By Mian A. Majeed, MD
Diabetes mellitus is a chronic disease. There is no cure for it. However, it is one of the few chronic diseases where good management can minimize complications and improve general health. Diabetes affects every cell of your body and decreases your immune response. It also increases atherosclerosis, leading to many complications in various organs.
As we overviewed in last month’s column, diabetes is essentially a mismatch of insulin and glucose utilization. It starts insidiously without many symptoms. Initial symptoms include excessive thirst (polydipsia), increased urination (polyuria), easy fatigability and tiredness, unintended weight changes (gain or loss), slow healing sores, and blurred vision.
Early detection is key in managing diabetes. You can take control by performing a self-diagnosis using an over-the-counter meter, which requires no prescription. You can purchase meters and strips fairly inexpensively at a pharmacy. Test your glucose levels in the morning before eating. A fasting glucose level over 130 indicates early diabetes. Check it again in 1-2 days, and if your fasting glucose remains higher than 130, it’s likely you have developed early diabetes. You should see your doctor for further testing. Factors that can influence early diabetes include being overweight, family history, uncontrolled hypertension, high cholesterol levels, fast food consumption, and excessive stress.
Remember, the treatment of diabetes is lifelong. It includes dietary changes, lifestyle changes, and maybe some medications. These changes can improve your quality of life and decrease complications and morbidity.
Meal planning is a key part of managing diabetes. Home-prepared meals are better and cheaper than commercially-prepared meals. You have a fairly good idea of the food contents. Limit the quantity of high glycemic index foods and ultra-processed foods (refer to Nutrition article for details). Divide your meals, usually 1/3 carbohydrates, 1/3 protein, 1/3 low-sugar fruits, vegetables, and fats. The usual recommendations are three major meals with two snacks… one mid-morning and one mid-afternoon. You can also make your own meal planning based on your work and lifestyle. Meals should be evenly distributed (calories and nutrition). Avoid having a very heavy meal. There are many diabetic cookbooks and information on the internet, including recipes available for different ethnicities (Indian, Russian, Middle Eastern, etc). This flexibility allows you to adapt your diet to your life, not the other way around.
Lifestyle changes. This relates to many different items. We will cover some of these here. Sleep is important: 6-8 hours of uninterrupted sleep. Based on your work schedule, it can be any time but usually the same pattern so that your circadian cycle can adjust to it. Activity and exercise: 15-20 minutes of exercise, 5-6 days a week (brisk walking, stretching, resistance band exercise, yoga, etc. – a routine that gets your heart rate above 100 for a few minutes, mild shortness of breath means you are doing a decent amount of exercise). Initially, this may happen within a few minutes of starting the exercise. Slow down but continue to exercise for at least 15 minutes. In a few weeks, you will be able to do this easily without getting tired.
If, during exercise, you develop palpitations (fast or slow heart rate, irregular heart rate), chest pain, or unusually excessive shortness of breath, stop immediately. Call your doctor or 911 immediately. Do not restart your exercise until your doctor has advised you. These symptoms could be heart- or lung-related.
General activities like walking and stretching for 5-10 minutes every 2-4 hours are also very helpful. Stretching exercises, light toe touching, stairclimbing, and walking are important for helping the lower back and leg muscles. For example, these muscles usually get stiff by sitting in a car all day.
Medications. Glycemic control is a very complex mechanism, it involves many organs and different pathways. For this reason, there are multiple medications working on different parts of the glucose control mechanism pathways. Sometimes, these medications are combined to better control diabetes. Some medications are also added to prevent diabetic complications (ACE inhibitors for microvessel protection, statins to control cholesterol, etc). Getting to the details of different medicines to control diabetes is beyond the scope of this article; it is a topic for a different conversation. Your physician has adequate knowledge regarding this and would be able to prescribe the appropriate medications.
General considerations.
- Take all your medications as prescribed. Keep a current list of all medications that you are taking. Update this list whenever any medication changes; otherwise, do it every six months.
- Abnormal blood sugar levels are not healthy, especially low blood sugar. If your blood sugar is very low, you most likely will pass out. If blood sugar is below the normal range, you may not pass out, but your response time to acute events may significantly decrease (e.g., similar to when you are half drunk), making you prone to causing an accident. If you do not feel right, pull over to a safe place and check your glucose level with a glucose meter. Different people have different symptoms related to low blood sugar (hypoglycemia). If your sugar is low, take a small amount of liquid sugar (honey, regular soda, diabetic gel for low glucose, orange juice, or any other juice). Do not take hard candy; it is slow to resolve and may cause choking. Low blood sugar is caused by skipping meals or having meals without any carbohydrates, or erratic eating. Certain antidiabetic medications may also make you prone to hypoglycemia. High blood sugar causes a lot of complications (heart attack, stroke, peripheral vascular disease leading to amputations, recurrent and slow-healing infections, etc.).
- Avoid significant day-to-day changes in food and exercise. This may lead to poor diabetic control, causing sudden low or high sugar.
- Check your blood sugar before exercise, and again 10-15 minutes after exercise. This will give you the correlation between exercise and glucose consumption.
- Keep an emergency information card in your wallet. Make a photocopy of your insurance card or driver’s license (preferably). Cut it to the size of a credit card. On the blank side of the photocopy, write the names and phone numbers of emergency contacts, pharmacy names, and telephone numbers, or any other pertinent information. Healthcare providers (paramedics, physicians, nurses) can access the pharmacy and get a list of your medications. This will also give them information regarding your allergies and illnesses.
The most important factors for good diabetic control are appropriate food, exercise, keeping near normal weight (BMI <25, waist < 40), consistent schedule (preferably), and reduced stress.
Your doctor may also do blood tests every 3-6 months to check your diabetic control.
Your goal regarding diabetic control is to keep:
- Hemoglobin A1c 7.0-7.5 range. Avoid 6.5 or less, as this might put you at high risk for hypoglycemia.
- LDL less than 100. HDL above 40, Triglycerides <150.
- Urine microalbumin negative yearly.
- Blood pressure of 135/80 or less.
Reliable websites for diabetic information include diabetes.org, fda.gov, and joslin.org.
Next month, we will discuss the cost of staying healthy.
Mian Majeed, MD has been practicing medicine for over 40 years and is licensed in NY. He also speaks Urdu/Hindi & Punjabi. You can email him at info@click2md.healthcare
