Are you managing your diabetes well?

Diabetes has become an increasingly familiar part of Indian life. Over 101 million Indians live with diabetes, according to a study by ICMR-INDIAB. In my own state of Kerala, one-fourth of the population are affected by this metabolic disease. Sugar is a common topic of conversation now at family gatherings with well-wishers handing out all sorts of suggestions. Someone recommends bitter gourd juice while another insists that brown rice is the answer. You may get many a WhatsApp forward about a miraculous herbal remedy too.

Amid all this advice, a simple question deserves a serious answer: How do I know whether I am managing my diabetes well?

Taking medicines regularly is important. So are the sensible eating habits and physical activity. But effective diabetes management involves more than following a list of dos and don’ts. It requires understanding your blood sugar, recognising warning signs, monitoring your overall health and knowing when to seek medical advice.

The good news is that you don’t need to become a medical expert to do this. You need reliable information, a practical routine and a willingness to learn from your own experience.

1. Know your HbA1c: the report card that matters

Many Indians with diabetes regularly check their fasting blood sugar. Some also check their post-meal glucose. These readings are useful, but they tell us what is happening at particular moments.

BhA1c provides a broader picture. It estimates your average blood glucose over approximately the previous two or three months.

For many non-pregnant adults with diabetes, an BhA1c below 7% is a commonly recommended target. However, the appropriate target depends on your age, general health, duration of diabetes, medications and risk of low blood sugar. Your doctor should help you determine your personal target.

Consider two examples.

1.     Ravi has an HbA1c of 8.4%. His fasting sugar occasionally looks acceptable, but his overall glucose control needs review.

2.     Suresh has an HbA1c of 6.7%. That sounds encouraging, but he frequently experiences dizziness and seating because his blood sugar falls too low. His treatment may need adjustment even though his HbA1c looks good.

The lesson is important: good diabetes management means controlling glucose safely, not simply achieving the lowest possible number.

HbA1c is generally checked every three to six months, depending on how stable your glucose levels are and whether your treatment has changed. Some conditions, including certain forms of anaemia and blood disorders, can affect the accuracy of the result.

What you can do: Keep your latest HbA1c report. Ask your doctor what your target should be, whether you are achieving it safely and when you should repeat the test.

2. Understand what your daily blood sugar readings mean

For ordinary adults with diabetes, commonly used targets are:

·      Before meals: 80-130 mg/dL

·      1 – 2 hours after the beginning of a meal: below 180 mg/dL

These are general reference targets, not rules for everyone. Your personal targets may be different.

In India, fasting blood sugar and post-meal blood sugar are commonly included in diabetes reviews. Both can provide useful information when interpreted correctly. However, you should not assume that food is necessarily the only explanation. Repeated readings can help you and your doctor identify the likely causes. A few days of organised observations may reveal patterns that occasional random testing misses.

3. Learn to recognise low blood sugar

Many people concentrate exclusively on reducing high blood sugar. Yet low blood sugar can be just as important, particularly for people taking insulin or certain medicines as sulfonylureas. Your glucose level may be low if following symptoms occur:

·      sweating and trembling

·      sudden hunger or palpitations

·      dizziness, irritability or confusion

·      weakness or difficulty concentrating

Ask your doctor whether your medicines can cause low blood sugar. Keep an appropriate source of fast-acting glucose available if you are at risk.

4. Moderation while eating is very important

For many Indian families, food is closely connected with hospitality, celebration and affection. Refusing a second helping at a family lunch can sometimes require more diplomacy than refusing a business proposal. Diabetes makes it necessary to understand what we eat and how much.

Indian foods such as rice, chapati, dosa, potatoes and sweets contain a lot of carbohydrates which is not what a diabetic requires. A more balanced meal should be opted for.

A useful starting point may be:

·      Half the plate: non-starchy vegetables such as beans, cabbage, gourds, cauliflower and leafy greens.

·      One-quarter: protein-rich foods

·      One-quarter: carbohydrate-rich foods such as rice, chapati or other grains.

5. Walking is good medicine – but know your limits

Walking is an accessible way to improve fitness and support glucose management. For many adults, a reasonable general goal is at least 150 minutes of moderate-intensity aerobic activity per week, spread across several days. Suitable strength-building exercises can also help. However, exercise is no substitute for prescribed medication when medication is required.

Choose an activity you enjoy and can maintain. Consistency matters more than heroic efforts followed by long periods of inactivity.

6. Could a continuous glucose monitor help?

The conventional glucometer which measures glucose using a small drop of blood obtained by pricking your finger remains a useful and often more affordable option for many people. Continuous glucose monitoring (CGM) offers a different approach.

One option available in India is Abbott’s FreeStyle Libre system. Its sensor measures glucose in the fluid beneath the skin and provides readings and trends through a compatible smartphone app or reader. The precise features depend on the model.

According to Abbott’s official India product information, the standard FreeStyle Libre sensor is designed to be worn up to 14 days. The FreeStyle Libre 2 Plus sensor is designed for up to 15 days and offers optional glucose alarms, subject to device and app compatibility.

You can explore the systems here: FreeStyle Libre India – official website.

Check out their valuable products here.

If you are curious about CGM, ask your doctor whether it would answer a specific question about your diabetes. Technology is most useful when the information it provides leads to sensible action.  

A practical monthly checklist

Once a month, take a little time to review your progress.

• Do I know my latest HbA1c and my personal target?
• Are my glucose readings generally moving in the right direction?
• Have I experienced any episodes of low blood sugar?
• Am I taking my medicines as prescribed?
• Are my food portions and physical activity realistic and sustainable?
• Do I know when my next eye, kidney and foot assessments are due?
• Have I checked my blood pressure and cholesterol as advised?
• Is there anything about my treatment that I need to discuss with my doctor?

Managing diabetes well

Living with diabetes in India can be challenging. We live in a food culture where grains and sweets are integral parts of our diet. We needn’t reject our food culture. But we definitely need to understand our glucose levels, take appropriate treatment, eat sensibly, move regularly and protect our vital organs like kidneys, eyes, and heart which can all be in danger if we disregard our diabetes.

Finally, Diabetes management is not a competition to produce perfect numbers. It is a lifelong practice of understanding your body, making informed choices and treating yourself with patience.

Sources and further reading

1.     Research Society for the Study of Diabetes in India (RSSDI) — Guidelines and position statements. Includes Indian recommendations on glucose monitoring and diabetes management.

2.     Indian Council of Medical Research (ICMR) — Guidelines for Management of Type 2 Diabetes. Guidance on glucose control, complications and preventive screening.

3.     Government of India, Ministry of Health and Family Welfare — Standard Treatment Guidelines. General principles of diabetes management.

4.     Abbott FreeStyle Libre India — Official website. Product information on continuous glucose monitoring, sensors and compatible systems.

5.     National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — The A1C Test. Explanation of HbA1c and its limitations.

 

Disclaimer: This article has been written as part of an awareness initiative by Blogchatter and reflects the author’s personal views. It is for informational purposes only. It does not constitute medical advice, diagnosis or treatment recommendations. Please consult your doctor for advice specific to your individual health needs.