Popular misconceptions about Diabetes

• Diabetes is caused by eating lots of sweets ( Diabetes is not caused by eating lots of sweets - the actual cause of diabetes is the loss of control by the body on the levels of digested sugars- Carbohydrates; a patient cannot be blamed for having pushed himself/ herself into being Diabetic just by eating some chocolates or sweets.) Also see- Diabetes more than just Blood Sugar....
• Honey & Jaggery do not increase blood sugar (Honey, jaggery, - Shakkar, demerara sugar, all are high calory sweeteners and steeply increase blood sugar, While sugar- sucrose- is highly refined , these are forms of sugars with other compounds which give them a specific flavour except sweetness, but nevertheless they have same effect on blood sugar-thus their intake has to be controlled)
• Diabetics should not eat any fruits at all (On the contrary Diabetics should eat more fruits yes they have to be choosey about which ones to eat, but fruits are very essential in a diabetic diet. fruits provide both soluble and non-soluble fibres many of them are virtually zero calory- like watermelons, melons, citrus varieties, pears, peach, apricots etc. but avoid very sweet and fleshy ones like banana, mango )
• Aspirin is harmful for Diabetics (Aspirin is not harmful at all for diabetics and infact it may be as essential part of the prescription of patients with CAD, hypertension or CVD's)
• Rise in blood sugar levels for few days is negligible ( Complications of Diabetes occur because of long term damage to tissues and blood vessels , not because of few days- so blood sugar has to be consistently controlled so as to avoid continuing damage )
• Herbal products like Karela and Neem are panacea (They can be harmful also- such as toxicity to kidneys from neem seeds, not all parts of the same plants have same properties, the plants may themselves be contaminated because of atmospheric, soil and underground water contamination).
• One should not start Diabetes medication because if once it is started you cannot stop it ( What's important is not that one is taking some tablets or not, after all we can easily take upto 250 gms of food at a time ( which we usually do )1/2 a gm or even 1 gm does not make any difference- What really counts is that the dreadful complications of Diabetes should be avoided at all costs )
• Once the Blood Sugar level is controlled Medication can be discontinued (The insulin making capacity in Diabetics is steadily declining- so without any efforts blood sugar level is not going to get controlled, it is only getting controlled due to the effect of the medicine, exercise or diet control; Diabetes melitus type 2- is not treated ( atleast as of yet) it is only managed; so if one discontinues the efforts the blood sugar level may again shoot up )

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Testing Blood Sugar (SMBG- Self monitoring of Blood Glucose)

Why?

Checking Blood Sugar at home or office with glucometer is very important as it gives you a fair idea of the

1. Status of diabetes control – wether your efforts are showing results or not
2. The way your body responds to different foods- you can see for yourself how your Blood glucose shoots up after having bread, while it remains controlled even after having sweet fruits.
3. Guide you to take action! Serves as a wake up call- if you’ve been irregular with medicines, exercise or diet!!
4. In case of very high sugar levels- reaching hospital in time or starting insulin makes a great difference to treatment and its outcomes.
5. It keeps you in touch with Diabetes- every time you check your Blood Glucose you are reminded about Diabetes , and your responsibilities about managing it and preventing complications..

When to check Blood Glucose?

¨      Fasting- in the morning before you have taken your meals/ tea, coffee or breakfast- levels should be less than approx. 120 mg/dl

¨      2 hrs after Breakfast – levels should be less than 140 mg/dl

¨      important to check before meals and 2 hrs after meals ( Lunch and dinner as well), helpful in judging how different foods or their combinations affect your glucose levels.

¨      Afternoon 4-5 p.m before tea – to assess post lunch control

¨      3:00 am in the morning – if you’ve been having too high unexplained fasting levels or episodes of hypoglycemia early mornings.

Doing all the above tests is called 360 degree Blood Glucose monitoring.

Atleast once a day – (fasting or 2 hrs post breakfast or meals) is very important and should not be missed.

How to check?

¨      Prick the side or the tip of finger (any finger), even though index and middle fingers are easily accessible- Most of the glucometers come with a lancing device which make it  easy to prick with minimum pain.

¨      Once you see a drop of blood sufficient enough to ‘fuel’ your glucometer- insert the strip, wait for the drop sign (almost ubiquitous in all glucometers).

¨      After you see the ‘drop’ or ready sign on the glucometer display press the drop of blood to the placed marked on the strip- it can be on the side, tip or centre of the strip depending on the model.

¨      After few seconds you can see your blood Glucose value on the Display.

¨      ( See the manufacturers instruction manual for more specific details)

Important points to remember

¨      If your strips are coded- make sure that the code on the box is same as that of the coding chip inserted in the meter- or the current code of the meter.

¨      If you have wiped your fingers with spirit or alcohol based wipes or cotton, let it dry as it may affect the glucose values shown by the meter.

¨      Do not leave the strips in an open box- close the box and keep it in dry places- away from humidity.

Some tips about checking Blood Sugar

¨      Don’t prick the same finger in the same area- keep on changing the places for pricks- this prevents the pain or infection which may happen if the same finger is needled all the time.

¨      If you use alcohol swabs to wipe the skin before pricks let it dry completely as alcohol itself is a reducing agent and may affect the values shown by the strip.

¨      When the oozing droplet is not sufficient increase the number on the dial of the lancing pen – or if you are pricking the finger manually, prick deeper - alternately change the place of pricks,

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Zero calory foods

Carbohydrate and calorie content of these vegetables are negligible and they may be used in any quantity. ( But watch out for visible and added fats like oil , ghee, butter or cream added during preparation of these items)

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More than 40% of Diabetics get some problems related to the feet during their lifetime. Due to loss of nerves the feet do not sense minor traumas like cuts and abrasions. Autonomic neuropathy causes increased blood flow to the bones of feet, which flushes away calcium and other minerals from bones making them weak and easily prone to fractures even with insignificant traumas or casual walking.

Decreased Blood flow due to Peripheral arterial Disease, results in lesser blood supply leading to poor healing and infection of the wound.

As the infection spreads – it may become life threatening inorder to save the life of the patient the infected portion may have to be amputated- toes, part of the feet or even a leg.

But these drastic complications are avoidable to a great extent.

 SAVING THE DIABETIC FOOT: 

1. Keep good control of Blood Sugar
2. Wear good comfortable footwear
   1. It should be wide and long enough to comfortably accommodate the foot without causing excessive pressure on any parts.
3. Never walk bare foot, always be in slip-ons even at home
4. Wash and inspect your feet daily before going to bed – If you notice any of the following see your doctor immediately or take the necessary action (like properly cutting nails).
5. 1. Look for CRACKED HEELS, TOES or SIDES
   2. CALLUSES on heels, toes or sides of soles
   3. CUTS, SCRATCHES on soles, heels or sides
   4. INGROWING TOENAILS
   5. Fungal infections ( Athletes Foot)
6. If you ever notice redness of any part of the foot immediately do an Xray- consult a doctor to avoid missing a Charcot foot or a fracture.
7. If you ever develop an ulcer or a wound you MUST WEAR PROPER MODIFIED FOOTWEAR so that the affected area does not bear any weight and is offloaded.

Look for CRACKED HEELS, TOES or SIDES
CALLUSES on heels, toes or sides of soles
INGROWING TOENAILS
Fungal infections ( Athletes Foot)
Fungal infections of toenails
Foot deformities leading to ulcers
Charcot Foot deformity

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