1. What is the best-recommended diet for diabetes?
There is no one universally recommended diet specifically for diabetes. People with diabetes should follow healthy eating principles. These include eating on time and in the right proportions. The “plate method” is an easy way of estimating proportions: fill half your plate with vegetables and greens; the other half of your plate can be divided between carbohydrate and protein. As much as possible, opt for complex carbohydrates. These will have more fibre and cause less elevation of your blood glucose levels. Fibre also makes you feel fuller sooner and stops you from getting hungry soon. If you eat “simple carbohydrates”, try to limit the quantity, and mix together some good quality protein.
When using fats, try to select oils that have polyunsaturated fats (PUFA), and limit the quantity. Be aware of “hidden fats” e.g. in processed or readymade foods like chips, baked goods, etc and limit fried and high calorie food to once a week. Egg whites, chicken, fish, are all sources of good quality, lean protein. For vegetarians, pulses, lentils, dairy products, and nuts are good sources of protein. You need to make sure that you are intaking some protein with every meal.
2. How is obesity linked with diabetes management in the Indian context?
Obesity is one of the most significant risk factors for diabetes. More importantly, it is one of the modifiable risk factors. In pre-diabetes, losing enough weight may normalise your blood glucose levels, or at least slow down progression to diabetes. In the first few years after diagnosis of diabetes, the more weight you lose, the better the chances of remission of diabetes.
Even later on in the course of diabetes, weight is significantly correlated with diabetes control and the amount of medication needed. At any stage of pre-diabetes, or diabetes, a loss of as little as 5 per cent of your body weight will result in an improvement of your health and control. Lose more, and you will reap the benefits.
Easier than losing weight is to try and stay at a healthy weight from a young age: encourage children to stay active, and prevent excess weight gain, especially at key points in life like at the end of education, when you start a new job, and between pregnancies.
3. When life-threatening diseases such as cancer are also detected in diabetes, what are the emerging areas of treatment?
Diabetes leads to many co-morbidities and long-term complications, and people with diabetes are at risk of various form of cancer including cancer of liver, pancreas, endometrium, colorectal, breast, and bladder cancer. This increase in risk of incidence of cancer, is coupled with worse outcomes and decreased survival with cancer. Age, physical inactivity, and obesity are also independently associated with both cancer and diabetes.
So, lose excess weight, become more active, exercise daily, and keep your diabetes in good control. Several recent drugs for diabetes have a variety of benefits that go beyond just controlling blood glucose levels, and there is also some evidence that some of the drugs used to treat diabetes may have some benefit in reducing the risk of cancer: discuss this with your diabetologist.
4. What is Remote Monitoring software made for diabetes management? How does it function? Side effects if any.
Remote monitoring has been in existence for some time in several areas of chronic disease care, but has come to the forefront during this pandemic when people are unable to visit their doctors in person. The emergence of new technologies has made it easier to continue to monitor patients through several telemedicine channels including phone, email, and video consults.
In diabetes, connected glucometers, continuous glucose monitoring and insulin pumps have brought remote monitoring, even in real-time, within the reach of everyone. Most of these devices link with a smart phone and transmit the data when connected to the web. Patients can send glucose data directly to their doctor; or with certain devices, the doctor can directly receive alerts and can see your readings. They can then recommend changes in management as required. Other devices like linked BP monitors can provide additional information.
Apart from providing metrics and data, these devices also allow monitoring of adherence to treatment and testing plans, close monitoring of patients that require extra care, adjustment of medication dosages, and perhaps prevent or reduce hospital admissions and complications. The main limiting factor for all these devices is cost and man power.
(Disclaimer: All Information provided in the article are independent views expressed by Dr. Usha Ayyagari, Senior Consultant Endocrinologist and Diabetologist, Apollo Specialty Hospital, OMR, Chennai for general overview and educational purposes only.)