Control quantity, control sugar levels

In my previous post I tried to categorize the behaviour of non-diabetics towards diabetics. The level of awareness of most non-diabetics regarding a diabetic diet is limited to avoidance of sweet stuff. Non-diabetics (and even quite a few diabetics) are not aware of the concept of glycemic index to know that foods that are not generally considered sweet can also raise blood sugar levels beyond acceptable levels. There are quite a number of such food items  - e.g. Bhelpuri, poha (rice flakes, can be had raw or prepared in various ways), white bread, fruit juices (even without added sugar), tomato ketchup etc.

When a diabetic, aware of the glycemic index of the food being passed around, declines to have a food item with a high glycemic index the others are surprised and wonder what the issue is when it is not sweet at all. What can the diabetic do? This is no time for explaining glycemic index. Smile apologetically and stay away or join the gang? .Such situations can be handled by controlling the quantity consumed. That way the glycemic load stays low. A complete rejection stands out and invites attention and comments. Having a small quantity allows you to go be with the gang and yet keep your sugar level under fair control.

Another mistake that many make is to decide on the level of sugar in an item merely by its taste. The actual sugar content can be high but the sweet taste offset by some other ingredient misleading one to conclude that the quantity of sugar is low and therefore more of it can be had. It is not always possible to get to know what has been added and roughly how much. Therefore here again controlling the quantity is the only way to avoid raising sugar levels.

But if you do happen to consume a substantial amount compensate by having less or none of something else and stick to you medication and exercise.

Patterns of behavior of non-diabetics towards diabetics

At work and play, diabetics have to get along with people who are not diabetics. Their knowledge of diabetes as a condition, presence of diabetics in the family etc. factors influence their behaviour and attitude towards diabetics. This is particularly true when food is a part of the socializing agenda, which is quite often. How normal people treat known diabetics when food accompanies discussion is an interesting subject and as a diabetic I have experienced different kinds of behaviour from friends, colleagues, relatives and acquaintances. 

I have tried to identify behaviour patterns and map them to well-known symbols of such behaviour. I have identified five such behaviour patterns. Though these are the fundamental patterns, quite a few display one of the hybrid behaviour patterns, which I have discussed later.

I have identified and described these patterns in the commonly occurring context of sweets being offered in a situation where roughly 4-10 people are together and one of them, you, is 'the' diabetic. The setting for this can be home, a restaurant or canteen or even a break during a meeting at work.

The basic patterns of behaviour towards diabetics:

The Monk - Is quite detached even though aware of your diabetic condition. Treats you just like anybody else, you are no one special. E.g. casually offers you sweets just as to anyone else and does not comment on your reaction, whatever it be, to that offer.

The Bull - Like the Cat, shows no overt concern for your condition. But if you refuse to have the sweets, tries to convince you that you are being unduly finicky ('come on, this small piece is not going to kill you'). Gives examples of people they know whose sugar levels have been 'permanently above 300 for years' and yet are doing fine. 

The Hawk - Immediately reminds you of your diabetic condition if you reach out for anything sweet. Keeps a hawk eye on you, but leaves it at reminding.

The Crow - Claims your share of the sweet since you are not supposed to have it and thanks you for that.

The Dog - Guards you against sweets. Takes effective action to keep sweets away from you using verbal and physical means to achieve that.

Some of the hybrid patterns are described below. I am sure more can be identified from experience.

Monk-Haw - Initially offers you sweets just as to the others, then casually mentions that you are diabetic and leaves it at that.

Bull-Crow -  Tries to convince you to have the sweets even when stating that you are diabetic and if you insist on not having, claims your share.

Monk-Crow - Offers sweets, says nothing, but if you refuse, claims your share.

Interestingly, Bull-Dog is not a valid behaviour pattern here.

Diabetics and the temptation of sugar-free sweets

Diabetics now represent a relatively large and growing segment of the Indian populace and with India wearing the crown of 'The Diabetes Capital of the World' it is not surprising that businesses are attempting to address the specific needs of diabetics.

One such thriving business is that of traditional Indian sweets labelled 'sugar-free'. They are sweet but supposedly do not contain any sugar and therefore safe for diabetics. Are they really sugar-free and safe? When I see something marked sugar-free I always ask the guy at the counter what has been used as the sweetner instead of sugar. The reply that I get most often is - dates. And then I am told that dates are fine as they are 'naturally' sweet and so OK for diabetics. The other choice of sweetners are the common fig/anjeer(Ficus carica) or apricot/jardalu. Dates, figs and apricots all have sugars and Glycemic Indices (GI) in the medium range i.e. between 56-69. Therefore it is wrong to claim that the sweets are sugar-free.

However, all of them are rich in terms of nutrition. Therefore I would be inclined to think that a small quantity of these 'sugar-free' sweets should not be a problem if otherwise the prescribed regimen for medication, exercise and diet plan is being followed with some compensation in diet for the small amount of sweets consumed.

The above sweeteners (in fact all sweeteners) cost much more than equivalent amount of sugar needed to achieve the same sweetness. But how can I be sure that plain sugar was not used? The makers of the sweets could have lowered the quantity of natural sweeteners and added sugar to achieve the same sweetness. It may be difficult to conclude for or against the idea even after testing for blood sugar levels because the natural sweetners have a medium level glycemic index and therefore would certainly be raising the blood sugar levels to an extent where it would become impossible to distinguish between their effect and that of plain sugar.

Maybe sprinkling a bit of powdered cinnamon on the sweets before having them may make them safer?

Diabetes, my good friend

Today, Nov 14, is World Diabetes Day. If it means something to you then surely you will remember that one day when your life changed track. You continued to live like the others but in the matter of food you had to live unlike them.

I remember the day towards the end of July'04 when the elderly doctor who summed up the results of my general health checkup gave me the 'breaking' news - my results showed a significant level of 'glucose intolerance'. I had miserably failed the 75gm 'glucose challenge'. She said I should get a proper blood sugar test done to confirm diabetes. But her very next words, 'you will find that tea and coffee taste much better without sugar', stamped 'DIABETIC' on me - with indelible ink.

Initially I saw diabetes as the 'enemy' within that needed to he 'destroyed'. I shunned all sweet food, exercised and walked much more regualarly and lost around 7-8 Kgs. in four months. Starting with Ayurvedic medicine and switched over to allopathic medicine and a diabetologist became the first 'specialist' in my life.

I had the first knowledge on being a diabetic from observing both my parents who were long-time diabetics and probably one of the reasons I was too. I read a lot about the disease and the fact that one never really got cured and could only hope to control it.  Control was absolultely necessary if one were to avoid 'diabetic complications' that significantly affected the 'extremities' (feet and hands), kidneys, eyes, heart and generally all the organs of the body. I read books that described diabetes as the 'worst curse' and many more colourfully negative adjectives.

Having acquired quite some knowledge about diabetes I summed up what diabetes had taught me:

1. Avoid high calorie food esp. food sweetened with sugar (consider glycemic index and glycemic load)

2. Avoid fried food to reduce the risk of high levels of bad cholestrol

3. Have healthy food, exercise regularly and be active

4. All of the above should result in a near-ideal, steady body weight and good overall fitness.

Diabetes was forcing me to adopt a lifestyle that any good health/wellness expert or a doctor would have advised anyway even if I were normal. But had I been normal, I would have probably ignored the advice. Diabetes simply made it difficult for me to ignore the healthy lifestyle advice. Besides, diabetes made me aware of the food I consumed, the nutrition it provided and of course, the calories it provided. Now isn't this what you would expect a friend who is deeply concerned about your health do for you? I remember reading somewhere about  diabetics who lived longer and better lives than those who were 'normal' and never forced to control their lifestyles.

I have looked upon diabetes as a friend who uses the threat of 'complications' to force me to follow a healthy lifestyle. I am no longer in conflict with diabetes. Diabetes is my health partner. 

Re-using blood glucose meter lancets

The lancet is the pricking device that actually pierces your finger tip and some blood capillary under the skin to draw out the drop of blood that you need to place on the testing strip. I have been using the Accu-Check Active blood glucose meter for around five years now. The instruction manual indicates that the lancets are single-use. However, I and quite a few other diabetics I know reuse a lancet many times until its tip get blunt and it starts to hurt when it pricks the finger.

This is how I re-use a lancet. I insert a new lancet into the lancing device and twist off the small cap that covers the sharp tip. I do not discard this cap and carefully keep it in the opened case of the Accu-Check kit.  After the test, I carefully replace the cap on the tip and then eject the lancet from the lancing device into the opened case of the kit. That way I can re-use the lancet again and again. Replacing the cap can be somewhat difficult for the first few times with a new lancet given that the tiny hole at the bottom of the cap must be made to exactly match the tip of the lancet.

I use the same meter to check my mother's blood sugar too. I have another lancet for her maintained as described above but in another small container separate from the lancet that I use. I ensure that I always use our respective lancets and that they never get mixed up.

I make sure the exposed lancet tip never comes in contact with any surface other than my skin and the hole in the lancet cap. I have never sterlized or even washed/wiped the tip of the lancet and faced no problems over the many years of doing this.

This technique has helped me keep down the cost of a blood sugar test giving me the opportunity to test more often.

Using cinnamon to lower blood sugar levels - an experiment

A few years ago I came across an article on the Net on the use of cinnamon to control blood sugar levels in Type 2 diabetics. Besides lowering sugar levels, the article said, cinnamon also helped lower triglyceride levels.
The link below may not be the same one that I read then, but its content is very similar to the one I did read: http://www.diabetesselfmanagement.com/Blog/Amy-Campbell/can_cinnamon_help_you_control_your_diabetes/
From what I could gather from the article I read (may not have been the link above), sprinkling cinnamon powder on your breakfast cereal & milk apparently helped keep blood sugar levels under control.

It was the month of May and season for mangoes in Mumbai. Mumbaikars love having mango pulp anytime of the day. Mangoes have a high glycemic index and are therefore (one of the the many) forbidden fruit for diabetics. To conduct the test on the effectiveness of cinnamon I had mango pulp at lunch time on two consecutive days, on the first, without and on the next, with cinnamon and measured my blood sugar 2 hours after lunch. The mangoes on both days were from the same box, equally ripe and therefore most likely to have a very similar influence of sugar levels. I also had to know my fasting sugar levels on both the days and make sure they are quite close by, control what I had for breakfast, avoid having anything between breakfast and lunch, have the same items for lunch (one of which was the mango pulp), roughly the same quantity of the mango pulp itself and also ensure I performed activities of generally similar physical intensities on both days. I did all the above to the extent practically possible and noted down the blood sugar levels post-lunch without and with cinnamon added to the mango pulp. On both days for lunch I had two chapattis and used the same bowl for the mango pulp filled to the same level. The first day was without the cinnamon in the mango pulp and my blood sugar level was 254 mg/dL 2 hours after lunch! On the next day, with a small spoonful of cinnamon power in the mango pulp the reading showed 175 mg/dL 2 hours after lunch. It was higher than the target of 140 but still much lower than the 254 without cinnamon. I did not record the fasting sugar levels on the two days but I did check them to make sure they were lower than 110 and close to each other. All blood sugar measurements were done at home and with the same instrument. From my observations and even after considering the not-so-clinical approach I would say that cinnamon does seem to help but having it certainly does not give you the freedom to throw caution to the wind regarding your diet.
I welcome any suggestions and advise on the use of cinnamon for controlling sugar levels and also any experience with the purported lowering of triglycerides.

Diabetic life

I have been a type 2 diabetic for more than 7 years now, diagnosed with the condition in 2004. I have been on oral medication since then. The initial suspicion during a general health checkup and confirmation of the condition through a proper blood sugar test disturbed me quite a bit, though this should not have come as a total surprise given that both my parents were diabetic. I initially started on Ayurvedic medicine ( I have always been a fan of Ayurveda/nature cure). They worked if I kept a very strict control on my diet, but any violation would lead to a high sugar level. I then consulted a diabetologist and started using allopathic oral medication. Soon after that for the first time I experienced hypoglycemia or low blood sugar condition. Soon I adjusted my diet a bit to match the power medicine. I also exercised/walked more regularly.

I have experimented with various types of food, natural substances such as cinnamon (dalchini), okra (bhindi) and fenugreek (methi) that help lower blood sugar. I will soon write about my experience with these later on.