The Guide

to

Diabetes

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 Table of Contents
What Is Glucose? What Happens to It Normally? ---------------------------------------------------------------- 3
So What Happens in the Body During Diabetes? ---------------------------------------------------------------- 4
What Are the Types of Diabetes? ----------------------------------------------------------------------------------- 5
Risk Factors for Diabetes -------------------------------------------------------------------------------------------- 7
Symptoms -------------------------------------------------------------------------------------------------------------- 8
Complications --------------------------------------------------------------------------------------------------------- 9
Who Should Get Tested for Diabetes? ----------------------------------------------------------------------------- 13
Evaluating for Diabetes ---------------------------------------------------------------------------------------------- 14
What Are the Criteria to Diagnose Diabetes? --------------------------------------------------------------------- 16
Treatment of Diabetes ------------------------------------------------------------------------------------------------ 17
Routine Medical Check Ups ----------------------------------------------------------------------------------------- 27
Prepare for Your Appointment -------------------------------------------------------------------------------------- 28
Preventing Complications of Diabetes ----------------------------------------------------------------------------- 29
When to Visit the ER ------------------------------------------------------------------------------------------------- 36
FAQs of Diabetes ----------------------------------------------------------------------------------------------------- 37

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What Is Glucose? What Happens to It Normally?

Glucose, a sugar, is a source of energy for the cells that make up muscles
and other tissues. It’s also the brain’s main source of fuel. Glucose comes
from two major sources: food and the liver.
When you eat something, it is metabolized and the glucose from that is
absorbed into the bloodstream. From there, it enters cells with the help of
insulin. The liver stores the extra glucose.

Insulin is a hormone comes from the pancreas, a gland behind and below
the stomach.
The pancreas releases insulin into the bloodstream. As the insulin enables glucose to enter the cells, and thus the
amount of glucose in the bloodstream goes down. As the blood glucose level drops, so does the release of insulin from
the pancreas… until you have your next snack/meal and then the whole process starts again.
If you wait too long to eat and your blood glucose levels start to become too low, the glucose stored in your liver will
be released into your blood to help maintain normal blood glucose levels. Got it?

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So What Happens in the Body During Diabetes?

Diabetes mellitus refers to a group of diseases that occurs either when the pancreas does not produce
enough insulin or when the body cannot effectively use the insulin that is produced.
When insulin is not able to take glucose from the blood into the cells,
the blood glucose levels remain high. This is known as
hyperglycemia.
Over time, hyperglycaemia leads to serious damage to many of the
body’s systems, especially the nerves and blood vessels.

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What Are the Types of Diabetes?

Prediabetes is a health condition where blood sugar levels are higher than normal, but not high enough
yet to be diagnosed as type 2 diabetes. Prediabetes puts you at increased risk of developing type 2 diabetes, heart
disease, and stroke.

 Type 1 diabetes is characterized by autoimmune destruction

of the pancreatic beta cells, leading to absolute insulin
deficiency. Type 1 diabetes accounts for approximately 5 to
10% of diabetes in adults. Type 1 diabetes can start at any age,
but usually starts during childhood or teen years.

 Type 2 diabetes, the most common type (over 90%), can

develop at any age, but it is more common in people older
than 40. However, type 2 diabetes in children is increasing. Type 2 diabetes is characterized by hyperglycaemia
usually due to progressive loss of insulin production as well as resistance to the insulin that is produced, resulting
in relative insulin deficiency

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 MODY (Maturity Onset Diabetes of the Young): It is a rare form of diabetes that typically runs in
families and is caused by specific genetic mutations.

 Gestational diabetes occurs during pregnancy. But it may go away after the baby is born. Women with
gestational diabetes are at an increased risk of complications during pregnancy and at delivery.
These women, and possibly their children, are also at increased risk of type 2 diabetes in the future.

Did You Know?

 The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014. The prevalence has
been rising more rapidly in low- and middle-income countries than in high-income countries.
 Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
 Between 2000 and 2019, there was a 3% increase in diabetes mortality rates by age.
 In 2019, diabetes and kidney disease due to diabetes caused an estimated 2 million deaths.
 Diabetes can be treated and its consequences avoided or delayed with a healthy diet, regular physical activity,
maintaining a normal body weight, avoiding tobacco, taking medication regularly and regular screening and
treatment for complications.

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Risk Factors for Diabetes

 Age – if you are over 45

 Genetic causes
o Many people with type 2 diabetes have a family member with either
type 2 diabetes or other medical problems associated with diabetes,
such as high cholesterol and triglyceride levels, high blood pressure,
or obesity.
o The lifetime risk of developing type 2 diabetes is 5 to 10 times higher
in first-degree relatives (ex: sibling or child) of a person with diabetes
compared with a person with no family history of diabetes.
 Lifestyle factors
o Eating an unhealthy diet
o Having a sedentary lifestyle
o Being overweight
 High blood pressure
 Having prediabetes or history of diabetes during pregnancy

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Symptoms

In type 1 diabetes, symptoms tend to come on quickly and be more severe.

In type 2 diabetes, the symptoms can be mild and may take many years to be noticed. Symptoms can also depend on
how high your blood glucose is.

Many people, especially if they have prediabetes, gestational

diabetes or type 2 diabetes, may not have symptoms.

Symptoms of diabetes seen in different people are:

 Feeling thirstier than usual (polydipsia)
 Urinating often (polyuria)
 Feeling hungrier than usual (polyphagia)
 Losing weight without trying
 Feeling tired and weak
 Feeling irritable or having other mood changes.
 Having blurry vision
 Having slow-healing sores

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Complications

The longer you have diabetes and the less controlled your blood glucose, the higher the risk of complications.
Eventually, diabetes complications may be disabling or even life-threatening.

The major complications of diabetes can be divided into those cause my microvascular disease versus those cause by
macrovascular disease.
o Macrovascular injury tends to affect the brain, heart, and peripheral blood vessels.
o Microvascular injury usually affects the eyes, kidneys, and peripheral nerves.

 Heart and blood vessel (cardiovascular) disease

o Diabetes significantly increases the risk of many heart
problems. These can include coronary artery disease with
chest pain, heart attack, stroke and narrowing of arteries
(atherosclerosis).
o If you have diabetes, you’re more likely to have heart disease
or stroke.

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  Nerve damage from diabetes (diabetic neuropathy)
o Too much glucose can injure the walls of the tiny blood vessels (capillaries)
that nourish the nerves, especially in the legs.
o This can cause tingling, numbness, burning or pain that usually begins at the tips of
the toes or fingers and gradually spreads upward. This leads to nerve damage and
poor blood flow and can cause foot ulcers and may even lead to an amputation.
o Damage to the nerves related to digestion can cause problems with nausea, vomiting,
diarrhea or constipation.
o For men, it may lead to erectile dysfunction.

 Kidney damage from diabetes (diabetic nephropathy)

o The kidneys hold millions of tiny blood vessel clusters
(glomeruli) that filter waste from the blood. Diabetes can
damage this delicate filtering system.

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  Eye damage from diabetes (diabetic retinopathy)
o Diabetes can damage the blood vessels of the eye. This could
lead to blindness.

 Skin and mouth conditions

o Diabetes may leave you more prone to skin problems, including bacterial
and fungal infections.

 Foot damage
o Nerve damage in the feet or poor blood flow to the feet
increases the risk of many foot complications, including
amputation of the limb.

 Hearing impairment
o Hearing problems are more common in people with diabetes.

 Alzheimer's disease
o Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease.

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 Depression related to diabetes
o Depression symptoms are common in people with type 1 and type 2 diabetes.

 Urinary Infections
o Diabetes can also lead to urinary tract infections due to high glucose levels in
the urine.

 Diabetic ketoacidosis (‘DKA’)

o A dangerous condition that occurs when fats are burned to make energy.
Ketones rise in the blood, making the level of acid in the blood too high.

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Who Should Get Tested for Diabetes?

It is recommended that the following people be screened for diabetes:

 Anyone with a body mass index higher than 23, regardless of
age, who has additional risk factors. These factors include:
o High blood pressure
o Non-typical cholesterol levels
o An inactive lifestyle
o A history of polycystic ovary syndrome or heart disease
o Having a close relative with diabetes
 Anyone older than age 35 is advised to get an initial blood glucose
screening. If the results are normal, they should be screened every
three years after that.
 Women who have had gestational diabetes are advised to be
screened for diabetes every three years.
 Anyone who has been diagnosed with prediabetes is advised to be tested every year.
 Anyone who has HIV is advised to be tested.

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Evaluating for Diabetes

 Clinical presentation

o Type 2 diabetes
The majority of patients with type 2 diabetes are asymptomatic, and
hyperglycemia is noted on routine laboratory evaluation.
o Type 1 diabetes
Diabetic ketoacidosis, may be the initial presentation in approximately
25% of adults with newly diagnosed type 1 diabetes. Symptoms may
include nausea, vomiting, abdominal pain, laboured
breathing, exhaustion.

 Comprehensive history
Patients with newly diagnosed diabetes require:
o A history and physical examination to assess the characteristics of onset of diabetes
o Nutrition and weight history
o Assessment of physical activity

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 o Cardiovascular risk factors
o History of diabetes-related complications
o Diabetic ketoacidosis (DKA) frequency (typically type 1 diabetes)
o Family history
o Current management
o More diabetes-specific microvascular complications are related to duration and degree of hyperglycemia.
Such complications may be present in newly diagnosed patients with type 2 diabetes owing largely to delays
in diagnosis.

 Biochemical testing
o Fasting and 2 hrs post food sugar
o HBA1C ( if not measured in last 3 months)
o If not measured in the past one year, measure:
 Fasting lipid profile
 Liver function tests
 Urine for microalbumin
 Serum creatinine (with estimated glomerular filtration rate [eGFR])

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What Are the Criteria to Diagnose Diabetes?

Plasma glucose test Normal Prediabetes Diabetes

Fasting Below 100 mg/dl 100 – 125 mg/dl 126 mg/dl or more

2 hrs post lunch or dinner Below 140 mg/dl 140 - 199 mg/dl 200 mg/dl or more

Hba1c < 5.7 5.7 to 6.49 mg/dl 6.5 or above

If the diagnostic test is consistent with prediabetes, it should be repeated annually.

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Treatment of Diabetes

Being diagnosed with type 2 diabetes can be overwhelming and you will
likely have questions about why it developed, what it means for your long-term
health, and how it will affect your everyday life. Your doctor can help answer
your questions and talk to you about what to expect. They can guide you to
supportive services such as diabetes lectures, an appointment with a dietician or
consultation with a diabetologists.

Treatment of diabetes includes holistic approach with steps to be taken as below:

Treatment of Diabetes

Sugar
Exercise Diet Quit smoking Medications
monitoring

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Lifestyle Modifications – Take Charge

 Exercise
Getting regular physical activity is very important for good health. Exercise makes the body more sensitive
to insulin which helps lower blood glucose levels.

o Types of exercise — Exercise could mean going to the gym

and running on a treadmill, but you can also do brisk walking,
doing housework, dancing, swimming, bicycling, or hiking.
Even gentle forms of exercise are good for your health.

o Wear well-fitting, protective footwear. Check your feet for

sores and blisters after you complete your exercise.

o Drink plenty of water before, during, and after exercise. This

helps to prevent dehydration, which can upset blood glucose
levels.

o Keep rapidly absorbed carbohydrates on hand (glucose tablets, hard candies, or juice). If your blood
glucose level becomes low during exercise and you develop symptoms of sweating and shaking, eat the
carbohydrate.
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o If you take oral diabetes medications, you probably will not need to adjust the dose of these
medications for exercise.
o If you have diabetes and use insulin, you should also do the following:
 Measure your blood glucose before, during, and after
exercise to determine your body’s
typical response to exercise.
 If your pre-exercise blood glucose reading is 270 mg/dl or
higher, avoid vigorous exercise until your blood glucose
level is lower. If your pre-exercise blood glucose is below
100 mg/dl, you may need to eat a small snack containing
carbohydrates so your blood glucose does not fall too low
during exercise.
 Choose an insulin injection site away from exercising
muscles. For example, if you go for a run, avoid using your legs as an injection site.
o Duration and frequency - a goal of 150 minutes of moderate-intensity or 75 minutes of vigorous-
intensity physical activity per week. Increase the intensity, frequency, and duration of exercise gradually.

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o Precautions With Exercise
 People with diabetes-related eye complications (severe retinopathy) may be advised to
avoid vigorous or high-impact activities and strenuous weightlifting, which can increase
blood pressure and cause bleeding in the eye.
 People with neurologic complications (peripheral neuropathy) are usually advised to
avoid traumatic weight bearing exercises such as running, which can lead to foot ulcers
and stress fractures.

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 Quit Smoking
Over 25% of people newly diagnosed with diabetes actively smoke.

People with diabetes who smoke have an increased risk of the following:
o Death, especially from heart attacks and strokes
o High low-density lipoprotein (LDL or ‘bad’) cholesterol levels
o Worsened blood glucose control compared with non-smokers
o Nerve damage from diabetes
o Kidney disease leading to dialysis
o Foot ulcer and amputation of toes, feet, or legs, caused by peripheral
vascular disease

Quitting smoking is one of the most important things people can do to improve their health.

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 Diet

Changing the type and amount of food eaten can help people with diabetes to lose weight, improve blood
glucose levels, and lower blood cholesterol levels and blood pressure.
There are a lot of dietary options available that can be followed in diabetes. You can choose from the option
suitable to you. Consult a dietician to guide you through the best possible option for you.
Few of the dietary recommendations for diabetics are:
o Minimize sugar and refined flours.
o Avoid high sugar beverages such as juices, soda and alcohol.
o Try millets instead of wheat or white flour.
o Consider adopting a 2-meal intermittent fasting regime after
discussing with your doctor.
o Incorporate salads and lentils into your routine meal plan.
o Maintain adequate hydration with plain water.
o Eat adequate amounts of fibre.
o Take vitamin D supplements as prescribed by your doctor.
o Opt for the low-fat version when you can.

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Medications and Blood Glucose Documenting

 If your blood glucose levels are not controlled by lifestyle

modifications alone, your doctor will start you on oral
medications.
 The daily regimen may include oral medications and/or insulin,
blood glucose monitoring, carefully planned meals and snacks,
and exercise.
 There are several different classes of diabetes medications that
work in different ways to help manage blood sugar levels.
Diabetes medicines available nowadays have minimal side effects and are very effective in controlling sugar.
Choice of medicines depends on multiple factors like age, comorbidities, sugar levels, social background of the
patient and social support available. Consult your doctor to discuss the plan of medications that can be best
suitable for you.
 Since medication regimens may be difficult to manage, it is best to make a list of all of your medications,
including dose and frequency. Along with this, make a blood glucose chart that you bring to the doctor each time
you come for your follow up appointment.

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Below is an example of the chart:

My blood sugar levels

My target sugar levels

Fasting 2 hrs post lunch

110 - 150 160 - 190

My Monthly Sugar log chart Month - September

Date and Time Fasting Time PPBS Remarks

1/09/23 8 am 115 3 pm 225 Ate Sweet – Jalebi in lunch

You can also maintain a record of your sugar values by using mobile apps like Diabetes Diary or Blood Pressure &
Sugar Tracker etc.
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Self Blood Glucose Monitoring
It is very important for you to have a blood glucometer at home and when you’re travelling. It allows you to
check your blood glucose level and regular times which can then me documented and shared with your doctor.
Not only will this help your doctor manage your treatment better, but it will also help you understand which dietary
choices are benefiting your most and will help you make better decisions for your health.

Here are the steps to checking your blood glucose at home:

 Gather your supplies. Get your lancing device ready.
 After washing your hands, insert a test strip into your meter.
 Use your lancing device on the side of your fingertip (usually your
middle or ring finger) by your fingernail to avoid having sore spots
on the frequently used part of your finger.
 Get a small drop of blood. Touch and hold the edge of the test strip
to the drop of blood and wait for the result.
 Your blood glucose level will appear on the meter's display.
 Document your glucose level in your diabetes chart.
You can watch the video on how to measure blood sugar on – https://www.youtube.com/@AHCH

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Continuous Glucose Monitoring devices

These automatically estimate your blood glucose level throughout the day
and night. You can see what your blood glucose level is at any time. You
can also review how your blood glucose level changes over a few hours or
days and spot trends. These are particularly helpful for people with
type I diabetes and fluctuating type II diabetes. You can discuss about
these devices with your doctor.

 What happens if my blood glucose level becomes too low?

Sometimes blood glucose levels drop below where they should be, which is called hypoglycemia. For most
people with diabetes, the blood glucose level is too low when it is below 70 mg/dL.
Symptoms of hypoglycaemia include
o Fast heartbeat Tremors
o Sweating Nervousness or anxiety
o Irritability or confusion Dizziness
o Hunger Unconsciousness

Hypoglycemia can be life threatening and needs to be treated right away.

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Routine Medical Check Ups
In addition to lifestyle changes and regular medication, routine medical health check-ups are also important
for long-term health in people with diabetes, particularly for preventing, detecting, and slowing the progression of
complications.
Your doctor may also recommend screenings to detect health problems that do not cause symptoms in the early stages.
These screenings include:
 FBS/PP2BS/HBA1c every three months
 Yearly urine microalbumin test
 Yearly fundoscopic eye examinations
 Yearly foot examinations
 Yearly dental examinations
 Yearly electrocardiograms / 2D – Echo / TMT
 Yearly lipid profile test
 Yearly kidney and liver function tests

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Prepare for Your Appointment
 When you go for your routine follow up with your doctor, take all your medicines with you.
 Make a list of them along with dose and frequency. Discuss if you’re having any problems with your current
treatment.
 Take your blood glucose chart with your doctor so they can see how the medicines are working for you.

Converse With Your Doctor

 If you’re starting new medicines, ask your doctor the following questions:
o How many pills do I take?
o How often should I take them, and when?
o Should I take my medicine on an empty stomach or with food?
o What if I forget to take my medicine and remember later?
o What side effects could I have?
o What should I do if I have side effects?
o Will my diabetes medicine cause a problem with any of my other
medicines?

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Preventing Complications of Diabetes

 Preventing Heart Complications

Diabetes is an added risk for developing heart disease. Sometimes a person with diabetes does not feel the normal
symptoms of a heart attack. This is called a ‘silent heart attack’. This is because of the nerve damage caused by high
blood glucose. A person may not feel any symptoms at all or may just feel heartburn type mild discomfort.

Here are some things you can do to help decrease your risk:
o Maintain your blood glucose level as discussed with your doctor
o Maintain your blood pressure < 130/80mmHg
o Make sure your cholesterol is in control; LDL < 70
o Make sure your weight is appropriate for your height
o Take a high fibre diet
o Drink adequate water
o Regular exercise 150 minutes/week
o Get a regular health check up every year

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 Preventing Kidney Complications

o Kidney issues related to diabetes are referred to as ‘diabetic kidney disease’ or ‘diabetic nephropathy’.
o Over time, diabetic kidney disease can lead to chronic
kidney disease and even kidney failure.
o To monitor your kidney function, your doctor will
check your blood creatinine level and urine for
microalbumin.
o You can help slow the rate of progression by managing
your blood glucose and your lipid (cholesterol and
triglycerides) levels.

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 Preventing Foot Complications

In diabetes, the sensations over the soles of the foot are less. As a result, there are chances of small injuries
going unnoticed. This can result in a more complicated diabetic foot or diabetic ulcer, in adequate care is not taken.
The steps to be taken to prevent diabetic foot are:
o Self-exams - It is important to examine your feet every day.
Look for broken skin, ulcers, blisters, areas of increased
warmth, redness, or changes in callus formation.
o Avoid activities that can injure the feet, include walking
barefoot.
o Use care when trimming the nails — Trim your toenails
straight across. Never cut your cuticles. See a foot care
provider (such as a podiatrist) if you need treatment of an
ingrown toenail or callus.
o Wear cotton socks that fit well, and be sure to change your socks every day.

Regular foot exams to check for problems or changes are a critical part of managing your diabetes.

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 Preventing Eye Complications

There are several eye problems related to diabetes.

o The most common affects the retina, a layer at the back of the eye; this is called ‘diabetic retinopathy’. In
diabetic retinopathy, the small blood vessels in the retina grow abnormally and leak, leading to vision loss and
eventually blindness if not treated.

Other eye problems associated with diabetes include:

o Diabetic macular edema (swelling of the central area of the retina that
has the sharpest vision)
o Glaucoma (high pressure in the eyeball)
o Cataracts (clouding of the lens of the eye)

Regular eye exams is essential for detecting retinopathy and other eye problems at an early stage, when the
condition can be monitored and treated to preserve vision.

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 Prevention of Diabetes From the Get-Go

Type 1 diabetes can’t be prevented. But the healthy lifestyle choices that help treat prediabetes, type 2 diabetes
and gestational diabetes, can also help prevent them.

o Eat healthy foods.

Choose foods lower in fat and calories and higher in fibre. Focus on fruits,
vegetables and whole grains. Eat a variety to keep from feeling bored.

o Get more physical activity.

Try to get about 30 minutes of moderate aerobic activity on most days of
the week. Or aim to get at least 150 minutes of moderate aerobic activity a
week. If you can’t fit in a long workout, break it up into smaller sessions
throughout the day.

o Lose excess pounds.

If you’re overweight, losing even 7% of your body weight can lower the risk of diabetes. To keep your weight in a
healthy range, work on long-term changes to your eating and exercise habits. Remember the benefits of losing
weight, such as a healthier heart, more energy and higher self-esteem.

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o Manage your Diabetes’ ABCs

Working toward your ABCs can help lower your chances of having a heart attack, stroke, or other
diabetes problems.

A for the A1C test

The HBA1C test shows your average blood glucose level over the
past 3 months. The A1C goal for many people with diabetes is below
7%.

B for Blood pressure

The blood pressure goal for most people with diabetes is below
130/80 mm Hg.

C for Cholesterol
Try and keep the target LDL cholesterol below 70 mg/dl. Also, keeping HDL above 50 mg/dl helps protect the
heart in diabetics

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S for Stop smoking
Not smoking is especially important for people with diabetes because both smoking and diabetes
narrow blood vessels. Blood vessel narrowing makes your heart work harder.
If you quit smoking:
 You will lower your risk for heart attack, stroke, nerve disease, kidney disease, diabetic eye disease, and
amputation.
 Your cholesterol and blood pressure levels may improve.
 Your blood circulation will improve.
 You may have an easier time being physically active.

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When to Visit the ER

If you have any of the following, call emergency number or have

a relative or friend take you immediately to the emergency room:
 Home blood glucose level > 350mg/dl or <70 mg/dl
 Clammy skin
 Profuse sweating
 Drowsiness or confusion
 Weakness or feeling faint
 Sudden loss of responsiveness
 Difficulty in breathing

Call 108 or call us on 9924343344 for emergency help.

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FAQ’s of Diabetes

 If I have type 2 diabetes, can I stop taking diabetes medications if I eliminate candy and cookies from
my diet?
Everyone with type 2 diabetes will benefit from an improved diet, but
you may still need other interventions, such as increased physical
activity, weight loss or medications to keep your blood glucose in the
target range. Check with your doctor about any diabetes medication
dose adjustments that may be required if you change your diet.

 Can type 2 diabetes go away? And if my blood glucose becomes

normal, do I still have diabetes?
When your blood glucose is normal with no treatment, then the
diabetes is considered to have gone away. However, diabetes can come back. If you have type 2 diabetes and
the blood glucose is controlled during treatment, it means that the treatment plan is working. You will need to
continue your treatment; otherwise your blood glucose will go back up.

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 Do I need to monitor my blood glucose when I have type 2 diabetes?
You may feel fine, but that is no guarantee that your blood glucose levels are in the target range.
Remember, diabetic complications do not appear right away. Regular blood glucose monitoring can help you
keep your blood glucose in control and prevent serious damage to your eyes, kidneys and nerves. If your
glucose levels are out of range, consult your doctor.

 Are my children at risk?

Yes. Type 2 diabetes is a genetic disease. The
risk is highest when multiple family members
have diabetes, and if the children are overweight,
sedentary and have the other risk factors. Your
child has a 10-15% chance of developing type 2
diabetes if you have it.

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Please use the space below to write down any further questions to ask the doctor when you come
to the hospital for your appointment.

We hope this information will help you clear all your doubts about diabetes.

Jai Sat Chit Anand

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