1 st time in India To keep the members of diabetes care team abreast with DSME and DSMS concepts USV as your reliable healthcare partner believes in supporting your endeavour to make India a Diabetes Care Capital of the World. Indian Diabetes Educator Journal (IDEJ) is a first-of-its-kind initiative in India developed to strengthen the concepts of Diabetes Self-Management Education (DSME) and Diabetes Self-Management Support (DSMS) among the members of diabetes care team, especially the diabetes educators (DEs). IDEJ content is developed based on seven self-care behaviours of the American Association of Diabetes Educators (AADE) i.e., healthy eating, being active, monitoring, taking medication, problem-solving, healthy coping and reducing risks. Can diabetes be cured? A major thought in every persons mind. This issue’s cover story is dedicated to being free from diabetes. This is a long process which requires dedication, compliance of medications and acceptance of consequences that occur while treating diabetes. The current issue focuses on minute details that people with diabetes deal with during this phase. This issue also covers a section on the crucial role of DEs in the management of people with diabetes, and pointers to help improve the personalised care and maintain patient-provider relationship. We sincerely thank our contributors for making this issue delightful reading for our readers. We dedicate this journal to all the healthcare professionals who are working relentlessly towards making “India a Diabetes Care Capital of the World”. Sincere Regards, Disclaimer: This Journal provides news, opinions, information and tips for effective counselling of diabetes patients. This Journal intends to empower your clinic support staffs for basic counselling of diabetes patients. This journal has been made in good faith with the literature available on this subject. The views and opinions expressed in this journal of selected sections are solely those of the original contributors. Every effort is made to ensure the accuracy of information but Hansa Medcell or USV Private Limited will not be held responsible for any inadvertent error(s). Professional are requested to use and apply their own professional judgement, experience and training and should not rely solely on the information contained in this publication before prescribing any diet, exercise and medication. Hansa Medcell or USV Private Limited assumes no responsibility or liability for personal or the injury, loss or damage that may result from suggestions or information in this book. You can contribute your articles, opinion, cases, recipes, experiences or write to us to if you want to subscribe to soft copy of IDEJ every month by sending an e-mail to: [email protected] or [email protected] or [email protected] *DSME:*DSME: DiabetesDiabetes Self-ManagementSelf-Management Education,Education, DSMS:DSMS: DiabetesDiabetes Self-ManagementSelf-Management SupporSupportt Expert Contributors of the Month Dr. Pramod Gandhi Dr. Rajiv Awasthi MD (Medicine), DM (Endocrinology) MD (Medicine) Consultant Endocrinologist, Nagpur, Lucknow, Uttar Pradesh. Maharashtra. Dr. Manoj Indurkar Dr. P. Ravi Kumar MD (Medicine) MD (Paediatrics), DM (Endocrinology) Professor and Head, Department of Medicine, Assistant Professor, MKCG Medical College, SS Medical College, Berhampur, Odisha. Rewa, Madhya Pradesh. Dr. Navneet Shah Dr. Praveenkumar Devarbhavi MD (Medicine), FICA MD (General Medicine), DM (Endocrinology and Metabolism) Diabetologist, Endocrinologist and Consultant Physician, Director, Department of Diabetes Consultant Endocrinologist, Maax and Endocrinology at Sterling Hospital, Superspeciality Hospital, Karnataka, Ahmedabad, Gujarat. Bangalore. Dr. B. Vijay Kumar Dr. Partha Roy MD (Medicine) MBBS, F. Diab (MDRF) Senior Consultant Physician, Yoshoda Consultant Diabetologist Hospital, Secunderabad, Telangana. Dr. Kiranmai Alla Dr. Ajish T. P. MD, DM (Endocrinology) MD, DM Dr. Kiran’s Endocure, Cure Hospital, Consultant Endocrinologist, Kollam, Kerala. Vijayawada, Andhra Pradesh. Dr. Satyam Chakraborty Ms. Ariba Zuhair MD (Internal Medicine), MSc DM (Endocrinology) Dietician, Dr. Mohan’s Diabetes Specialties Consultant Endocrinologist, Institute of Centre, Lucknow, Uttar Pradesh. Neurosciences, Kolkata, West Bengal. Table of Content Problem Solving: Dealing with Diabetes Burnout and Diabetes Distress Diabetes Educators Speak! 01 16 Dr. Satyam Chakraborty Cover Story: Freedom from Diabetes Reducing Risk: A Sudden Drop in Weight may Sometimes Not be Linked 02 to Patient’s Healthier Habits 19 Dr. Pramod Gandhi Dr. Rajiv Awasthi Healthy Eating: A Guide to Choose the Healthy Coping: Does Fasting Help Perfect Diet for People with Diabetes 04 Prevent Diabetes? 22 Dr. P. Ravi Kumar Dr. Manoj Indurkar Being Active: The Impact of T2DM on Diabetes in Control: Cultural Issues People with Osteoporosis 07 When Treating Diabetes 25 Dr. Navneet Shah Dr. Praveenkumar Devarbhavi Monitoring: Transform your Health – Monsoon Highs and Lows! Compliance to SMBG among People with T2DM 10 30 Dr. B. Vijay Kumar Dr. Partha Roy Taking Medication: The Harmful Family and Diabetes Corner: Living Consequence of Aggressive Glycaemic with Diabetes is a Family Affair Control in Adults with Diabetes 13 33 Dr. Ajish T. P. Dr. Kiranmai Alla Table of Content Importance of Patient-Centered Therapy in Diabetes Mellitus 36 Get Active! 49 Ms. Ariba Zuhair Multiple Feathers on the Cap 41 National Diabetes Educator 50 Program (NDEP) Best Practices Eat Out, Be Wise Conference Highlights 43 52 Tools: Pregnant with Diabetes 44 Shopping Smart 53 Future Trend: Smart Health IT - A New Model of Healthcare for 45 Superfood: Whole Grains (साबतु अनाज) 54 Rural India Diabetes Educator of the Month 46 Recipe 55 Patients’ Corner 47 References 57 Diabetes Educators Speak! Can diabetes be reversed? Yes, it is possible. How? Here is an example: Ms. Anju Paul had unhealthy eating habits and a sedentary lifestyle. She had a sweet tooth and used to skip meals for having sweets. Her sleep routine was irregular. She was detected with diabetes, with glycated haemoglobin level (HbA1c) of 7.5%, which scared her and she soon visited an NDEP certified DE, Ms. Natasha Kapre Vora to seek help. Ms. Natasha Kapre Vora taught her discipline of eating and importance of staying physically active. She followed her advice with determination and was focused towards achieving her goal even during the festive season and or while going for outings or fun tours. The DE, Ms. Natasha Kapre Vora was constantly in touch with her during the festive season and when she was travelling. Under her guidance, Ms. Anju increased her protein and fibre intake, included exercise in her daily routine, started sleeping on time and increased her fluid intake. With time she lost weight and her visceral fat levels which were high significantly reduced. Her HbA1c levels came down and diabetes medicines were stopped by the doctor. She was on cloud 9 to say she used to have diabetes, and losing weight had helped her boost her confidence. Her diet plan was also followed by her husband who also lost weight. Her son liked the healthy recipes shared by Natasha. The whole family started eating healthy. Even after losing weight and reversing diabetes, Ms. Anju is still motivated and focused on maintaining her weight and continuing the lifestyle modifications for the rest of her life. Kudos to Ms. Anju Paul and her certified DE Ms. Natasha Kapre Vora! 1 Cover Story: Freedom from Diabetes The diabetes burden Expert According to the Centres for Disease Control and Prevention, Opinion in 2012, 1.7 million adults were newly diagnosed with diabetes and currently, more than 29 million adults are living 1 Dr. Pramod Gandhi with diabetes. People with diabetes are at risk for numerous complications, therefore, they must participate in many MD (Medicine), DM (Endocrinology) facets of self-care including home glucose monitoring, Consultant Endocrinologist, Nagpur, 2 Maharashtra. healthy eating and exercising. Importance of family in diabetes self-care DSME is a critical component of care for all individuals with diabetes.2 For adults with diabetes, engaging in diabetes self-care activities helps in improving glycaemic control as well as preventing complications. Quite a bit of diabetes management happen within family and social environment.3 Thereby, addressing to the family members of adults with diabetes is critical, since the majority of disease management happens at home. Family members can actively support and care for people with diabetes. Here are some tips/ways they can help their kin with diabetes: ¢ Sharing responsibilities: Support can be provided in many in many forms, such as instrumental support in driving them to appointments or helping inject insulin and social and emotional support in helping them cope with their disease.4 ¢ Impact of attitude: The family member’s communication and attitude often seem to have a significant impact on a patients psychological well-being of a, his/her decision to follow recommendations for medical treatment and ability to initiate and maintain changes in diet and exercise. ¢ Lifestyle changes: There may be a need for changing, the types of food prepared and consumed at home, making time away from work to attend medical visits with the person and reprioritisation of family finances. 2 ¢ Update yourself: The family members should educate themselves about diabetes- care needs so that they know answers to certain questions such as why lifestyle changes are necessary?