, carry glucose tablets or a carbohydrate snack with you in case your blood glucose levels get low.

[S] – SMBG :

SMBG or Self-Monitoring of Blood Glucose play a vital role in managing your diabetes by keeping a regular check on your blood sugar daily.

1. This involves obtaining a small drop of blood from your finger and the use of a glucose meter which tells your blood glucose levels at the moment it is being checked.
2. Regular monitoring is important because blood glucose levels always keeps on changing at daytime and at nighttime.

Remember…

Regular checking helps your doctor know how your daily activity, diet meal plan and medicine are affecting your blood glucose levels.

Recommended Tips :

• Check your blood glucose 2-4 times a day. You may also check it at 1 -2 hours after meals and before and after exercise.
• You should keep a record of your blood glucose in your diary. If you notice your blood sugar is too high or too low, consult your doctor immediately

[T] – Treatment :

Treatment varies from person to person as your doctor prescribes you treatment depending on your blood glucose levels, age, height, weight, and other associa­ted health complaints. Each type of treatment helps lower blood sugar in a unique way.

1. Diabetes treatment aims to maintain glucose levels in normal range i.e. FBG levels between 70-110mg/dl and post prandial glucose <140mg/dl
   Ideally HbA1c should be less than 7. If it goes above 7.5, it indicates the need of change in your treatment plan.
2. For Type 1 diabetes, one needs to be treated with insulin injections every day.
   Your doctor will help you find the right type of insulin depending on your glucose levels.
3. Type 2 diabetes treatment is based on increasing availability of insulin in body. As there is a continuous destruction of the insulin-producing beta cells over time, it leads to the addition of oral anti-diabetic medicines in every few years. Eventually people with type 2 diabetes also require insulin.

Remember…

Depending on your blood glucose levels, your doctor may prescribe you a combination of anti-diabetic oral medicines, or oral medicine plus insulin.

[U] – Understanding Diabetes :

Be sure to take prescribed medications exactly as instructed by your doctor.

Do not stop taking your diabetes medicines on your own and without checking with your doctor first.

Understanding diabetes can help you get a clear picture to confront and manage your diabetes and lead the sort of life you want to live.

1. Understanding Diabetes is Vital as…
   • Although your doctor will guide you, the ultimate power to manage and control your diabetes is in your own hands.
   • Although diabetes is a common disease, yet every individual needs unique diabetes care and treatment.
2. Living with diabetes is not easy…
   • To manage it properly, you should try to know your diabetes well so that you achieve your treatment goals successfully.

Remember…

• Understanding as much as you can about your diabetes will help you take a healthy approach towards your diabetes self-management.
• More you learn about your diabetes the better you know how to take care of it and how to prevent some of the serious diabetes related problems.

[V] – Vascular Complications :

Vascular complications occur due to uncontrolled diabetes over a long period of time and usually involve blood vessels.

1. Vascular complications involve damage to both small and large blood vessels leading to “Micro vascular” and “Macro vascular” complications respectively.
2. Micro vascular compli-cations affect small blood vessels, creating problems with the eyes (retinopathy), nerves (neuropathy), and kidneys (nephropathy).
3. In Macro vascular compli-cations large blood vessels supplying blood to the heart, brain and limbs (more commonly legs) can get damaged leading to heart attack, stroke or peripheral arterial disease respectively.

Remember…

Sometimes people with diabetes suffer a silent heart attack without the classic symptoms of chest pain and difficulty breathing. Thus, people with diabetes should have regular medical checkups.

Effective blood glucose control should be undoubtedly the first step, but as vascular complications affects your whole body. Thus, controlling your lipid levels and blood pressure can further help to decrease its risk.

[W] – Weight :

Reaching and maintaining a healthy weight is essential for a better control on your blood glucose levels and also on your other diabetes related problems.

1. Your healthy weight range is based on a measurement known as the body mass index (BMI).
   BMI can be determined by using your weight and height of a person
2. Your BMI is an indicator of your appropriate weight based on your height and is a more reliable indicator of body fat than just your weight alone.

Remember…

• Sometimes, people with type 1 diabetes tend to be thin with little body fat at the time of diagnosis.
• And, mostly people with type 2 diabetes may be overweight.
• Achieving a healthy weight as per your BMI may seem difficult at first but it is well worth the effort.
• Managing a healthy weight is the most effective treatment for Type 2 diabetes if you are overweight.
• To aid in weight loss, role of high fiber, low calorie diet and regular exercise is vital. Consult your doctor if you have any concern regarding your weight.

[X] – Xpert Advice :

Xpert advice comprises of proper counseling and specialized medical support at each stage for you to know how to deal with your diabetes effectively.

1. Diabetes Expert Team may include… Diabetologist / endocrinologist, Diabetes Educator, Dietician, Ophthalmologist (for eye care), Nephrologist (for kidney care), Neurologist (for nerve care). Dentist (for dental care) and Podiatrist (for foot care).
2. Don’t hesitate to consult your expert/doctor whenever you have any queries related to diabetes treatment and care from head to toe.
3. Your doctor can help adjust your medicines as per your blood sugar levels, thus you should always notify your doctor if any of your symptoms change.
4. Your doctor should be kept informed of any changes in your diet, exercise, or medicines and of any new illnesses that you may have developed.

Always Remember…

Doctors are always there to help & guide you in making your diabetes care & treatment plan successful.

Yearly checkup is an essential step for managing your diabetes well. This also helps to keep a check to prevent or delay any further diabetes related problems.

[Y] – Yearly Checkup :

1. A1C Tests (At least two times a year)
   Your A1C test will tell you what your average blood glucose levels were for the past 2 to 3 months.
2. Blood Lipid Tests (At least once a year).
   Your blood test results will help your doctor plan how to prevent a heart attack and stroke.
3. Kidney function tests (Every year).
   Your urine tests like ‘Microal buminuria test’ and your blood tests like serum creatnine are recommended to detect the earliest evidence of kidney disease
4. Eye Fundus exam & Foot exam (Once a year).
   See an eye care professional for a complete eye exam.
   Opt for a complete foot exam to make sure that your foot nerves and your blood circulation are ok.
5. Dental exam (Twice a year).
   See your dentist twice a year for a cleaning and complete dental checkup.

[Z] – Zzz Sleep :

Sleep problems and diabetes often go hand in hand.56 In people with diabetes, poor sleep can make control over your blood glucose levels more difficult.”

1. Poor sleep can affect your blood sugar levels and your high blood sugar levels can also affect your sleep, which can also cause in sleeping problems.
2. Lack of sleep for a long time causes an increase in the levels of stress hormone i.e. Cortisol which can promote insulin resistance.
3. Consult your doctor if you….
   Have difficulty falling or staying asleep, Feel excessively sleepy during daytime, if you snore in your sleep, Feel restless during your sleep

Remember….

• Getting a good 7-8 hour s of sleep can have a positive impact on your blood glucose control.
• Recommendation Tips for a Good Night Sleep :
• Keep regular bedtime and waking hours,
• Try relaxation techniques such as taking a hot bath Restrict alcohol and caffeine before bed time