Complication are major cause of morbidity and mortality in people with diabetes. Type 1 Diabetes Mellitus are at high risk of a acute and chronic complications. The acute complications are Hypoglycemia (low sugar) and Diabetic ketoacidosis (DKA). Hypoglycemia means when the blood glucose falls to below 70mg/dl, which requires to be corrected by oral glucose or Sweets or any available food. Mild and moderated hypoglycaemia can be managed at home, but severe hypoglycemia presents with unconsciousness, abnormal behavior, seizures or rarely paralysis, such cases need Hospitalization. Diabetic Ketoacidosis begins with mild ketosis due to high blood glucose, dehydration, infection etc. It should be checked in urine ( by keto-Diastix ) if fasting glucose is more than 250mg/dl or Postmeal / Random Glucose is > 350 mg/dl or during episode of vomiting, fever abdominal pain or any sick Day. Early correction of Blood glucose by insulin correction of dehydration and antibiotic for infection may prevent hospitalization, which is otherwise mandatory during severe DKA. Chronic complication may appears after many years of duration and can be related to Eyes (Diabetic Retinopathy), Kidney (Diabetic Nephropathy), Nerves (Diabetes Neuropathy), Sexual Dysfunction, Heart (CVD), Brain (Stroke) etc. All these complication are preventable by control of glucose, lipids, blood pressure & healthy lifestyle.

Therefore health care providers should counsel and educate people with type 1 diabetes to help them live stress free life with diabetes.

Recorded on 23rd June 2023 with Radhika Patrikar, at Akashwani Nagpur.

Nurses play an important role in supporting people with diabetes (PWD). Nurses account for half of the global health. As the number of people with diabetes are increasing every day, the role of nurses as an educator becomes increasingly important. By creating nurse educators, a person with diabetes can receive a high quality evidence based knowledge & a good clinical care, which can help to maintain their blood glucose, blood pressure & lipids to the target levels and thus can avoid life threatening preventable complications of diabetes. Educators can burst the myths & misconceptions from the mind of a lay person, which prevails due to unawareness and sharing of non-scientific evidence based data in various social media platforms. Nurses can save PWD’s from unnecessary sufferings & can help for their psycho- social wellbeing. (Recorded June 9, 2023)

Type 1 diabetes can occur at any stage of life. Educating parents/caretakers regarding management of diabetes can improve the quality life of a person with Type 1 DM. Children with Type 1 Diabetes Mellitus faces different challenges with advancing age like, from early childhood, schooling, adolescent age, career, at work place, marriage etc. Regular Monitoring of different organs and good blood sugar control, practicing healthy eating habits and regular physical exercise helps in achieving the glycemic, Lipids & blood Pressure goals. Emotional support also plays an important role in managing diabetes. Thus, Diabetes Self-Management Education (DSME) and Support is mandatory for empowering, each individual with Type 1 Diabetes Mellitus and their family member at every stages of life. (Recorded on 26th May 2023)

Type 1 Diabetes Mellitus(T1DM) is also known as Juvenile or Insulin Dependent Diabetes Mellitus. In This, Beta Cells of Pancreas produce either very little or no Insulin thus they need to take insulin injections for their whole life. Type 1 DM most commonly occurs between 5 to 15 years of age, but it can occurs at any age after 6 months of birth and even in elderly people. In T1DM beta–cells of pancreas get destroyed completely due to autoimmunity or post-viral infection or idiopathic (Unknown Cause).

India ranks at first position in the prevalence of Type 1 Diabetes Mellitus in the World. It’s common symptoms include polyuria.(increased urination), polydipsia (increased thirst), polyphagia (increased appetite) & weight loss. Their treatment includes Insulin and medical nutrition therapy. They have to take insulin injection 4 times a day or sometimes even more Acute complications of T1DM includes Diabetic Ketoacidosis (DKA) & hypoglycemia, which needs immediate action. Some important diagnostic tests for T1DM include fasting C-Peptide, GAD 65 antibodies test and antibody to Celiac Disease etc.

Recorded on the 12th May 2023 at Aakashwani Nagpur.

Type 2 Diabetes doesn’t develop in a day. It starts much early as Pre Diabetes, where ,Fasting blood glucose is between 100-125 mg/dl called as Impaired Fasting Glucose(IFG) and/or 2 hours post prandial blood glucose 140-199 mg/dl called as Impaired Glucose Tolerance (IGT). Both IGT & IFG are being classified as Pre Diabetes. So, T2DM develops after a period of 3-7 years of pre diabetes in India. This is a golden opportunity in the life of a person with T2DM, that if they follow consistent structured Life Style Modification (LSM), at least 50% of these people with pre diabetes can become normal, remaining 50% either will remain Pre Diabetes or will become T2DM in next 5-10 yrs. Thus, screening and early detection of Pre Diabetes can play a vital role in prevention of T2DM.

Dr. Sunil Gupta also discussed about how ketones develop in Type 1 diabetics, adhesive capsulitis or Frozen shoulder, heart health, Stress , importance of exercise in diabetes. He also highlighted on Primordial prevention of diabetes during pregnancy.

Recorded on 27th April 2023.

Every 11th adult in the world may have diabetes. Diabetes can be tested by Oral Glucose Tolerance Test (OGTT) in which you have to do an overnight fasting of 8-14 hrs before the test. After withdrawing fasting blood sample, consume 75 gms of glucose in appx 250-300ml of water and test the blood glucose after 2 hours. During this period avoid any type of physical exertion and smoking. If 2 hours, post (75gm) glucose blood sugar level is less than 140 mg/dL it is considered as normal, if it is between 140 to 199 mg/dL this indicates you have Pre Diabetes, and when it is 200 mg/dL or higher indicates that you have diabetes. Another method diagnosis diabetes is HbA1c test. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have Pre Diabetes and 6.5% or higher indicates that you have diabetes. Similarly, A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have pre diabetes, and 126 mg/dL or higher it indicates you have diabetes.

Dr Gupta also discussed about ICMR and other studies which indicates that more and more younger population is getting affected with diabetes which is a concern for the healthcare system. Moreover 50-70% of our adult population is overweight which increases the risk of non communicable diseases (NCDs) like diabetes. Studies have shown that Life Style Modification (LSM) alone can prevent diabetes. Researches have shown that LSM can prevent 54% of people with prediabetes from developing frank diabetes. Metformin has been recently approved by the Government for the treatment of Prediabetes in India. To make India diabetes free, focus should be on Obesity & Prediabetes .We should preach “Eat less, chew well, walk more, sleep well & Smile”!

(Recorded on 31st March 2023)

Fasting may have some general health benefits. It helps in weight loss, lowers bad cholesterol (Triglycerides, LDL-Cholesterol) and increases good cholesterol (HDL-C) and helps improve your blood sugar level. People with diabetes (PWD) should practice smart fasting .During Ramadan, PWD should have protein rich, high fiber meals at Sehari and should avoid high fat, high carb meals at Iftar. Instead of sharbat and juices opt for buttermilk, soups, lime water, jaljeera to keep yourself hydrated. During Navratri, try to eat at regular intervals and instead of fried food & sweets choose low fat foods, bhagar , kuttu ka aata, fresh fruits and vegetables, nuts and oilseeds. Avoid Vigorous exercises during fasting but be physically active. Monitor blood glucose frequently while fasting and also watch for low blood sugar. Recorded on 24th March 2023 at Akashwani Nagpur.

The pious month of Ramadan and Navratri has commenced and many people would observe fasting with food, without food and water (for limited hours). Approximately 80% of diabetics can observe safe fasting. International Diabetes Federation (IDF) has made global guidelines on Ramadan fasting for People with Diabetes (PWD), which should be followed during fasting. According to these guidelines, most of PWD can do fasting with precautions. Those who have Brittle Diabetes with lot of fluctuations of blood glucose should avoid fasting. PWD on many oral drugs or multiple doses of insulin should avoid fasting to prevent hypoglycemia, hyperglycemia or ketosis. Many T1 Diabetics (T1DM) are on Insulin Pump, where insulin doses can be adjusted as per the carbs in their meal, lifestyle and blood glucose. They must consult their treating Doctor before commencing any type of fast. Similarly, T2DM those who are on single or multiple drug combinations or on diet control should also consult their doctor before fasting. Few medicines like Biguanides (Metformin), Gliptins etc. are safer during fasting and have low risk of hypoglycemia. Those who are on insulin, the dose may need to be reduced to prevent hypoglycemia. PWD with associated complications like heart disease, brain stroke, kidney failure, retinopathy, Cancer etc. and those with history of any recent major surgery should avoid fasting. It is advisable to take a fitness certificate for fasting from your Doctor and practice smart fasting.

While fasting, mild exercises like daily household work, walking, yoga & Pranayam can be incorporated, however we should avoid vigorous exercises. Women with diabetes in pregnancy should avoid fasting for a healthy fetal growth. Awareness about fasting should be created amongst the health care professionals, para medical staff and diabetes educators, so that they can counsel their PWD for safe fasting.

If the management of diabetes is being presumed as a “Table”, it will have 4 pillars, 1st is Diet, 2nd is Exercise, 3rd pillar is Drugs (Insulin & Oral drugs), 4th pillar is Monitoring. But, despite all four pillars in place, the table is incomplete without a Table-Top, this tabletop is “Education.”Education plays a key role in the management of diabetes. Without education, the prescription of diabetes is incomplete. Every clinician, nurse or paramedical staff involved in diabetes care, can focus on educating people for better management of diabetes and can play the role of a successful educator. With the growing burden of diabetes, it is imperative to empower people with evidence-based knowledge and help them to live a healthy and happy life with diabetes. Education can be One to One, in a small group, in a conference hall and for masses through radio, print media, television and social media. It can be conducted in a small clinic, corporate/government hospitals, rural/ urban health care centers, in different offices, and at public places like parks, with/without the help of NGOs. Education is needed at different phases of the transition of diabetes, like from very early childhood to adolescence, adult, during a change of job, marriage, pregnancy, menopause, elderly etc. A key focus of diabetes education involves lifestyle changes (Diet, Exercise, weight & stress management), annual screening for target organs, compliance of medicines and visits to treating doctor, management of acute complications like hypoglycemia or ketosis at home etc.Sunil’sDiabetes Care n’ Research Centre (DCRC) is actively involved in educating society under the banner of “Hello Diabetes” for the last 30 years. Apart from the general population, we also focus on specific groups like Juvenile Diabetes(JD-Con), Couple Diabetes, Gestational Diabetes, Type 2 Diabetes and so on. DCRC & DCFI (Diabetes Care Foundation of India) also create diabetes educators through a certificate course NDEP (National Diabetes Educators Program) and take annual conferences for Nurses (Nu-Con), for Women (Wo-Con), for educators (DE-Con) and Hello Diabetes Academia for doctors. Hello Diabetes Education is also done through the YouTube channel & Podcast of Dr Sunil Gupta.