Diabetes: Monitoring & Management Made Easy

Diabetes is a condition, where you are unable to control your sugar levels because either your pancreas is unable to produce enough insulin or your body is resistant to the produced insulin.

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GLUCOSE METABOLISM

When the food is ingested, it undergoes digestion and breaks down into glucose in the intestine. These glucose molecules enter the cells through the bloodstream to yield energy (ATP). The excess glucose is stored in the liver and the muscles in the form of glycogen. The stored glycogen can be converted back into glucose whenever the demand arises.

ROLE OF PANCREAS IN MAINTAINING NORMAL BLOOD GLUCOSE LEVELS

Pancreas have clusters of cells called islets of langerhans which contain 2 types of hormone producing cells called alpha and beta cells. The alpha cells produce glucagon whereas the beta cells produce the insulin. Glucagon is the hormone which stimulates the conversion of glycogen into glucose. On the other hand insulin has a reverse effect and promotes glucose uptake. In order to maintain normal blood glucose level, the production of these hormones is always in accordance with present glucose concentration in the blood. For eg: when your blood glucose level is high, the insulin production is high, whereas when blood glucose levels are low, glucagon production is high.

WHAT HAPPENS IF YOU HAVE ABNORMAL GLUCOSE LEVELS

The condition of having blood glucose level below the normal range is referred to as HYPOG

LYCEMIA. Skipping of meals, being abnormally physically active, impaired thyroid or kidney functioning can lead to hypoglycemia. Patients with hypoglycemia can experience shakiness, sweating, slurred speech or memory complaints. While an increased level of glucose above the normal range is referred to as HYPERGLYCEMIA. Existence of hyperglycemia over a prolonged period can lead to diabetes. Diabetes is a condition, where you are unable to control your sugar levels because either your pancreas is unable to produce enough insulin or your body is resistant to the produced insulin.

THE THREE Ps

When you have high blood glucose levels, your body works to eliminate the excess glucose from your bloodstream. While the kidney begins the blood filtration, it eliminates the glucose through urine, resulting in excess urine formation. This results in frequent urination also called polyurea. Frequent urination leads to loss of water and dehydration, also known as polydipsia. During this entire process the glucose molecules remain in the bloodstream and get eliminated through urine, and do not enter the cells, where they are supposed to convert into ATP molecules. As a result the cells are deprived of glucose and therefore utilise the fat and protein sources to produce energy. In such cases, the diabetic patients can observe weight loss, muscle loss, weakness and increased appetite called polyphagia. Unfortunately high blood sugar levels are sometimes asymptomatic but still there is a need for early diagnosis and ascertain the class of diabetes. This will help you get your correct treatment started and avoid further complications.

TYPE 1 DIABETES

Type 1 diabetes is also known as juvenile diabetes or insulin dependent diabetes. It is usually seen in children, teenagers and rarely in young adults. In type 1 diabetes, the patient does not produce insulin. This is the result of an autoimmune response, where the immune system mistakenly attacks the beta cells of pancreas, hindering them to produce insulin. The treatment encompasses introduction of insulin through injection or pump.

TYPE 2 DIABETES

Type 2 diabetes is also known as maturity onset or non insulin dependent diabetes. This is the most common type of diabetes and can be triggered by obesity or sedentary lifestyle. In type 2 diabetes, the body is unable to produce enough insulin to control the blood sugar levels, and can be associated with insulin resistance too.

GESTATIONAL DIABETES

This is a class of diabetes that appears during the pregnancy. Though the cause of gestational diabetes is not very clear, experts state that the hormones produced by the placenta of a pregnant woman inhibit the insulin action. This causes temporary insulin resistance and lasts till the baby is born. During the pregnancy, the patient is unable to convert glucose into energy and considerable rise of glucose level is observed in the bloodstream. This is how a pregnant woman is diagnosed with gestational diabetes.

Diabetes has no specific cause and can be caused by a combination of environmental and inherited factors. Several factors like, hormonal imbalance, genes, obesity, shape of your body, sedentary lifestyle can lead to diabetes.

MONITORING DIABETES

• Home Devices: Using glucometers at home is the most sophisticated way to keep a check on your glucose levels ( RBS /FBS/PP). Monitoring your glucose levels everyday also helps you to modify your dietary habits and eating patterns. For better management and accurate values consult your doctor for timings and frequency at which you should test.
• HbA1c: Unlike the home monitoring, HbA1c is conducted in a lab under the supervision of a health professional. The test is advised to be carried out once in three or 6 months to evaluate the average glucose levels of the past few weeks. The result is represented in percentage, considering 6–7 as normal.
• CGM Sensors: These are the advanced wearable glucose monitoring devices which give the data of every five minutes of reading. With continuous glucose monitoring devices, you can understand the impact of your diet, physical activity, medication or any other influencers on your blood sugar level. By connecting the device to your smartphone, you can read the patterns of glucose highs and lows and get access to better diabetes management.

DIETARY MODIFICATION WITH DIABETES

• Carbohydrates

There is never a need for a complete NO to carbohydrates. Including carbohydrates and sugars in moderation while you are on medication is completely fine. To maintain your calorie balance, you can include moderate levels of workout or simple exercises in your daily regime. Along with the portion control, planning your meal frequency and timing is equally important. Consulting your dietician for a customized diet plan is the first step for diabetes management. Ask your dietician about the carbohydrate foods with low glycemic index, complex carbohydrates and fruits you are allowed to eat. Though most of the fruits have simple sugars, they are equally a good source of fiber and a wide range of vitamins.

• Fibre

Deposition of fat in your abdominal region can make you more susceptible to diabetes. People who are obese and are observing mild symptoms of diabetes, should try to draw their body weight under normal BMI. Fibre is the best option to lower your LDL levels and enhance your metabolism. Planning your meals with whole grains can be helpful.

• Proteins

As you are about to cut down your carbohydrate sources than your usual intake, your body needs a perfect substitute for energy. Taking proteins in moderation can help you meet your daily energy demand and maintain your muscle weight. A combination of plant and animal protein is a healthy choice but cutting down red meat will be helpful.

• Fat

Choose your fat sources wisely. Maintaining a good LDL to HDL ratio is important. Excess fat intake can result in fat depositions. Stored fat can be converted to glucose through lipolysis and shoot up your glucose levels again. Monitoring your lipid profile as per your doctor’s advice will help you modify your diet accordingly.

• Liquids & Alcohol

Fruit juices, lemonades or other sugar drinks are easily digested and should be avoided or sparingly used. These simple sugar recipes can be replaced with sugar free drinks using skimmed milk . Alcohol contains simple sugars and it is therefore advisable to keep your alcohol consumption to the recommended limits.

SELF MOTIVATION

• Diet Diary

Maintain a diet diary to keep a check on your food choices, meal frequencies and portion size. This will help you understand your present diet pattern and modify it accordingly. You can also share your diet diary with your doctor/ dietician and get advice to manage your glucose levels more effectively. Regular monitoring of your diet plan can make you more proficient in understanding which foods are to be avoided and what serving size will help you maintain your calorie balance. Several diabetic patients find maintaining a diet record helpful and encouraging as this regular habit ensures desired results.

• FITNESS TARGETS

Talk to your health professional and set your fitness targets. These include body weight, BMR, WHR, calorie burnt, etc. Setting up fitness targets is more motivating than fixing your target HbA1c, RBS, FBS, or PP levels. In order to make your fitness journey more interesting, you can pair up with a partner in your workout place and talk to them about your fitness goals and plans. Remember physical fitness is just not a channel to fight diabetes but is required to all for heart endurance, healthy muscles and strong bones.

• SMART SHOPPING

Before you begin to shop for your groceries, discard all the high calorie or unhealthy food items from your refrigerator. Keeping in mind, the dietary guidelines pick your items wisely before you add them into your cart. Accompany yourself with someone who is health conscious and makes healthy food choices.

[NOTE: Dear Reader, if you are a family member of a diabetic patient, this note is for you. The dietary guidelines of diabetes are substantially similar to a healthy diet. This is why I encourage even you to follow healthy eating and lifestyle practices and avoid categorizing your diabetic family member. Your support and motivation would be the first thing they would ever need to fight diabetes !!]

REFERENCES

Walker, R. A., & Rodgers, J. (2010). Diabetes: A practical guide to managing your health. London: Dorling Kindersley.

Gestational diabetes: What to expect(5th ed.). (2005). Alexandria, VA: American Diabetes Association.