DIABETES MELLITUS Type 2 – The scourge of Indians – Part III
THERAEUTIC MEASURES
If you have been diagnosed with Diabetes Mellitus Type 2 (DM2), you’d want to know how best you can control the disease. Management of DM2 has become much easier with our understanding of the illness and the advent of new drugs. But no matter what therapeutic measures you decide to follow, “glycemic control” – optimal control of your blood glucose – is of paramount importance. This would mean you have to know your goal in terms of target numbers and they are:
Pre-meal/ Fasting Blood glucose: 90 – 130 mg/ dl
Post meal (Post Prandial) Blood glucose: < 180, ideally < 150
Hb A1 C <7% ( corresponds to average Blood Glucose of < 154 mg/dl)
The following suggestions, if followed carefully, should be helpful in the management.
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Diet: Eating healthy foods that will help to control blood glucose is the key. This would mean learning more about carb counting, glycemic value of different foods, nutrition facts of packaged foods, portion size, proper timing and frequency of your meals, how to eat in restaurants, during holiday parties, etc. You may consult a dietitian to understand the principles involved in proper dieting. Weight reduction for overweight and obese persons and keeping the BMI (body mass index) within the normal range alone will improve your diabetes. Even persons with relatively normal weight can achieve significant improvement by shedding 5 percent of their weight. Some recent studies have shown “bariatric surgery” in obese patients reduced the severity of their diabetes. Now you know the importance of maintaining a normal weight.
When you eat is just as important as what you eat, so plan your meals properly. Several small meals spaced evenly through the day will keep your blood glucose in the target range. And never skip your breakfast. Your doctor and dietitian can tell you more about these.
Here is a simple formula to calculate your caloric needs: First, find out what is your ideal weight from the charts. The standard recommendation is: “Men who are moderately active should multiply their weight in pounds by 15; women multiply by 12. The resulting number is the total calories per day needed to maintain the weight. Relatively inactive men should multiply their weight by 13 and women, by 10. A moderately active woman who weighs 150 pounds would need 1,800 calories per day to maintain her weight.”
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Exercise: Getting active improves the utilization of the ingested carbohydrates and is a great way to manage your blood glucose. Physical exercise also improves your blood pressure and cholesterol, among other benefits. An active lifestyle can improve the body’s ability to use insulin. A mix of moderate aerobic exercise and strength training would be ideal. Along with proper diet, regular exercise will go a long way in maintaining optimal blood sugar levels. This may also help to reduce the dosage of the anti-diabetic drugs you are taking. So start an exercise program — walk, jog, dance, swim or whatever you like -- today and stick with it.
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Drugs to avoid: Some drugs can adversely affect diabetes control and hence either avoid them altogether if you can or try to cut down the dosage. Diuretics in general, niacin preparations, cortico-steroids in any form, some antiasthmatics such as albuterol inhalers, alcohol in excess, etc., may adversely affect DM2 and hence discuss with your doctor if you are on any one of these. Beta blockers can mask symptoms of low blood sugar, so beware.
You may rightfully ask why I am so obsessed with keeping the blood glucose on target. The simple answer is “the closer your blood glucose stays in the target range, the lower your risk for diabetic complications like blindness, vascular disease including heart attacks and strokes, neuropathy, etc.”
To be continued . . .
Dr. M. P. Ravindra Nathan is a Brooksville cardiologist.