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 American Association of Diabetes Educators (AADE) i.e., healthy eating, being active, monitoring, taking medication, problem-solving, healthy coping and reducing risks. This issue cover story gives insights on the importance of exercise for people with diabetes. People with diabetes can achieve their targets by various ways; however, it is important for them to take precautions while exercising so as to not injure themselves while achieving result-focused goals. This issue also covers a section on diabetes and women’s health – A double challenge for women with menopause. 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. S. Sridhar Dr. Ramesh Omprakash Goyal MD, DM (Endo – PGI, Chandigarh) MD (General Medicine & Therapeutics), DM (Endocrinology) Assistant Professor, Department of Endocrinology and Metabolism, Consultant in Diabetology & Endocrinology, Madurai Medical College; Consultant Apollo Hospitals, Ahmedabad, Gujarat. Endocrinologist, Vadamalayan Hospital, Madurai, Tamil Nadu. Dr. Ajay Vasant Rotte Dr. Jamal Ahmad MBBS, PGDHHM, DFID, IDC, MBA MD (General Medicine), DM (Endocrinology), (Hospital Management) FCCP, FRCP, PhD (Medicine), DSc (Endocrinology) CEO and Senior Diabetologist, United CIIGMA Hospital, Aurangabad, Maharashtra. Physician and Endocrinologist, Diabetes and Endocrinology Super Speciality Centre, Aligarh, Uttar Pradesh. Dr. (Wg. Cdr.) Arun Kumar Dr. Milind Katta MD (Medicine), DM (Endocrinology) MBBS, Diabetology (CPS), CCGDM, CCEBDM, CCD, FICM, DPHARM Senior Consultant Endocrinologist, Arunosha Labs Pvt. Ltd., Delhi. Consultant Critical Care Specialist and Diabetologist, Balaji Hospital and Sugun Hospital, Andheri, Mumbai. Dr. Banshi Saboo Dr. Samir Dasgupta MD, PhD MD Chief Diabetologist and Chairman, Diabetes Consultant Diabetologist and Endocrinologist, Care and Hormone Clinic, Ahmedabad, Rabindranath Tagore Surgical Centre, Kolkata, Gujarat. West Bengal. Dr. Lavanya Katakam Dr. Parimal Swamy MD (General Medicine), MD, Dip. (Preventive Health Care) DM (Endocrinology) Apollo, Sugar Balance Centre, Asthama-Allergy Consultant Diabetologist and Endocrinologist, Care Centre, Jabalpur, Madhya Pradesh. Aswini Endocrine Center, Guntur, Andhra Pradesh. Dr. Gurpreet Singh Ms. Umasakthy G. MBBS MSc, RD, PGDDE Consultant and Head, Minerva Medica Senior Executive Dietician and Diabetes Diabetes and Endocrine Clinic, Ludhiana, Educator, Dr. Mohan’s Diabetes Specialities Punjab. Centre, Gopalapuram, Tamil Nadu. Table of Content Cover Story: Healthy Coping: Exercise Prescription for Diabetes 01 Pursuit for A Healthier Tomorrow 21 Dr. S. Sridhar Dr. Ramesh Omprakash Goyal Being Active: Special Concerns for Assess and Address the Women with Diabetes 06 Risk of Diabetic Foot 23 Dr. Jamal Ahmad Dr. Ajay Vasant Rotte Taking Medications: Six Protective Herbs to Your Diabetes Report Card 09 Include in Your Diet! 27 Dr. Arun Kumar Dr. Milind Katta Monitoring: Diabetes by the Number Why Settle For Normal When 13 You Can Reach Optimal? 29 Dr. Banshi Saboo Dr. Sameer Dasgupta Problem Solving: Diabetes and Menopause: Coping with Uncertainty of Diabetes A Double Challenge 15 32 Dr. Parimal Swamy Dr. Lavanya Katakam Reduce Your Risk: Neutralise the Role of Medical Nutrition Effects of High Blood Sugar Naturally 18 Therapy in Diabetes Management 34 Dr. Gurpreet Singh Ms. Umasakthy G. Table of Content Tools in Diabetes: Eat Out, Be Wise! Livongo for Diabetes 40 49 Future Trends: “Ouchless” Patch Promises Needle-Free 42 Shopping Smart 50 Diabetic Monitoring Diabetes Educator of the Month 43 Diet-Related Behavioural Tips 51 Busting the Myth: Superfood: Beans (Lente carbs)/फिलयां Egg Yolk Must be Discarded 44 53 Get Active! 45 Recipe 54 National Diabetes Educator Program (NDEP) Best Practices 47 References 55 Dr. Shachin Kumar Gupta Cover Story: Exercise Prescription for Diabetes Benefits of exercise in the prevention of type 2 diabetes (T2DM) Expert Opinion 'If exercise was a pill it would be prescribed to every patient' was noted among some of Australia’s leading experts and 1 Dr. S. Sridhar was published in the journal ‘The Guardian’. Globally, T2DM has reached epidemic proportions and is associated with an MD, DM (Endo – PGI, Chandigarh) Assistant Professor, Department of increased risk for cardiovascular disease (CVD) and 2 Endocrinology and Metabolism, premature mortality. A sense of change in people’s lifestyle Madurai Medical College; Consultant must be implemented for this reason. Endocrinologist, Vadamalayan Hospital, Madurai, Tamil Nadu. A dual strategy of aerobic activity and strength training makes sense: 3 ¢ Aerobic activity, like walking or swimming, strengthens the heart, lungs and muscles. It helps control blood pressure and blood sugar. It keeps arteries flexible. It is also essential for maintaining or losing weight and excess body fat. All of these are key strategies for many people with diabetes. ¢ Strength training helps muscles respond better to insulin, the hormone that ushers blood sugar into cells. A single bout of it can make muscle cells "listen" to insulin better for 12 hours or more. It also improves muscle mass, muscle strength, blood pressure and body composition. Table 1: Strategies to stay active for people with diabetes Aerobic activity Muscle strengthening activity Activity Walking, jogging, cycling or group fitness classes Walking uphill, weight lifting or other muscle strengthening resistance exercises Duration At least 30 minutes per day At least 30 minutes or less per day Intensity Moderate-intensity activity; means that the person should feel If using weight for example dumbbells; try to do at least warm, mildly out of breath and mildly sweaty 1 set of 8–12 repetitions per activity Frequency If the person aims to do 30 minutes per day then he/she should do At least 2 days a week this at least 5 times per week so that he/she can reach a total of 150 minutes a week 1 Miscellaneous benefits of exercise ¢ Helps people achieve and maintain a healthy weight and prevents obesity ¢ Reduces feelings of stress, anxiety and depression ¢ Builds and maintains healthy bones, muscles and joints ¢ Boosts energy level ¢ Improves quality of sleep Muscle strengthening exercises/Resistance exercises Flexibility exercise Flexibility exercise increases the ability to bend joints and stretch muscles through a full range of motion. Some activities include: ¢ Stretching (sit and reach) ¢ Warm-up and cool-down Exercising caution4 People with diabetes need to be a bit more careful about exercise than other people. Here are some tips for exercising safely with diabetes: ¢ Start slowly: If the patient is new to exercise, start with a low-impact activity like walking, swimming or bicycling and then gradually increase the intensity. ¢ Time it right: The best time to exercise is an hour or so after eating when your blood sugar is likely to be a bit higher. 2 ¢ Know your limits: Ask the patient to check their blood sugar before and after exercise to see how their body responds to exertion, particularly in elderly and brittle diabetic individuals and people with type 1 diabetes (T1DM). ¢ Protect your feet and eyes: – Make sure that the patient uses appropriate footwear with supportive midsoles and socks to avoid blisters so as to avoid skin ulcers. – If the patient has nerve pain or loss of sensation, ask him/her to avoid activities that could