World Health Day is on 7th April.
While the theme for World Health Day has been to create more awareness on diabetes management and care, we were wondering what exactly can be done to lower the burden of diabetes and help people deal with this epidemic. To understand better on how to control this lifestyle condition and help people deal a normal life, devoid of complications that can follow, we spoke to Dr Roshani Sanghani, consultant endocrinologist and founder of diabetes self-management clinic, P D Hinduja Hospital & Medical Research Centre, Mumbai to answer some basic questions on diabetes management and living healthy.
When we say diabetes self-management, what does it exactly mean?
In layman terms, it means managing and controlling your blood sugar level to avoid complications. But in India, we usually advise patients to undergo diet changes and start exercising and often they don’t know how to begin. This is where diabetes self-management education or DSME comes in. It is an approach to treat and control diabetes which is endorsed by the American Diabetes Association that helps an individual take charge of his own condition to live a healthy life by controlling blood sugar. DSME is a critical part of treating diabetes and also for those who are at risk of developing the condition.
What are the attributes of DSME?
The DSME has a seven-point approach detailed by the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA). These seven points include:
1. Checking blood sugar level after meals
2. Healthy eating
3. Staying active
4. Taking medications on time
5. Solving own problems (i.e. what to do when the blood sugar level rises or lowers)
6. Reducing risk of complications (losing weight or managing cholesterol level)
7. Coping with the emotional challenges
A patient is taught about managing his condition depending on these seven parameters. The approach of DSME is to empower the patient and help him take valid steps to keep and manage his blood sugar level. This is the reason we ask them to meticulously measure their blood sugar level after meals and also before and after an activity like walking or gyming so they are constantly aware of their condition and can take the right steps to prevent fluctuation in the blood sugar level.
Even with so much awareness about eating right and exercising, people still suffer from fluctuating blood sugar levels, especially high sugar, why so?
It is more to do with the right approach than with having the right knowledge. In India, when a person is diagnosed with diabetes he might be given a list of foods that he needs to avoid which might include banana, white bread, white rice, chips, sweets, pastries, white pasta and the list is endless. So with a vague list like this, people are usually confused about what to eat and what not. However, with the DSME approach, we treat it a little differently. We ask a patient to maintain a food diary. So if he has been eating four chapattis and a bowl of subzi and his sugar level after the meal increases, he can cut down on his carbohydrate portions and include more of proteins. However, he needs to bring all these minute details to the doctor’s notice during his visit. This will help in drafting a better management approach for the future.
On the contrary, when sugar level drops many people tend to eat calorie dense foods like sweets to bring the levels to the optimum — is that the right approach?
Remember, with diabetes most of the time our aim is to help one lose weight and having high caloric snack means piling more calories and doing just the opposite of what is needed. If you resort to sweets or pastries or chocolates to raise your blood sugar, you run the risk of causing the sugar to swing too high in the opposite direction. Also, do not judge on your own whether your sugar has dropped. Always measure with a glucometer to see if you are really suffering from low sugar. Your sugar will be low only when it reads below 70 mg/dL. If one reaches that state, it is better to follow the 15/15 rule. Eat a snack, which need not be high in sugar but has 15 gm of carbohydrate in it. For instance, a glass of milk or even half glass of fruit juice will do. Wait for 15 minutes and check your blood sugar again, which should increase by 15 mg/dL. However, if the drop in sugar level is a common occurrence, it is better to inform your doctor as it could be due to the affect of medications. The doctor would usually lower the doses, so you don’t have to worry to incorporate sugar into your meals and keep eating healthy.
What is the need of the hour when it comes to treating diabetes in India?
The WHO’s campaign is to prevent, treat and beat diabetes and if one is able to self-manage the condition with the right education and knowledge, this would not be a distant dream.
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