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Old 26th January 2023, 18:32   #1
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The Diabetes Thread

The old diabetes thread is IMO too cluttered and it helps to have an easy guide of reference on what diabetes is, the types of diabetes, treatment options etc.

Hence, here is a comprehensive article on Diabetes.

The Diabetes Thread-r-4.jpg

What is Diabetes?

The simplest question, but one that is important to answer. What even is Diabetes? Well, diabetes mellitus refers to a group of diseases regarding how the body uses glucose (blood sugar). There are two distinct types: Type 1 and Type 2 diabetes. The differences between these two will be explained later. According to the WHO, in 2014, 8.5% of adults aged 18 years and older had diabetes and in 2019, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years. Another 460,000 kidney disease deaths were caused by diabetes, and raised blood glucose causes around 20% of cardiovascular deaths. Symptoms of Diabetes, according to Mayo Clinic, include having blurry vision, mood swings, and sores that heal slowly as well as feeling irritable, tired and weak.

The difference between Type 1 and Type 2 Diabetes

The main difference to note is that while Type 1 Diabetes is usually caused by an autoimmune reaction and develops at an early age, Type 2 Diabetes is usually caused by lifestyle choices and tends to develop in adults. While Type 2 Diabetes is more prominent in adults over 40, there is an increasing number of children with Type 2 diabetes. Additionally, according to Healthline, people with Type 1 diabetes don't produce insulin (likened to not having a key), while people with Type 2 diabetes don't respond as well to Insulin as they should and later on don't make enough insulin, similar to having a broken key.

Glucose and Insulin - what are they?

Quoting from Mayo Clinic:
Quote:
How insulin works
Insulin is a hormone that comes from a gland behind and below the stomach (pancreas).
The pancreas releases insulin into the bloodstream.
The insulin circulates, letting sugar enter the cells.
Insulin lowers the amount of sugar in the bloodstream.
As the blood sugar level drops, so does the secretion of insulin from the pancreas.

The role of glucose
Glucose a sugar is a source of energy for the cells that make up muscles and other tissues.
Glucose comes from two major sources: food and the liver.
Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
The liver stores and makes glucose.
When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose. This keeps your glucose level within a typical range.

Complications, Prevention and Treatment

Complications include:
  • Cardiovascular Disease
  • Nerve Damage
  • Eye Damage
  • Depression
  • Alzheimer's
  • Hearing Impairment
  • Kidney Damage

Prevention techniques for Type 2 Diabetes (Type 1 can't be prevented) include:
  • Eat healthier food
  • Lose excess weight
  • Do physical activities (Cycling, running, playing football etc.)

Treatment options include:
  • Insulin (taken through injections, pumps etc.)
  • Oral or injected drugs
  • Lifestyle Changes
  • Blood Sugar Monitoring
  • Carbohydrate Counting

Questions?

Post them on this thread and I as well as fellow BHPians will do our best to answer them
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Old 27th January 2023, 04:59   #2
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Re: The Diabetes Thread

Thread moved out from the Assembly Line. Thanks for sharing!
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Old 27th January 2023, 06:07   #3
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Re: The Diabetes Thread

In addition to Type 1 and Type 2 Diabetes, there is also Type 1.5 known as LADA (Latent Autoimmune Diabetes in Adults), which starts off with symptoms similar to Type 2 and progresses into Type 1.

In Type 2 Diabetes, Insulin Resistance plays a big role and if caught early, can be reversed with lifestyle changes and minimal to no medication. An often misunderstood term because it is referred to as an "Insulin Deficient" condition which is meant to convey that insulin isn't doing it's intended job correctly (when the body is actually producing excess insulin and the insulin receptors in the cells are resisting insulin).

Dr Eric Berg and Dr Ken Berry on YouTube explain these very well and have several videos on this and related topics.

Last edited by NPV : 27th January 2023 at 06:10.
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Old 27th January 2023, 09:34   #4
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Re: The Diabetes Thread

Excellent thread, thanks for starting a fresh discussion on diabetes. Both my parents had diabetes, so 4 of us siblings take a lot of care. At 46, my fasting & post-meal sugar levels are well within control. What I do:

- Zero or low carb food

- Almost daily exercise. Only day I don't is on break / rest days

- Sleep well. Usually out by 1030 and up by 6 - 630

- 16-hour intermittent fasting (no breakfast). Dinner at 8 PM, then lunch at 1 PM

- Minimise stress. I work hard, but work with pleasure

- I have 1 or 2 cheat meals in a week. Usually 1. Got to live a little!

- My meals are full of fresh food, veggies & some fruit. Even if I go out, it's always at a restaurant known for top quality

- Swiggy / Zomato are almost inexistent at my place. The cook is exceptional. If I feel like a pizza, he whips up a yummy keto pizza. The last time I ordered a meal from Swiggy / Zomato was perhaps a month back, but we do go out 3 - 4 times a week

- Usually eat till I am 70 - 75% full. Almost never overeat (except cheat days)

- Keep a close eye on my weight

- Pro-tip. The key to eating well is to never starve; it's when you are really hungry that you cheat. E.g. if you are very hungry and go to a restaurant, first order a yummy healthy soup. It'll be served quickly and will fill your tummy up, thereby making you take sensible choices for the rest of the meal.

You have to make lifestyle changes and make them enjoyable. If things get boring, you veer off the intended part. We have lots of social outings, we party a lot (am hosting 18 people tomorrow night), loads of road-tripping...but "healthy + tasty" is our food ethos. At a recent party, we didn't eat pakoras, chips or any junk food. Instead, the starters were hummus & dips with carrot / cucumber sticks, cheese & veggie-stuffed mushrooms, barbequed paneer sticks with a spicy sauce dip, a deadly salad bowl with veggies + feta cheese etc., keto burgers (patty, cheese, veggies, sauces wrapped in leaf not bread) and pav bhaji with keto bread from Farmer's Cafe.

It's not easy, but nothing of value in life comes easy. Everything good requires effort, whether it's good health, a good car, a good house, a good marriage, a good career...if you want it, you got to shake it, you got to push hard.

Test in end November. My usual levels are a little lower, this was right after a week-long holiday in Goa
The Diabetes Thread-screenshot-20230127-093541.jpg

Last edited by GTO : 27th January 2023 at 09:41.
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Old 27th January 2023, 09:51   #5
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Re: The Diabetes Thread

Type 1, to put it in simple terms is when your pancreas stops the production of insulin. The sugars will be way too high if insulin is not supplied externally and can lead to severe complications if not attended to faster. There are no clear reasons like genetics/lifestyle etc for it to happen though there has been a huge spike in the number of cases post covid. I am sure at some point studies will be conclusive on this.

My son is Type 1 for more than a year now. He is now aged 11. He too had covid before this happened. Early detection is critical to avoid damage to internal organs. Fortunately, we were able to detect it before it got worse. His appetite was very bad, drinking lots of water, appearing extremely weak and thin in a matter of days, low energy, and bedwetting were the factors that alarmed us. Seeing froth in his urine, we took him to the hospital and our fears were confirmed. Photos of him about a week earlier from this time, he looks entirely different.

There is no medication to treat the condition and the only way to manage Type 1 is by supplementing insulin by injection. We use an insulin pen. The moment he started to get insulin, he recovered well and is leading an extremely normal life except that the choice of food that he can have is a bit limited. Sweet/ice cream/pastries are ok once in a while as long as you provide the necessary insulin. As per our experience, Maida is a strict no. The kind of sugar spike we have seen after he took maida-based food was way too much.

He needs to have rapid-acting insulin(Novorapid) before eachof his meals, including snacks and slow-acting insulin(Lantus) before bed. The effect of Lantus can be about 24 hours and Novorapid about 3-4 hours.

Each one's body differs in the way it manages sugar. Though normally we are advised to reduce rice and prefer wheat, our experience is the opposite. His insulin requirement is generally 2 units less when taking rice. We take brown rice mostly (even before him developing this). Similarly, if he plays more than what he normally does, his insulin requirement also comes down. So you need to be observant to get it right. With time, we are doing good.

Monitoring: We started with blood sugar monitoring. For better management of Type 1, especially to ensure the sugar doesn't fall way too below which can lead to more complications, we need to monitor frequently. We are now using Continous Glucose Monitoring (CGM) device to avoid frequent pricks. It is costlier, but for us, it has been a boon especially since he can check it very easily while at school.

There are insulin pumps, which will keep monitoring your sugar levels frequently and supplies insulin automatically. These are costly but the latest models are known to manage the levels very well. We might opt for this in a year or two once we feel confident that he can manage it.

There is also research going on in stem cell therapy and I did read the news a few months back that someone who was type 1 for more than 40 years has stopped taking insulin altogether. But this is still an early research phase as I understand.

There is also insulin under development that needs to be injected only once a week. But I believe this is more for Type 2(Didn't see any reference where it mentioned it was for Type 1). But maybe this too will be out for Type 1.

As noted earlier, you need to be careful about low-sugar situations as well. He keeps a couple of small packets of sugar, each about a spoonful in his pocket while in school. When encountering low sugar, the key factor is about giving something that releases sugar fast. Chocolates are way too slow to release in an emergency. Candies are better. Sugar is faster.

I do feel sad that this happened to my son. But I am grateful that this is something that can be managed. About a 100 years back, before the discovery of insulin, children used to die of this condition.

Note: Only treatment for Type 1 as of now is by supplementing insulin. There is no reversal that I could see in homeopathy/ayurveda/naturopathy. I have seen parents in Type 1 communities who are eager to stop insulin and try some medicine available online. This is foolishness as the problem is not about insulin resistance but insulin production.

Also noting again, this is an autoimmune disease and not caused by lifestyle habits.

Last edited by rajesh1868 : 27th January 2023 at 09:56.
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Old 27th January 2023, 11:41   #6
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Re: The Diabetes Thread

Quote:
Originally Posted by rajesh1868 View Post
I have seen parents in Type 1 communities who are eager to stop insulin and try some medicine available online. This is foolishness as the problem is not about insulin resistance but insulin production.

Also noting again, this is an autoimmune disease and not caused by lifestyle habits.
Insulin for Type 2 also doesn't sound logical since it's basically a case of Insulin Resistance due to excess insulin, so the better line of treatment could be on the dietary and exercise side (lifestyle changes).

Since most people usually check only sugars, insulin resistance can go unnoticed and can lead to Type 2 sugar levels eventually (sometimes suddenly if you think you're doing well going by sugar levels alone), so it's always good to get tests like HOMA-IR and C Peptide to know how bad your insulin resistance is.
_-----_-------


For your son - have you considered using a CGM (Continuous Glucose Monitor) for a few months to see what foods have a tendency to spike sugar levels? This can help you adjust the diet appropriately and minimise/be more precise with the insulin intake.

Edit: missed the point that you're already using a CGM, that's good

Last edited by NPV : 27th January 2023 at 11:44.
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Old 29th January 2023, 09:25   #7
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Re: The Diabetes Thread

Great thread!

I am vigilant about my parameters as they are in border range especially Cholesterol ones. I have come across few videos of Dr. Eric Berg and he explains things in a very simple way that includes Do's and Don't.


What Happens If You Stop Eating Sugar for 14 Days Dr. Berg On Quitting Sugar Cravings



How to Reverse Damage from Diabetes? Dr.Berg on Reversing Diabetes


Hope these videos helps fellow t-bhpians.
Cheers
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Old 29th January 2023, 09:46   #8
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Re: The Diabetes Thread

I have been suffering from Type - 2 Diabetes since almost 10 years now, and I am only 39. I am moderately obese, lead a very sedentary lifestyle, try getting into a whole exercise routine, but invariably fall off that within a few weeks. My family has a history of diabetes and cardiovascular diseases. My diabetes is often uncontrolled and despite my best efforts, my sugar levels are always above the desired levels.

I did my tests in October and was in for a rude shock when my HB1AC levels came in at 9.5/226 and Fructosamine came in at a scary 294. My HS-CRP levels were at 7.1 which says I am high risk for cardio vascular issues in future.

I did change my doctor and in 3 months since my HBA1C levels have come down to 7.5 or 169. While these will come down, my Fasting Plasma Glucose and Post fasting Plasma Glucose were still at 161 and 188 respectively. The doctor has tweaked my medication but is still trying to see how to get my fasting and Post Fast levels down. Here is the issue - since last 3 months, while my average sugar levels are down, despite eating healthy and even trying to be active, I have gained close to 6 Kgs. I did discuss these with my doctor and he says that my initial weight loss was due to diabetes and as my condition improves, I will simply have to exercise much more to maintain and lose my weight as the weight I lost due to diabetes will come back on.

Like many of you have said, my tests indicate that my body produces more than adequate insulin, but there is an insulin resistance.

I am trying to once again control my diet, and get in some exercise, but that is easier than it sounds. My Smart watch says I hit close to 9000 steps almost every day save the weekends, but that is just me during my normal course of day and I still haven’t managed to fit in an extra few minutes of walk or slow jog (running is still beyond me and hurts my knees). I am hoping these posts here help me try to have a change in my lifestyle on a more permanent basis. I have had a few freak tests where my sugar levels shot close to 400 and I somehow manage to get it down to 200 levels and then fall off the wagon. By penning this on here, I am hoping I can stay committed and have that much needed change in my diet and lifestyle to help me manage the Diabetes.
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Old 29th January 2023, 09:52   #9
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Re: The Diabetes Thread

Quote:
Originally Posted by GTO View Post
16-hour intermittent fasting (no breakfast)...
I am 57 and from my own experince feel that beakfast is must. Such long breaks are Ok when you are young but later as you approach 50 better to have breakfast but light lunch. I used to skip breakfast whilst in the Navy, as it used to be very oily/fried but changed after medical advise in 40s.
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Old 29th January 2023, 11:55   #10
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Re: The Diabetes Thread

People with diabetes, I'm curious what your Vitamin D levels are and how much sunlight or supplements you're getting.

I say this as there seems to be some evidence of correlation between insulin levels and Vitamin D levels. There's also this book that proposes that a lack of Vitamin D puts the body into 'winter hibernation mode' where in it makes you eat more and increases blood sugar to help with the cold weather.
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Old 29th January 2023, 12:01   #11
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Re: The Diabetes Thread

I am 64 plus and I have type 2 diabetics for the past 23 years. I am going to same diabetics clinic at least once in 2-3 months . Doctor there changed once. Right from the begining i was prescribed tablets. Since mine was uncontrolled always they slowly increased medication. Apart from 2 grams of Gluconorm forte G4 they also prescribed Glyxambi 25/5. I have been given small doses of cholosteral bp tablets also. My latest hb1ac figure is 9.1 . It never came below 8. Doctor always tweak tablets based on figure.

All other parameters in my case is perfectly normal when I take full check up once in 6 months. I am able to feel my nervous system is slowly becoming weaker since it was not controlled for 23 years.


Earlier I used fo walk one and half hour and 15 minutes exercise. Now I walk 50 minutes walk daily without fail. I am over weight by 8 kgs. I cannot reduce further.

I was not careful in food intake in the first 18 years . Now I do excersie control on my food. But when I feel hungry I do not say no. I do not know whether intermittent fasting will help at this age. SOMEONE CAN ADVISE ON THIS. so that my medication can come down.

I can try for 12 hours to start with. whether 16-17 hours like what GTO practicess who is the leader in cars now leader here also will be advisable in my case as I need coffee for my early morning walk. May be I can skip breakfast and can have brunch at 11am

I do feel hungry mostly in the morning and not so in the night. Insulin was tried once but it did not suit me and sugar levels went up.
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Old 29th January 2023, 13:13   #12
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Re: The Diabetes Thread

Quote:
Originally Posted by Ays7 View Post
I am trying to once again control my diet, and get in some exercise, but that is easier than it sounds.
Get your diet under control and you can focus on exercise next. A few things you may want to do:
1. Cut down refined carbs (reduce wheat and rice, cut out general flour/maida products and sugar completely)

2. Cut out milk or keep to very small quantities, no sugar (and milk too if possible) in tea, coffee. It may take some time but do try and get adjusted to Black tea and coffee, it's an acquired taste and well worth it for the benefits it provides. Buttermilk and curd are both good, do not cut them out.
*Tip - if you find it difficult to omit milk in tea, coffee then a good substitute is whipped/heavy cream, you can dilute it with water in 1:4 ratio

3. Don't fear fat and protein - cheese, paneer, ghee, coconut, coconut oil, olive oil, nuts like walnuts, macadamia, pecans, hazelnut in small quantities

4. If you're a vegetarian, try to include eggs in your diet. If you're a non-vegetarian then it's fine

5. Add leafy greens, cruciferous vegetables to your diet (at least 5 cups of vegetables a day). You can completely ignore carbohydrate content in veggies, but avoid starchy vegetables like potato completely

6. Cut down on fruits, especially the sweeter ones like bananas, apples, pineapples, mangoes, etc Avocados, berries (Blueberries, Blackberries, Strawberries in small quantities), semi ripe guavas/papaya are fine and even pomegranate in small quantities

7. Follow a good routine with your meal times, do not overeat any meal and do not eat frequently (no snacking between meals, if you have to take something then go with black tea/coffee or Buttermilk, maybe some salad is fine too, after a few days you will get used to not snacking)

8. Sleep well - at least 7 hours of not more will definitely help, high fasting sugar could be because of inadequate/bad sleep quality

9. Try to include intermittent fasting by having your dinner before 8pm and skipping breakfast the next day. Do consult your doctor on this though especially if you have a history of low sugar bouts

10. Get a CGM (Continuous Glucose monitor) to see what foods have a tendency to spike your sugar levels, you can then take appropriate actions on your diet

11. Cut out all sugary juices/sodas and alcohol completely (if you take any)

* I had mentioned almost all these things in another post on the weight loss thread as well, because diet plays the most important role for both weight loss and diabetes control/reversal.

Type 2 diabetes is actually a condition caused mostly due to excess carbohydrate intake causing your body to produce excess insulin and cells becoming insulin resistant. If not controlled/reversed, beta cells can die and the pancreas may stop producing insulin leading to Type 1 diabetes later.

Last edited by NPV : 29th January 2023 at 13:22.
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Old 29th January 2023, 13:13   #13
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Re: The Diabetes Thread

Since I am not an expert, neither a medical professional I will share about prevention, diets and exercise.
There are macro nutrients and then there are micro nutrients. Micro nutrients are bigger topic, will keep it out.
Macro nutrients are Proteins, Carbohydrates and Fats. All are essential to us. However the problem starts when we do not take them in the correct quantities. To highlight protein is the ignored macro in India. Where as carbohydrates are consumed overtly. Fats are also consumed more, many times with processed oils, processed and high calorie diets.
The satiation factor for protein is high. Personally after eating two eggs, one phulka roti and one cup of tea I dont get hungry until lunch time. Sometimes it gets delayed to 3pm.
Having protein and salad in every big meal helps in filling stomach and keeping satiated for longer time.
If we quantify our food correctly, we are in control of calorie intake. Exercising 3 to 5 days a week helps in keeping muscles firm, strengthening immune system and having strong cardiovascular profile.
One should work on their diets with scientific approach, take guidance, create and contour diets and exercise over period to fit in likings and lifestyle and follow it.
Many imbalances in diet can be corrected through conscious quantification. Its tedious in the beginning but once used to it, helps in transforming into a healthier and fitter person.
The prevention part as I have understood is all about making lifestyle changes, keeping calorie intake in check and balancing macros correctly.
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Old 29th January 2023, 14:13   #14
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Re: The Diabetes Thread

15 years back, when I was studying pharmacy and thereafter during a few years of job in cardio division in topmost pharmaceutical company, I strongly remember it was hyped by MNCs that we should have carbohydrate rich meal and totally avoid fats and ghee and oil.

Thank god I left the job to start business and came to know basic fundamentals of nutrients and time.

As described by members, everybody need to take all these points seriously as there are many many people at the borderline of diabetes.
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Old 29th January 2023, 17:06   #15
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Re: The Diabetes Thread

I'm currently in a pre-diabetic stage and have reversed my diabetes from 8.9 HBA1C few years ago to 6.5/6.6 now. My doctor stopped my medicine as well. Some of things I have done to bring about this change -
1. Control your weight. Always be on the lower side of BMI. It is better to be slightly underweight than normal.
2. Start using a kitchen weighing scale. With this weigh your portion size. With this, count your calories per day. I track it using Healthify (not endorsing it). You may see what suits your requirement. Ideally it should never cross 2k per day (again as per individual body and health condition - refer a good dietitian).
3. Give away any urge to munch savory foods, biscuits or anything that's processed. Prefer home cooked savories if you cannot avoid that urge.
4. Exercise is a must. I generally don't go by the step counter on my smart watch. It inflates the step count even if you shake your hand. Discount it by 25-30% to get the real number. Or put a target of walking/ running 2-3 Kms at a stretch per day.
5. Use raw salad in every meal. I prefer having beet roots, carrot and cucumber which have a low GI.
6. Make sure we drink 8-9 glasses of water per day.

Some simple lifestyle changes will go a long way to control and manage this condition. Diabetes is not a disease, it is a Disorder.

Last edited by ShankarG : 29th January 2023 at 17:09. Reason: Typo
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