What is Glycemic index and why you should know about it

Blood sugar levels in our body is determined by what we eat,when we eat and how much we eat and is regulated by a hormone called Insulin. In a normal person,insulin hormone regulates the post prandial blood sugar that is roughly 1-2 hours after a meal and keeps it under control.

If you have Diabetes, high blood sugars can be a wake-up call, telling you that it is the time to start making healthier food choices.

In simple language,the carbohydrate component of the food breaks down in the stomach and contributes towards the blood sugar levels.Excess protein and fats too convert to blood glucose eventually by various pathways.

Complex carbohydrates which contains fibers and starches made of complex structures gets broken down and absorbed slowly in the stomach and the blood sugar levels rise steadily. These foods are better choices for people with Diabetes, because they do not cause spikes in blood glucose levels which cause damage to your organs in the long run. Simple sugars like sucrose,fructose are broken down easily and increase blood sugar quickly causing harm.

What is Glycemic Index?

Glycemic Index or GI, measures how a carbohydrate-containing food raises blood glucose.

GI can be classified into-

  • Low GI-Foods which do not increase the blood sugar levels too much post meal.
  • Higher GI-Foods which increases blood sugar levels considerably post meal.

Why is Glycemic Index important?

In diabetes patients,the regulation of blood sugar levels are impaired and there is a unregulated sugar levels.These blood sugar levels have a direct association with which food is consumed.As mentioned earlier,carbohydrates after consumption contribute towards the blood sugar levels and hence  glycemic index of a carbohydrate is an important factor in determining the post prandial blood sugar levels.

Hence for diabetics it is advised to include lower glycemic index foods to the diet on the contrary high glycemic index foods are told to be avoided as they increase blood sugar levels quickly.

Research shows that both the amount and the type of carbohydrate in food affect blood glucose levels. Studies also show that the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response than the GI.

What affects the glycemic index of food?

As a general rule fiber lowers the GI and simple sugars have higher GI.

  • Ripeness and storage time — the more ripe a fruit or vegetable is, the higher the GI and increase in storage time increases GI
  • Processing — juice has a higher GI than whole fruit; mashed potato has a higher GI than a whole baked potato,  whole wheat bread has a lower GI than white bread.Processed potato chips,snacks made of rice and potato have higher GI.
  • Cooking method — Food cooked for longer duration tends to break into simple sugars and have lower GI.
  • Variety —  Brown rice has lower GI than white rice.

The Glycemic Index of a food is different when eaten alone than it is, when combined with other foods. Include Higher GI food with lower GI food items to balance out the meal.

Example of foods according to Glycemic index

Low Glycemic Index Foods

  • Oatmeal, oat bran, muesli
  • Barley,ragi,millets,bajra
  • Sweet potato, corn, yam, beans, peas, legumes and lentils,chickpeas
  • Most fruits, non-starchy vegetables and carrots
  • Whole wheat, rye and pita bread
  • Brown, wild or basmati rice

High GI

  • White bread,maida
  • Corn-flakes,puffed rice snacks,bran flakes,instant oat
  • Short grain white rice, rice pasta, macaroni,pizza,cheese
  • Potato, pumpkin
  • Rice cakes, popcorn,  crackers,cookies,candies,donuts and cakes
  • pineapple,mango

There is no best meal plan best for diabetics.So it is important to follow a meal plan that is tailored according to the requirements. Better food choices and lifestyle changes keep the blood sugar levels steady.

Research indicates Glycemic Index is a tool that helps with Diabetes management. Combined with carbohydrate counting, it may provide an additional benefit for achieving blood glucose goals for diabetics and pre diabetics.

Discuss with your doctor/nutritionist about the various glycemic indices in the food of your choice and tailor it to your diet by using this important tool.

-Dr Prerna Gaur

Acknowledgements-

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370345/

http://care.diabetesjournals.org/content/28/7/1839

https://www.webmd.com/diabetes/glycemic-index-directory

 

SELF MONITORING OF BLOOD GLUCOSE

Self monitoring of blood glucose or SMBG refers to home blood glucose testing for people with diabetes.

-Self-monitoring of blood glucose provides information regarding an individual’s dynamic blood glucose profile. This information can help with the appropriate scheduling of food, activity, and medication. It is also required for understanding of the timing of blood glucose variations

There are a number of benefits of home blood glucose testing:

  • Helps to determine which foods or diet are best for one’s blood sugar control.
  • Helps in informing the patient and doctor about how well the medication regime is working.
  • Reduces anxiety about, and increases understanding of, hypoglycaemia.
  • It is important for undertaking serious tasks which could be influenced by high or low blood sugar such as driving.

There are several necessary steps to assure accurate data from Self-monitoring of blood glucose.

using the glucometer for Self-Monitoring of Blood Glucose- The instructions must be read and followed thoroughly as missing out on them may affect the results. Proper use of the strips and general procedures for meter handling must be understood appropriately in order to obtain useful data.

-Some practical tips to make the self-monitoring of blood glucose easy and effective

  1. Make sure that the area to be pricked is cleaned with soap and water thoroughly.
  2. Use a new lancet for each blood glucose check.
  3. Store the testing strips as advised (in moisture and heat free environment)
  4. Alternate the fingers instead of repeatedly using the same finger.
  5. To minimize pain from forceful squeezing of the fingertip to get a sufficient blood sample, start squeezing the palm and push the blood progressively into the fingertip.

6.Make sure to note down all the readings in a systematic way-with date, time, relationship with meal, exercise etc. and take the log to the doctor, so that necessary steps can be taken by your doctor to help you to control your blood sugar levels after going through the reading.

http://clinical.diabetesjournals.org/content/20/1/45

https://www.diabetes.co.uk/blood-glucose/blood-glucose-self-monitoring.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864180/

https://www.mdedge.com/ccjm/article/108318/diabetes/self-monitoring-blood-glucose-advice-providers-and-patients

-Dr. Afroze

Differences between type I and II diabetes

If you have ever wondered what your doctor means when he writes down Type I or Type II diabetes in the diagnosis section or when you generally hear both the terms and wonder what they mean, here is an article that would help you.

Basic understanding of what Diabetes is,

Diabetes mellitus (or diabetes) is a chronic, lifelong condition that affects your body’s ability to use the energy found in food.

Glucose is the fuel that feeds your body’s cells, but to enter your cells it needs a key. Insulin is that key.

What happens to the key (Insulin) in type I and Type II?

People with type 1 diabetes don’t produce insulin. You can think of it as not having a key.

People with type 2 diabetes don’t respond to insulin as well as they should and later in the disease don’t make enough insulin. You can think of this as having a broken key or defect in the lock.

Risk Factors in Type I and Type II-

Type I-Different factors, including genetics, Family history and body’s immune system is responsible. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin.

Type II –Multiple factors like Genetic , being overweight, Inactivity. , Family history, history of Polycystic ovary syndrome or diabetes during pregnancy, High blood pressure, Abnormal cholesterol and triglyceride levels

Age Groups most commonly effected by-

Type I DM – Often diagnosed in childhood

Type II DM- Usually diagnosed in over 30 year olds

Prevention-

Type I DM- unfortunately can not be prevented.

Type II DM- It may be possible to lower your risk of developing type 2 diabetes through lifestyle changes like staying active, maintaining healthy weight, regular exercise and eating balanced diet, and reduce your intake of sugary or overly processed foods.

Symptoms- The inability to control blood sugar causes the symptoms and the complications of both types of diabetes.

Type I-The first symptoms of type 1 diabetes appear when blood sugar gets too high. Symptoms include thirst, hunger, fatigue, frequent urination, weight loss, tingling or numbness in the feet, and blurred vision. Very high blood sugar can cause rapid breathing, dry skin, fruity breath, and nausea( an emergency situation called DKA=Diabetic ketoacidosis)

Type II-the first symptoms of type 2 diabetes may not show up for many years Early symptoms include frequent infections, fatigue, frequent urination, thirst, hunger, blurred vision, erectile dysfunction in men, and pain or numbness in the hands or feet.

Diagnosis / tests-

Blood tests used to diagnose type 1 and type 2 diabetes include fasting blood sugar, a hemoglobin A1C test, and a glucose tolerance test.

References

https://www.diabetes.co.uk/difference-between-type1-and-type2-diabetes.html

https://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus#1

https://jdrf.org.uk/information-support/about-type-1-diabetes/what-is-the-difference-between-type-1-and-type-2-diabetes/

https://www.everydayhealth.com/diabetes/difference-between-type-1-type-2-diabetes/

https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html
-Dr. Afroze

PREPARATION FOR BLOOD SUGAR TESTING

A blood glucose test measures the amount of glucose in your blood.Your doctor may order this test to help diagnose diabetes. And people with diabetes can use this test to manage their condition.

It is very important that you know and understand the method, precautions necessary for the tests so that the results are more accurate. Here are a few tips that you would want to know about particular tests( fasting and random)

  1. RANDOM BLOOD SUGAR TEST– If you are going for a random glucose test, you may eat and drink normally as you do but don’t overdo on high sugary drink.
  2. FASTING BLOOD SUGAR TESTING– If you will be taking a fasting blood glucose test, you must not eat or drink anything other than water for 8-10 hours before the test.
  3. It is much better if you can schedule your fasting glucose test early in the morning so you can have overnight fasting and will not have to fast during the day.
  4. 2-hour Postprandial (post lunch) blood sugar- For a 2-hour postprandial test, you need to have your blood collected exactly 2 hours after a regular meal, ideally breakfast or Lunch.

 

            A few general tips to keep in mind –

  • High stress is another reason for high blood glucose levels temporarily. It is very important that you tell your doctor when your doctor is reviewing the lab results,  if you had any health issue recently such as any infection or any stressful event recently.
  • Drink plenty of water before your blood test. This helps keep your blood pressure from dropping. The leading cause of fainting and dizziness during a blood test is a drop in blood pressure.
  • Take a snack with you if you will not be going directly back home or to work. That way you can eat it directly after the blood draw.
  • You should never stop taking prescribed medication on the day of the test, unless you’re advised to do so by your doctor.

https://www.healthline.com/health/glucose-test-blood#preparation

https://www.healthline.com/health/blood-sugar-tests#results

http://www.caringpush.com/diabetes/how-to-prepare-for-a-blood-glucose-test/

– Dr. Afroze

PREVENTION OF PROGRESSION OF PRE-DIABETES TO DIABETES

Prediabetes means that your blood sugar level is higher than normal but not yet high enough to be type 2 diabetes. Without lifestyle changes, people with prediabetes are very likely to progress to type 2 diabetes. If you have prediabetes, the long-term damage of diabetes especially to your heart, blood vessels and kidneys may already be starting.

There’s good news, however. Progression from pre diabetes to type 2 diabetes isn’t inevitable. Eating healthy foods, incorporating physical activity in your daily routine and maintaining a healthy weight can help bring your blood sugar level back to normal.

Prediabetes affects adults and children. The same lifestyle changes that can help prevent progression to diabetes in adults might also help bring children’s blood sugar levels back to normal.

Symptoms:

Prediabetes generally has no signs or symptoms.

One possible sign that you may be at risk of type 2 diabetes is darkened skin on certain parts of the body.     

Affected areas can include the neck, armpits, elbows, knees and knuckles.

Classic signs and symptoms that suggest you’ve moved from prediabetes to type 2 diabetes include:

  • you’re hungrier than normal
  • you’re losing weight, despite eating more
  • you’re thirstier than normal
  • you have to go to the bathroom more frequently
  • you’re more tired than usual
  • blurred vision

Risk factors:

Research indicates that prediabetes is often associated with unrecognized heart attacks and can damage your kidneys, even if you haven’t progressed to type 2 diabetes.

The same factors that increase the risk of developing type 2 diabetes increase the risk of developing prediabetes. These factors include:

  • Weight. Being overweight is a primary risk factor for prediabetes. The more fatty tissue you have especially inside and between the muscle and skin around your abdomen the more resistant your cells become to insulin.
  • Dietary patterns. Eating red meat and processed meat, and drinking sugar-sweetened beverages, is associated with a higher risk of prediabetes.
  • Inactivity. The less active you are, the greater your risk of prediabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
  • Age. Although diabetes can develop at any age, the risk of prediabetes increases after age 45. This may be because people tend to exercise less, lose muscle mass and gain weight as they age.
  • Family history. Your risk of prediabetes increases if you have a parent or sibling with type 2 diabetes.
  • Gestational diabetes. If you developed gestational diabetes while pregnant, you and your child are at higher risk of developing prediabetes.
  • Polycystic ovary syndrome. This common condition characterized by irregular menstrual periods, excess hair growth and obesity increases women’s risk of prediabetes.
  • Sleep. People with a certain sleep disorder have an increased risk of insulin resistance. People who work changing shifts or night shifts, possibly causing sleep problems, also may have an increased risk of prediabetes or type 2 diabetes.

Diagnosis of Diabetes:

There are several blood tests for diagnosis of prediabetes.

  • Glycated hemoglobin (A1C) test
  • Fasting blood sugar test
  • Oral glucose tolerance test

Prevention of progression of Prediabetes to Diabetes

Healthy lifestyle choices can help you bring your blood sugar level back to normal, or at least keep it from rising toward the levels seen in type 2 diabetes.

To prevent prediabetes from progressing to type 2 diabetes, try to:

  • Eat healthy foods. Choose foods low in fat and calories and high in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition.
  • Be more active. Aim for 30 to 60 minutes of moderate physical activity most days of the week.
  • Lose excess weight. If you’re overweight, losing just 5 to 10 percent of your body weight, i.e only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) can reduce the risk of developing type 2 diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
  • Stop smoking.

Children and prediabetes treatment

Children with prediabetes should undertake the lifestyle changes recommended for adults with type 2 diabetes, including:

  • Losing weight
  • Eating fewer refined carbohydrates and fats, and more fiber
  • Spending at least one hour every day in physical activity

References:

https://www.webmd.com/diabetes/features/prediabetes-diagnosis-what-to-do#1

https://www.mayoclinic.org/diseases-conditions/prediabetes/diagnosis-treatment/drc-20355284

https://www.endocrineweb.com/conditions/pre-diabetes/pre-diabetes

 

-Dr.Chandrashekar

UNDERSTANDING TREATMENT FOR TYPE I AND TYPE II DIABETES

Type II Diabetes– In type 2 diabetes, the pancreas usually produces some insulin. But either the amount produced is not enough for the body’s needs, or the body’s cells are resistant to it. Insulin resistance, or lack of sensitivity to insulin, happens primarily in fat, liver, and muscle cells.

Management of type 2 diabetes includes: It is a choice that a doctor makes based on the blood sugar levels and the status of the patient. The first line treatment includes Life style modifications Below are a few recommendations-

  1. Eat healthy :

-This is crucial when you have diabetes, because what you eat affects your blood sugar

-Foods to avoid are those rich in trans fats (also called hydrogenated fat), saturated fat, and sugar.

  1. Exercise :

-An active lifestyle helps you control your diabetes by bringing down your blood sugar.

-Your goal should be 30 minutes of activity 4-5 days a week, that makes you sweat and breathe a little harder

  1. Manage stress:

-When you’re stressed, your blood sugar levels go up.

-Find ways to relieve stress — through deep breathing, yoga, or hobbies that relax you.

  1. Stop smoking:

Diabetes puts one at a higher risk of getting heart diseases, eye diseases, kidney, vessel and nerve damage and smoking multiplies the risk.

-talking to one’s doctor for help to quit smoking is highly advisable.

  1. Watch your alcohol

– Alcohol can make your blood sugar go too high or too low.

-It may be easier to control your blood sugar if you don’t get too much beer, wine, and liquor.

-If in spite of following the above lifestyle modification, the blood sugar levels do not come under control, your doctor may have to start medicine for diabetes. A few tips that will help you to achieve good control over blood sugars when you are put on medicine for diabetes-

  1. Stick to your medication plan – Take the medicines as and when advised by your doctor.
  2. Eat on schedule – Plan on your meal timings in coordination with the medicine.
  3. Test your blood sugar – Testing with a glucometer is the only way to know how your body responds to the medicine.
  4. Stay consistent- Taking your prescribed medicine consistently can help with more stable blood sugar readings.
  5. Use a pill box- using a pill box is one of the best ways to take your medications correctly. Not only does it help you remember to take your meds, but it can help tell you when you’re missing your medications and prevent re-dosing

TYPE I DIABETES MELLITUS – People with type 1 diabetes don’t produce insulin due to damage of insulin producing cells by the body’s own immune system therefore, treatment for type 1 diabetes involves taking insulin. Along with Insulin injections, people with Type 1 Diabetes Mellitus also need to follow all the lifestyle changes mentioned above, ust as people with Type 2 Diabetes need to follow.

Insulin needs to be injected through the skin into the fatty tissue below.

The methods of injecting insulin include:

  • Syringes
  • Insulin pens that use pre-filled cartridges and a fine needle
  • Jet injectors that use high pressure air to send a spray of insulin through the skin.
  • Insulin pumps that dispense insulin through flexible tubing to a catheter under the skin of the abdomen.

References

https://www.diabetes.co.uk/difference-between-type1-and-type2-diabetes.html

https://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus#1

https://jdrf.org.uk/information-support/about-type-1-diabetes/what-is-the-difference-between-type-1-and-type-2-diabetes/

https://www.everydayhealth.com/diabetes/difference-between-type-1-type-2-diabetes/

https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

https://www.webmd.com/diabetes/diabetes-lifestyle-tips

https://www.everydayhealth.com/type-2-diabetes/treatment/tips-help-take-your-diabetes-medications-on-time/
– Dr. Afroze

Diet in Diabetes

Management of diabetes is formed by the three pillars namely diet,exercise and medications.Only with the combined effect of all three,a tight control of blood sugar can be achieved.

Diet in diabetes doesn’t mean living in deprivation; it means eating a tasty, balanced diet that will also boost your energy and improve your mood. You don’t have to give up sweets entirely or resign yourself to a lifetime of bland food. With correct food choices you can still enjoy food and keep blood sugar at check.

Meal plan

There isn’t one specific “diabetes diet.” A meal plan is a guide that tells you what kinds of food to eat at meals and for snacks. The plan also tells you how much food to have. For most people who have diabetes (and those without, too), a healthy diet consists of:

  • 40% to 60% of calories from carbohydrates.
  • 20% calories from protein.
  • 30% or fewer calories from fat.

Your diet should also be low in saturated fats, low in salt, and low in added sugar.

It is important to space out the meals throughout the day with smaller portions taken every 2 hours so as to avoid any episodes of hypoglycemia or surge in blood sugars.

Foods to include-

Carbohydrates
Blood glucose is affected most by carbohydrates. And insulin dosing is typically based on food intake, especially carbohydrates. Knowing what foods contain carbohydrates and the amount of carbohydrates in a meal is helpful for blood glucose control.

Foods with carbohydrates that break down quickly during digestion and release glucose rapidly into the bloodstream tend to have a high GI (glycemic Index) like white rice,corn flakes,ice creams,white breads; foods with carbohydrates that break down more slowly, releasing glucose more gradually into the bloodstream, tend to have a low GI and better controlled blood sugar levels. Beans,nuts like almond,cashews,vegetables and fruits have low Glycemic index.

Adding low and moderate glycemic index foods to your diet will help in maintaining blood sugar without undue fluctuations of blood sugar and keep you full for longer.

Food options-Whole grain(brown rice,oatmeal,fresh vegetables,fresh fruits,nuts.

Proteins

Proteins are a necessary part of a balanced diet and can keep you from feeling hungry. They also do not raise your blood glucose like carbohydrates. However, to prevent weight gain, use portion control with proteins. In people with Type 2 diabetes, protein makes insulin work faster, so it may not be a good idea to treat low blood sugar with protein shakes or mixes.

options-chicken, fish, pork, turkey, seafood, beans, cheese, eggs, nuts, tofu,curd and paneer.If you eat meat, keep it low in fat. Trim the skin off poultry.

Fats
Fats are a necessary part of a balanced diet, especially healthy fats like olive oil and fatty fish.They’re tough to resist. But it’s easy to get too much and gain weight, which makes it harder to manage your diabetes.

Options-

  • Natural sources of vegetable fats, such as nuts, seeds, or avocados (high in calories, so keep portions small)
  • Foods that give you omega-3 fatty acids, such as salmon, tuna, or mackerel

Dietary Do’s-

  • Healthy eating for diabetes is healthy eating for the whole family.
  • Enjoy having regular meals, starting with breakfast first, then lunch and dinner. Space meals with healthy snacks (mid morning snack and evening snack)
  • Eat a variety of foods in each meal, including healthy fats, lean meats or proteins, whole grains and low-fat dairy.
  • Choose fiber rich foods such as fruits, vegetables and whole grains as much as possible, like brown bread, bran cereals, whole wheat pasta and brown rice. 
  • Explore alternatives to meat such as lentils, beans or tofu. 
  • Choose calorie-free liquids such as unsweetened tea, coffee or water and even coconut water.(except very sweet ones which tend to increase blood sugar levels)
  • Eat local foods which include seasonal fruits and vegetables grown in your local area than opting for exotic food options.

Dietary don’ts

DO NOT:

  • Skip meals.
  • Eat heavy and fatty meals.
  • Eat saturated fats such as butter, coconut oil and palm oil.
  • Eat high salt foods..
  • Choose foods that are high in sugar, such as cake, pie, doughnuts, sweetened cereal, honey, jam, jelly, ice cream, or candy.
  • Choose sugar-sweetened beverages like sodas and fruit juices.
  • Add sugar to your foods.

Healthy eating is the 1st step towards healthy living.The food choices you make now will prevent future complications by keeping blood sugars at check. Discuss with your doctor /Dietician about the meal plan according to your food choices and requirements.

-Dr Prerna Gaur

References

https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295

http://www.diabetes.org/food-and-fitness/weight-loss/food-choices/the-best-food-choices/

https://www.healthline.com/nutrition/16-best-foods-for-diabetics\