How persons with diabetes can manage their blood sugar levels amid the pandemic

Dr Mala Dharmalingam, an endocrinologist, provides a list of dos and don’ts for persons with diabetes.
Glucose meter reading
Glucose meter reading
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COVID-19 patients with diabetes have a 50% higher risk of dying than those without. The grim statistics highlight the importance for persons with diabetes managing their blood sugar levels amid the ongoing pandemic. Left untreated, diabetes can lead to other health conditions such as cardiovascular diseases, kidney failure, blindness etc. 

In an email interview to TNM, Dr Mala Dharmalingam, a Professor and the Head of the Department of Endocrinology at MS Ramaiah (MSR) Medical College in Bengaluru and  the Director of the Bangalore Endocrinology & Diabetes Research Centre (BEDRC) emphasised maintaining a disciplined lifestyle and provided a list of dos and don’ts for those who may be vulnerable to COVID-19. 

What makes people with diabetes more vulnerable to COVID-19? 

People with diabetes are as likely as the general population to contract COVID-19. However, those with diabetes are more likely to develop severe symptoms and complications if they are infected with COVID-19. The risk of a fatal outcome from COVID-19 is up to 50% higher in people with diabetes than those without diabetes. Additionally, the common comorbidities of diabetes like high blood pressure, obesity, dyslipidaemia and cardiovascular diseases are known to worsen the severity of COVID 19.

Given that until a vaccine is developed, those with diabetes and comorbidities will continue to remain vulnerable, how can a person with diabetes manage their blood sugar levels? 

People with diabetes should focus on maintaining good glycemic control as it helps to improve the immune system. In this respect, people with diabetes should monitor the glycemic status for both low and high blood sugar levels. People living with diabetes should maintain a disciplined lifestyle of an appropriate and balanced diet, stay hydrated and exercise regularly at home. An active lifestyle helps in boosting immunity and in maintaining better control of sugars. Furthermore, physician consensus review concedes that taking insulin is a safe and only choice for people with type 1 diabetes mellitus and is a superior alternative in people with type 2 diabetes mellitus, having poor metabolic control with oral medications.

What are the dos and don’ts for persons with diabetes? 

When a person with diabetes is left untreated, it may cause comorbidities like cardiovascular diseases, nerve damage, blindness, kidney failure, amputations, and in some cases, early death. Thus, it becomes vital to treat diabetes strategically. 

An optimum diabetes treatment consists of maintaining a proper diet, exercising, and consulting your doctor at regular intervals. Meals should be divided into small portions, and high fibre food such as wheat, millets, and green leafy vegetables should be consumed. Less than 5gm/or one teaspoon of salt should be eaten in a day as excess salt can raise the blood pressure.

People living with diabetes should cut down on refined carbs like sugar, honey, jaggery, cakes, pastries, etc., as they quickly increase the blood sugar. Processed foods such as white bread, potato chips, cookies, etc., should be avoided as they are rich in salt and oil. Aerated and caffeinated drinks should be avoided too. Artificial sweeteners can be used with tea and coffee in small amounts. Skipping meals is not advised. 

India has the second-highest number of people with diabetes in the world at 77 million, as per the International Diabetes Federation 2019 Diabetes Atlas. What makes Indians especially prone to diabetes? 

Scientific evidence suggests that Indians have an increased degree of pancreatic beta-cell dysfunction responsible for insulin secretion compared to the western population. But even as the Indian population is genetically pre-dispositioned to diabetes, lifestyle choices significantly impact the occurrence of Type 2 diabetes in our country. Additionally, the diet for Indians is high in refined carbohydrates, sugars, fats and salt. All these factors contribute to the rising prevalence of diabetes, hypertension and cardiovascular diseases (CVDs).

From a policy point of view, what does India need to be doing to tackle diabetes?

Promoting an active lifestyle that incorporates a healthy diet plan and regular exercise, can substantially reduce the risk of developing type 2 diabetes - even for people who have a family history of diabetes. A BMI below 23 reduces the risk of diabetes. In addition to this, the ideal waist circumference is below 80 cms for women and 90 cms for men.

All Indians should be screened for diabetes once they cross 30 years of age. Early testing should be carried out for those with family history, obesity, and women with a history of PCOS or large-sized babies. People suffering from high blood pressure or high cholesterol are also more likely to be suffering from diabetes.

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