Diabetes

Diabetes

IDEA CLINICS is a clinic chain for Diabetes care formed by some of the reputed Endocrinologists across India. Endocrinologists are super specialists in the field of Diabetes and Endocrinology. Our team of specialists work together to create an individualized treatment plan for you.

Our team may include an endocrinologist, Diabetes educator and dietitian They will work closely with you to manage your diabetes effectively. IDEA CLINICS will ensure there is comprehensive screening and if required prompt referral to eye, kidney and foot specialists when needed.

Diabetes Check Idea Clinics

Know More About Diabetes

Type 1 diabetes is a condition where blood glucose levels are high as the body can’t make insulin.

Around 5% of people with diabetes in India have Type 1 diabetes. It can happen to anyone and not linked to lifestyle or weight and usually seen commonly in children.

When one has Type 1 diabetes, body attacks the cells in  pancreas that make insulin and there is no  production of  insulin. Insulin allows the glucose in blood to enter cells and thereby provide energy to the body.

Signs and symptoms of Type 1 diabetes

Excess urine as body tries to get rid of glucose through kidneys. Excess urination and sometimes bed wetting at nights in children can be one of the main symptom of diabetes.

These symptoms come quickly in over few days or weeks. Anyone who has these symptoms should visit a doctor as soon as possible.

Managing Type 1 diabetes

If one has Type 1 diabetes they have to take insulin either by injecting it, or using an insulin pump, which delivers a constant supply.

They also need to check to ensure that blood glucose levels are not too low or too high by using a blood glucose testing device several times a week or even everyday. When the patient start taking insulin, he will begin to feel better and as blood glucose levels go down.

This is significant as over a long period of time, high glucose levels can seriously damage heart, eyes, feet and  kidneys. These complications from diabetes can then lead to premature deaths and sometimes reduce  lifespan by a decade or more.

With initiation of Insulin and titrating doses as per glucose readings the long term of diabetes can be mitigated to a large extent.

About 90% of people with diabetes have Type 2 diabetes. Type 2 diabetes is a condition seen in over 10% of population and happens when the insulin can’t work properly, or the pancreas can’t make enough insulin.

What causes Type 2 diabetes?
When we have Type 2 diabetes, the body still breaks down carbohydrate from your food and drink and turns it into glucose, pancreas responds to this by releasing insulin which can’t work properly due to resistance and more insulin is released. In some with Type 2 diabetes this can eventually tire the pancreas out with less insulin and higher blood sugar levels.

Signs and symptoms of Type 2 diabetes
A lot of people don’t get any symptoms but the common symptom of Type 2 diabetes tiredness. Some people live with Type 2 diabetes for up to 10 years before being diagnosed. This can seriously damage the heart, eyes ,feet and kidneys.

Managing Type 2 diabetes

There are different ways of treating Type 2 diabetes. Some people can manage it by healthier eating, being more active and losing weight. However, most people will need medication or even insulins to control their blood glucose.

Treatments for people with Type 2 diabetes

DIET AND EXERCISE
Lots of people with Type 2 diabetes don’t take any medication, and they instead treat their diabetes by eating well and moving more. At IDEACLINICS, for motivated overweight diabetes patients an attempt is made towards Diabetes Reversal where we aim to keep HbA1c below 6% for atleast a year without medications.

Tablets and medication
There are a number of different medications available to people with diabetes, all of which work in a variety of different ways.

METFORMIN

For most metformin is usually is the first diabetes medication prescribed if a healthy diet and physical activity alone is not sufficient

SULPHONYLUREAS

These tablets work by stimulating the cells in the pancreas and make more insulin, and helping in reducing glucose levels in the blood.

ALPHA GLUCOSIDASE INHIBITOR (ACARBOSE)

Acarbose slows down the intestine’s absorption of starchy foods, in turn, slowing down any rise in blood sugar levels after meals.

GLINIDES (Prandial glucose regulators)

Similar to sulphonylureas, glinides are  medication that stimulate the cells in the pancreas to produce more insulin. But they work much quicker than sulphonylureas and last for a short time, so are taken half an hour before each meal.

THIAZOLIDINEDIONES (GLITAZONES)

This medication by working on the fat cells reduces insulin resistance and improves sensitivity, allowing the insulin to work more effectively.

GLP-1 AGONISTS (INCRETIN MIMETICS)

GLP-1 AGONISTS  are injectables which increases the level of incretins in the body. Incretin hormones help the body to produce more insulin when needed and reduce the amount of glucose production when it’s not needed. They help with weight loss and glucose control without hypoglycemias.

DPP-4 INHIBITORS (GLIPTINS)

DPP-4 inhibitors work by blocking the action an enzyme that destroys the hormone incretin thereby helping the body produce more insulin as needed.

SGLT2 INHIBITORS

This medication reduces the amount of glucose absorbed by the kidneys and lets it out in the urine. This mechanism of action helps in glucose control and also weight loss. However, in some can cause fungal infections at the genitals.

WEIGHT LOSS SURGERY

Surgical procedures to the stomach or intestine  can  help in weight loss and can help to put Type 2 diabetes into remission, particularly in morbidly obese individuals.

I have Type 2 diabetes – what can I eat?

What’s the diabetes diet?

There is no such thing as a special diabetic diet exclusively for people with Type 2 diabetes.

There is no  list of foods they are not allowed to eat.

IDEACLINICS  advice is to make healthier choices, eat in small portions
and to make changes to the food choices that are realistic and achievable..

Diabetes diet plans to lose weight

If you’re overweight, finding a way to lose weight can help manage blood sugar, blood pressure and cholesterol levels.

Losing extra weight can put Type 2 diabetes into remission. Speak with the endocrinologists or the dietitians at the IDEACLINICS to know if this is achievable for you.

Can I eat fruit?

Yes, whole fruit is good for everyone including  for those with diabetes. Some patients avoid them because they are sugary,, but as it is natural sugar, they are safe.

Can I snack in between meals?

Diabetic patients don’t need to eat snacks unless on medication like insulin that puts at risk of hypos in spite of adjustments in medications.

Snacking can make it harder to manage a healthy weight which is  important for treating type 2 diabetes.

Sructured education course

These courses can help understand what diabetes is and how food affects the body.IDEACLINICS is rolling out these courses via telediabetes and via online.

What can I eat?

There is no food restrictions for Type 1 Diabetes and  all kinds of food are fine. There are no “do’s and don’ts” in diet for type 1 diabetes any more.

Also a restrictive diet plan is no long recommended as the present flexible insulin options can address various dietary needs.

Is there anything I should avoid?

Avoid foods labelled as diabetic foods as they contain similar amounts of calories and fat, are usually more expensive. for occasional treats can try normal ones but watch portion sizes.

Is there anything I should definitely eat or have at mealtimes?

It is important to include some carbohydrates with the meals. Healthier sources of carbohydrate include fruit and vegetables, pulses and wholegrain starchy foods.

It is very important to eat at roughly the same times when using a twice-daily insulin regime. Otherwise,  a basal bolus insulin regime may be preferred.

What’s good to eat for breakfast, lunch and dinner?

Normal breakfasts which includes some carbohydrate are prefered.

Sometimes, a small snack between meals to help keep blood glucose levels up may be needed however it is important to  maintain a healthy weight, the healthy snack choice is fruit.

Dietary recommendations in the long term – Carbohydrate Counting

Extra education and training can help to manage the amount of carbohydrate to eat and the insulin to take that helps to control blood glucose levels more effectively.

If on fixed amounts of insulin twice a day (eg:MIXTARD), having consistent amounts of carbohydrates on a day-to-day basis, and  at similar times each day can get better control without hypoglycemias.

If on a basal bolus insulin regime a more flexible eating habits can be possible as long as one adjusts their insulin doses accordingly by counting the carbohydrates that they eat and drink and then calculate how much insulin they need to take.

A healthy diet

Apart from managing blood glucose levels by adjusting insulin and carbohydrates, people with Type 1 diabetes are also need healthier food choices that are lower in sugar, salt or saturated fat.

Gestational diabetes is a type of diabetes that affects pregnant women diagnosed through a blood test at 24 weeks into pregnancy. They don’t have diabetes before their pregnancy usually goes away after delivery.

 What causes gestational diabetes?

The hormones of pregnancy cause insulin resistance and when there is not enough insulin this can lead to gestational diabetes.

Who is at risk of gestational diabetes?

Women are at an increased risk if they are overweight or obese, had gestational diabetes before, or a large baby in a previous pregnancy (above 4.5kg), or with family history of diabetes. One in five pregnancies in India can present with gestational diabetes.

IDEACLINICS Gestational diabetes checklist:

  • Understand gestational diabetes and how it is treated by consulting our specialists.
  • Use a blood glucose meter and understand individual targets
  • Visit a dietitian to talk about diet and physical activity
  • Take IDEACALL (Telediabetes) contact details to call for any extra support.
  • Understand how to treat a hypoglycemia.

What are the possible complications?

Gestational diabetes if remains uncontrolled can cause labour problems, increase chances of caesarean section, put towards high risk for a big baby (macrosomia), and the newborn may develop hypoglycemia with risk for Perinatal death.

There can be a higher risk for the child to be obese and/or developing Type 2 diabetes in later life.

Testing and treatment for gestational diabetes
It’s extremely important that the mother checks her blood glucose levels regularly when they have gestational diabetes. Blood glucose meter is required all through the pregnancy.

 Medication for Gestational Diabetes

Medications may be needed if changes in diet and physical activity alone fail to bring blood glucose to target range.

 Metformin

Metformin reduces the glucose produced by the liver and make insulin work properly.

Insulin
Insulin is the major treatment option if gestational diabetes is not controlled with diet alone.

Can I inject insulin into my abdomen?

With a short needle (4–6mm), insulin can be delivered into the abdomen safely by avoiding the area too close to belly button. Injecting into abdomen will not harm baby as the uterus is way below the skin compared to the short Insulin needles.

Gestational diabetes starts when women’s body is not able to make and use all the insulin it needs for pregnancy. As the baby is already formed before the mother develops Gestational diabetes in late pregnancy, the risk of birth defects is rare unlike in babies whose mothers had diabetes before pregnancy.

However, untreated or poorly controlled gestational diabetes can cause other problems. Although insulin does not cross the placenta, glucose does which provides with the extra energy and stored as fat causing big baby or macrosomia. This can cause birth injuries to shoulders during birth or lead to low blood glucose levels at birth and other perinatal problems. In later life these babies are at risk for obesity and type 2 diabetes.

One of your first questions when a pregnant woman finds out that she has gestational diabetes is, “what can I eat?”

There can also be lots of myths about diabetes and food, IDEACLINICS has listed the information on gestational diabetes – what can I eat?

  • There is no special diet when one has gestational diabetes.
  • There is no list of foods that a woman is not allowed to eat.
  • There is no need to completely avoid sugar.
  • However, one need to follow the same healthy, balanced diet that’s recommended to everyone.
  • The main aim for managing gestational diabetes is to keep blood glucose levels under control.
  • Carbohydrates affect blood glucose levels so portion size matters with preference for nutritious foods such as wholegrain starchy foods,dairy foods, pulses, fruit and vegetables.
  • At times it is preferred to eat less carbohydrate in small portions.
  • Dietitians will advise with a specific eating plan that is tailored to your needs.

What snacks should I eat?

Snacking is recommended only if on insulin treatment in order to avoid risk of hypos when dose adjustment alone is not sufficient. The risk however remains weight gain during pregnancy.

What diet is recommended in the long term and subsequent pregnancy?

A healthy, balanced diet with watching portions, including fruit and vegetables, and eating less saturated fat, sugar and salt  will help maintain healthy weight and avoid developing type 2 diabetes in later life.

As there remains a higher risk of gestational diabetes in  subsequent pregnancies it isvery important to continue a healthy eating plan.

Can type 2 diabetes be prevented?
People can prevent type 2 diabetes or even reverse sometimes if they are able to lose weight (if they are overweight) and by being active and eating healthy.

Other ways of reducing the risk are by taking metformin or Quitting smoking.

What increases the risk for type 2 diabetes?

  • Being overweight or obese.
  • Sedentary life style and not doing enough physical activity
  • Smoking
  • Having a family history of diabetes
  • For women with history of gestational diabetes

However, amongst Indians the risk is higher even though they may not have the above risk factors and at IDEACLINICS we are working hard to identify other reasons specific for Indians

What tests are available to identify at risk?

  • Fasting glucose test done after 8 hours fast should be below 100mg/dl and if between 100 and 125 its prediabetes and anything above is Diabetes.
  • Random or post meal glucose between 140 and 200 is prediabetes.
  • Hemoglobin A1C test suggests if levels are between 5.7 and 6.4.

What should I do if I have pre-diabetes?

  • Make lifestyle changes
  • Lose weight
  • Eat right
  • Be active for 30 minutes a day
  • Quit smoking

WHAT ARE THE SIGNS AND SYMPTOMS OF DIABETES?
Are you worried that you, your child or someone you know may have diabetes? Having some of the signs of diabetes doesn’t mean you definitely have the condition, but you should always contact your GP, just to make sure.
The common symptoms of diabetes
Going to the toilet a lot, especially at night.
Being really thirsty.
Feeling more tired than usual.
Losing weight without trying to.
Genital itching or thrush.
Cuts and wounds take longer to heal.
Blurred vision.
Why does diabetes create these symptoms?
These symptoms occur because some or all of the glucose stays in the blood, and isn’t being used as fuel for energy. The body tries to reduce blood glucose levels by flushing the excess glucose out of the body in the urine. High levels of glucose being passed in the urine are a perfect breeding ground for the fungal infection which causes thrush. But not everyone gets symptoms, in fact 6 out of 10 people have no symptoms when they’re diagnosed with Type 2 diabetes.

I have some diabetes symptoms. What now?
If you have any of symptoms of diabetes, you should contact your GP. It doesn’t necessarily mean you have diabetes, but it’s worth checking – early diagnosis, treatment and good control are vital for good health and reduce the chances of developing serious complications.

What happens if you ignore the signs of diabetes?

It’s hard to ignore the signs of Type 1 diabetes because symptoms can often appear quite quickly. But leaving it untreated can lead to serious health problems, including diabetic ketoacidosis, which can result in a potentially fatal coma.

Although the majority of people with Type 1 diabetes are diagnosed in childhood and early adulthood, the symptoms are the same at any age. Adults with Type 1 diabetes may not recognise their symptoms as quickly as children, which could mean their diagnosis and treatment may be delayed.

Type 2 diabetes can be easier to miss as it develops more slowly, especially in the early stages when it can be harder to spot the symptoms. But untreated diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Being diagnosed early and controlling your blood sugar levels can help prevent these complications, so check your risk here.

  • Sometimes it may be confusing to differentiate between Type 1 and Type 2 diabetes. LADA or Type 1.5 diabetes is another entity that is easily confused between Type1 and Type 2 Diabetes. MODY and other rare forms are also confusing forms.
  • In India Type 1 contributes to 5% and Type 2 diabetes affects about 95% of all Diabetes population.
  • Type 1 is managed by taking insulin to control blood glucose. However, Type 2 can be managed in many ways whether through medications, exercise and diet or sometimes prescribed insulin.
  • Currently there is no cure for Type 1 but research continues. Type 2 cannot be cured but can be prevented or put into remission.
  • Type 1 is not linked to lifestyle, weight and common in children.
  • Type 1 Diabetes develops quickly and if ignored can lead to diabetic ketoacidosis (DKA). Type 2 develops more slowly, they can have it for up to 10 years without knowing and can incidentally diagnosed

Type 1, Type 2 and gestational diabetes are the familiar varieties of Diabetes. However, in about 2% of people there can be other types of diabetes like

Monogenic diabetes, cystic fibrosis related diabetes, and rare syndromes.

  • Maturity onset diabetes of the young (mody)
  • Neonatal diabetes
  • Wolfram syndrome
  • Alström syndrome
  • Latent autoimmune diabetes in adults (lada)

Maturity onset diabetes of the young (mody)

  • MODY is a rare form of diabetes found in some families and is different from both Type 1 and Type 2 diabetes.
  • MODY is caused by a mutation in a single gene, has a 50 per cent chance of inheriting if parents have it. MODY usually happens before 25 years of age, whatever their weight or lifestyle might be.
  • Prevalence is around 1% about 90% of people are mistakenly diagnosed with Type 1 or Type 2 diabetes at first.

The most common types of MODY are:

HNF1alpha gene causes about 70 per cent of cases of MODY.The amount of insulin production drops, sulphonylureas are usually effective and insulin is not usually needed.

HNF4alpha. This rare form usually presents with  birth weight of  more than 4kg with occasional neonatal hypoglycaemia and treatment is with sulphonylurea.

HNF1beta. This type of MODY can present with renal cysts, uterine abnormalities and gout, with associated diabetes which can develop in later life and may need insulin. This form can develop complications of diabetes.

Glucokinase. This gene resets the normal values at a slightly higher point so when this gene is not working properly the body allows the level of blood glucose to be higher than it should be, but are typically only slightly higher than normal, generally below 150mg/dl.  This type of MODY need not be treated.

It’s important to diagnose MODY for the following reasons:

  • All types of MODY apart from glucokinase carry a risk of the long-term complications of diabetes and needs treatment.
  • To make sure you get the right treatment and advice for the type of diabetes (eg stopping insulin).
  • As there is a 50% chance of a parent passing on MODY to their child, screening family could be useful.
  • Genetic testing can be offered to other family members.
  • IDEACLINICS can support with further guidance if MODY is suspected.

Neonatal diabetes

Neonatal diabetes is diagnosed under the age of six months and unlike Type 1 diabetes it’s not an autoimmune condition and very rare.

The key features of neonatal diabetes are:

  • Neonatal diabetes is caused by a change in a gene which affects insulin production causing very high glucose levels.
  • Over one fifth of these children neonatal diabetes also have some developmental delay, , learning difficulties and epilepsy.
  • There are two types of neonatal diabetes.

          Transient neonatal diabetes usually resolves before first birthday and      generally recurs during the teenage years. It accounts for over half of all       cases.  Permanent neonatal diabetes lasts forever

  • Around half of the neonatal diabetes can be managed with Glibenclamide. There is a defect in the KCNJ11 or ABCC8 gene and need higher doses of Glibenclamide than would be used to treat type 2 diabetes and insulin can be discontinued.

Wolfram Syndrome (DIDMOAD syndrome)

Wolfram Syndrome is a rare genetic disorder, also called DIDMOAD syndrome after its four most common features Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness.

The key features of Wolfram Syndrome are:

DIABETES MELLITUS:

  • It is not an autoimmune condition
  • No microvascular complications like retinopathy or nephropathy.
  • Treatment similar to Type 1 diabetes with insulin injections,
  • Everyone with Wolfram Syndrome is likely to have diabetes at some point.

DIABETES INSIPIDUS:

  • ADH deficiency leads to polyuria with diluted uring.
  • 50% of people with Wolfram Syndrome have diabetes insipidus.

OPTIC ATROPHY:

  • Causes colour blindness and gradual loss of vision.
  • Patients with Wolfram Syndrome will have optic atrophy at some stage.

DEAFNESS:

  • Cannot hear in a crowded room due to high pitched deafness.
  • Over 50% with Wolfram Syndrome w6ill have hearing loss and about one in four of these will need a hearing aid.

RENAL PROBLEMS:

  • Due to problems with the renal tract, there can be bedwetting due to loss of bladder control.
  • About two thirds of people with Wolfram Syndrome have renal problems.

NEUROLOGICAL PROBLEMS:

  • Can present with loss of balance, sudden muscle jerks, loss of taste and smell, breathing problems and depression.
  • One in four with Wolfram Syndrome may have a mental health problem at some stage.

Alström Syndrome

The key features of Alström syndrome are Retinal degeneration, nystagmus, hearing loss, cardiomyopathy, obesity and type 2 diabetes and renal failure..

People with Alström Syndrome can have problems with their bones and joints.

Other problems such as hypogonadism, undescended testes, low testosterone, polycystic ovaries, underactive thyroid and acanthosis nigricans may also be present.

Latent autoimmune diabetes in adults (LADA)

Latent Autoimmune Diabetes in Adults is called LADA  with features of both type 1 and type 2 diabetes. It’s a different form of diabetes.

But they generally come on much slower than Type 1, and more quickly than Type 2 Diabetes.

LADA tend to have a healthy weight, Diagnosing LADA can be difficult and diagnosed with having Type 2 diabetes by mistake.

However, similar to Type 1 Diabetes, GADA antibody test is positive

LADA is treated like Type 2 diabetes but tend to go on to insulin much quicker than you would normally if you had Type 2 diabetes.Its recommended that insulin treatment is started early.

There is no cure for Diabetes at present but there is lot of research going on across the World.

TYPE 2 DIABETES:

Though there is no cure for Type 2 Diabetes, there is significant progress towards achieving remission of Diabetes for some eligible patients. Ring IDEACLINICS if you can try this diabetes reversal programme.

Remission is when blood glucose levels are in a normal range with HbA1c below 6% without medications for a year or over.

At the IDEACLINICS diabetes reversal program is rolled out for selected few who are overweight, motivated recently diagnosed diabetes patients.

TYPE 1 DIABETES:

Type 1 diabetes the changes in immune system leading to destruction of  insulin producing beta cells in the pancreas and insulin production stops causing diabetes.

To stop Type 1 diabetes various immunotherapies are presently being explored.

There are three types of immune cells:

  1. Killer T cells role is to recognise and destroy harmful bacteria and viruses in the body but in  Type 1 Diabetes they mistakenly attack beta cells.
  2. Regulatory T cells role is to keep the killer T cells in check. However, in type 1 diabetes they fail to control killer cells and hence cause Type 1Diabetes.
  3. B cells: They produce antibodies whose role is to stick to the surface of harmful bacteriae and viruses and alert killer T cells. However, in Type 1 Diabetes these B cells produce autoantibodies which attack own body cells(beta cells) and cause diabetes. Immunotherapies which can stop this phenomena are being developed.

Who could immunotherapies help?

  • Preventing Type 1 Diabetes by identifying those at high risk by testing their genes and autoantibodies in blood, Immunotherapyoptions can be given.
  • Newly diagnosed Type 1 diabetes, the immune system may not completely damaged and over 20% of beta cells can still be alive. Immunotherapies could be used in newly diagnosed to preserve these beta cells.
  • By regenerating Beta cells, Immunotherapies could potentially help people already living with Type 1 diabetes and facilitate cure of Type 1 diabetes.

Diabetes reversal can be attempted in selected few who meet the criteria but this is unlikely to be permanent. Remission of Type 2 diabetes can be achieved.

How do you reverse diabetes?
By attempting weight loss in people who are overweight or obese through lifestyle and diet changes or weight loss surgery reversal or remission can be achieved.

Fat in the liver and pancreas affects Type 2 diabetes and losing this fat can help get diabetes into remission.

Is there a diet to reverse Type 2 diabetes?

There is no special diet exclusively for people with diabetes as no one size fits all diet, there are various options suggested at Ideaclinics.

Myth: Type 2 diabetes is a mild form of diabetes

All diabetes is serious and if not controlled can lead to serious complications.

Myth: People with diabetes cannot have sugar

Having diabetes does not warrant a sugar free diet. Patients with diabetes aim for a healthy balanced diet which is low in fat, salt and sugar.

Myth: People with diabetes should eat diabetic foods

There is significant marketing for so called diabetes foods like sugar free Indian sweets and biscuits but these are not healthy in any form and can safely be avoided. At the same time, one does not need to avoid sweets for special occasions or festivals and can still enjoy in small amounts now and then.

Myth: People with diabetes eventually go blind

Although diabetes is one of the major causes of blindness in India, it can be easily avoided by periodic check ups at the IDEACLINICS or other centers. One can reduce the chances of developing diabetes complications by controlling blood pressure, glucose, and cholesterol and keeping active without smoking and keeping a healthy weight.

Myth: People with diabetes can’t play sport

People with diabetes are encouraged to exercise as part of a healthy lifestyle while taking sufficient precautions particularly in avoiding hypos and ensuring a healthy feet.

Myth: People with diabetes are more likely to get colds and other illnesses

Patients with diabetes may become more unwell for longer than a person without diabetes but there is no conclusive evidence that these patients are prone for frequent colds and coughs.

Myth: People with diabetes can’t eat grapes, mangoes or bananas

In India patients with diabetes stop eating fruits when they come to know that they have diabetes. They particularly stop eating grapes, bananas and mangoes  as they taste sweet. In fact, fruits make a healthy choice as they are high in fibre, low in fat with vitamins and minerals and protect from developing complications of diabetes.

People with diabetes can be more at risk of developing certain types of cancer and over 20% of cancer patients may have diabetes.

Diabetes control can worsen during some cancer treatments, especially high dose steroids can upset glucose control.

Though a causative link between the two is not directly established, however, being overweight increases the risk of developing diabetes and cancers of the oesophagus, bowel, breast, uterus and kidney.

Type 1 diabetes increases risk of cancer of cervix and stomach.

The cancer risk is reduced by keeping to a healthy weight, eating well, keeping active and not smoking,

Diabetes risk factors

  • Your risk increases with age. You’re more at risk if you’re over 25.
  • You’re four times more likely to get Type 2 diabetes if you have a parent, brother, sister or child with diabetes.
  • You’re more at risk if you’ve ever had high blood pressure.(130/80mm Hg or 140/90mm/Hg)
  • You’re more at risk of Type 2 diabetes if you’re overweight (BMI>23),
  • Smoking is associated with a higher risk of Type 2 diabetes
  • Gestational diabetes increases risk of developing Type 2 diabetes by 50% within 5 years.
  • Women who have PCOS are at an increased risk of developing Type 2 diabetes.
  • Mental health conditions (schizophrenia, bipolar disorder and depression)are a risk factor for Type 2 diabetes.
  • Sedentary is associated with an increased risk of Type 2 diabetes.
  • Drinking too much alcohol is associated with an increased risk of Type 2 diabetes.
  • Disturbed sleep can be associated with an increased the risk of Type 2 diabetes.

What does it mean if I’m at risk?

  • Low (One out of 20 people with low risk will get Type 2 diabetes in the next 10 years.)
  • Increased (One out of 10 people with increased risk will get Type 2 diabetes in the next 10 years.)
  • Moderate (One out of 7 people with increased risk will get Type 2 diabetes in the next 10 years.
  • (One out of 3 people with increased risk will get Type 2 diabetes in the next 10 years.)

How  to reduce your risk?

  • Eating well
  • Moving more
  • Losing weight (if overweight)

BMI measurement

  • Normal < 23
  • Overweight < 25
  • Obese < 27

Waist measurement

  • 80cm (31.5in) for women

90cm (35in) for men.

Things to check before you go

IDEACLINICS provides a  letter with all health conditions and medications and ensures insulin packs are provided for those who are on insulin. They can avail telephonic support during their stay abroad through our IDEACALL (Telediabetes)

Ideaclinics advise patients with diabetes to split diabetes supplies in separate bags and have some diabetes supplies in hand luggage in case bags get lost.

If on insulin pump or a CGM avoid scanners or X-ray machines as they can interfere with their functions.

If on insulin a letter from Idea clinics is useful that has diagnoses, the medication list, and should include insulin, insulin delivery devices, needles, blood glucose monitors, glucose tablets or liquid and ketone test strips.

Hypos are more dangerous in cold conditions and increase the risk of hypothermia and hence keeping glucometers with sufficient strips is advisable. A word of caution, strips from different countries for same glucometers do not work, hence our advise is to take sufficient numbers from India before the travel.

Work and diabetes

Don’t let diabetes hold you back at work. Being open about your condition will make it easier for your colleagues to support you. And if you do experience problems, you have rights that protect you.
Talking to your colleagues and manager about diabetes
The better your colleagues understand your diabetes, the easier it will be to get the support you need.
A good first step can be to share our information on Diabetes: the basics and Supporting people with diabetes in the workplace.
Encourage your colleagues to ask you questions and give them the information they need to help – for example, what to do if you have a hypo. Reassure them that you’re in control of your condition and it’s nothing to worry about.

If you didn’t talk about your diabetes when you applied for the job, it’s a good idea to tell your line manager about it sooner rather than later. They’ve already decided you’re the best person for the job and will want you to be the best you can be at work. And if they don’t know about your diabetes, they may not be able to give you the support you need.

“I’ve had to make some adjustments at work – regular breaks, keeping Jelly Babies nearby and letting my managers know about my condition. I’ve also told all my colleagues too, which is not something everyone does, but I feel safer knowing they know.”

Online forum member

Managing your diabetes at work

At work, it’s more important than ever to be organised to manage your diabetes safely. Put reminders for blood sugar tests and injections in your calendar. Look at what meetings you have at the start of the day so you can plan around them. And if you need to leave your workplace or travel, make sure you pack what you need.

Sticking to your usual work pattern at work can be tricky, especially in office environments where biscuits and cake are ever present. Try introducing fruit as an alternative to sweet treats. It’s likely that there will be a few work colleagues who are glad of having a healthier option too. And prepare your lunch and snacks in advance so you don’t end up eating unhealthily as a last resort.

Like anyone, your stress levels are likely to be higher at work than at home, which can make managing your diabetes more difficult. Make sure you take time out to relax throughout the day. And talk to your manager about flexible working options, which can make it easier to manage your diabetes and do your work.

Treating your diabetes at work

If you inject insulin and monitor your blood glucose levels, you will know these are things you need to do to keep safe. You shouldn’t feel embarrassed about it. Explain to your colleagues what you’re doing and don’t feel the need to hide in the toilet.

If you’re at risk of hypos, tell your colleagues how to spot the symptoms and how to treat one. This will make sure you get the right help and stop them panicking because they don’t know what to do. Talk to your first-aider so they know how to act in an emergency.

If you have a hypo at work, talk to your colleagues afterwards. Explain why it might have happened, as although you don’t always know why you have a hypo, some things make them more likely. Let them know it can happen if diabetes is treated with insulin or certain diabetes medication.

Your rights at work

One in six working people with diabetes feel they’ve been discriminated against by their employer because of their diabetes. If you feel you’ve been mistreated, remember you have rights.

As someone living with diabetes in England, Scotland or Wales, your rights at work are set out in the Equality Act 2010. If you live in Northern Ireland, they are in the Disability Discrimination Act 1995.

Both these acts state the steps employers must follow in their treatment of employees and job seekers who have a disability. While you might not think of your diabetes as a disability, you should be protected by these acts.

The Equality Act 2010 describes a disability as a physical or mental impairment that has a substantial long-term negative effect on a person’s ability to carry out normal day-to-day activities. If you take medication, the decision is based on how your impairment would affect you if you didn’t take the medication. So, to ask whether diabetes fits the description of disability, you must consider the effect of diabetes if it wasn’t being treated.

The Equality and Human Rights Commission (EHRC) has guidance for employers and workers on the Equality Act which gives information on what the law means in practice and includes practical examples. For a more detailed description of the legislation and to see the Act itself, go the Equality and Human Rights Commission. The Equality Advisory Support Service can also provide further advice.

The Equality Commission for Northern Ireland is where you should go for more information and advice about the Disability Discrimination Act 1995 and how that applies to you in Northern Ireland.

Reasonable adjustments

Disability law is about levelling the playing field by making sure people with a disability have the same chance at a career as others. This means your employer may need to make ‘reasonable adjustments’ so you can do your job.

For example, if you have diabetes and need to eat at set times to stay on top of your blood sugar levels, having your lunch break swapped around every day on a rota could make this difficult. A reasonable adjustment could be for your employer to allow you to have your lunch break at the same time every day.

You can get advice on reasonable adjustments from the Disability Employment Adviser (DEA) at your local Jobcentre Plus office, or the Disability Employment Service if you’re in Northern Ireland.

Access to Work is a government programme to help keep people with long-term conditions and disabilities in work. You should speak to them if your employer can’t or isn’t willing to make reasonable adjustments so that you can carry on working.

There’s more detail about employer obligations on the Equality and Human Rights Commission website.

Time off work for illness and check-ups

Everybody needs time off work when they’re unwell or have a medical appointment – whether they have diabetes or not. Diabetes doesn’t mean you’re more likely to be ill. You’re probably taking better care of your health than someone without the condition.

You’ll need regular check-ups as part of your 15 Healthcare Essentials. Make sure your line manager understands why these checks are necessary – don’t apologise for them.

It’s important to read your organisation’s policy on time off for medical appointments and managing long-term conditions, because the rules vary between workplaces. Try to arrange multiple appointments in the same morning or afternoon if you can and give your manager plenty of notice.

Always seek medical attention when you’re ill. Don’t wait until it’s urgent. And keep your employer up to date with what’s happening so that they can support you in the best way possible.

You may need time off to support someone with diabetes. Find out your employer’s policy on care leave. Talk to your manager about the condition and how you’re helping, so they understand how important it is.

Discuss options for flexible working if you need to give long-term support. And remember to look after your own emotional wellbeing – is there an employee assistance programme or in-house counsellor you can talk to?

“I work for a council and was penalised for taking time off for appointments that I had no control over the timing of. I got in touch with HR and now I can attend appointments without losing out financially.”

Online forum member

Time off work for a diabetes education course

Going on a diabetes education course may mean time off work.

Explain to your line manager that the course will help you manage your diabetes and mean you’re less likely to need time off in future. And you’ll have a lower risk of developing diabetes related complications that could affect your work. Some course providers, like DAFNE, have materials you can pass on to your employer that explain the benefits.

Use our template letter to put your leave request in writing. You can ask a member of your healthcare team to write to your employer explaining why the course is important and how it can improve your health in the long term. You may have the right to go on a course under the Equality Act.

If taking time off isn’t possible, or classroom-based learning isn’t right for you, check with your healthcare team about evening, weekend or digital courses. You can also sign up to our Learning Zone for free educational support online that’s tailored to your needs.

Applying for a job with diabetes

When you apply for a new job, your potential employer will want to find out if you fit the person specification and have the necessary skills and experience for the role. If you meet the needs of the job description, you should feel confident. Having diabetes doesn’t mean you’re less likely to get the job.

For most jobs, there’s no legal obligation to tell an employer you have diabetes. The Equality Act makes it unlawful for them to ask about your health before offering you work.

But talking about your diabetes from the start can show that you’re positive about your condition. It can even be an opportunity to give examples of how resourceful and well organised you are.

In some cases, the organisation may ask if you have a disability. For example:

to find out if you need any support during the recruitment process,

to increase the representation of disabled people in the organisation,

if they have signed up to the ‘Disability Confident’ scheme, committing to offer disabled people an interview if they meet the minimum criteria for the role,

or to monitor how many disabled people apply for jobs.

Telling them about your diabetes shouldn’t affect your application. Any information you give them must be kept separate and confidential.

Some professions do have special requirements because of the demands of the role. The employer will need to decide whether your diabetes poses any additional risk at work. If your condition could stop you carrying out your responsibilities or make you unsafe, think about reasonable adjustments that would make it possible for you to do the job.

Employers that don’t allow people with diabetes

We’ve campaigned successfully to stop employers banning people with diabetes from applying for roles. But we still have work to do.

Emergency services. Blanket bans have now been lifted for people with Type 1 diabetes and people with Type 2 diabetes using insulin. It’s now up to your local service to decide – they will have their own rules. For example, some NHS Ambulance Trusts have rules about people with diabetes applying for jobs as ambulance crew. You should expect to be fairly assessed against these rules by someone who understands the role and how diabetes is managed.

The UK armed forces are exempt from the Equality Act and have a blanket ban on employing people with diabetes.

Being self-employed with diabetes

Self-employment can seem like the easier option when you have diabetes. But you shouldn’t feel like it’s your only choice. Weigh up your options carefully and decide what will work best for you.

Being self-employed gives you more flexibility to attend appointments. And working from home means you can treat your diabetes more easily in privacy, if you prefer this. But self-employed people don’t get sick or holiday pay. And working alone can mean you lack the support of colleagues and the social benefits of teamwork.

  • Risk of having a hypo when glucose below 70mg/dl need to be promptly addressed when driving. Diabetes patients should keep a glucometer and test strips in the car during long journeys. They should keep hypo treatments in the car during long journeys.
  • Check your blood sugar levels before the long journey. Diabetes patients are fit to drive when blood glucose levels are above 90mg/dl.
  • Complications of eyes (retinopathy) or nerve damage (neuropathy) can sometimes affect the ability to drive.
  • Driving license in India is not a problem for patients with diabetes.
  • If hypos are a problem contact the IDEACLINICS team for further advise and safety measures.

Insurance and diabetes can be sometimes difficult whether it is life, health and travel assurance.

Travel insurance

It is essential that all travellers have sufficient cover when going abroad as healthcare can be very expensive in the unlikely event of falling ill.  IDEACLINICS can guide you and also support with medications and telephonic advise while abroad.

Motor insurance

When applying for car insurance you must declare if you have diabetes as there is a risk for hypoglycaemia if on insulin.

Private medical health insurance

Insurance for patients with diabetes can be difficult or expensive and cost of any treatment relating to diabetes can be excluded from the policy.

If  covered by a scheme run by employer, check the benefits available to you and if you can continue the same cover when moving jobs. You can get further information by contacting us at the IDEACLINICS.

  • Illness, infections or other stresses can raise blood glucose levels even when not eating enough food. There is stress hyperglycemia as insulin production is not adequate.
  • Dehydration can happen due to temperature and sickness and may need intravenous fluids sometimes if not drinking water adequately
  • Check your blood sugar more often and be aware of symptoms of both hypos and hypers. Keep taking your diabetes medications unless advised by doctors.
  • Type 1 diabetes need to check for ketones particularly if glucose levels above 250mg/dl
  • If taking steroids for conditions like Addison’s disease, severe asthma, rheumatoid arthritis and lupus glucose levels may go up and seek expert help.
  • Hospital admissions for patients with diabetes need a plan in place to manage diabetes and doctor can arrange that.

Most women with diabetes have a healthy baby. But having diabetes puts both of them at risk of serious health complications during pregnancy and childbirth. Hence visiting IDEACLINICS for preconception counseling and management of diabetes can facilitate a healthy pregnancy and to a healthy baby.

Checklist for a healthy pregnancy

  • Keep blood sugar to target levels as advised by endocrinologists.
  • Get medications reviewed as some are contraindicated during pregnancy.
  • Take folic acid every day at 5mg dose at least a month before planning.
  • Get eyes and kidneys screened for any diabetes complications.
  • Plan pregnancy when HbA1c below 6.5% and never above 9%
  • IDEACLINICS helpline has highly trained advisors with counseling skills, and an extensive knowledge of diabetes and they will suggest appropriate advise.

 

Risks of possible complications if Diabetes is not in  good control (HbA1c < 6.5%)

  • There could be a risk for miscarriage or stillbirth.
  • Baby may be born with serious health problems, such as spina bifida or heart defects.
  • Diabetes mothers have five folds higher risk for a pre-term baby
  • There is risk for a big baby leading to birth injuries or need for caesarion section.
  • May have problems with your eyes and kidneys.
  • Should plan

Blood sugar levels ranges to be aimed for are:

Fasting glucose values and before each meal:  80mg/dl to 110mg/dl

After meals 90mg/dl to 140mg/dl

Having diabetes shouldn’t affect fertility unless there is co existing polycystic ovarian disease with type 2 diabetes. However, it is important to get diabetes to get under control and stop medications which are unsafe and initiate insulin if needed to bring HbA1c below 6% – 6.5%

Diabetes is one of  the leading cause for blindness and diabetic retinopathy can be missed if retina is not examined periodically.

What is diabetic retinopathy and what causes it?

Diabetic retinopathy is an eye disease that people living with diabetes are more at risk of getting. If your blood sugar levels and blood pressure are consistently high, you can seriously damage your blood vessels.

And there are lots of important blood vessels in your eyes. These vessels help supply blood to the seeing part of the eye (called the retina). When these blood vessels are damaged, they can get blocked, leak or grow randomly. This means the retina can’t get the blood it needs and so can’t work properly. Which means you won’t be able to see properly.

There are lots of things you can do to keep your blood sugars and your blood pressure in your target range. And the more you do this, the lower your risk of developing serious problems with your eyes.

Keeping your eyes healthy for as long as possible is in your control, and we’ve got all the facts and advice to help you do it.

You can prevent sight loss and we’re here to help. We’ve got information on the steps you can take to avoid eye problems and how to manage eye problems you have now, to stop them getting worse.

Types of retinopathy

There are four main types of retinopathy.

BACKGROUND RETINOPATHY :This is stage one where eye sight isn’t affected yet but action is needed to prevent the problem getting worse. The management is to ensure good diabetes, BP and cholesterol control.

NON-PROLIFERATIVE RETINOPATHY : This is stage two when the damage is more serious and eye screening at a more frequent intervals is recommended.

PROLIFERATIVE RETINOPATHY: This is stage three with a very high risk of losing sight and warrants urgent eye treatment which could be by laser or injections usually.

MACULOPATHY: Macula is the area in the retina which provides maximum vision and in this type of retinopathy vision can be affected.

Cataracts and glaucoma

Cataracts and glaucoma are other eye problems that people with diabetes may develop. A cataract is when the lens get cloudy and glaucoma is when pressure builds up in the eye..

To prevent serious eye damage, eye screening should be part of Diabetes management.

Foot problems in patients with diabetes is common and can be debilitating

Serious foot problems can lead to amputations which can be prevented by:

  • Quiting smoking
  • Managing blood sugars, cholesterol and blood pressure
  • Checking feet every day
  • Eating a healthy, balanced diet and staying active
  • Watch out while cutting nails and learn the right way.
  • Make sure footwear is the right one fitting well.
  • Use moisturising cream every day and avoid dry skin.
  • Get feet examined for neuropathy and blood supply at every clinic visit.
  • The important thing to remember is to keep your weight off your foot if there is a neuropathic or neuroischaemic ulcer.
  • Ask the specialist questions and learn about foot care and keep an eye on any changes in your feet.

Heart attacks are common in patients with  diabetes especially in smokers.

A heart attack can happen if blood vessels are damaged or blocked and diabetes is a major risk factor alongside hypertension, smoking and high cholesterol.

Link between diabetes and heart attack is well established and the risk is reduced by keeping the HbA1c on target.

Getting HbA1c, cholesterol and blood pressure checked at least twice a year along with a healthy diet, exercise and quitting smoking will ensure good health.

A stroke can happen if blood vessels are damaged or blocked and diabetes is a major risk factor alongside hypertension, smoking and high cholesterol.

Link between diabetes and stroke is well established and the risk is reduced by keeping the HbA1c on target.

Getting HbA1c, cholesterol and blood pressure checked at least twice a year along with a healthy diet, exercise and quitting smoking will ensure good health.

Kidney disease can be a very serious condition and about 1 in 3 people with diabetes might develop kidney disease particularly when diabetes and hypertension remain uncontrolled. They are five times more likely to need either kidney dialysis or a kidney transplant

As diabetic nephropathy progresses, the kidneys become less efficient and patient can become very ill due to the buildup of waste products in the blood.

Kidney disease is caused by damage to small blood vessels. However, keeping blood glucose and blood pressure levels under control can greatly reduce the risk of kidney disease

As part of annual health care review the blood test will measure urea, creatine, and estimated glomerular function (eGFR) showing how well the kidneys are working along with urine test for microalbuminuria.

Usual treatment for people with diabetes is ACE inhibitor or angiotensin II receptor antagonists. For worsening kidney disease we may need to limit certain foods in your diet, such as protein foods or foods high in potassium. For further information dietitian at IDEACLINICS will be able to guide.

In some cases, dialysis might be needed or as an alternative kidney transplant remains the final solution for the failed kidney.

Dental health is an important part of managing diabetes, however, its not given much significance in India and largely ignored.

Infact, having diabetes puts the patient at high risk of dental problems like gum disease.

People with Type 2 diabetes are around three times more likely to develop dental problems than people who don’t have diabetes.

Too much sugar in the blood can lead to more sugar in saliva, become a breeding ground for bacteria producing acid  thereby damaging tooth enamel and gums. High blood sugar levels can also damage the blood vessels in the gums.

Dental problems can present with tooth decay, gingivitis, periodontitis, dry mouth (xerostomia) or thrush causing sore mouth, and ending with abscesses with tooth loss.

To keep mouth healthy one has to keep blood glucose levels in target range, brush twice a day, visit dentist for regular checkups, choose the right food and drink which is low in sugar, stop smoking if they have this habit.

For further information please visit a dentist or contact ideaclinics.

Neuropathy is a very complication which affects the nerves and presents as painful or painless neuropathy. Diabetes can cause neuropathy as by damaging the small blood vessels which supply the nerves. There are three different types of neuropathy: sensory, autonomic and motor. One in two diabetes patients may have some form of neuropathy.

Sensory neuropathy

Sensory neuropathy affects the touch, temperature, pain and other sensations from the skin, bones and muscles affecting the nerves in the feet and rarely hands.

Symptoms are tingling, numbness, no pain or temperature sensation, Some may have burning or shooting pains particularly at night.

The main danger of sensory neuropathy is when due to lack of sensation there is damage to the feet causing ulcers or infections.

Charcot joint is a rare complication caused by severe neuropathy. Treatment includes immobilizing the foot in a plaster cast and in some cases surgery.

Autonomic neuropathy

Autonomic neuropathy can lead to Gastroparesis causing bloating, constipation or diarrhoea, rarely urinary incontinence, lack of sweating in feet causing dry skin with callus or even gustatory sweating. Impotence with inability to keep an erection can be due to autonomic neuropathy

Motor neuropathy

Motor neuropathy affects muscles causing weakness, wasting and deformities of feet.

How to avoid neuropathy

Neuropathy can be avoided by keeping diabetes under control, with regular check ups of feet at least once a year.Moisturise and  protect feet from injury

Having diabetes doesn’t mean there are going to be problems with sex and even for those with problems there are various treatment options.

COMMON CONCERNS WITH SEXUAL HEALTH

  • Sex is a form of exercise and glucose levels may drop and cause a hypo.
  • Both men and women with diabetes are more likely to have sexual problems than people without diabetes
  • High blood sugar levels can affect your nerves and blood vessels.
  • Diabetes can put you at more risk of urinary tract infections and thrush.
  • Your feelings about sex can go down with low libido or sex drive either due to diabetes or due to psychological factors leading to it.

Sexual problems can affect women with diabetes due to reduced circulation, neuropathy or psychological burden. The common problems women can have are as below.

Vaginal dryness

Restricted blood flow and nerve damage can reduce vaginal stimulation or dryness. One in four women with Type 1 diabetes have sexual problems. Lubricants can help with vaginal dryness,  make sex less painful and improve libido.

Thrush

Thrush is a fungal infection which is common in women. It can present with  Itchiness and pain with white thick discharge with burning sensation while passing urine or during sex. Good diabetes control can reduce this risk.

  • Sexually transmitted Diseases (STD)

Diabetes does not make one susceptible to STDs but can be passed on after sex with someone with STDs.

  • Urinary tract infection (UTI)

UTI are not sexually transmitted but is common in those who are active in sex. They are more common in women and more likely if diabetes is uncontrolled. The symptoms are usually a high temperature with chills and rigors with  loin pain with vomitings.

Diabetes and sexual problems  are common for those with uncontrolled diabetes for a long duration.

Diabetes can damage blood vessels and nerves, including the ones that supply the penis which reduce the blood flowing to sexual organs leading to reduced sensation and erectile dysfunction.

  • Erectile dysfunction

The most common type of sexual problem in men is erectile dysfunction. Erectile dysfunction or Impotence is when you can’t get or keep an erection.

Erectile dysfunction is three times more common in diabetes patients than others. Apart from limited blood flow and neuropathy it can also be due to medication or psychological reasons like underlying depression

Pills like Viagra and tadalaphil are very effective but need to check with doctors as they can cause heart problems.

  • Thrush

Thrush is a fungal infection common in women than men. Though can be transmitted during sex it is not a sexually transmitted infection. Sometimes diabetes is suspected when patients present with thrush as a lot of sugar in urine causes thrush.

  • Sexually transmitted Diseases (STD)

Diabetes does not make one susceptible to STDs but can be passed on after sex with someone with STDs.

  • Urinary tract infection (UTI)

UTIS  are not sexually transmitted but is common in those who are active in sex. They are more common in women and more likely if diabetes is uncontrolled. The symptoms are usually a high temperature with chills and rigors with  loin pain with vomitings.

Hypoglycaemia is a low glucose reading of below 70mg/dl. Hypoglycaemias can happen if there is a mismatch between diabetic medications versus diet or exercise. It can happen quickly and hence it is important to know the signs to identify and treat.

Signs and symptoms of a hypoglycaemia may vary but could include feeling tired, lack of concentration, headache, shaky, excess sweating, being anxious or irritable, palpitations and sometimes lips feeling tingly or blurred sight, being hungry and if severe can cause unconsciousness.

Understanding why we get hypos can help prevent them. Sometimes missing or delaying a meal or not having enough carbohydrate, exercise, excess insulin or diabetes medication can lead to this preventable complication.

Please discuss with our staff and endocrinologists at the IDEACLINICS if you have any concerns about these episodes.

Hyperglycaemia is when fasting glucose is above 126mg/dl and post meal values are above 150mg/dl.

High glucose levels are seen when medications are missed due to poor compliance, when patient has a high carbohydrate meal or is stressed or unwell from an infection.

They may be asymptomatic but sometimes be passing more urine than normal, especially at night, feel thirsty, tired with headaches.

Treating a hyperglycemia will depend on what the cause and may need readjusting lifestyle or medications. If it’s a short term event drinking plenty of fluids, taking extra insulin if on insulin or seeking help by contacting IDEACALL (Telediabetes) for advice can be useful.

To prevent  hyperglycemia one should be aware of carbohydrate portions and its impact on glucose.

If glucose levels are high in type 1 diabetes it is useful to check urine for ketones particularly if  blood glucose level is above 250mg/dl. If ketones are present small amounts we may need to increase the dose or give an extra dose, however, if ketones are in large amounts it is important to seek expert help by contacting Ideaclinics particularly if unwell with vomitings.

Hyperosmolar Hyperglycaemic State (HHS) occurs in people with Type 2 diabetes when glucose levels are high (eg above 500mg/dl). Unlike DKA, It develops over a course of weeks due to underlying illness,infection and dehydration.

Sometimes poor compliance with diabetes medication during illness particularly for reasons of loss of appetite, swallowing difficulties or nausea can contribute towards this complications and worsened by other hormones like cortisol, catecholamines etc which are counter regulatory hormones produced during illnesses.

HHS symptoms can be those of dehydration with confused state, drowsiness and finally comatose state. HHS is a life-threatening emergency and warrants prompt inpatient treatment to correct dehydration and bring blood glucose down to normal levels with insulin and intravenous replacement of fluids.

To avoid this complication patients should be encouraged to  take diabetes medication even when unwell and can’t eat by close monitoring of blood glucose with frequent testing. To avoid this complication, its better to keep blodd glucose levels below 250mg/dl

DKA is a life threatening emergency and most common in people with Type1 diabetes though can also be seen rarely in patients with type 2 diabetes.

One in four children present with  diabetic ketoacidosis (DKA) at the time of diagnosis.

If untreated, DKA can be life threatening, hence prompt diagnosis and treatment with extra insulin, glucose and fluid with close monitoring is critical.

DKA can be avoided if one takes  insulin in the right amounts by  keeping a good check on blood glucose levels and periodic check up with endocrinologists.

DKA usually develops over few days or hours but can develop faster particularly in young children and hospital admission and treatment is essential for close monitoring and treatment with intravenous fluids, insulin and glucose if needed.

Ketones in the blood/urine which can be detected easily can help identify DKA from hyperglycemia where there is no acidosis. Always check for ketones if your blood glucose is over 250mg/dl

Mental health issues in a patient with diabetes remains a underreported problem.

Whether a newly diagnosed or with long term diabetes different emotions are involved which could be stress, anxiety or depression. A psychologist or a psychiatrist can be useful if one is suffering from mental health issues and should be the part of a multidisciplinary diabetes team.

Being diagnosed with diabetes, particularly at a young age as seen amongst Indians can come as a shock. There may be disbelief, anger or low mood.

IDEACLINICS can support if you have any issues and can visit any of our nearest centres or contact our Telediabetes centre for a counselling session or medications if needed.

Diet in diabetes patients can be a factor of stress and could lead to eating more or sometimes less as they feel depressed.

Stress in patients with diabetes can affect the blood sugar levels, so it’s important you know how to recognise and deal with it.

Depression and diabetes often co exist and the former is often missed to be diagnosed. People with diabetes are twice as likely to develop depression than people who don’t have diabetes.

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