Dr. Indira Kedlaya, Senior Consultant, Internal Medicine, Columbia Asia Hospital Whitefield
Diabetes Mellitus is a disease that is endemic in India. What was previously a disease of the developed world has made its way through small towns and villages of our country. This can be attributed to improved standards of living, access to food coupled with changes in lifestyle in terms choice of food/physical activities as we have become more developed.
Diabetes Mellitus is defined as a fasting glucose level of ≥126 mg/dl, random glucose of ≥200mg/dl or hba1c of ≥6.5. Prediabetes is defined as fasting glucose 100-125mg/dl or hba1c of 5.7 to 6.4. The constant presence of high glucose levels leads to inflammation and thus induces changes in blood vessels both large and microscopic ones. This predisposes to heart attacks, strokes, circulatory problems in legs, kidney, neuropathy and retinal complications. These complications of diabetes start at prediabetic stage. It is hence important to prevent diabetes by identification of prediabetes also and start aggressive lifestyle changes. Hence, the diagnosis of prediabetes is a very important one, although it is ignored by patients/medical practitioners alike. Women with gestational diabetes and PCOS are at increased risk of developing diabetes. We Indians have abdominal obesity more than generalized obesity, Hence BMI is a poor marker for cardiovascular risk, instead abdominal girth is better measure of the risk.
What should I do to prevent diabetes mellitus?
1. Reduce carbohydrates (rice, roti, bread, poha, sabudana/seviya, dosa/idli), diary, non-vegetarian foods (since they are calorie-rich even in smaller quantities), oily foods and concentrated sweets.
2. Substitute the above with fiber-rich foods, fruits and vegetables that are low in calories, Consider using healthier grains such as millets, unpolished dhals and grains. Increase vegetarian sources of protein/egg whites, nuts/dry fruits.
3. Quantity of food is just as important as quality of food.
4. Disciplined exercise regimen/cardio and strength training.
5. All these changes should result in decreased abdominal fat and/or overall weight.
6. Regularly get blood tests for diabetes/prediabetes/cholesterol levels, quit smoking and get your blood pressure controlled.
7. Avoid fad diets unless you can make that a long standing change
What should I do once I have diabetes mellitus?
1. All lifestyle changes as mentioned above, except for elimination of most fruits from your diet.
2. Check HBa1c thrice a year and do home monitoring with a glucometer at least a few days/week. Get your medications changed so as to achieve HBa1c levels of 6-7. For people on insulin or frail elderly a slightly higher hba1c may be acceptable.
3. Do not be afraid to use medications, including insulin if lifestyle changes are insufficient. Ultimately all these will reduce your risk of complications of diabetes. Do not fall prey to certain myths about diabetic medications.
4. See an ophthalmologist yearly.