Diabetes Mellitus is a disease that is endemic in India. What was previously a disease of the developed world has made its way through small towns and villages of our country. This can be attributed to improved standards of living, access to food coupled with changes in lifestyle in terms choice of food/physical activities as we have become more developed.

Diabetes Mellitus is defined as a fasting glucose level of ≥126 mg/dl, random glucose of ≥200mg/dl or hba1c of ≥6.5. Prediabetes is defined as fasting glucose 100-125mg/dl or hba1c of 5.7 to 6.4. The constant presence of high glucose levels leads to inflammation and thus induces changes in blood vessels both large and microscopic ones. This predisposes to heart attacks, strokes, circulatory problems in legs, kidney, neuropathy and retinal complications. These complications of diabetes start at prediabetic stage.

It is hence important to prevent diabetes by identification of prediabetes also and start aggressive lifestyle changes. Hence, the diagnosis of prediabetes is a very important one, although it is ignored by patients/medical practitioners alike. Women with gestational diabetes and PCOS are at increased risk of developing diabetes. We Indians have abdominal obesity more than generalized obesity, Hence BMI is a poor marker for cardiovascular risk, instead abdominal girth is better measure of the risk.

What should I do to prevent diabetes mellitus?

1. Reduce carbohydrates (rice, roti, bread, poha, sabudana/seviya, dosa/idli), diary, non-vegetarian foods (since they are calorie-rich even in smaller quantities), oily foods and concentrated sweets.
2. Substitute the above with fiber-rich foods, fruits and vegetables that are low in calories, Consider using healthier grains such as millets, unpolished dhals and grains. Increase vegetarian sources of protein/egg whites, nuts/dry fruits.
3. Quantity of food is just as important as quality of food.
4. Disciplined exercise regimen/cardio and strength training.
5. All these changes should result in decreased abdominal fat and/or overall weight.
6. Regularly get blood tests for diabetes/prediabetes/cholesterol levels, quit smoking and get your blood pressure controlled.
7. Avoid fad diets unless you can make that a long standing change

What should I do once I have diabetes mellitus?

1. All lifestyle changes as mentioned above, except for elimination of most fruits from your diet.
2. Check HBa1c thrice a year and do home monitoring with a glucometer at least a few days/week. Get your medications changed so as to achieve HBa1c levels of 6-7. For people on insulin or frail elderly a slightly higher hba1c may be acceptable.
3. Do not be afraid to use medications, including insulin if lifestyle changes are insufficient. Ultimately all these will reduce your risk of complications of diabetes. Do not fall prey to certain myths about diabetic medications.
4. See an ophthalmologist yearly.

Dr. Indira Kedlaya
Senior Consultant – Internal Medicine
Columbia Asia Hospital
Whitefield, Bengaluru

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Gestational diabetes mellitus is a condition that as many as 9% of pregnant women develop. It increases the risk of issues during pregnancy and delivery. During your pregnancy, your cells have a bit more insulin resistance. This results in an increase in the amount of sugar or glucose in your blood. This additional glucose helps in making more nutrients for your baby.

However, if your cells get too insulin resistant, it can result in your blood sugar level becoming too high. This can be problematic for you as well as your growing baby. Some factors make you more likely to develop gestational diabetes during pregnancy, so it is not always possible to prevent it. However, a pregnant woman can take certain steps to reduce the risk of developing the condition.

Gestational diabetes may harm both the fetus and woman. The possible effects are:

• Increased blood pressure
• An increased risk of preeclampsia
• A higher risk of the woman having type 2 diabetes in future
• Premature birth
• Higher birthweight
• Low levels of blood sugar for the baby at birth

Preventing gestational diabetes

While gestational diabetes isn’t always avoidable, women can take a few steps to reduce their risk of developing the condition.

1. Having a healthy weight when trying for pregnancy

If you want to have a healthy pregnancy, you should look to exercise regularly. If you are looking to conceive, you should try to make lifestyle choices that can help you reach a healthy weight and maintain it before you get pregnant. Studies have shown that one of the most significant risk factors for gestational diabetes is being overweight.

Research has confirmed that a woman whose BMI is higher than 25 is more likely to develop gestational diabetes when she gets pregnant. However, this risk can be reduced by making the necessary dietary changes. If you are looking to lose weight, you should modify your diet by taking steps like:

• Eating smaller portions of food
• Avoiding junk food and packaged food
• Preventing candy and preferring fruit
• Consuming more lean protein, like tofu and fish, which helps in staying fuller for longer.
• Eating plenty of whole grains and vegetables to increase fiber intake
• Avoiding sodas, juices, and coffee drinks with high dairy content and replacing them with black coffee, herbal tea, or sparkling water with lime or lemon slices.

2. Exercising

Exercise is an important aspect of healthy weight maintenance. Exercising can help prevent gestational diabetes, both during and before pregnancy. When you exercise, your body becomes more sensitive to the insulin created by your pancreas, which helps in regulating blood sugar levels.

You should try to become more active even before you get pregnant. It might simply mean making certain long-term lifestyle choices. If you have more of a sedentary lifestyle, you can take measures like:

• Cycle or walk to work
• Park your car some distance away from your destination and walk the rest of the way
• Take the stairs instead of elevators
• Perform leisure activities like gardening, hiking, or playing outdoors with children.
• Try out yoga. It would be a good idea to join a class particularly meant for beginners or pregnant woman
• Performing low impact exercises like swimming
• Join a running club to maintain your motivation.

If you want to avoid gestational diabetes, it is recommended to do around 30 minutes of exercising with moderate intensity for 4-5 days every week. Maintain an intensity that causes you to break a sweat. Good options for cardio exercises include walking, stationary biking, using elliptical machines, and swimming. For pregnant women, it is important to discuss with a doctor about their exercise regimen and get to know about the exercises that are safe for each stage of their pregnancy.

3. Eating right when you are pregnant

Having a nutritious diet when you are pregnant can be particularly challenging because of food aversions, morning sickness, and cravings. However, if you eat well, it ensures that you only gain healthy weight for each trimester and avoid gestational diabetes. Eating non-starchy vegetables and whole grains can help in reducing the risk of developing the condition.

Following are the healthy food choices:

• Lean proteins like beans, tofu, white poultry, and tofu
• Healthy fats from coconut oil, olive oil, nuts, and other plant-based sources of fat
• Low-fat dairy products
• Fruits
• Whole grains like brown rice, oatmeal, bread, and pasta.
• Non-starchy vegetables

Following food items should be avoided

• Processed foods
• Added or extra sugar
• Sugary beverages such as energy drinks, sodas, juices, and store-bought coffee.

Throughout your pregnancy, make sure you visit your gynecologist regularly for routine care. The doctor will ask about any symptoms and even do an ultrasound and pelvic examination. If they do notice any early indications of gestational diabetes, they will give suggestions to help you prevent it.

Dr.Poornima Ramakrishna
Consultant Obstetrics and Gynecology
Apollo Cradle & Children’s Hospital
Koramangala & Jayanagar, Bengaluru.

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