Life style modification

American Diabetes Association (ADA) recommends

  • 50–60% of daily calories come from carbohydrates,
  • 12–20% from proteins and
  • Less than 30% from fats.

Spacing meals throughout the day is preferred instead of eating heavy meals once or twice a day.

Carbohydrates:

            One gram of carbohydrate is equivalent to 4 calories, so if the person suffering from diabetes is on a 1200-calorie diet, approximately 600 calories should come from carbohydrates (150 grams of carbohydrate) spread over the day. Meals that are rich in carbohydrates produce the highest amount of glucose in the body.

Fats

            A maximum of about 25-30% of the diabetic diet can consist of fat. Unlike saturated fat, polyunsaturated or monounsaturated fat does not raise our cholesterol levels. In fact, it lowers levels of the bad cholesterol lipid known as low-density-lipoprotein (LDL).

Proteins

            In uncontrolled diabetes, muscle protein is broken down into amino acids to be converted into glucose by the liver. If left to fend for itself, this can create a commotion within the body. Since proteins have to supply enough energy to substitute for carbohydrates, proteins are broken down faster than they are made. The body ends up with a protein deficit, a situation with subtle, yet far-reaching effects on normal body functions. Importantly, for diabetics, a protein deficit has been shown to impair resistance to infections. Replenishing the depleting protein stores is a vital requirement of all diabetic diets. The proteins should be of high biological value and provide about 20 – 25 %of the calories in the diet. However intake of high protein in diabetes can be harmful. Studies have reported high protein intakes during diabetes to lead to increased protein excretion in the urine which can lead to kidney diseases.

Fiber

            Fiber in our food helps us to control blood glucose spikes. Foods that are rich in fiber can:

  • reduce the rate of glucose absorption,
  • Lower blood glucose rise,
  • decrease urinary glucose excretion,
  • Slower stomach emptying and
  • delay intestinal transit time

Foods to prefer and avoid if you are suffering from diabetes

Foods to be avoided Foods to be allowed in prescribed amount Foods to be allowed liberally
Sugar, jaggery, sweets, candies, jams, jellies etc. Cereals such as wheat, rice, jowar, bajra, ragi etc. Clear soups
Alcohol & alcoholic beverages & soft drinks Spaghetti, macaroni, noodles, bread etc. Raw & green leafy vegetables
Concentrated milk preparations, mawa preparations such as pedha, burfi, rabdi, ice creams, gulab jamun, rasogolla & other sweets Dals & Pulses Thin Buttermilk
Fried Preparations Root Vegetables such as potato, yam, sweet potato, colocasia root (arvi) Spices to taste
Nuts & oilseeds such as groundnut, coconut, etc. Vegetable Oils
Vanaspati, ghee, cream, margarine etc. Lena meat, fish & eggs
Fatty meat cuts, organ meats like liver, kidney, brain etc. Fruits according to exchange list
Shell-fish like shrimp, lobsters, mackerel, oysters etc. & oily fish like sardines
Bakery products such as cakes, doughnuts, pastries, biscuits, etc.

A slight modification in your lifestyle helps to manage your diabetes for your long life.

  • Maintain ideal body weight –

Maintaining ideal body weight helps to maintain a healthy life.

  • Eat a well balanced diet –

A well balanced diet containing healthy quality & quantity nutrition helps to provide essential nutrients required to maintain a healthy disease free life.

  • Reduce intake of fried / fatty / junk foods –

Reduction in intake of fried / fatty / junk foods reduces accumulation of unhealthy nutrients in the body, which in turn improves the body’s state of well being.

  • Involve in at least 60 min of regular physical exercise –

Regular physical activity is a key component for achieving and maintaining ideal body weight. A total of 60 minutes of physical activity is recommended every day for Indians in view of their high tendency to develop diabetes and heart disease. Daily exercise includes aerobic activity, work-related activity and light weight training.

  • Go for regular health check ups –

A routine health check up help us to know our own health’s status, which enables better monitoring of our health, especially in the prevention of developing expected risk factors.

Exercise was the recommended therapy for diabetes in India as early as 500 BC. The American Diabetes Association (ADA) recommends exercise as the most effective way of controlling diabetes.

 Weight Loss/Weight Management:

Losing weight and keeping it off is a real challenge for most people. Losing even a relatively small amount of weight can make a real improvement in reducing the risk of diabetes and other serious conditions.

Helpful suggestions on weight management:

→     It is better to spread the physical exercise all over the week instead of pounding the body during weekends. Blood pressure, blood glucose and other metabolic parameters will accrue if there are consistent exercise sessions, which are not separated by 24 hour period.

→        Static yoga should not be considered equivalent to aerobic exercise done with a purpose of weight loss, and for gaining several other metabolic benefits, as it does not involve rhythmic muscle movement to burn calories, and control blood sugar similar to other aerobic exercises which we do.

→        Exercise can be done at any time during the day; however it is best to avoid exercise after meals, especially in elderly and those with heart problems. The total time of exercise (e.g. 45- 60 minutes) can also be spent in doing short bouts of exercise several times a day (e.g. 15 minutes 3-4 times daily).

→        If activity during work means taking a walk or any kind of strenuous physical activity for 30-45 minutes daily then it will lead to benefits. However, any kind of sedentary work (sitting /desk job) with minimal office walking does not lead to any benefit and should not be counted as being active.

→        Muscle can never convert to fat but their function starts decreasing immediately after stopping exercise. Regular aerobic and resistance (with weights or resistance exercise machines) exercises are needed to maintain function, tone and adequate girth of muscles, which are important for glucose and cholesterol control.

→        Exercise will lead to effective weight loss only if combined with low calorie diet. Doing regular exercise alone has multiple benefits (metabolism, cardiovascular, fitness) but long term weight loss may not occur. However many people may have short term weight loss.

→        It is a common belief that exercise and training a particular body part will preferentially shed the fat on that part. All types of aerobic and resistance exercises will lead to generalized fat reduction including abdominal fat. Despite popular advice to do various exercises which are aimed at specific fat reduction, there is no scientific basis to it. These exercises, however, may increase the muscle tone.

→        Any aerobic exercise along with a balanced calorie-restricted diet will lead to weight loss. A Brisk walk remains the best exercise. However, gym provides varied options for exercising and once you have paid money you tend to become more regular.

→        If the person is above 40 years of age, one should get himself checked and then start gradual physical activity gradually. A gradual escalation of exercise would not stress bones and muscle in undue manner.

Pharmacological Management

Management of Type II

management type-2

Management of Type I

Most people with type 1 diabetes should be treated with multiple-dose insulin injections (three to four injections per day of basal and prandial insulin) or continuous subcutaneous insulin infusion.

Consider educating individuals with type 1 diabetes on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity.

Most individuals with type 1 diabetes should use insulin analogues to reduce hypoglycaemia risk.

Individuals who have been successfully using continuous subcutaneous insulin infusion should have continued access after they turn 65 years of age.

Diagnosis and Management of GDM

DIPSI- The Diabetes In Pregnancy Study group India 

The DIPSI recommends a non-fasting OGTT based on the belief that fasting OGTT would be logistically difficult in pregnant women in the community as it required them to return to the clinic on a separate day

The need for a simple screening test for GDM, is undoubtedly important, considering its relevance for the population at large

dipsi-test-g75 diaognosis-g75

Lifestyle Management: After diagnosis, treatment starts with
Medical nutrition therapy
Physical activity
Weight management depending on pre-gestational weight

Pharmacological Therapy

 Insulin Use Insulin is the preferred agent for management of pregestational type 1 diabetes and type 2 diabetes that are not adequately controlled with diet, exercise, and metformin.
All insulins are pregnancy category B except for glargine, glulisine, and degludec, which are labelled category C.

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