Lifestyle changes for diabetics: Dr. Jagruti Shah

crop3_240x240_12nov14Dr. Jagruti Shah has an exclusive practice of Diabetology and has more than 22 years experience of treating more than 10,000 persons with diabetes. She has popularized the concept of Preventive Diabetology through various seminars, workshops for Pharma companies, doctors, and diabetics in India.

She is the founder of Diabetes welfare Trust ( DOSTI), recognized as one of the biggest continuous Diabetes educational activities free of cost in India .

Dr. Shah answered Sify readers’ queries related to the above in an exclusive chat. Read the transcript below.

What is your say on fasting which is very common in India? Is it harmful?
Fasting is not recommended especially for diabetic patients as it can push the patient into dangerous hypoglycemia.

Does one never gets diabetes or any other health complications if one maintains a slim waist?

What if one does not have time to exercise, and I do have a sedentary lifestyle, then how can I avoid diabetes Dr.Jagruti Madam?
If you are overweight then reduce your food consumption atleast by 10 percent, reduce all your food portions by overall atleast 30 percent p/day. Even if you are not overweight, reduce it to 30 percent and replace it with fibre and nutritious portions including fruits, salads etc. Minimum 45 mins of brisk walking is suggested.

And what do advise on the use of artificial sweeteners? I do use them sometimes when I travel.
Artificial sweeteners if used in moderation should not be harmful to diabetic patients . However it has been shown with various studies that some artificial sweeteners leading to complications of eyes and nervous systems and hence it is advisable to minimize the use of artificial sweeteners.

Please give some advise on the daily care of foot for normal people.
Keep your feet clean, nails should be trimmed, use a moisturizer on feet, check your feet daily before bath and check for infections.

What is right schedule of eating in terms to time and portions of food for diabetics?
For a better glycaemic control I recommend that the patient should have small frequent food portions that is:- Early morning tea with biscuits-Marie around 7am Light Breakfast around 9 am Small portion food- soup/ fruit/salad at 11 am Lunch 1 pm Fruit/ evening with light snacks like roasted kurmura- 4 pm Soup or salad-7pm Dinner-9pm A cup of milk or fruit -Bedtime

Are there any symptoms attached to diabetes complications?
Diabetic patients can have complications involving various systems like eyes, heart, kidneys, legs, skin and joints, so the patients can have symptoms involving any of these systems involvement.

And what about alcohol intake for diabetics?
Should be totally avoided because patients have the tendency to have alcohol on an empty stomach. Chances of hypoglycemia are more, if the quantity is not defined as a regular consumption since excessive calorie intake increases and this can increase the blood sugar values. All diabetic patients are more vulnerable to alcohol related diseases including liver diseases.

Should smoking be completely be avoided by diabetics?

My uncle aged 54 yrs has high cholesterol and is diabetic. How does cholesterol add on to the complications related to Diabetes 2?
If your uncle keeps his HBA1C above 7.5 then chances of increase in arterial stiffness increases and formation of atherosclerosis also increases resulting in blood pressure, heart disease, Cerbrovascularaccidents (paralysis) and peripheral vascular disease (Diabetic foot).

How does stress generally affect one’s blood sugar?
Usually stress causes increase in the blood sugar and it becomes difficult to control blood sugars in a stressed individual. However it varies from individual to individual that is, it does not always increase.

Madam I want to know what is hemolglobin A1C?
That is glcosylated hemoglobin is the average of 3-4 months blood sugar in an individual. Normally the value should be less 6.4. If the values are above 6.4 then the person can be diagnosed to be diabetic. Between 6.5 to values till 7.5 is a good control. Beyond 7.5 is a poor control of blood sugar. And above 8 chances of micro and micro vascular complications increases very dramatically.

How does one know that he/ she needs to go for Diabetes screening Madam?
After 30 yrs of age, every year, a routine check up is recommended for people with family history of diabetes and for obese with family history. The same is recommended after 21 yrs of age if one is obese then diabetic screening should be done at every illness like cough, cold or fever..

Hi Dr. Shah. How does one’s body control blood sugar?
Whatever we eat in a healthy meal consisting of carbs, fats and proteins , to digest that, insulin is required to be released from pancreas, however in diabetic patients the insulin release is delayed or it is inadequate in quantity or whatever is released is not properly utilised which we commonly summarize as insulin deficiency or insulin resistance. So after 2 hrs of meals food gets broken down or metabolized into calories and can be stored in various body cells for various body functions. So in diabetic patient because of insulin malfunction this does not happen properly and the blood sugar rises after 2 hrs.

Is it advisable for women with gestational diabetes to breast feed their babies?

When does the chances of gestational diabetes increase in a pregnant woman?
It usually increases from 5th to 9th month of pregnancy.

My elder sister aged 34yrs is 4 months pregnant. What should be her BG levels?
All fasting blood sugar values should be less than 106 and post lunch values should be less than 140

Are there ways to prevent Diabetes Type 1 Madam?
There are definitely some ways we can prevent Type 1 Diabetes that is by proper vaccination in early childhood,additional vaccination if required due to some known exposures.And also due to prompt diagnosis and treatment of childhood infections.

Is Diabetes Type 1 considered more serious than Diabetes type 2?
Serious is not the right word to differentiate between type 1 type 2 Diabetes since Type 1 diabetes develops in childhood and requires insulin injections for control, lack of understanding, lack of compliance and non scientific treatments pushes patients into serious complications like coma or diabetic ketoacidosis and thus can be serious. Similar situation can also happen in Type 2 diabetes .

What are the latest methods to treat Diabetes 1?
Type 1 diabetes the most commonly accepted treatment is insulin injections which give excellent results in most of the cases if given scientifically along with lifestyle modification. However some patients require additional support in the form of insulin pump or pancreatic transplantation or islet transplantation.

Why is it that most persons diagnosed with Diabetes 1 are children and young adults?
As type 1 diabetes occurs because of autoimmunity in early childhood because of various viral and bacterial influences or nitrosamine group of compounds influence in early childhood which usually occurs before hormonal maturation i.e before 18yrs of age.

Please share some basic tips to control glucose swings for women? Thanks.
Since the females have got more food related environmental influence as they are most of the time in the kitchen preparing food, so by incorporating some simple exercises in their daily routine can help. Exercising like on the spot jogging, skipping, sit ups, suryanamaskar can be incorporated.

Do glucose levels also fluctuate during menopause?

What guidelines should females follow to balance their blood sugar levels?
There are no special guidelines as such except that they have to be very careful during periods with abnormal bleeding which can increase blood sugar values and there is a chance of developing bad obstetric history in the premature deliveries, abortions, complicated pregnancies developing type 2 Diabetes or hyperglycaemia and hypothyroidism during menopause.

How does menstrual cycle affect blood sugar levels?
Usually whenever there is hormonal imbalance in the body in females blood sugars get slightly elevated . Therefore in many female patients Type 1 diabetes is detected during menarcha and gestational diabetes during pregnancy and classical Type 2 diabetes during menopause.

crop2_240x240_12nov14Can monthly glucose levels fluctuations be monitored by females at home? How?
Yes. By home sugar monitoring with the help of a glucometer.

What are the best foods for diabetics who travel a lot. Please guide.
Foods like dry fruit preparations, or low calorie ready to serve or ready to eat processed foods. Kindly read the labels because low sugar foods are not necessarily low calorie or low fat. Avoid intake of white bread, items made from white flour.

What are the best fruits to have for diabetics?
Diabetics can eat almost every fruit however some fruits in lesser portion size and less frequently. Fruits like guava, pears, apple, a diabetic can consume almost everyday(medium size). The fruits like mangoes, bananas, sitaphal, chikoo can also be eaten by diabetics daily but in smaller portion size( after consulting the doctor). Fruits should never be eaten with meals or after meals. But should be consumed 2 hrs before or after meals.

What should be the right method for losing weight for persons suffering from Diabetes type 2?
Rapid weight loss programmes marketed are not recommended for diabetic patients instead 1-2 kgs p/ month, weight reduction is recommended. (as it not only permits permanent reduction no.of fat cells.but also fats cells size) minimizing the chances of relapses.

When diabetics are usually restricted for carbohydrate intake, then why are some fruits ricjh in carbohydrate allowed Dr.?
Carbohydrate intake is restricted because some of the carbs have high glycaemic index and glycaemic load that means after consuming such carbohydrates within 2 hrs sugar can increase very rapidly so such carbohydrates should be eaten less and less frequently. However some fruits have carbohydrate but they are allowed because of their high water content, vitamin content and fibre content and because of less glycaemic load and less glyceamic index like for eg: watermelon.

What is the basic difference between Diabetes type 1 and 2?
Basic difference between Type 1 and type 2 is that type 1 diabetes usually occurs in childhood before 18yrs of age and usually requires insulin injections for control of diabetes and they have a tendency to go into ketoacidosis if untreated and usually the c-peptides levels less than one. Type 2 diabetes is usually seen in obese people or adults above 18yrs of age. They can usually be controlled on initial stages on tablets and their c-peptides levels are usualyl more than one.

Does prediabetes always mature to Diabetes 2?
Not necessary. It does not always mature to Diabetes 2, that means if proper lifestyle modification involving diet, exercise and weight reduction and stress management is done scientifically during this period then the patient can postpone diabetes for years together or he may not develop diabetes but he may develop cardiovascular metabolic syndrome and progress to heart problems.

When does prediabetes occur?
Prediabetic stage is always there in almost all type 2 diabetic patients (in genetic penetration) However it can be detected early in most of the patients if all diabetic family go for a routine screening procedure every year.

Can type 2 diabetes be eliminated if a diabetic person stops carbs diet?
No, it cannot be eliminated as every individual requires a diet with carbohydrates, protein and fat in calculated portions.

What is prediabetes M’am?
Prediabetes is a condition which occurs before biochemically manifest diabetes that means in simple, nobody develops diabetes overnight in the common genetic variety of diabetes where there is a stage of dysglycaemia, that means you have a fasting blood sugar values between 106-126 and post lunch blood sugar values is 140-200.

And what should be the right blood sugar before and after meals?
Before meals it should be like the fasting blood sugar levels that is between 80-120 and after meals it should be less than 140.

Hello Doctor, pl tell me what should be the right blood sugar(fasting) on waking up for diabetics?
Ideally speaking it should be between 100-120. In patients with infections and operative interventions we prefer it to be between 80-120mg percent.

Is the use of jaggery suggested instead of sugar to prevent diabetes?
both contains approximately same calories per gram however jaggery may contain additional vitamins and minerals depending upon source of preparation and method – ideally should be avoided in day to day preparations

My father has a sweet tooth. He needs to have one Indian sweet daily after dinner. We have advised him to eat fruits instead but he doesn’t listen.What is your advise?
Diabetic patients are allowed approximately 15 to 25 grams of dry fruits daily ,so you can make sweet dishes with out sugar or ghee with help of resins or dates and serve 1 kaju or badam or mix dry fruits rolls daily. alternatively you can try gajar halwa, sweet patatoes recipes with artificial sweetners.

What should be the right proportion of sugar intake everyday for any normal male/female?
ideally speaking no sugar should be consumed as daily routine occasionally may be half spoon can be permitted.