One day in the life of a diabetic!

By Dr. Muhammad Hafizullah

“Oh, not again,” I reprimanded myself and regretfully remembered the transgressions I ventured during and after dinner last night. Blood sugar was again high –hovering above 150 – the maximum limit I have set for myself is 120. Now that I have diabetes (and of course not by choice) I have to learn to abide by the rules and make the best out of the situation. I have to use all my intellectual and physical resources to fight the war against the beast that has landed upon me and I cannot get rid of it. My first priority was to update myself on diabetes. A previous distant poor relative soon became an intimate mate and I had sound knowledge of it. After understanding the reasons for the causation of diabetes it seemed a ‘number game’. The raison d'être for diabetes became clear as the body fails to consume sugars effectively. There is not enough Insulin – a chemical produced by Pancreas occupying the mid of upper abdomen. The amount of Insulin may be sufficient but body develops resistance to Insulin.

A ‘high level’ enquiry is ordered whenever blood sugar level shoots up above 150. I am the head of enquiry committee and I am the member as well. I go through the details of dinner right from starters to dessert. I keep telling myself that I have to behave myself responsibly! I try to identify (yet once again!) the specific food items which my body cannot handle and pushes my sugar level high. I decide about those ‘items’ and order my body to keep away from such ‘bullets’ that harm my body. I understand that these recurrent insults can eventually cause serious damage to my heart, kidneys, eyes, brain or feet. It took me some time to convince myself that the effect of every ‘bullet’ may not be apparent and appreciable but a bullet riddled body can become victim to any of the calamities without any premonition. Food rich in calories and fats is like a small assault on body’s chemical integrity and many chemical hormones have to swing in action to placate the storm. Every time an attack is launched human body has to pay a price for that. Morning high sugar reveals that body has not been handling carbohydrates well and more efforts are required to optimize the control. I learnt that many studies conducted on thousands of patients prove that eventual complications correlate with fasting blood sugar.

To control diabetes it is imperative to know the levels of sugar at different times of day. The aim is to keep it controlled round the clock. Sophisticated small pieces of equipment, at a reasonable price, are available to check blood sugar levels. These devices can store data to check the old record. Obtaining blood sample has become very easy with the help of pen pricks using very fine needles and these can be reused. Blood sugar should be checked at different times of the day but importantly before and two hours after meals. A record should be maintained mentioning date, time and dosage of drugs. Whereas fasting blood sugar is desirable to be below 110, two hours after a meal should not be more than 180. A properly record can be of immense help to the doctor to make adjustments in dosage. Morning and evening dose of Insulin can be altered independently to improve the control.

Among the first few things that I have ordained myself to do – checking up blood sugar before breakfast is a must - at least three times a week. Previously under the pretext of ‘not today’ I would keep postponing for one or another reason till I skipped a fortnight all together. Then I decided in all serenity that I would check up my sugar level fasting every Monday, Wednesday and Friday or Saturday. Whereas Monday level gave me feedback on my misadventures of the weekend, the one on Friday or Saturday determined the liberties I could take with food over the ensuing weekend. During week, the level of sugar will determine the level of exercise I have adhere to.

Anytime I have a dinner outside my house the little cost I have to pay is to have an extra prick and check blood sugar. Though snapshots of sugar level checked at different times of the day on different days of the week offer a reasonable assessment of control of diabetes yet it does not reveal the whole story. My doctor friend confided that many diabetics become more vigilant of their diet as the appointment with their doctor draws near, hence resulting in relatively lowly sugar level on the day of appointment. A blood test that measures the average sugar level of last three months is called HBA1c. This is highly recommended and should be performed on a regular basis preferably every three months. This has been shown to be the best predictor of future complications. This is not affected by the time of the day and recent food intake. Those who had been taken liberties with diet and amended their selves close to the appointment get caught by this test. HbA1c should be checked every three months preferably using the same laboratory to avoid errors. All diabetics should know about it and ask their doctors to check it even if they do not volunteer it themselves.

Every time I am invited to a meal, my first instinctive answer is ‘no’ but then somehow or the other I fall into the same old social traps and accept the invitation. I cannot possibly put an end to my social life because of diabetes. I learnt my dos and don’ts and decided not to be bogged down by silly arguments like, ‘only today’, ‘only for friends’ ‘an occasional digression will not cause havoc’ ‘you are too strict’ etc. The worst advice one has to resist is, “My friend Farhan has long standing diabetes but he eats everything” or “my uncle had diabetes and he never refrained from anything.” The secret they do not share is that Farhan underwent Bypass surgery and required angioplasty twice after that. I learnt to say a polite but firm ‘no’ and then stick to it. I understand what is good and what is bad for me and I am responsible for my body and I have to bear the consequences if any.

As a matter of policy I try to restrict my intake of rice and totally refrain from it if it is cooked in ghee. I watch the amount of rice being consumed and accordingly restrict the intake of bread/roti. I enjoy fresh salad and try to curb the appetite by taking lots of it before the meal. I try to avoid oil dipping fried food and prefer grilled or baked food. I try to stay away from gravy with lots of oil.

Two things are absolutely prohibited – carbonated drinks unless diet versions are available and desserts. Even a teaspoonful of dessert results in very high level of sugar.