special edition of idej aims to raise awareness of the ...you can contribute your articles, opinion,...

*DSME: Diabetes Self-Management Education, DSMS: Diabetes Self-Management Suppor t*DSME: Diabetes Self-Management Education, DSMS: Diabetes Self-Management Suppor t

To keep the members ofdiabetes care team abreast with

DSME and DSMS concepts

st 1 time in India

You can contribute your articles, opinion, cases, recipes, experiences or write to us to if you want to subscribe to soft copy of IDEJ every month by sending an e-mail to:

[email protected] or [email protected] or [email protected]

Disclaimer: This Journal provides news, opinions, information and tips for effective counselling of people with diabetes. This Journal intends to empower your clinic

support staffs for basic counselling of people with diabetes. This journal has been made in good faith with the literature available on this subject. The views and

opinions expressed in this journal of selected sections are solely those of the original contributors. Every effort is

made to ensure the accuracy of information but Hansa Medcell or USV Private Limited will not be held responsible for any inadvertent

error(s). Professional are requested to use and apply their own professional judgement, experience and training and should not

rely solely on the information contained in this publication before prescribing any diet, exercise and medication.

Hansa Medcell or USV Private Limited assumes no responsibility or liability for personal or the injury,

loss or damage that may result from suggestions or information in this book.

USV as your reliable healthcare partner believes in supporting your endeavour to make India a Diabetes Care

Capital of the World.

Indian Diabetes Educator Journal (IDEJ) is a first-of-its-kind initiative in India developed to strengthen the concepts

of Diabetes Self-Management Education (DSME) and Diabetes Self-Management Support (DSMS) among the

members of diabetes care team, especially the diabetes educators (DEs).

IDEJ content is developed based on seven self-care behaviours of American Association of Diabetes Educators

(AADE) i.e., healthy eating, being active, monitoring, taking medication, problem-solving, healthy coping and

reducing risks.

thWorld Diabetes Day (WDD) is celebrated on 14 November, and this year, the theme is family and diabetes. This

special edition of IDEJ aims to raise awareness of the impact that diabetes has on the family, support the network of

those affected, and promote the role of the family in the management, care, prevention and education of diabetes.

Family support in diabetes care has been shown to have a substantial effect on improving health outcomes for

people with diabetes. It is therefore important to point out that families have a key role to play in addressing the

modifiable risk factors for type 2 diabetes mellitus (T2DM), and must be provided with the education, resources and

environments to live a healthy lifestyle.

We sincerely thank our contributors for making this issue delightful reading for our readers.

We dedicate this journal to all the healthcare professionals who are working relentlessly towards making “India a

Diabetes Care Capital of the World”.

Sincere Regards,

Expert Contributors of the MonthExpert Contributors of the Month

Dr. Vinod Mittal

MD (Medicine), FICP, FCAM, FCCP, FGSI, FIAMS, FACP

Sr. Consultant Diabetologist, Delhi Heart and Lung Institute, Delhi.

Dr. Ksh. Achouba Singh

MD (Medicine), DM (Endocrinology)

Associate Professor, Dept. of Endocrinology, JNIMS, Manipur.

Dr. Varun Chandra Alur

MD (Gen. Medicine), DM (Endocrinology)

Consultant Endocrinologist, Alur Superspeciality Center, Davangere, Karnataka.

Dr. Ajitesh Roy


Consultant Endocrinologist, Ruby General Hospital, Kolkata, West Bengal.

Dr. Rakesh Kumar Sahay

MD (Internal Medicine), DM (Endocrinology), DNB (General Medicine)

Consultant Endocrinologist, Mediciti Hospitals, Hyderabad, Telangana.

Dr. Phatak Sanjeev Ratnakar

MD (Medicine)

Consulting Diabetologist, Vijayratna Diabetes Diagnosis and Treatment Centre, Ahmedabad, Gujarat.

Dr. Shameer C. Sulaiman

MD (Physician), PGD (Diabetology)

Consultant Diabetologist and Foot Care Specialist, South Zone Hospitals and Research Centre Pvt. Ltd., Thrissur, Kerala.

Dr. Chandratreya Sujit Arun

MD (Medicine), DM and DNB (Endocrinology)

Consultant Diabetologist and Endocrinologist, Nasik, Maharashtra.

Dr. Anjana Bhan

MBBS

Senior Consultant (Endocrinology),Max Hospital, Delhi.

Dr. Sahil N. Fulara

MD, RCP (Endocrinology), D. Diab, FACE

Consultant Endocrinologist, Fulara Medicheck Centre, Mumbai, Maharashtra.

Dr. Shashank Gupta

MD (Medicine)

Former Director, Prof. and Head, Dept. of Medicine, Pt. JLN Memorial Medical College and Dr. BR Ambedkar Memorial Hospital, Raipur, Chattisgarh.

Dr. Saurabh Goel

MD (Medicine)

Shri Sant Hospital, Bareilly, Uttar Pradesh.

Dr. D. Vijay Sheker Reddy

DNB (Internal Medicine), DM (Endocrinology)

Consultant Endocrinologist, Yashoda Hospital, Hyderabad, Telangana.

Dr. Rattan Prakash Kudyar


Jammu.

Expert Contributors of the MonthExpert Contributors of the Month

Dr. Rakesh Goyal

MD, DM (Endocrinology)

Endocrine Clinic, Ludhiana, Punjab.

Dr. Santosh Kumar Singh

MD, DM

Endocrinologist and Diabetologist.

Ms. S. Suganya

BSc

Dietitian and Certified Diabetes Educator,Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu.

Dr. Tuhin Dubey

MD (General Medicine), DNB (Endocrinology)

Consultant Endocrinologist, Medipulse Hospital, Jodhpur, Rajasthan.

Dr. Haritha G.


Consultant Diabetologist and Endocrinologist, Vijayawada, Andhra Pradesh.

In Case of Emergency,

Use Your Mobile!

Watching Out for Medication

Failure or Side-Effects

Dr. Anjana Bhan

Evaluating the Economic Burden

of Diabetes on Family

Dr. Sahil N. Fulara

Eyes on Diabetes – Be Watchful!

Dr. Shashank Gupta

Rollercoaster of Emotions on

Diabetes Diagnosis

Dr. Saurabh Goel

Overcoming Challenges

the Family Way!


Dr. Rakesh Goyal


16

18

21

23

25

27

29

31

Diabetes Education in Family

Members – The Beneficial Impacts!

Do Not Wait, Vaccinate!

Dr. Vinod Mittal

14Battle Against Diabetes –

“Steps” to Combat


Controlling Diabetes is in Your Hands!

Diabetes Educators Speak!

Cover Story: World Diabetes Day –

Focus on Family and Diabetes


Uncovering Diabetes


A Family That Eats Healthy Together

Stays Together!


Managing Diabetes – An Overview


01

02

04

06

08

12Do Not Sugar-Coat Your Diabetes –

Spot the Signs!


Dr. Ajitesh Roy

10

Table of Content

Table of ContentFood Labels – Take A Closer Look

Flu and Diabetes – A Devastating

Combination

Tune Up Your Diet!

33

36

38

40

Dr. Haritha G.


Dr. Tuhin Dubey

Multiple Feathers on DEs Cap

Conference Highlights

Tools: DiaBits

43

44

45

46Future Trend: Attention –

A Better Needle-Free Blood Sugar

Monitor is Here!

Supporting Role of Family Members

in Diabetes Care

47

49

52

Diabetes Educator of the Month

Patients’ Corner

Get Active!

National Diabetes Educator Program

(NDEP) Best Practices

Eat Out, Be Wise!

Shopping Smart

Superfood: Eggs/vaMs

53

55

56

57

58

60

Recipe

References

Ms. S. Suganya

1

Mr. Bhaven Parikh, a 25-year-old man, is having type 1 diabetes mellitus (T1DM) and thalassemia major. He was diagnosed with

major thalassemia at 11 months of age and T1DM at the age of 13. He was not aware of carbohydrate counting. His blood

glucose levels used to be between 200–300 mg/dL. To correct hyperglycaemia, he used to take extra insulin and often go into

hypoglycaemia.

He was referred to our health coach and DE Ms. Minal Gada.

She taught him carbohydrate counting. He is studying IT in Pune. He consumes food at the hostel mess which is high in

carbohydrates. Hence, he was taught to reduce the glycaemic index of the meal by choosing protein and fibre sources and take

insulin accordingly. She also helped him to manage his thalassemia and advised him to avoid iron-rich foods.

Ms. Minal Gada was in constant touch with him for guiding him in counting carbohydrates properly as per his meal. Within a few

days, his blood glucose levels came under control and his basal has now reduced by 2 units.

Attached below is his feedback.

Diabetes Educators Speak!

Kudos to Mr. Bhaven Parikh and his DE Ms. Minal Gada!

Can hypoglycaemia or hyperglycaemia be prevented? Yes, it is possible! Carbohydrate counting and guidance from a qualified person is a way to achieve blood glucose control.

2

ExpertOpinion

The impact of diabetes

Over 425 million people are living with diabetes while 1 in 2 people are currently undiagnosed. However, T2DM is largely preventable through regular physical activity, a healthy and balanced diet, and the promotion of a healthy lifestyle. Early diagnosis and treatment are keys to prevent the

1complications of diabetes and achieve healthy outcomes.


MD (Internal Medicine),DM (Endocrinology), DNB(General Medicine)

Consultant Endocrinologist, Mediciti Hospitals, Hyderabad, Telangana.

Families have a key role to play in addressing the modifiable risk factors for T2DM and

must be provided with the education, resources and environment to live a healthy

lifestyle. However, all families are potentially affected by diabetes and so being aware

of the signs, symptoms and risk factors for all types of diabetes are vital to detect it 1early.

Family members can actively support and care for people with diabetes. Most

individuals live within a household that has a great influence on diabetes-

management behaviours. They can provide many forms of support, such as

instrumental support in driving the person with diabetes to appointments or helping them inject insulin, and social and emotional support in helping them cope with their condition. Through their communications and attitudes, family members often have a significant impact on the person with diabetes psychological well-being, his/her

decision to follow recommendations for medical treatment, and ability to initiate and maintain changes in diet and exercise.

Cover Story: World Diabetes Day – Focus on Family and Diabetes

3The role of family in managing diabetes

For parents with diabetes

¢ Contribute with cash money to the household economy.

¢ Provide food recommended by the clinician.

2Family members can actively help their loved ones!

3

¢ Provide post-surgery care (bathing, dressing the wound), if required.

¢ Keep an eye to watch that the parent does not eat food forbidden by the

clinician.

¢ Be mindful of regular screenings and check-ups and the results of the medical examinations.

¢ Accompany the parent to medical appointments.

¢ Buy products that are suitable for family consumption.

¢ Act as translators or readers for parents when they cannot read or write.

For spouse with diabetes

¢ Accompany the respective partner to exercise and to medical appointments.

¢ In case he/she forgets to take medicines, be attentive to the medication used to treat

diabetes and remind them on a timely basis.

¢ Take the effort to prepare food according to the medical recommendation and keep

consistency.

¢ To reduce the household economic burden, pay for private medical consultations.

¢ Help one another morally in times of crisis with an expression of affection, listen to and

chat with them more often, share moments of leisure and relaxation.

¢ Agree to be on the same page while battling with the condition.

It is a known fact that a strong bond with the family members helps to maintain a positive attitude toward diabetes.

Important pointers for DEs

¢ Being accompanied is considered as the main emotional support. DEs must advise people with diabetes to get their spouse/parent/friend along with them during the appointments.

¢ DEs must also understand a persons cultural and family environment in supporting diabetes self-care and consider how to culturally tailor interventions for people from racial/ethnic minority populations.

4

ExpertOpinion


MD (Medicine)

Consulting Diabetologist, Vijayratna Diabetes Diagnosis and Treatment Centre, Ahmedabad, Gujarat.

Why is medical history important in 4diabetes?

Family members share their genes, as well as their

environment, lifestyles, and habits. Everyone can recognise

traits such as curly hair, dimples, leanness, or athletic ability

that run in their families. Risks for diseases such as diabetes

also run in the family.

People with a family history of diabetes may have the most to gain from lifestyle

changes and screening tests. They cannot change their genes, but they can

change unhealthy behaviours such as smoking, inactivity, and poor eating habits.

Being aware of the family’s health history is an important part of a lifelong wellness

plan. Even if a person does not have a history of a particular health problem in the 4family, he/she could still be at risk. This is because of:

¢ Their lifestyle, personal and medical history, and other factors that might

influence their chances of getting a disease.

¢ They may be unaware of disease in some family members.

¢ They could have family members who died young before they had a chance to develop chronic conditions such as heart disease, stroke, diabetes, or cancer.

Uncovering Diabetes

5The warning signs of diabetes

Family members should be eyeful to watch out for any warning signs:

¢ Increased thirst

¢ Increased hunger (especially after eating)

¢ Dry mouth

¢ Frequent urination or urine infections

¢ Unexplained weight loss (even though one is eating and feels hungry)

4Seriousness of detecting diabetes early

5

¢ Fatigue (weak, tired feeling)

¢ Blurred vision

¢ Headache

Family members should get their affected ones screened immediately if they observe any warning signs as mentioned above. Parents can help their child in following a right diet while siblings can help in maintaining a regular exercise routine and other members can help by preparing a checklist for example medications. The person can manage T2DM and live an active, productive life with family support.

Prediabetes/Borderline diabetes is a silent condition, so getting a regular wellness check-up is important for early detection.

If diabetes runs in the family, there are chances that other members may have borderline diabetes;

this should be further discussed with a clinician.


¢ DEs must advise family members of the symptoms of hypoglycaemia - including nausea, a jittery or nervous feeling, a rapid heartbeat, mood changes, blurred vision, and difficulty in walking. Severe hypoglycaemia can lead to loss of consciousness, seizures, coma and may be fatal.

¢ Hyperglycaemia may be caused by skipping or forgetting insulin or diabetes medicine, eating too many grams of carbohydrates for the amount of insulin administered, simply eating too many grams of carbohydrates in general, or from stress or infections.

¢ In many cases, adopting a healthier lifestyle can reduce the risk of diseases that run in the family.

6

ExpertOpinion


MD (Gen. Medicine),DM (Endocrinology)

Consultant Endocrinologist, Alur Superspeciality Center, Davangere, Karnataka.

A Family That Eats HealthyTogether Stays Together!

Children may demand fried, junk food, while the spouse may demand hot parathas with extra butter on the top and grandparents may expect gulab jamun or jalebi after dinner. They may be our loved ones, but this can be dangerous in the long run.

For a person with diabetes in the family, we tend to cook different food items; however, this can take a bad turn in

cooking different dishes, high calorie for some while low-

calorie and bland food for the one with diabetes. The goal is to get the family to unite

over a new way of eating. Regardless of which family member has diabetes, the 6bottom line is that nutrition applies to everyone.

Reducing the family’s risk starts at home

6Two ways to make the switch

¢ The first is to simply lay down the law. In other words, tell the family, "This is the new normal." But make sure to be clear as to

why everyone's eating habits have to change. Ensure to mention that diabetes is not one person's problem or one person's

solution. The entire family will benefit in coordinating with the rules and regulations.

¢ The other way to alter the family’s eating habits is to not let them know about it. This is known as “Sleath health”. Switch from whole milk or 2 percent to 1 percent or skim without telling the family. Buy fruit instead of junk food without asking permission.

When questions arise, mention the importance of healthy eating, but do not dwell on it. If changes are made without people noticing, then that is the best.

It is time to bring the "family" back to the dinner table. Sharing dinner together gives everyone a sense of identity. It can help ease 7day-to-day conflicts, as well as establish traditions and memories that can last a lifetime.

7


¢ Regardless of how one handles the transition, make sure both, wife and husband stay on the same note for the sake of their child. A parent who does not follow the new rules undermines the whole family's plan.

¢ Ensure that the family sits down to dinner together with the television and cell phones switched off. That goes for adults, too. Dining without distractions can help them focus on the food and appetite, and will make it easier to stop when they are full.

¢ Sharing meals helps children understand family and cultural traditions about food. As well, they learn teamwork and valuable life skills if they help with getting the meal on the table.

A study showed that adolescents who had the most shared family meals when growing up, had higher intakes of fruits

and vegetables into adulthood. The reason behind this is that shared family meals are an opportunity to put healthy 8

foods in front of children (and teens) and then to establish healthier eating patterns for a long-term.

8

ExpertOpinion


MD (Physician), PGD (Diabetology)

Consultant Diabetologist and Foot Care Specialist, South Zone Hospitals and Research Centre Pvt. Ltd., Thrissur, Kerala.

Managing Diabetes – An Overview

One of the biggest challenges for clinicians today is addressing the continued needs and demands of individuals with chronic illnesses like diabetes. The importance of regular follow-up with their DE for people with diabetes is of great significance in averting any long-term complications.

Managing diabetes requires daily treatment, regular monitoring, a healthy lifestyle and ongoing education.

It is known that strict metabolic control can delay or prevent the progression of

complications associated with diabetes. Sometimes, very poor adherence to

treatment regimens due to poor attitude towards the condition and poor health literacy

among the general public causes a downfall and deterioration in the condition. It is of

utmost importance that family members are educated about the condition together

and bust the societal myths that surround the condition.

Finding a way to achieve treatment compliance is a challenge for the health system. In

addition to the negative effects the disease has on individual health, family members

can play a huge role in managing diabetes.

9Challenges in managing diabetes

10Mother’s role in managing her child’s diabetes phase

¢ Emotional support: Take care of the child emotionally as the child may seem to be

disconnected due to differences that occur at school when the child uses his/her pump or medications. Show solidarity with the child by not eating food the child cannot eat.

¢ Be a provider: Support the treatment of the child by paying for medical consultations, pumps, medications and laboratory studies.

¢ Be supportive: Accompany the child for every appointment,

screenings and tests. Encourage compliance with treatment.

Accompany the child to exercise. Remind the child to take

medications on time.

¢ Be the best chef: Provide the right food recommended by the

doctor in the right quantities and adhere to the child’s diet.

9

Regardless of challenges, four main dimensions of support to the affected ones are economic support,

help with treatment compliance, emotional support and material aid.


¢ DEs can introduce home blood glucose monitors and the widespread use of glycated haemoglobin (HbA1c) as an indicator of metabolic control that can contribute to self-care in diabetes.

¢ Family members can help manage diabetes by knowing more about the medications and its effect on blood sugar. Family members need to know the signs and symptoms of low blood sugar as well as how to respond to them (usually by offering simple snacks such as a small juice or some carbs). Let them know how vital their quick response will be to the person with diabetes in an emergency.

¢ Family members can work as a team to clean out the cabinets and the refrigerator, to replace junk foods with healthier options to help manage the one with diabetes.

10

ExpertOpinion

Dr. Ajitesh Roy

MD (Gen. Medicine),DM (Endocrinology)

Consultant Endocrinologist, Ruby General Hospital, Kolkata, West Bengal.

Controlling Diabetes is in Your Hands!

11Understanding the risk assessment

People with diabetes cannot do anything about their age or their genetic predisposition. On the other hand, the rest of the factors predisposing to diabetes, such as being overweight, abdominal obesity, sedentary lifestyle, eating habits and smoking can be modified. A person’s lifestyle choice can completely prevent T2DM or at least delay its onset until a much greater age.

If diabetes runs in the family, the person should be careful to not gain weight over the years.

The growth of the waistline, in particular, increases the risk of diabetes, whereas regular

moderate physical activity lowers the risk. They should pay attention to their diet, and should

eat plenty of fibre-rich cereal products and vegetables every day. They should omit excess

hard fats from the diet , and instead should favour soft vegetable fats.

Indian Diabetic Federation (IDF) has created an online diabetes risk assessment test which

aims to predict an individual’s risk of developing T2DM within the next ten years. The test is

based on the Finnish Diabetes Risk Score (FINDRISC) developed and designed by Adj. Prof

Jaana Lindstrom and Prof. Jaakko Tuomilehto from the National Institute for Health and

Welfare, Helsinki, Finland.

The test takes only a couple of minutes to complete. It is a quick, easy, and confidential way to find out the risk of developing T2DM.

The following questions are asked and points are allotted as per the option decided by the person taking the test.

1. Age 2. Body mass index (BMI)

2Lower than 25 kg/m 0 point225–30 kg/m 1 point

2Higher than 30 kg/m 3 points

Men Women

0 points Less than 94 cm Less than 80 cm

3 points 94–102 cm 80–88 cm

4 points More than 102 cm More than 88 cm

Under 45 years 0 point

45–54 years 2 points

55–64 years 3 points

Over 64 years 4 points

3. Waist circumference measured below the ribs (usually at the level of the navel)

11

The decision to lose weight must be made mutually between the DE and the person with diabetes.

The persons involvement and investment in the process is crucial for success.


¢ Family members can help be accountable to each other for quarterly check-ups to avoid the progression of diabetes.

¢ To avoid complications, family members must get screened.

¢ 2Weight loss therapy is recommended for people with a BMI ≥30 kg/m and for people 2with a BMI between 25 and 29.9 kg/m or a high-risk waist circumference, and two

or more risk factors.

4. Do you usually have daily at least 30 minutes of physical activity at work and/or during leisure time (including normal daily

activity)?

Yes – 0 points No – 2 points ¢ ¢

5. How often do you eat vegetables, fruit or berries?

Everyday – 0 points Not everyday – 1 point¢ ¢

6. Have you ever taken medication for high blood pressure on regular basis?


7. Have you ever been found to have high blood glucose (e.g., in a health examination, during an illness, during pregnancy)?


8. Have any of the members of your immediate family or other relatives been diagnosed with diabetes (type 1 or type 2)?

No – 0 points¢

Yes: Grandparent, aunt, uncle or first cousin (but not own parent, brother, sister or child) – 3 points¢

Yes: Parent, brother, sister or own child – 5 points¢

If the person scored 15 points or more in the risk test, they should have their blood glucose measured (both fasting value and

value after a dose of glucose or a meal) to determine if they have diabetes without symptoms.

12

ExpertOpinion

Diabetes have plenty of early signs, but they are subtle

enough that one might not notice. It is not like a person may

wake up one day and all of a sudden feel thirsty, hungry, and

go to the bathroom all the time, it picks up gradually. Most

people are unaware that they have diabetes in their early or

even middle phases.

The longer one goes without controlling diabetes, the greater


MD (Medicine),DM and DNB (Endocrinology)

Consultant Diabetologist and Endocrinologist, Nasik, Maharashtra.

Do Not Sugar-Coat Your Diabetes –Spot the Signs!

the risk of heart disease, kidney disease, amputation, blindness, and other serious complications. It is recommended that people

with risk factors for diabetes, such as a family history or being overweight, get evaluated on a regular basis.

Diabetes - a gradual process

12 Important points to spot the signs

Taking more bathroom breaks

The body becomes less efficient with diabetes in breaking food down into sugar,

so there is more sugar sitting in the bloodstream which is released by urinating

(Polyuria). Going to the bathroom once or twice might be normal, but if it affects

the person’s ability to sleep (Nocturia), it could be a diabetes symptom to pay

attention to.

Feeling thirstier than usual

Urinating a lot will also make the person feel parched. People normally drink juices, soda, or chocolate milk to quench their thirst. These sugary beverages then pack the bloodstream with excess sugar, which can lead to the problem all over again.

13

Finding the right diet and exercise plan is crucial to the health of the people with diabetes.

Rather than managing the disease by themselves, they should be able to trust their family members to work closely with

a DE to devise an individualised plan for their loved ones.

Feeling shaky and hungry

When a person has high blood sugar, the body has a problem in regulating its glucose.

If one has eaten something high in carbohydrates, the body shoots out a little too much

insulin, and the glucose drops quickly. This makes them feel shaky, and tend to crave

carbohydrates or sugar. This can lead to a vicious cycle.


¢ DEs should remind people that elevated sugar levels can cause complications well before one realises he/she has diabetes. For e.g., mild nerve damage in feet causes numbness, increasing the chances of missing any kind of skin damage leading to fatal infections in the feet.

¢ DEs should also remind people that it is important for those with either type of diabetes to be closely monitored during exercise in case of any sudden health complications.

14

Managing T2DM and exercising regularly go hand in hand. According to the American Diabetes Association (ADA), exercise is just as important for managing T2DM as eating right, taking medications and managing stress.

A study found that people with pre-diabetes who exercised 150 minutes a week and lost about 7 percent of their body weight significantly reduced their chances of developing full-

MD (Medicine), DM (Endocrinology)

Associate Professor, Dept. of Endocrinology, JNIMS, Manipur.

Battle Against Diabetes – “Steps” to Combat

blown diabetes. Many health advocates, as well as numerous fitness apps and

devices, urge people to aim for 10,000 steps a day. Ten thousand steps can be a lot for

a beginner especially people with T2DM. No matter how much one intend to walk, it is

suggested to get an activity tracker or an app for the phone to help one keep track of

their steps and recognise their goals.

People with diabetes should get a baseline of how many steps they do in a day, and

then add 1,000 more each week until they hit their goal.

13More the steps – better the journey!

Better blood sugar control

With T2DM, the body’s blood sugar goes too high, but exercise helps to use that sugar and, therefore, helps lower it. In fact, regular exercise can help improve HbA1c level.

13Walk the battle and combat diabetes

Weight management

One may need to burn more calories than they consume in order to lose weight, a healthy diet is just as important as exercise, walking helps in maintain weight loss.

ExpertOpinion


15


¢ Uncontrolled diabetes can lead to a number of serious health issues, including eye, feet, and kidney problems, along with nerve damage. Exercise can help manage T2DM better and the lower the risk of complications.

¢ DEs must ensure people to eat a small snack before exercising and having quick-acting carbs on hand, such as glucose tablets.

Here is how families can help: Each family member can be a part of a digital diabetes app to track the progress of their loved

ones and try having a healthy competition to reach a target goal of 10,000 steps.

Improved heart health

According to the World Heart Foundation, people with diabetes are two to four times more likely to develop cardiovascular disease than people who do not have diabetes.

Aerobic exercise helps strengthen the heart as well as the whole cardiovascular

system.

Improved mood and stress relief

Exercise releases endorphins (hormone) that can lift the mood of people with diabetes and relieve stress, according to the Anxiety and Depression Association of America (ADAA). People with diabetes are at greater risk of becoming depressed than people without diabetes, and exercise can be one tool for caring for their emotional health.

1616

ExpertOpinion

Living in such an era, the revolution in personal attitudes toward technology developments and digital healthcare is changing positively. Younger generations and older adults have started to enjoy the outcomes of the recent technology

14 progresses.

The Food and Drug Administration (FDA) encourages the development of mobile medical apps that improve healthcare

Dr. Vinod Mittal

MD (Medicine), FICP, FCAM, FCCP, FGSI, FIAMS, FACP

Sr. Consultant Diabetologist, Delhi Heart and Lung Institute, Delhi.

In Case of Emergency, Use Your Mobile!

Introduction

and provide consumers and health care professionals with valuable health 15information.

Apps aim to help healthcare professionals improve and facilitate care. Some mobile

medical apps can diagnose cancer or heart rhythm abnormalities or function as the

“central command” for a glucose meter used by an insulin-dependent person with 15 diabetes.

Apps also help to improve the relationship between a person with diabetes and

clinician, and also helps in setting up treatment protocols tailored to individual needs. It

helps in following medical status, disease activity, functional abilities, quality of life, 14medication monitoring and co-morbidity (ies).

How can family members help?

Family members can view/track the progress of their loved ones on the registered app. They will be able to view the highs and lows,

and in case of emergency, there will get an alert notification which will prompt them to take immediate action.

17


Health data can also be beneficial to more than just the user, and large-scale health data analysis can support epidemiologic

studies with a positive impact on overall health and fitness.

¢ DEs must note that apps can have a positive impact on diet monitoring, physical activity, adherence to medication and chronic condition management, therefore, they must advise people with diabetes accordingly.

¢ Apps that use established behaviour change techniques, such as promoting goal setting, review and feedback on performance to encourage engagement, may prove increasingly valuable in helping to sustain behaviour change.

18

ExpertOpinion

Introduction

When people are diagnosed with diabetes, a large number of medications become involved in treating their condition. These include medications for dyslipidaemia, hypertension, antiplatelet therapy, and glycaemic control. So many medications can be overwhelming, and it is imperative that people with diabetes are thoroughly educated about their drug regimen.

Dr. Anjana Bhan

MBBS

Senior Consultant (Endocrinology),Max Hospital, Delhi.

Watching Out for Medication Failure or Side-Effects

¢ People with diabetes may avoid medication due to side-effects.

¢ People with diabetes may not stay on track with their given dosage.

¢ People with diabetes may not inform doctors and family members about over the

counter medications that they may have taken, which could lead to adverse

events.

¢ People with diabetes may not be regular with their diet and exercise pattern.

Commonly prescribed drugs for chronic conditions that may require an adjustment in insulin dosage include:

¢ Prednisone

¢ Olanzapine

¢ Thyroid hormones

¢ Angiotensin-converting enzyme inhibitors

¢ Selective serotonin reuptake inhibitors (SSRIs)

¢ Sulphonamides

¢ Disopyramide

¢ Quinine and quinidine

In addition, some drugs that are prescribed for temporary conditions, such as antibiotics for infection, may require an adjustment to

insulin dosage.

16Medications to avoid

Challenges faced by doctors and family members

19

¢ To stay on track, set reminders, such as an alarm on a smartphone or computer. Try to

connect each dose with another daily activity done at the same time. For instance, if one

takes medication before breakfast; keep the medication bottle by the area you eat or

next to your toothbrush as part of your morning routine.

17Tips to stay on track and how the family can stay involved

¢ It is important that family members understand how the medications work. One is more

likely to take medicines properly if they know their mechanism. Do not be shy about

asking the doctor to explain how the medication works.

¢ Some diabetes drugs can cause nausea, vomiting, or diarrhoea – any of which could

tempt you to go off care plan. Do not do that, instead, talk to the doctor about the

side-effects.

¢ Consider using a daily pill organiser with various compartments for each day – morning,

afternoon, and evening. Sit down every Sunday night and carefully fill your pillbox. Family

members can help to do this and make a routine activity of this.

¢ It is also wise to use just one pharmacy so that the pharmacist can cross-check all the

prescriptions for possible drug interactions. Family members can assist in

accompanying to the pharmacist and help in understanding drug interactions, by sitting

in sessions.

¢ Over time, diabetes medications may need adjustment. A drug might stop working. Losing or gaining weight, or exercising more or less, can affect your medications and

dosing schedule. If one is having symptoms of low or high blood sugar, or if blood sugar numbers are going out of range, talk to the doctor.

20

¢ People with diabetes need to work continually with doctor so that they do not have unexpected low or high blood sugars. Family members can sit in sessions that might help them understand the effects of the medications to better plan and prepare a schedule which is most effective for the person with diabetes.

¢ Most importantly, people with diabetes should not forget to continue

eating well and exercise regularly. They should work with family

members to get best response to the medication.

It is best to check drug interaction information with a physician and to double-check with pharmacist each time one refill

a prescription of insulin.


¢ Typically, a negative drug interaction either decreases or increases insulin's effects, posing the risk of high or low blood glucose. But rather than insisting to avoid these medications, it is more likely that doctor will want to adjust insulin dosage for the period one takes them.

¢ Remember to do the things that help keep blood sugar levels under control. Exercise, eat right, and take any diabetes medicines that are needed.

¢ It is important you take your medications on schedule because they have a timed-release.

21

ExpertOpinion

Diabetes is primarily a self-managed disease. In order to stay

healthy, a person with diabetes needs supplies like test strips,

meters and insulin. Sometimes, due to complications, there is

a need for health insurance to help them access the supplies,

medications, education and healthcare to manage their

diabetes and prevent, or treat it. Diabetes can be expensive

for the individual and family; there is a need to improve

access to affordable diabetes medicines and care.

Dr. Sahil N. Fulara

MD, RCP (Endocrinology), D. Diab, FACE

Consultant Endocrinologist, Fulara Medicheck Centre, Mumbai, Maharashtra.

Evaluating the Economic Burden of Diabetes on Family

Although India is classified as “the diabetes capital of the world”, not many insurance

companies are out there are willing to provide people with comprehensive coverage

for diabetes and its complications.

The reason is quite obvious, even after taking into account the dreads of diabetes and

its complications; there is a high probability that the insured will outlive the policy

term. Therefore, taking into account the costs people with diabetes incur for their

treatment and the medications required, insurers are evasive about providing these

people with comprehensive coverage that tackle such costs.

People with diabetes, in the long-term, the body takes longer to heal a wound and becomes

more vulnerable to eye, nervous system and kidney damage. They find it difficult to find an

affordable health insurance plan to cover diabetes-related medical costs. Most health

insurance plans extend their exclusion to not only diabetes but also to complications arising

from it.

Currently, available health covers that include diabetes and related complications do not provide it before a 4-year waiting period, post-diagnosis. Certain policies that do provide diabetes coverage earlier than 4 years have very high premiums. In case of most health

plans, diabetes and hypertension always feature as an exclusion that is not included after 1, 2 or even 4 years.

18The cost of diabetes on a family

19What can people do in such a situation?

¢ A slow and steady approach to get covered is to buy a health plan and pull through the waiting period. One should look out for

plans that offer coverage for diabetes and its complications after a shorter-than-usual waiting period.

19Health insurance scenario in India

22

¢ Another way is to get covered by a group health insurance, provided by their employer. Such a plan covers them against pre-

existing conditions including diabetes, but it is active only as long as they are an employee with

the organisation.

The expert group set up by the Planning Commission of India aim to achieve universal health 20coverage by 2022 to increase coverage and pool healthcare costs across the population. The

following plans, Diabetes Safe from Star Health and Varistha Mediclaim from National Insurance,

were among the first of to be launched in India. ICICI Prudential and Apollo Munich Health have also

offered plans for diabetes care.

Health Plan: Star Health Diabetes Safe

¢ Eligibility: Any person who is diagnosed with T2DM

¢ Entry-Exit age: 26 – 65 (Renewals can be made up to 70 years)

¢ Sum assured: 50,000 to 5,00,000

¢ Premium: Starts from 800

¢ Coverage: Eyes: Diabetic retinopathy; Kidneys: Diabetic nephropathy; Feet: Diabetic foot ulcer

Health Plan: National Insurance Varistha Mediclaim

¢ Eligibility: Any person aged between 60 to 80 years

¢ Entry-Exit age: 60 – 80 (renewed up to the age of 90)

¢ Sum assured: 1,00,000 (plain cover) or 2,00,000 (with critical illness cover added)

¢ Premium: Starts from 4100

¢ Coverage: Diabetes even if pre-existing is covered right from the inception of the policy (at a 10% additional premium). It is

designed for senior citizens only


¢ Family members can support one another by managing the economic household cost so that the affected one does not bear the entire burden.

¢ DEs must inform people with diabetes and their family members that early disease detection and treatments in outpatient settings provide cost-saving ways of tackling the disease.

If diabetes could be efficiently prevented at 65 years of age, a lump sum in medical spending could potentially be saved over

the remaining lifetime. Investments in prevention among people who are currently younger than 65 years of

age and who are at high risk for T2DM may financially benefit health insurance policies in the long run.

23

ExpertOpinion

Importance of screening

“Screening is the process of identifying those individuals who

are at sufficiently high risk of a specific disorder to warrant 21

further investigation or direct action.”

The key goal of management of T2DM is to help people with the condition achieve good glycaemic control through best practice for care, treatment and education for self-management. Staying within near-normal blood glucose values improves current wellbeing and minimises the risk of

22future complications.

Dr. Shashank Gupta

MD (Medicine)

Former Director, Prof. and Head, Dept. of Medicine, Pt. JLN Memorial Medical College and Dr. BR Ambedkar Memorial Hospital, Raipur, Chattisgarh.

Eyes on Diabetes – Be Watchful!

Risk for undiagnosed T2DM: People with undiagnosed T2DM are at particular risk from

developing complications, because the signs and symptoms of diabetes are often not felt

or detected for many years, even decades. Tragically, it is not uncommon for people to be

first diagnosed with diabetes after presenting with vision loss due to diabetic retinopathy,

or a neuropathic foot wound that may require amputation. There is a race against time to

identify those with undiagnosed T2DM, and to provide a diabetes treatment plan that

incorporates nutrition and exercise guidelines, often with medication, before such 22complications arise.

Prerequisites for screening: Before exploring how screening should be

undertaken, it is important to define who falls into the category of sufficiently high

risk. Assessment is based on age, ethnicity, BMI, waist circumference, diet, and 22 physical activity, history of high blood pressure and family history of diabetes.

Screenings test – an essential part in diabetes management

¢ Fasting plasma glucose (FPG) test is preferred in clinical settings because it is easier and faster to perform, more convenient

and is less expensive. An FPG ≥126 mg/dL (7.0 mmol/L) is an indication for retesting, which should be repeated on a different day to confirm a diagnosis. If the FPG is <126 mg/dL (7.0 mmol/L) and there is a high suspicion for diabetes, an oral glucose

23tolerance test (OGTT) should be performed.

24

¢ OGTT is a gold standard’ for diagnosis of diabetes. It involves having a blood sample taken for measurement of glucose after an

overnight fast, then taking a drink containing 75 grams of glucose, followed two hours later by another blood sample to

measure glucose level. The advantage of this test is that it assesses both fasting and postprandial glucose in a standardised

way.

¢ HbA1c could be used as a screening test for diabetes with a cut-point of 6.5% (48 mmol/mol) being diagnostic. The advantage

is that this is a single test that can be taken at any time of day and does not require fasting.


¢ The disadvantage of the HbA1c test is that it is more expensive than measuring glucose and therefore less affordable in low-resource settings. While keeping this in mind, it is important to be aware that a value below 6.5% does not conclusively exclude diabetes.

¢ One of the most common complications of diabetes is retinopathy. This is a disease of the retina which results in impairment or loss of vision. Retinopathy can be prevented. Screening is important to ensure early diagnosis and treatment of T2DM to reduce retinopathy as well as other serious complications, such as heart attacks, strokes, kidney failure, impotence, amputations and infections.

It is possible to prevent the progression of the development of T2DM by regular screening.

Diagnostic test Intermediate hyperglycaemia Diabetes

(‘pre-diabetes’)

Fasting glucose 110–125 mg/dL (6.1–7 mmol/L) 126 mg/dL (7.0 mmol/L)

OR

Glycated Haemoglobin (HbA1c) 6.0–6.4% (42–47 mmol/mol) 6.5% (48 mmol/mol)

OR

2-hour glucose following ingestion of 75 g glucose load or random 140–199 mg/dL (7.8–11.0 mmol/L) 200 mg/dL (11.1 mmol/L)

plasma glucose

Table 1: WHO recommendation for the diagnostic criteria for diabetes

Keep your family safe, screen regularly

Not only the affected one but also other members of the family should be screened to reduce risks of diabetes and further

complications. While visiting the clinic for screening, other family members should consider getting screened for diabetes.

25

ExpertOpinion

According to the ADA, stress triggers an increase in the body's fight-or-flight hormone levels, as if the body were under attack. In response, the body releases extra energy in the form of glucose and fat. People with diabetes are unable to properly process that glucose because of insulin resistance, and consequently, glucose builds up in the blood.

Dr. Saurabh Goel

MD (Medicine)

Shri Sant Hospital, Bareilly, Uttar Pradesh.

Rollercoaster of Emotions on Diabetes Diagnosis

“For someone who does not have diabetes, stress causes a temporary rise in blood

sugar, but their body can adjust, however, for someone with diabetes, the blood sugar

level stays high.”

People with diabetes should closely monitor their blood glucose when stressed. Not

only negative stressors like getting stuck in traffic, bickering with a family member, an

unhappy marriage or a cruel boss can affect blood glucose but also happy stressors

like planning a wedding, moving to a new city, getting a job promotion can also send

fight-or-flight hormones into overdrive.

When the person with diabetes does not understand, often a family member will step in and take the reins.

¢ The DE should suggest people with diabetes to talk to their family member. Often children, spouses and family friends can help

the person understand what is needed from them.

¢ Communicating with family and friends of people with diabetes is always

beneficial and should be encouraged.

¢ Family and friends can help the DE to communicate with the person because they know how that person thinks. It may help to have a three-way conversation between the person, their caregiver and the DE.

¢ When everyone works together to help the person understand, the DE stands a much better chance of putting the person with diabetes at ease with all that is happening around them.

25Include family in the conversation

24How stress affects blood sugar?

26

Families of people with diabetes are also suffering, and it can be challenging to communicate with them as well. Honesty is always the best course of action to take with families. One of the best ways to talk to families is through active listening. Since

these people may be highly emotional they have the need to be heard as much as the person.

Example of active listening is when the family member is screaming and shouting, the DE can

respond with, “It seems like you are very angry. Can

you tell me more about that?” Keep eye contact, nod, and use encouraging words, such as, ‘go on’

or ‘tell me more’. This can help with any emotional situation from anger to sorrow to apathy. Using

this method, one can help the family come to terms with the truth of their loved one’s prognosis.

25Helping families

Important pointers forDEs

¢ DEs must not ignore the person’s emotional responses and concerns during his/her visit. DEs must consider giving a clear introduction of them first and establish an atmosphere of trust and confidentiality.

¢ DEs should choose their words to fit the situation and the audience.

¢ DEs must remind people with diabetes about advances in medications, technology and education that were not available years ago and that they can positively change the course of their diabetes by managing their diabetes and making healthy lifestyle changes.

One of the most important communication skills of a DE is the ability to stop and listen actively and ethically,

to what is being said by the person with diabetes.

27

¢ A diagnosis of diabetes can be a stressful event for

families as a whole. Family dynamics have been shown

to have an impact on diabetes management and

metabolic control in children, adolescents, and the

elderly.

¢ Complex nature of the medical management of diabetes,

Overcoming Challenges the Family Way!

people with diabetes and their family members often face psychological issues that

make long-term balance and control very difficult.

¢ Diabetes certainly has a pronounced emotional impact upon families and particularly on

those who are in a close relationship with those with diabetes, which might lead to

anxiety.

26Challenges for family

¢ Healthy communication: It is important to establish a healthy communication with the family member to better help them cope

with the disorder.

¢ Motivation: Family members should try to motivate persons with diabetes by trying small things, such as accompanying them

to a walk or by just lending an ear to them.

¢ Focussing on long-term health: It might be tough for family members as well to constantly motivate their concerned persons with diabetes, but it is important to focus on the long-term benefits of doing the small things and thinking of how their help can lead to improvement in long-term health.

26,27Impact of diabetes on family

ExpertOpinion



Jammu.

26What healthy changes should I encourage my relative to make?

¢ If one share a meal with relatives make sure that they eat healthy food. It is adviced not to buy any types of food that people with diabetes should not eat.

¢ People with diabetes need to stay aware of their diet, and if one understands a healthy diet for diabetes, it can be all the easier to communicate to their relative. Exercise is another fundamental part of diabetes management.

¢ Relatives can make exercising easier by agreeing to exercise together, although each person with diabetes should speak to

their healthcare adviser in order to find out what type of exercise will suit their condition.

Important pointers for

26,27DEs

¢ Although physicians, nurses, dieticians, mental health professionals, and providers from other disciplines are important sources of information, expertise, and support, at the end of the day, most clinicians would agree that HbA1c results are largely related to how persons with diabetes and their family members manage diabetes in daily life.

¢ It is important to provide family members with information about the illness and possible treatment options, validate their experiences as providers of support, teach them various stress management skills, and help them plan for the future.

¢ Problems may include undiagnosed depression, social issues, limited daily means, and coexisting health problems.

Knowledge is power here, and if one can learn how to recognise any signs of problems, one could be a genuine help.

28

29

ExpertOpinion

Dr. Rakesh Goyal


Endocrine Clinic, Ludhiana, Punjab.

¢ Practical and emotional support received by both family and friends have a

positive influence on global measures of disease management in people with

diabetes.

¢ Strong associations between positive family dimensions (e.g., cohesion and

familial guidance) and better glycaemic control among people with diabetes have

been observed in recent studies.

¢ The primary goals in the treatment of diabetes care for people with diabetes are to maintain proper metabolic control and to reduce the risks of health complications.

¢ Peoples efforts to maintain and adhere properly to diabetes management directives often take place in social settings and can alter family and social dynamics.

Diabetes Education in Family Members – The Beneficial Impacts!

28Diabetes primary goals

28,29DSME to reduce the emotional impact of the disease

¢ Self-monitoring is an integral part of diabetes management because it puts one in

charge. Regardless of how one manage their diabetes –through diet and exercise

alone or combined with oral medicines or insulin– regular blood sugar monitoring provides immediate feedback on how your program is working.

¢ Checking your blood glucose gives one the freedom to make choices without

worry, the confidence to learn from one’s actions, and the motivation to keep

striving to do better.

¢ The important thing is to know how to interpret the numbers and take the

necessary action. For example, if one takes insulin and their blood sugar is high,

one may need to bolus, or take more rapid-acting insulin, to bring their levels

down into range. If one manage their T2DM with diet and exercise, one might treat

high blood sugar with a walk around the block.

30

¢ People who use insulin and certain oral diabetes drugs are also at risk of developing low blood sugar, or hypoglycaemia, which needs to be treated promptly when it occurs. Regular monitoring may enable one to catch and treat it early, and any symptoms of hypoglycaemia should be checked with a meter reading.

¢ Over time, blood sugar monitoring records can be analysed for patterns of highs

or lows that may suggest that a change is needed in the treatment regimen.

28Coaching family member in managing diabetes

Training programs can be developed for the family and people with diabetes that can:

¢ Educate people about the development of diabetes and how to manage living

with illness.

¢ Allow people with diabetes to discuss thoughts and feelings and accompanying

lifestyle changes associated with diabetes.

¢ Facilitate self-esteem and help people cope and take control of their illness.

¢ To develop solutions and techniques to maintain proper diet.

¢ To help people develop supportive relationships among family members to maintain dietary adherence over time.


28,29DEs

¢ Behavioural family systems therapies can be employed as multifaceted intervention that targets communication between family members, problem-solving skills, family beliefs that affect communication, and potential barriers to problem-solving tasks, ultimately aiding in management of diabetes.

¢ Maintaining a good metabolic balance on a daily basis is challenging from the family members’ point of view as well. Therefore, they need to be counselled on the same.

One can be in charge of their own health and see long-term benefits with support and trust of their family members.

31

ExpertOpinion


MD, DM

Endocrinologist and Diabetologist,

¢ Diabetes, even if well managed, can make it harder for immune system to fight infections, so one may be at risk for more serious complications from an illness compared to people without diabetes.

Why vaccines are important to those 30with diabetes?

Do Not Wait, Vaccinate!

¢ Some illnesses, like influenza, can raise one’s blood glucose to dangerously high

levels.

¢ People with diabetes have higher rates of hepatitis B than the rest of the

population. Outbreaks of hepatitis B associated with blood glucose monitoring

procedures have happened among people with diabetes.

¢ People with diabetes are at increased risk for death from pneumonia (lung

infection), bacteraemia (blood infection) and meningitis (infection of the lining of

the brain and spinal cord).

30,31Vaccines people with diabetes need

¢ Influenza vaccine

¢ Pneumococcal vaccine

¢ TDAP ( Tetanus, diphtheria and whooping cough) vaccine

¢ Zoster vaccine

¢ Hepatitis B vaccine

Getting vaccinated

¢ One should regularly see their provider for diabetes care, and that is a great place to start! If one’s healthcare professional does not offer the vaccines one needs, ask for a referral so that one can get the vaccines elsewhere.

¢ Adults can get vaccines at doctors’ offices, pharmacies, workplaces, community health clinics, health departments and other locations.

32


30,31DEs

¢ It can be harder than estimated to control blood sugar levels when people with diabetes contract preventable diseases.

¢ Immunisation provides the best protection against vaccine-preventable diseases.

¢ Vaccines are one of the safest ways to protect health, even if one is taking prescription medications. Vaccine side-effects are usually mild and go away on their own. Severe side-effects are very rare.

If one has diabetes, It is advised to talk to the doctor about getting their vaccinations up-to-date.

¢ Most health insurance plans cover recommended vaccines. It is advised to check with one ’s insurance provider for details and

for a list of vaccine providers covered by their plan.

33

Comparison of food labels based on total calories, 32 total carbohydrates, protein and fats

¢ If one’s meal plan are based on carbohydrate counting, food labels become an essential tool.

¢ It is recommended to look at total carbohydrates, not just sugar. Evaluate the grams of total carbohydrates –which includes

sugar, complex carbohydrates and fibre– rather than only the grams of sugar. Zeroing in on sugar content could lead to missing

out on nutritious foods naturally high in sugar, such as fruit and milk.

¢ Do not miss out on high-fibre foods. Pay special attention to high-fibre foods. Look for foods with 3 or more grams of fibre.

¢ When counting carbohydrates, if a food has more than 5 grams of fibre, one can subtract half of the total grams of fibre from the

total carbohydrates to get your count. High-fibre foods help reduce the absorption of more-simple carbohydrates.

¢ Fat-free can still have carbohydrates. Fat-free foods can have more carbohydrates and contain nearly as many calories as the standard version of the same food. Compare food labels for fat-free and standard products carefully before one makes a decision.

¢ Look for a breakdown of types of fat as the amount of total fat listed on a food label does not tell the whole story.

¢ Choose healthier fats. Although still high in calories, monounsaturated and polyunsaturated fats are better choices, as they can help lower cholesterol and protect one’s heart.

¢ Limit unhealthy fats. Saturated and trans-fats raise cholesterol and increase the risk of heart disease.

Introduction

Planning ones diet plays an important role in the treatment

plan of diabetes. Better choices can be made using the

nutritional facts on food labels. Paying attention to the details,

such as calories, total carbohydrates, fibre, fat, salt and sugar,

and reading food labels can help one make the best choices.

Food Labels – Take A Closer Look

ExpertOpinion

Dr. Haritha G.


Consultant Diabetologist and Endocrinologist, Vijayawada, Andhra Pradesh.

34

32Difference between total carbohydrate and sugar

No sugar added, does not necessarily mean no carbohydrates. The same applies to products sporting a "no sugar added" label. These foods may not contain high – sugar ingredients but may still be high in carbohydrates.

Sugar-free does not mean carbohydrate-free. A sugar-free label means that one serving has less than 0.5 gram of sugar. If the sugar-free product has noticeably fewer carbohydrates, the sugar-free product might be the better choice. But if there is little

difference in carbohydrate grams between the two foods, let taste

or price be one’s guide.

Sugar alcohols contain carbohydrates and calories, too. Likewise, products that contain sugar

alcohols –such as sorbitol, xylitol and mannitol– are not necessarily low in carbohydrates or

calories.

32Where to start grocery shopping?

¢ Avoid unhealthy ingredients, such as hydrogenated or partially hydrogenated oil.

¢ Keep in mind that ingredients are listed in descending order by weight. The main

(heaviest) ingredient is listed first, followed by other ingredients used in

decreasing amounts.

32Role of family

¢ Family members can help consider daily calorie goals of people with diabetes.

¢ One can create a diet chart with the help of a family member.

¢ Apps can be downloaded to track calorie intake and a family member can help

supervise the same.

¢ Foods with fats, cholesterol and sodium should be kept on the low end of daily value; while fibre, vitamins and minerals should be kept on the high end.

¢ One can take family members help in picking food, they may also help in counting calories at the grocery store.

35


¢ Keep an eye out for heart-healthy ingredients such as whole-wheat flour, soy and oats. Monounsaturated fats –such as olive, canola or peanut oils– promote heart health, too.

¢ Pay attention to serving sizes. The serving sizes listed on food labels may be different from the serving sizes in ones meal plan. If one eat twice the serving size listed on the label, one should also double the calories, fat, carbohydrates, protein, sodium and the other ingredients.

¢ Just as food labels can help one avoid certain foods, food labels can also serve as a guide to free foods. A free food is one with:

– Fewer than 20 calories a serving

– Less than 5 grams of carbohydrates a serving

¢ Encourage and educate people with diabetes and family members about the same.

Use of food labels help one meet their healthy-eating goals.

36

ExpertOpinion

DNB (Internal Medicine),DM (Endocrinology)

Consultant Endocrinologist, Yashoda Hospital, Hyderabad, Telangana.

People with diabetes are generally at a greater risk to catch flu (influenza) as it can pose significant difficulties with diabetes management. Flu, and other viral infections, can lead to higher blood sugar levels and increase the risk of serious short-term complications. Flu is a viral infection which is easily caught through inhaling small droplets released when someone with the flu virus nearby coughs or sneezes.

Flu and Diabetes – A Devastating Combination

Introduction

Some over-the-counter flu medication is suitable for people with diabetes. For

instance, some flu medications contain non-steroidal anti-inflammatory drugs, such

as ibuprofen, which are not usually recommended for people with diabetes because

they may slightly increase the risk of heart problems and stroke. A number of flu

medications may contain a relatively high level of sugar which could present a certain

amount of increased difficulty with managing blood sugar levels. Lower sugar versions

should usually be available and pharmacist should be able to help one to pick an

appropriate medication.


A dangerous complication of the flu is pneumonia and people with diabetes are more

at risk of developing this complication than people without diabetes.

33How will flu affect my blood sugar?

Flu usually causes an increase in blood glucose levels. If (in most cases, when) one

get flu, it is important to check blood glucose levels more regularly than usual because the feelings of illness can mask symptoms of high or low blood sugar. For this reason, one could develop hypoglycaemia or hyperglycaemia without realising, both of which can be serious if not treated quickly enough. LOW HIGH

BLOOD SUGARLEVEL

Diabetes and flu medication

37

Family and flu management

¢ It is recommended that everyone in the family get vaccinated with flu shots.

¢ Restrict the access of small children in the family to the person with diabetes to prevent the

spread of flu.

¢ Family members can help in checking blood glucose levels.

¢ Family members can also keep an eye out for low sugar medications available to people with

diabetes.

¢ Family members can assist in medication management therefore aiding in quick recovery.

¢ It is encouraged that family members continuously help in maintaining food habits during flu.


¢ Recommend vaccination for both people with diabetes and their family members.

¢ The Centers for Disease Control (CDC) recommends that everyone with diabetes get a flu vaccination. There is a both a shot and a nasal spray available:

– ‘Flu shot’: An inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than6 months, including healthy people and people with chronic medical conditions. If a pregnant mother is vaccinated, the immunity will pass to the child!

– Nasal-spray flu vaccine: A vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “live attenuated influenza vaccine” or FluMist). LAIV (FluMist) is approved for use in healthy people 2-49 years of age who are not pregnant.

People with diabetes should get a flu vaccination as they are generally at a greater risk to catch flu.

Flu increases blood sugar levels and the risk of short-term complication in people with diabetes.

38

have to give up sweets entirely or resign oneself to a lifetime of bland food. With these

tips, one can still take pleasure from meals without feeling hungry or deprived.

Contributed by

MD (General Medicine),DNB (Endocrinology)

Consultant Endocrinologist, Medipulse Hospital, Jodhpur, Rajasthan.

Introduction

People with diabetes have nearly double the risk of heart disease and are at a greater risk of developing mental health disorders such as depression. But most cases of T2DM are preventable and some can even be reversed. Taking steps to prevent or control diabetes does not mean living in deprivation; it means eating a tasty, balanced diet that will also boost one energy and improve one’s mood. One does not

Tune Up Your Diet!

34T2DM is a lifestyle disease

T2DM is sometimes described as a 'lifestyle disease', because it is more common in

people who do not do enough physical activity, and who are overweight or obese. It is

strongly associated with high blood pressure, high cholesterol and an 'apple' body

shape, where excess weight is carried around the waist. T2DM often runs in families.

Dr. Tuhin Dubey

356 worst foods to avoid in for preventing diabetes

¢ Added sugars

¢ Refined grains

¢ Fried foods

¢ Trans fats (Margarine, fast food, processed baked foods)

¢ Red and processed meat

¢ Whole eggs

39

¢ ¢ Fatty fish Seeds: Chia seeds, flax seeds

¢ ¢ Garlic Leafy vegetables

¢ ¢ Nuts: Almonds, walnuts, pistachios, pecans and hazelnut Broccoli

Family and diet management in diabetes

Family members can help in several ways in the management of diabetes:

¢ Charting out diet plans: Family members can sit down with people with diabetes

and chart out diet plans which may help them eat better by understanding what

works best with them. Such diet plans can help the entire family eat better.

¢ Family members can help in grocery shopping, therefore look into food labels and

nutritional content aiding in making healthier food choices.

¢ Family members can help in counting calories to maintain the diet of persons with

diabetes. This can be achieved by sharing and tracking calorie counting apps and

diet charts.

¢ Apart from these, it is of essential importance to give emotional support to the

member of the family with diabetes.


36DEs

¢ Obesity and a sedentary lifestyle are the biggest diabetes risk factors that are controllable.

¢ People should watch their weight and exercise on a regular basis to help reverse prediabetes, and prevent the development of T2DM.

¢ Diet is important because it helps with weight loss. Some foods such as nuts in small amounts provide health benefits in blood sugar regulation.

¢ There is no single recommended diabetes prevention diet, but following a sound nutrition plan and maintaining a healthy weight are important steps in preventing the disease.

¢ Educating family members is important in managing diabetes. If possible, training plans with essential family members can be created to aid in better management of diabetes.

Eating foods that help keep blood sugar, insulin and inflammation under control can dramatically

reduce the risk of developing complications.

356 best foods for managing diabetes

40

Diabetes management not only includes medical therapy but also needs development

of a right attitude and behaviour, with support being provided at every level and not just

depend on healthcare professionals.

Contributed by

BSc

Dietitian and Certified Diabetes Educator,Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu.

Introduction

Diabetes is a complex chronic disease that places numerous demands on people. Diabetes can significantly affect persons

37 quality of life and have deleterious effects on overall health.People with diabetes often have difficulty in accepting their diagnosis and may be anxious about anticipated lifestyle changes, sudden realisation of ones vulnerability to poor quality of life, morbidity, mortality, dependency on family

38members, healthcare professionals etc.

Supporting Role of Family Members in Diabetes Care

Ms. S. Suganya

Family and its support

Being diagnosed and living with diabetes can affect in different ways. While

some may let the diagnosis of diabetes have very little impact on their day-to-

day lives, others may find that it has turned their lives upside down. Diabetes affects not only individuals, but their families as well.

Family members can:

¢ Play a supportive role

¢ Help take corrective steps

¢ Understand the feelings

¢ Reinforce small gains in behaviour

Management of diabetes places greater emphasis on targeting family members’. Family members need to have knowledge regarding diabetes management, strategies to alter family routines and optimal ways to cope with the emotional aspects. Educating

family members about diabetes-care needs can help ease this strain by explaining why these changes are necessary, how these changes can best be implemented, and where to find additional information, such as healthy recipes or exercise routines. Effective

family management can also reduce the strain that family members may experience when coping with altered lifestyles and disease progression. It is important to provide family members with information about the illness and possible treatment options, validate their experiences as providers of support, teach them various stress management skills, and help them plan for the future. Numerous studies have focused on the role of family functioning and its

39influence on diabetes management behaviour and metabolic control.

41

Social support can be defined as “an exchange of resources between two persons,

aimed at increasing the well-being of the receiver’’. Social support plays an important

role in the management of diabetes, as day-to-day management can be

overwhelming. Familial relatives, peers, friends, neighbours, colleagues, fellow person

with diabetes, or even pen friends, and social networking on the internet can provide 40social support.

How social support helps?

¢ Positive family environment has warmth and closeness, and can help in good metabolic

control with respect to :

– Reminding about treatment recommendations

– Family accompanying for check-ups

– Supporting dietary recommendations

– Helping financially

– Providing encouragement

¢ Negative family environment has conflict and criticism, leading to poor metabolic

control.

¢ Social support may offer coping strategies and structure in daily routines, enabling people with diabetes to cope with stressful

events, follow the treatment regimen in times of stress and reduce the likelihood of stress leading to poor health.

Positive support has been associated with improved medication, dietary and exercise adherence, decreased depression, smoking

cessation, good diabetes self-management and improved clinical outcomes.

Social support

Family and its barriers in management of diabetes

The behaviour of the family members can also be a potential barrier in diabetes management. The lifestyles changes required for diabetes management often conflicts with family routines. Self-management tasks may necessitate changing the types of food prepared and consumed in the home, time away from work for the family member to attend medical visits with the person, and reprioritisation of family finances, all which may affect family routines. In studies of adults with T2DM, participants have reported that family members’ nonsupportive behaviours were associated with being less adherent to one’s diabetes medication regimen and with

41having poorer glucose control.

Importantpoints for DEs

Family may require to redistribute responsibilities, modify daily routines and renegotiate family role due to diabetes.

¢ Encourage healthy eating

¢ Self-monitoring of blood glucose

¢ Advice for regular physician appointments

¢ Exercise together and stay active

¢ Attend the diabetes lecture programmes with family members

¢ 42 Always be positive

Support provided by family members play a major role in diabetes care. Positive support from family members has been associated

with improved medication, dietary and exercise adherence, decreased depression, smoking cessation,

good diabetes self-management and improved clinical outcomes in people with diabetes.

42

43

DEs guide and assist with day-to-day diabetes management, and are an essential member

of any healthcare team for people living with diabetes. They teach skills in areas such as

monitoring blood glucose levels, adjusting meal plans and physical activity, managing

medications and achieving overall personal health goals. Their specialised training makes 43them a truly invaluable resource.

A DE has the potential to expose multiple continuous glucose monitors (CGMs), various insulin pumps, “smart” pens, and numerous apps to person with diabetes as per their

44needs.

44Why should DEs consider these?

¢ As insulin dosing algorithms become more common place and CGM usage expands further, the DE will spend less time

explaining the complexities of insulin dosing and more time on making sure the system is set up properly.

¢ The same goes for people with insulin pump. With sensor-augmented pumps becoming the standard, education will become

more systems-oriented.

¢ DEs can help the people navigate the highs and lows of diabetes management.

DEs are on the front lines and therefore, have the positive ability to make modern changes in diabetes management. It is time that

DEs embrace technology for better outcomes in people diabetes.

Multiple Feathers on DEs Cap

DEs on the front lines of care

44

¢th th Dates: 26 –27 November, 2018

¢ Location: Dublin, Ireland

¢ Theme: Outlining the forefront research in the field of Diabetes and Endocrinology

Euro Endocrinology Conference 2018 will focus on the latest and exciting innovations in all

areas of Diabetes and Endocrinology research and aims in proclaim knowledge and share

new ideas amongst Endocrinologists, Diabetes expertise, Researchers, Professors,

Scientific communities, Counselors, Delegates, Students, Business professionals and

Executives. The Conference will have space for institutions and/or companies to present 45their services, products, innovations and research results.

In support of improving diabetes care, this activity has been planned and implemented by

Conference Series and Center for Education Development (CED). CED is jointly accredited by

the Accreditation Council for Pharmacy Education (ACPE), the Accreditation Council for

Continuing Medical Education (ACCME) and the American Nurses Credentialing Center 45(ANCC), to provide continuing education for the healthcare team.

45Important session/tracks during the conference

¢ Diabetes therapeutics and diagnostics

¢ Hormone dependent cancers

¢ Thyroid and adrenal disorders

¢ Pituitary and neuroendocrinology

¢ Osteoporosis and bone health

¢ Paediatric endocrinology

Conference Highlights

th13 European Diabetes and Endocrinology Congress

45

Tool: DiaBits

Predicting future glucose fluctuations using machine46learning and wearable sensors

DiaBits is a companion app for users of the Dexcom continuous glucose monitoring

system. The researchers of this tool developed a predictive algorithm to estimate future

glucose values based on fitness data in addition to insulin-glucose data.

¢ The accuracy of the algorithm was measured in an 8-week study in a children’s

hospital.

¢ Their goal was to predict future glucose fluctuations 60-minutes in advance with a

high degree of accuracy in people with diabetes .

¢ On average, +94% of the predictions were A+B regions [where A is Predicted values

with ±10% of the reference values and B is Predicted values beyond ±10% of the

reference value but will not lead to inappropriate treatment (medically acceptable

errors)].

People with diabetes can use the DiaBits app to:

¢ See their future glucose fluctuations 60-mins ahead of time

¢ Stay informed throughout the day on how they have been doing and how their glucose might fluctuate throughout the day

¢ Follow loved ones while respecting their privacy

Prediction technology can help people with diabetes better manage glucose fluctuations. This app is currently available of the App

store, yet to be released on Google Play.

46

Future Trend: Attention – A Better Needle-Free Blood Sugar Monitor is Here!

Self-testing is an essential yet crucial part while managing blood glucose levels on a daily basis.

Since the first self-monitoring tests came out in the 1970s, people with diabetes have had to prick their fingers multiple times a day to track their blood sugar. The accuracy also left a little to be desired. The FDA approved a version of day FreeStyle Libre flash glucose monitoring system that can be worn continuously for up to 14 days, and this version appears to offer improved accuracy as well.

¢ The FreeStyle Libre is the first wearable CGM device that does not require finger-stick calibration to provide accurate glucose

readings.

¢ This revolutionary device is first in diabetes management. It is significantly more affordable than others on the market, and

allows people with diabetes to obtain glucose values throughout the day and night without routine finger sticks.

¢ It can measure their glucose levels with a simple wave of a mobile reader above a small, round sensor worn on the back of the

upper arm.

¢ They will be alerted immediately if their glucose levels are too high or too low; at that point, they may require finger sticks to

make treatment decisions. Users can also observe how their glucose levels change throughout the day.

47New in trend – A blood-sugar-monitoring device that is virtually needle-free!

47

Diabetes Educator of the Month

Contributed by

Ms. Shefa Syed

BSc (Food and Nutrition);PG (Clinical Nutrition and Dietetics)

Health and Lifestyle Coach, Nurture Health Solutions.

Intervention by DE

The DE took a detailed history of the girl and noted that she feels different from her peers.

She is embarrassed to take insulin in front of them and so tends to miss her insulin or does

not take it on time and therefore her blood glucose levels are erratic and she has frequent

highs and lows in her sugar levels.

The DE advised her mother to visit the doctor regarding her erratic blood glucose levels and

to request the doctor to adjust her insulin does and timing according to her school schedule .

The DE took details about her family background and told her mother that she has to be more

like a friend to her daughter. She explained to her that the teenage years are a time of

physical, mental, and emotional growth. The changes happening in their bodies make

maintaining blood glucose control more challenging, teens are often expected to take more

responsibility for managing their diabetes. At the same time, the increasing demands of school/college, the possibility of holding a

job and wider social life make managing diabetes difficult or less important for them. She told her that teenagers respond well when

they are explained things with logical and scientific backup. So she should explain to her why managing diabetes is important and

that she should get her daughter often to a DE or counselor who can explain to her and help her overcome her challenges.

During the discussion, the mother said she has not visited a dietician/nutritionist.

The DE explained to her the importance of diet and exercise in keeping the blood glucose levels under control. The DE asked her to

visit a qualified dietician/nutritionist immediately.

A 13-year-old girl was diagnosed with TIDM at the age of 11. She coped well for a year until last year; she has been very secretive

about her highs and lows. Her peers and studies tend to stress her out and her mother can not seem to help her enough. Her mother

has come to visit a DE to understand how she can help her out at such a crucial age.

Following sections are contributedby Nurture Health Solutions

Nurture Health Solutions is a true health and well-being

company offering niche comprehensive health and

wellness solutions to corporates and individuals.

48

The DE counseled her daughter that T1DM is nothing to be afraid or shy of. It is indeed manageable if taken care of properly as per the

healthcare teams advice. She advised her that she should not hide it from her friends. True friends will not judge her. She should

proudly say that she is strong enough to take injections every day and manage her studies along with her health.

Also, she should always share her blood glucose reading with her mother as she plays an important role in improving her health. The

DE advised her to do yoga or meditation to de stress herself. She can also take up her favourite sport. She was also advised to

prepare for her exams well in advance to reduce chances of stress.

The DE convinced her to be in touch regularly and took her follow ups regularly. The girl and the mother visited the doctor too and soon her blood glucose levels were under control.

49

Query: I am 52 years old, and my daughter is 27 years old. She has been on the heavier side for

the past couple of years. She has been living with PCOS and has been refusing to take the necessary medications. I have been living with diabetes for more than 10 years, are there chances that my daughter, too, will have diabetes in the near future?

DE: PCOS is a known risk factor for T2DM. Most women with PCOS, particularly those with

obesity, do in fact have insulin resistance. Insulin resistance is a known key factor in the

development of T2DM. A positive family history of T2DM contributes to increasing the risk of

diabetes. She needs to start focusing on losing weight. Weight loss will bring down the insulin

resistance and will help to reduce risk of inheriting diabetes. A Healthy balanced diet with more

of complex carbohydrates, fibre, adequate protein and controlled fat intake is the key to weight loss along with a good exercise

regime. You can take her to a qualified dietician and get a customised diet chart. Encourage her to take up some form of exercise that

she will enjoy like walking or any sport, swimming etc. She needs to take the necessary medication regularly as prescribed to lower

her risk of future complications. It is also advisable to get an annual health check done to catch any derangement in blood glucose

levels early, to help her start the required treatment soon.

Query: My husband is 47 years old and has diabetes for the past 12 years and weighs 109 kilos. When initially diagnosed, he was

very determined to bring back his HbA1c levels to normal ranges, however, after few years of highs and lows, he gave up completely.

He does not eat anything healthy and drinks occasionally. We have also been spending a fair amount for medical expenses due to his

behaviour. Is there anything I can do to help him get better?

DE: Diabetes is a chronic condition and so adherence problems are common in people with

longstanding diabetes. His behaviour suggests that he is undergoing diabetes distress. High

levels of diabetes distress can lead to poor self-management and medication adherence. It is

always best to seek professional help from DE or mental health practitioner who is trained in

psychotherapy. Seeking professional help or counselling is one of the best treatments when it comes to adjust to major life changes.

You can help him by giving maximum emotional support. Be willing to listen to him and offer

words of support often. Offer healthy food options which should be had by the whole family.

Make exercise part of the family routine and be his exercise partner. Assist with blood glucose

testing and offer gentle reminders about taking medications on time. Identify the signs of

hypoglycaemia or hyperglycaemia. Try to understand from him, which aspect of management he finds difficult. Help him to check

his foot and skin for signs of complications, such as infections, cuts and ulcers. Accompany him to the healthcare provider and seek

help from a qualified counsellor. Always show confidence in him and do not taunt him for his failure in management, instead help him

set his priorities and be a part of the changes that he needs to make for a healthy lifestyle.

Frequently asked questions

Patients’ Corner

50

Query: My mother is 81-years-old and has multiple conditions like gastrointestinal disorders

with constipation, high uric acid, diabetes and vitamin D deficiency. Although she does try to take care of her diet and daily medications, her glucose levels reach high levels at times. She is frustrated with the number of medications she has to take, that sometimes she tends to not eat food because of that issue. How can I help her to manage her routine better?

DE: Diabetes is a chronic condition, and can cause distress in some, due to the stress of

managing it lifelong. This is normal, and you need to be empathetic towards her. Have a

discussion with her as to what part of the management is stressing her out. Get the help of the

entire family to help her deal with the situation. It is important that there is family support when it

comes to making changes in diet and positive lifestyle changes. Everyone in the family should follow a healthy routine and diet as

there is no specific diet for diabetes only. Diabetes just demands eating healthy foods and reducing junk and refined carbohydrate

which can be followed by the entire family to stay healthy. You can also be an exercise partner to your mother so that she enjoys her

exercise and is regular in it. Help her with reminders on phone apps or calendars, alarms, pillboxes etc to take her medication on

time. Another thing is to keep the medicines at a place where she will be reminded of taking it on time e.g., Keeping the morning

medicines at the breakfast table will help decrease forgetfulness. If you still feel she is feeling very low you must seek help from a

professional psychologist as emotional disturbance can cause her blood glucose levels to rise. Talk to her healthcare provider if

combination drugs can be given to reduce the no of pills. Take her to a DE who can emphasise the need for the right medication to

enjoy a better quality of life. You can get her involved with some diabetes support groups too.

Query: I live in a house where 3 out of 7 people live with diabetes. We try to maintain a good diet;

I slit and soak okra in a glass of water and make my family members drink the water, as I read it

is good to lower high blood glucose. However, my neighbour mentioned that this is just a myth

and not true. Can you clarify if I should continue with this routine, if not, please suggest

alternatives?

DE: Medical research on the effect of okra for diabetes management is still in the early stages.

Some studies have shown that Okra extract has a hypoglycaemic effect that helps decrease

blood glucose level. Its properties can be a useful remedy to manage diabetes mellitus. However, it is important to understand that okra is definitely not an insulin or medication

replacement. It may be worth trying alongside traditional treatment if your doctor agrees. One study showed that okra extract blocked the absorption of metformin which is a medicine to manage blood glucose levels. Therefore it is important to keep your doctor informed about any tweaks or additions to your diabetes treatment plan. There can be no replacement t for a healthy lifestyle with balanced diet and exercise in managing diabetes.

Query: My wife was recently diagnosed with T2DM; She has been extremely stressed due to the

new norms. She tends to feel that no one can possibly understand what she is going through at

the moment and she feels she will never be able to have a normal life again. She refuses to seek

support from anyone, and I am unable to handle this situation. What can I do to make her life

better?

DE: Feeling overwhelmed and burdened by the demands of diabetes management is normal. If

she is feeling overwhelmed, help her to make one change at a time. Meet a DE with her and get started with making smaller changes in diet like reducing junk food, eating more fruits and

51

vegetables and avoiding refined carbohydrates. These changes should be followed by the entire family as they are basically for

healthy living and not specifically only for diabetes. Emphasise that diabetes may be a chronic condition but she can enjoy a normal

life if her blood glucose levels are in the target range. So she just has to comply with the healthcare teams advice and be rest assured

to enjoy a good quality of life. Discuss the challenges with her. Talking it out can help a person gain perspective, identify specific

aspects of self-management that have become problematic, and make plans to address each aspect of the problem in a focused

way. Help her create a list of priorities for change, and address each separately, one at a time. Pick up one small change in diet or

exercise and start with it and gradually progress to make the next change. A slow pace of change enables the new behaviours to

become more easily incorporated into a person’s general lifestyle. Give her emotional support and be a part of these healthy lifestyle

changes. You can be her exercise partner so that she is regular in her exercise and enjoys it too. Assist her by giving gentle reminders

about taking medication on time, assist her with monitoring and encourage and praise her for the changes she makes. Family

support goes a long way for adherence to treatment. Never shy away from seeking professional help from a mental health

practitioner if needed.

Busting the myth: If one has diabetes, one can never eat sugar

Fact: Having diabetes does not mean one has to cut sugar out of their diet completely. Sugar is found naturally in fruits and dairy

products. It is the added sugar that needs to be cut down. Also, it is not only the sugar that matters, but overall consumption of

carbohydrates needs to be monitored. Balance is the key. Diet should be a balance between low glycaemic index carbohydrates,

good quality proteins and low fats. If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be

eaten by people with diabetes. A well-balanced diet with portion control customised by a qualified dietitian is necessary to enjoy

everything in moderation.

Get Active!

Physical activity for diabetes and heart disease

Exercising with diabetes complications and heart disease

It is a known fact that exercise is very important and has many benefits for people with diabetes. However, a comprehensive clinical assessment to

identify potentially harmful complications of diabetes, and determining the

fitness level of people with diabetes is needed before a suitable exercise

program can be prescribed. In the presence of diabetes complications,

exercise need not be stopped, in fact, it becomes more important, however, the

exercise regime needs to be structured keeping in mind the current fitness

level and existing complications and should be supervised by a qualified

healthcare practitioner.

52

High-intensity exercise, particularly if one is not used to it, can trigger a heart attack or

stroke, or may cause angina. Angina (chest pain) may be caused due to reduced blood flow

to the heart muscle (ischaemia) during an aerobic activity like treadmill walking than

during weight training. Lifting heavy weights can increase blood pressure.

Avoid: Very strenuous activity, lifting heavy weights or holding breath while lifting,

isometric exercises, exercise in extreme heat or cold condition may increase heart rate

and blood pressure and could lead to a cardiovascular issue.

Pick: Moderate activity such as walking, daily chores, gardening,

stretching. Opt for resistance training with light weights. When lifting,

exhale during the strenuous part. Exercise in a moderate climate.

National Diabetes Educator Program(NDEP) Best Practices

NDEP – National Diabetes Educator Program has been ongoing since 7 years. It has been developed with the

objective of creating DEs. A DE is a healthcare professional who is specialised and certified to teach people

with diabetes how to manage their condition. This program is under the auspices of the Indian Association of

Diabetes Educators (IADE) and Dr. Mohan’s Diabetes Education Academy (DMDEA), a unit of Dr. Mohan’s

Specialties Centre, and is promoted by USV.

The program is being conducted in 150 NDEP centres across India.

For more information, follow us on: https://www.facebook.com/NDEPCOURSE/

Join NDEP Facebook page to know more about it!

53

I have been part of the NDEP since 2011 with 10 trainees and later on, it increased to 15 trainees. NDEP offers state of the art diabetes education for healthcare professionals. The program can be highly recommended for all healthcare professionals who work in the field of diabetes. It helps the healthcare team to effectively meet the needs of people with diabetes or who

Contributed by

Dr. G. Vijay Kumar

MD

Medical Trust Hospital, Thiruvalla, Kerala.

54

are at risk of diabetes and their families. When trained teams provide diabetes care to society, it can bring a lot of changes and

motivation among people with diabetes for better diabetes management. Our centre is proud to announce our care delivery, and

follow up pattern will definitely help people with diabetes to achieve their targets and wellness. This program helps to up-skill

healthcare professionals to deliver diabetes care with high standard and delay or prevent future complication.

Eat Out, Be Wise!

Sindhi koki

Koki is a trademark Sindhi dish made of whole wheat flour, onions, sesame seeds and spices.

It is traditionally eaten at breakfast and is similar to paratha but there is a difference in the

method of preparation.

It is flavoursome and is served with yoghurt or raita. It is a winter food because of the warm

spices used in it.

Paneer bhapa

Paneer bhapa is Bengali styled steamed paneer. It is prepared with grated coconut, poppy

seeds and mustard seeds. It is a very healthy dish served with roti or paratha that makes it a

balanced meal.

South

Onion adai

This dish is commonly known as Vengaya adai in Tamilnadu. It is a type of Indian pancake or crepe made of mixed lentils (chana, toor, urad, masoor dal), rice, coconut and finely chopped onions mixed in the batter. It is a very healthy breakfast recipe that is served with chutney.

East

North

West

Dadpe pohe

A typical Maharashtrian breakfast or snack dish that is made of thin poha, vegetables and coconut . The unique feature of this dish is that no cooking is required for poha. Just make the

tempering and pour on uncooked poha!

The raw poha in dadpe pohe gets softened because of the moisture that is released by the

vegetables. One will not be able to tell the poha is uncooked; it absorbs the flavours so well.

55

Shopping Smart

56

Brown rice vs. White rice

Brown rice being unpolished, retains most of its fibre and nutrient content that is otherwise removed from refined, white or polished

rice. These nutrients include B vitamins, selenium, magnesium and phytonutrients. A cup of brown rice supplies about 14% of the

daily recommended value for fibre. This high fibre content helps lower blood sugar and cholesterol. White rice, on the other hand,

goes through polishing and refining which takes away its natural coating which is full of nutrition. The only thing that remains in

abundance in white rice is carbohydrate. Brown rice contains more vitamins and minerals as compared to white rice. While white

rice is easy to digest, it is low on nutrition and leads to an instant release of energy. Brown rice comparatively takes a longer time to

digest causing a slower release of energy. Also, brown rice makes you feel fuller throughout the day and hence is ideal for weight

watchers and those who have diabetes.

How to use?

Brown rice can be used as a substitute for white rice to make dosa, pulao or biryani.

Egg is a zero carbohydrate, high protein food which serves as a perfect snack for people with diabetes. It is an excellent source of

micronutrient choline which is critical for foetal brain development and memory enhancement. It can promote healthy hair because

of good sulphur containing amino acids and biotin. Egg yolk is a rich source of readily absorbable and usable iron. There is no need to

discard the yolk as numerous studies have demonstrated lack of relationship between egg intake and heart disease.

Superfood: Eggs/vaMs

57

Health benefits

¢ Various preparations can be made out of egg like omelet, poached egg , scrambled egg or simply boiled egg.

¢ One whole egg or two egg whites = 6 gram of protein.

Recommended dosage

How to consume?

¢ National Institute of Nutrition (NIN) recommends three whole eggs a week to meet the nutritional requirements.

Method

¢ In a bowl, mix together the corn, tomatoes, beans, parsley, cumin, paprika, chilli powder and jalapeño.

¢ Place the two tortillas down on a plate or cutting board. On one of the tortillas, add the kidney bean mixture and spread over the tortilla. Sprinkle the cottage cheese over the mixture. Cover with the other tortilla and press together.

¢ Take a pan and add oil to grease the pan.

¢ Place the quesadilla in the pan over medium high heat to cook until crispy, for about 3 minutes, and then flip.

¢ When crispy, remove from the pan and place it onto a plate. Cut into four equal pieces and garnish with the Greek yoghurt and some parsley.

Serves: 1

Ingredients Amounts

Tortillas, 8 inch 2 no

Freshly cooked corn 3 tbsp

Tomatoes diced 3 tbsp

Red kidney beans freshly cooked 3 tbsp

Jalapeno finely diced ½ no

Cumin ¼ tsp

Chilli powder ¼ tsp

Paprika ¼ tsp

Parsley finely chopped 1 tsp

Shredded cottage cheese ½ cup

Greek yoghurt 2 tbsp

Oil 2 tsp

*1 cup = 30 gm 1tsp = 5 gm

Recipe

Bean and corn quesadillas

58

Secret behind grandma’s recipe

Amla

¢ Amla, also called the Indian Gooseberry, has been associated with a number of health benefits and has been used in our houses

since ages.

¢ Amla has high vitamin C content and therefore is a powerful antioxidant.

¢ Studies suggest that Amla helps in decreasing both fasting and post prandial blood glucose levels and also has a lipid lowering

effect.

¢ Amla benefits in improving the quality of hair, nail, and skin and also has antiviral and antimicrobial properties.

How to consume?

¢ As a fruit itself or in the form of fresh amla juice or powder.

Dosage:

¢ Juice: 10 mL diluted in a glass of water on an empty stomach.

¢ 2–3 grams of amla powder with one glass of water.

59

References

1. World Diabetes Day 2018–19. Diabetes concerns every family. Available at: https://www.worlddiabetesday.org/about-wdd/wdd-

2018-19.html

2. Baig AA, Benitez A, Quinn MT, et al. “Family interventions to improve diabetes outcomes for adults.” Ann N Y Acad Sci.

2015;1353:89–112.

3. Juárez-Ramírez C, Théodore FL, Villalobos A, et al. Social support of patients with type 2 diabetes in marginalized contexts in

mexico and its relation to compliance with treatment: a sociocultural approach. PLoS ONE. 2015;10(11):e0141766.

4. Appendix B, family history is important for your health. Genetic alliance; The New York-Mid-Atlantic Consortium for Genetic and

Newborn Screening Services. Understanding Genetics: A New York, Mid-Atlantic Guide for Patients and Health Professionals.

Washington (DC): Genetic Alliance; 2009. Available at: https://www.ncbi.nlm.nih.gov/books/NBK115560/

5. WebMD. Diabetes warning signs. Available at: https://www.webmd.com/diabetes/ diabetes-warning-signs#1

6. Neithercott T. Healthy eating for the whole family. 2010. Available at: http://www.diabetesforecast.org/2010/nov/healthy-eating-

for-the-whole-family.html

7. Lahiri SA. The family that eats together stays together. 2016. Available at: https://www.linkedin.com/pulse/family-eats-together-

stays-shankar-achintya-lahiri

8. Larson N, Fulkerson J, Story M, et al. Shared meals among young adults are associated with better diet quality and predicted by

family meal patterns during adolescence. Public Health Nutrition. 2013;16(5):883–893.

9. Shrivastava SR, Shrivastava PS, and Ramasamy. “Role of self-care in management of diabetes mellitus.” J Diabetes Metab Disord.

2013;12:14

10. Juárez-Ramírez C, Théodore FL, Villalobos A, et al. Social support of patients with type 2 diabetes in marginalized contexts in

mexico and its relation to compliance with treatment: a sociocultural approach. PLoS ONE. 2015;10(11):e0141766.

11. Finnish Diabetes Association. Type 2 diabetes risk assessment form. Available at: https://www.diabetes.fi/files/502/

eRiskitestilomake.pdf

12. Gelman L. 10 Silent symptoms of diabetes you might be missing. Available at: https://www.rd.com/health/conditions/signs-

diabetes/

13. Orenstein BW. 6 Reasons 10,000 Steps a day helps type 2 diabetes. Available at: https://www.everydayhealth.com/hs/type-2-

diabetes-care/10k-steps/

14. El-Miedany Y. Telehealth and telemedicine: how the digital era is changing standard health care. Dove Press. 2017;4:43–51.

15. U.S. Food and drug administration. mobile medical applications. Available at: https://www.fda.gov/medicaldevices/digitalhealth/

mobilemedicalapplications/default.htm

16. Diabetes management. Health communities. Available at: http://www.healthcommunities.com/diabetes-management/insulin-

drug-interactions.shtml.

17. Diabetes medication mistakes to avoid. Everyday health. Available at: https://www.everydayhealth.com/hs/better-type-2-diabetes-

control/avoid-medication-mistakes/.

18. American Diabetes Association. Health insurance. Available at: http://www.diabetes.org/living-with-diabetes/health-insurance/

60

19. Policy bazaar. Health insurance for Diabetics. Available at: https://www.policybazaar.com/health-insurance/critical-illness-

insurance/articles/health-insurance-for-diabetics/

20. Yesudian CAK, Grepstad M, Visintin E, et al. “The economic burden of diabetes in India: A review of the literature.” Globalization and

Health. 2014;10:80.

21. Screening for type 2 diabetes. Report of a world health organization and international diabetes federation meeting. Available at:

World Health Organization. http://www.who.int/iris/handle/10665/68614

22. Cavan D. Why screen for type 2 diabetes? Diabetes Voice. 2016;62(4):13–17.

23. Screening for Diabetes. American Diabetes Association. Diabetes Care . 2002;25(suppl 1):s21–s24.

24. Geer KK. Is stress the source of your blood sugar swing? Available at: https://www.everydayhealth.com/hs/type-2-diabetes-

management/stress-blood-sugar-swing/

25. Hodginson K. Communication skills for nurses. Available at: https://www.ausmed.com/articles/communication-skills-for-nurses/

26. Diabetes and family. The global diabetes community. Available at: https://www.diabetes.co.uk/Diabetes-and-the-family.html

27. Solowiejczyk J. The family approach to diabetes management: Theory into practice toward the development of a new paradigm.

Diabetes spectrum. 2004;17(1):31–36.

28. Miller TA, DiMatteo MR. Importance of family/social support and impact on adherence to diabetic therapy. Diabetes, metabolic

syndrome and obesity: targets and therapy. 2013;6:421–426.

29. Rebecca K. A blood sugar monitoring: when to check and why. Available at: https://www.diabetesselfmanagement.com/managing-

diabetes/blood-glucose-management/blood-glucose-monitoring-when-to-check-and-why/

30. Diabetes type 1 and type 2 and adult vaccination. Available at: https://www.cdc.gov/vaccines/adults/rec-vac/health-

conditions/diabetes.html

31. Diabetes and vaccines. Increasing vaccine use in people with diabetes. Available at: https://www.diabeteseducator.org/practice/

educator-tools/vaccine-resources?utm_source=Internal&utm_medium=MAST&utm_campaign=Vaccines

32. Reading food labels: tips if you have diabetes. Available at: https://www.mayoclinic.org/diseases-conditions/diabetes/in-

depth/food-labels/art-20047648.

33. Flu and Diabetes. Living with diabetes; the global diabetes community. Available at: https://www.diabetes.co.uk/flu-and-

diabetes.html.

34. Diabetes type 2. Better health channel. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/

diabetes-type-2.

35. Best and worst foods for diabetics. Food revolution network. Available at: https://foodrevolution.org/blog/how-to-eat-to-prevent-

diabetes/

36. Type 2 diabetes prevention tips and facts. Preventing diabetes naturally. Available at: https://www.medicinenet.com/

diabetes_prevention/article.htm#type_2_diabetes_prevention_tips_and_facts.

37. International Diabetes Federation. Diabetes Education Modules 2011

38. Penckofer S, Ferrans CE, Velsor-Friedrich B. The psychological impact of living with diabetes: women's day-to-day experiences.

Diabetes Educ. 2007;33(4):680–90.

61

39. Tubiana-Rufi N, Moret L, Czernichow P, et al. The association of poor adherence and acute metabolic disorders with low levels of

cohesion and adaptability with diabetic children. Acta Paediatr. 1998;87:741–746.

40. Kadirvelu A, Sadasivan S, Ng SH. Social support in type 2 diabetes care : A case of too little, too late. Diabetes Metab Syndr.

2012;5:407–17.

41. Mayberry LS, Rothman RL, Osborn C ‘Family members' obstructive behaviors appear to be more harmful among adults with type 2

diabetes and limited health literacy.’J Health Commun. 2014;19 Suppl 2:132–43.

42. Wen LK, Shepherd MD, Parcman ML. Family support, diet and exercise among type 2 diabetes. The Diabetes Educator.2004;

30(6):980–93.

43. Diabetes educators: on the frontline of care. Diabetes Current October. Available at: https://www.diabetes.ca/publications-

newsletters/diabetes-current-newsletter/diabetes-current-archive/diabetes-current-october-2015/news/diabetes-educators-on-

the-frontline-of-care

44. Fliff D. Diabetes Educators on the Front Lines of Care. Available at: http://www.diabetesincontrol.com/diabetes-educators-on-the-

front-lines-of-care/

th45. 13 European Diabetes and Endocrinology Congress. Available at: https://europe.endocrineconferences.com/

46. DiaBits. What's your glucose telling you? Available at: https://www.diabits.com/

47. Readers digest. Attention, Diabetics: A Better Needle-Free Blood Sugar Monitor Is Here. Available at: https://www.rd.com/health/

better-needle-free-blood-sugar-monitor-for-diabetes-is-here/

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