​We love to keep everything under control, be it our life or even what happens around us. When that’s the case, it comes as no surprise when individuals with diabetes do all that’s within their potential to keep blood glucose levels under control. Diabetes is a metabolic condition where the body is incapable of producing insulin or using it correctly. To correct this, many diabetics need to administer insulin which in turn helps in regulating blood glucose levels. Only when our body has sufficient levels of the insulin hormone, the cells can absorb enough glucose from the blood preventing raises in blood sugar levels.
 
Hence, when insulin is injected into the body, it helps in decreasing blood glucose levels and keeps them within the desired limits. But, the same hormone, when injected repeatedly at close intervals of time can cause an individual’s blood sugar levels to dip way beyond imagination. The phenomenon here is defined as ‘insulin stacking.’
 
Insulin Stacking
 
Insulin is of different types namely rapid-acting, intermediate-acting, short-acting, ultra-long acting, and long-acting insulin. Inhaled insulin also comes under the category of rapid-acting insulin. Such intake of rapid-acting (or short-acting) insulin occurs before any meal to avoid skyrocketing of blood sugar levels. There are instances where people might using this rapid-acting insulin (commonly called as bolus insulin) to lower their blood sugar levels. Such an insulin acts fast on the body and starts working only after 15 minutes of injecting it and starts to peak after an hour of administration. The effects last up to 4 hours.
 
But, if a person gives another shot of insulin well under the 4-hour period, the shot administered must be decreased to compensate for the lingering insulin inside the body that’s active from the previous shot. Any person with diabetes who suffers from high blood sugar levels or predicts high levels after any meal must accurately calculate the required dose of rapid-acting insulin to control blood sugar levels. But, there are many instances where such individuals might end up miscalculating the required dose of insulin and get themselves more shots than required. Such actions might result in hypoglycemia.
 
Insulin Stacking: A backup for Insulin Levels?
 
Hyperglycemia Dread: There are instances when the individual is well aware of the fact that bolusing emotionally might lead to low glucose levels. But, these people would rather be ok with low levels than higher ones. They can’t bear to see higher numbers but it’s always necessity to keep control over glucose levels preventing occurrence of both, hyperglycemia and hypoglycemia.
 
Numbers Don’t Match: Many times, people have definite numbers in mind and expect the glucose levels to match them. For instance, some feel that the glucose should drop down 30-40 points in an hour or so, and so on. In reality, there is no determined formula for such numbers nor are there stringent rules to adhere by them.
 
Improper Guidance: There are many cases when the individual involved doesn’t fully understand the impact of the rapid-acting insulin. Hence, they overdo the dosages injecting a second dose even before the impact of the first dose wears off.
 
Tackling Insulin Stacking
First and foremost, never blame yourself for the glucose numbers if they don’t come down immediately after administration. Even rapid-acting insulin takes time to act on the body. You might be emotionally inclined to give another dose when the sugar levels go up, but experts suggest waiting for at least 3 hours before giving the next dose. Be calm and cool as there might be times when the sugar levels go high depending on various factors. Hence, the best thing here is to stay tight and check the levels later.
 
Put on the detective cap and check for situations where the blood sugar levels goes high or falls low. Maybe, the levels go low after doing some physical activity or after a second corrective dose. When you understand the pattern, finding a corrective solution becomes an easier task.
 
Technology is both a boon and a bane to mankind. More and more people are using continuous glucose monitors (CGM) to keep a tab on their blood sugar levels. While CGM might be of tremendous help to some people, many individuals making use of this technology become victims to over-blousing. It’s mainly because these devices give a reading every five minutes and waiting simply after seeing the numbers seem impossible for these individuals.
 
Hazards of Insulin Stacking
 
Very high levels of blood glucose levels might result in hyperglycemia which increases the risk of ketoacidosis, a life-threatening condition occurring due to the accumulation of waste products. To avoid this, many people succumb to insulin stacking to correct their blood sugar levels. But, too much of stacking can result in hypoglycemia (very low blood sugar levels).
 
Ways to Administer Insulin
 
There are various ways to administer insulin and the choice depends on the individual’s lifestyle, preferences, and insurance. The most traditional method is to use a needle with syringe which sends insulin into the fat layer beneath the skin. A pen injector shaped like a pen is very easy to use compared to the needle and syringe. These pens also send reminders, help in keeping track of insulin doses, and also send reports. Another useful device that comes with a bolus calculator which tells individuals if they set doses at very close intervals is the insulin pump—these machines can either send insulin continuously or send as short bursts.
 
The Bottomline
 
There are various latest-technology devices that keep track of the time and quantity of every dose, gives reminders when it’s time for the next dose, comes with correct dosage depending on the present blood sugar levels, food choices, and also give alerts when the insulin is way above the recommended temperature range. To correct your food choices, get in touch with a dietitian/nutritionist.
 
Use of such technology helps in avoiding insulin stacking as we are provided with valuable data for maintaining blood sugar levels in a constant state. According to the American Diabetes Association, rapid-acting insulin lasts between 2 and 4 hours after injection. It is always suggested to talk with the physician regarding any doubts about insulin. Also, it is always advisable to wait until for at least 3-4 hours after the first dose before taking more insulin.
 
Insulin stacking has the potential to cause debilitating consequences including very low blood sugar levels. Making use of insulin appropriately, keeping a journal on the daily intake, and leading a healthy lifestyle can help in avoiding bizarre changes in blood glucose levels.

​The world is not getting any better on the diabetes front as more and more people are succumbing to  consuming processed foods, following an unhealthy lifestyle, refraining from exercising regularly, and not sleeping well. We have much awareness regarding the importance of a healthy diet and its role in controlling diabetes risk and there are a greater number of individuals who have started including physical activity as a part of their everyday schedule. What remains undermined is the need for sufficient sleep and its impact on diabetes.
 
Are We Heaping Over Insufficient Daily Sleep Levels?
 
Sleep has been our utmost priority during early years of growth with teenagers and young adults trying to squeeze in as many sleeping hours as possible during weekends and holidays. But, the advent of the social media and Internet has stirred up utmost distress among all including kids and adults. Most of us spend most of our time hooked up to smartphones or iPads losing out on hours of overnight sleep.
 
The concept of night owls and early birds has become very popular during recent times with night owls including people who prefer to stay active during the latter part of the day up to late into the night. Early birds are those individuals who wake up early in the morning. Whatever category you belong to, it’s been observed that most individuals lack enough sleeping hours accumulating them and compensating for such hours during weekends. But, our body needs sufficient rest to think clearly and perform our tasks with excellence and preciseness.
 
Such lack of sleep not only affects our quality of life but when we sleep is integral to determining the risk of diabetes and heart disease.
 
An Early Bird Not Only Catches its Prey But…
 
There’s the popular saying “The Early Bird Catches Its Prey.” But, in our case, early risers benefit even better. They not only get to see the sunrise and wake up to breathing fresh air but are also better guarded from diabetes risk. That’s primarily because early birds are more dependent on fat as their primary source of energy for performing various activities and stay more active through the day with better aerobic fitness levels. Whereas, night owls utilize less fat for energy while resting or exercising.
 
That’s the effective conclusion of a recent study done by researchers at the University of Rutgers who also found yet another useful information—early birds are more insulin sensitive than night owls who are, in fact, insulin resistant. Hence, night owls require greater insulin levels to lower blood glucose levels and their body chose carbohydrates instead of fats as their energy source. Such  a response by the night owls is harmful for their body as it increases their risk of diabetes to a greater extent.
 
One explanation given for this includes how the body’s circadian rhythm could have a solid impact on the body’s efficiency rate in utilizing insulin. For example, a night owl might sleep late but their responsibilities might force them to get up early thereby ruining their circadian rhythm out of proportion to a great extent. The result clearly shows that deviating from the body’s natural sleep-wake cycle magnifies health risks multi-fold times.
 
The Bottomline
The best possible solution for night owls to avoid increasing their risk of diabetes includes going to bed earlier than their usual timing. It is also recommended that individuals must avoid performing strenuous physical activity during late evenings to prepare their body for some peaceful sleep during the night. Some others don’t include staying away from carb- and fat-rich foods and avoiding using smartphones before going to bed. The light from the electronic gadgets can affect sleep quality as well as keep you from sleeping.
 
It’s impossible to do this all at once but incorporate small changes every day to bring bigger positive results. Try going to bed 10-15 minutes earlier than usual and getting up 15 minutes earlier than your regular timing. Start loving the sunrise, make small tweaks to enhance energy and mood levels, and above all, stay well-rested—this helps you spring out of bed with better energy than you could imagine. 

Having the urge to pee always? It’s normal in the case of individuals with diabetes but some individuals excrete excessively large quantities of urine than what’s normally observed in the case of diabetes. We have a scientific name for this problem—polyuria, a condition where the human body passes too much urine too frequently every time during urination. The average daily urine output in any individual is not beyond 1-2 litres/day but in those with polyuria, the urine output goes anywhere from 3 litres to as high as 15 litres a day. Such immoderate excretion is a typical sign of diabetes. In general, people with diabetes feel the need to urinate frequently but the problem discussed here is different from the need for frequent urination.
 
For instance, people with diabetes generally pass urine frequently during the daytime but with polyuria, individuals get up too often during the night to urinate. When their sleep routine is disturbed and they fail to sleep well due to such interruptions, people start noticing the presence of polyuria, one of the common symptoms of diabetes.
 
Common Causes of Polyuria
 
There are multiple conditions that can cause polyuria, a condition where excessively high quantities of water are filtered by the kidneys. The presence of elements such as glucose in the urine might pull out too much water. These include:
 

• Untreated diabetes including Type 1 and Type 2 diabetes. Polyuria occurs in diabetes-affected individuals when there’s too much glucose in the blood. In general, our kidneys absorb the sugar and put it in the bloodstream while creating urine. But, in case of diabetes, the excess glucose mixes with the urine pulling more water and making more urine.
• Diabetes insipidus which includes decreased secretion of the antidiuretic hormone (ADH) and decreased sensitivity of the ADH
• Consumption of excessive quantities of water
• Pregnancy-related gestational diabetes insipidus which goes away post delivery
• Damage to the kidneys can prevent these organs from processing urine as they are ought to and polyuria could be a warning sign of kidney-related problems
• Some other problems such as Cushing’s syndrome, liver disease, and hypercalcemia
• Even anxiety can cause frequent urination as vasopressin, the substance that helps kidneys hold onto urine is affected

 
There are some other conditions such as urinary tract disorder, enlarged prostate, and overactive bladder which induce the urge to pee at all times irrespective of whether or not the bladder is full. On the contrary, polyuria makes an individual pee frequently.
 
Symptoms of Polyuria
 
The predominant symptom of this problem is excessive production of urine throughout the day and night. If you feel there are any deviations from the normal amounts urinated, it is recommended that it’s better to note down the quantity of water consumed, frequency of urine passed, and the quantity of urine excreted every time during urination. Another major symptom of polyuria is feeling thirsty continuously. As there is too much fluid lost from the body, the individual feels thirsty to compensate for this loss.
 
Frequent wake up calls disturbing sleep routines are another emergency call to check your body. Even when sleeping, the urge to urinate doesn’t stop in the presence of this condition.
 
Treatment
 
The required course of action depends on the underlying cause of the problem. If diabetes is the root cause of the disease, it is mandatory to ensure control of blood sugar levels by bringing lifestyle changes and treatment-related modifications. A reputed dietitian nutritionist might help in correcting the haphazard blood sugar levels by incorporating healthy eating habits, forming a well-balanced meal plan, and recommending simple but effective exercise routines.
 
Individuals who drink caffeine and alcohol in excess would be suggested to cut down on the intake of those beverages. Sometimes, the medications taken could be the cause of the problem and hence, discussing with the physician to change the medication or alter the dosage is necessary.
 
Getting in touch with a healthcare provider after observing the urination routines for a couple of days is mandatory if there are any abnormalities noticed including excessive urination that remains unexplained. The doctor might prescribe a couple of tests including blood sugar tests, creatinine, urine osmolality test, electrolytes, and urinalysis.

​Pregnancy is a beautiful period which is cherished for a lifetime in every woman’s life. Every couple look forward to receiving their little bundle of joy with utmost joy and affection into this world. The most critical aspect during this period is none other than good health of both, the expecting mom and the baby. During earlier times, pregnancy was a cakewalk and complications arose only very rarely. But now, many women face tough times during this period, there are a lot more scans and tests involved than before, and some of them become victims to additional health problems such as thyroid, diabetes, blood pressure, and more.
 
Advent of Gestational Diabetes
 
A type of diabetes, gestational diabetes can occur during the pregnancy period in women who don’t have a history of diabetes. The condition happens when the body is not well-equipped to produce insulin in sufficient amounts. It’s no wonder that the body is busy producing many hormones to tackle all the requirements during and after pregnancy. Besides this, there are many other changes happening in the body including weight gain. Such changes forces the body to make less efficient use of insulin resulting in insulin resistance.
 
It’s generally observed that pregnancy induces insulin resistance in every pregnant woman but there are some of them who suffer from insulin resistance even before the start of their pregnancy. Those women who start off with their pregnancy requiring more insulin are at a higher risk of gestational diabetes.
 
Risk Factors for Developing Gestational Diabetes
 
Some prominent risk factors that enhance the individual’s risk of acquiring gestational diabetes include:
 

• Being obese or overweight
• Having earlier history of gestational diabetes
• Having a close family member with type 2 diabetes
• Suffering from polycystic ovary syndrome or PCOD
• Suffering from prediabetes
• Inactivity

 
Chances to Lower the Risk of Gestational Diabetes
 
There is no guarantee that gestational diabetes can be avoided completely but we can take a number of steps to minimize the chances of developing it.
 
Enter Pregnancy with a Healthy Weight Range
 
One of the main risk factors for gestational diabetes include being obese or overweight. Research shows that individuals with a BMI score of 25 and above are likelier to succumb to gestational diabetes and those with a BMI of 30 and above are at a three-times increased risk than others. If you have a BMI value of 30 and above, an oral glucose tolerance test will be done at the start of the term before the 16th week of pregnancy. In those with a BMI value of 25 and below, the test is done between the 24th and 28th week of pregnancy. Doing the test is important as exceedingly high glucose levels can lead to transfer of glucose to the body resulting in a condition called as ‘macrosomia.’
 
It is always advisable to lose any excess weight before getting pregnant. Never try to lose weight during the pregnancy term as it is not recommended. Also, weight gain is a normal part of the journey and even obese/overweight women are expected to gain weight. Research shows that obese/overweight women who change their diet during pregnancy are at a decreased risk of gestational diabetes.
 
Choose the Right Foods for Your Meal Plan
 
While the food choices can contribute towards development of gestational diabetes, diet alone isn’t the sole reason for the problem. The hormones in the placenta sometimes block the body from using or making insulin. To avoid putting yourself in a risky situation and to stay healthy during the pregnancy term, it is recommended that you follow a healthy diet plan that doesn’t raise blood sugar levels.
 
There is no specific meal plan for pregnancy but all that’s required is to draft a well-balanced meal plan with the help of a dietitian/nutritionist. Focus mainly on cutting down processed foods and those containing empty calories, replace sweets with fruits, eat plenty of rainbow-colored vegetables, have smaller portion sizes, and increase the intake of fiber and lean proteins.
 
Obesity exists as one of the top factors contributing toward gestational diabetes and sadly, a majority of the pregnant women are either obese/overweight. A recent study conducted at the University of Turku focused on the link between dietary intake and gestational diabetes onset. Results showed that eating a healthy diet during the early stages of pregnancy reduces the risk of gestational diabetes. Also, eating foods that elevate the inflammatory markers in the body increased the risk of the disease. It’s better to keep these markers under control by adding foods such as whole grains, berries, veggies, and fruits.
 
Exercise Regularly
 
There has always been the myth that high-intensity exercises aren’t advisable during pregnancy. This is not true and even if you don’t wish to pursue strenuous workouts, it is always suggested to perform some physical activity regularly. Go for a walk, do yoga, or even swimming to keep the body active and to control weight gain. Before starting on any exercise routine, consult with your gynaecologist and get the approval.
 
Exercising before and during pregnancy minimizes the risk of gestational diabetes, makes the body more sensitive to insulin, and helps you get out of the sedentary lifestyle mode.
 
Conclusion
 
Preventing gestational diabetes isn’t always possible as there are some risk uncontrollable factors that make it likelier for the pregnant woman to develop the condition. In case of obesity, try losing weight before pregnancy to decrease the risk, stay on a healthy weight range before and after conceiving, eat a well-balanced diet, and perform physical activity for at least 30 minutes a day 4-5 times a week, and sleep well.
 
A disciplined lifestyle and better eating routines improve the body’s energy levels and your personal confidence levels. Gestational diabetes isn’t going to ruin your beautiful journey during pregnancy. Do all that’s possible to avoid getting into this condition by following the measures stated above. Even if you are affected by gestational diabetes, it goes away on its own in most people. But, the risk of being affected by diabetes in the future always exists. To stay healthy and put this risk to rest, follow a healthy lifestyle routine.

Our body runs on energy and the primary source of this energy is supplied by glucose to every cell in the human body. Every organ functions tirelessly to keep our body running smoothly and it’s the brain that issues commands to different organs in the human body. Being the command center, the brain controls every action including how we emote, remember, and learn new stuff. Our brain encompasses innumerable neurons which increase the energy demand, and hence, a considerable portion of the glucose is directed to the brain. Only then, we achieve full capability to think, act accordingly, and complete chores successfully.
 
Too Much or Too Little, Both Cause trouble!
 
But, simply because the brain depends on glucose for energy, it doesn’t mean that we perform better when more and more energy is supplied to the brain. Hyperglycemia can cause stress to our brain and this remains unseen immediately as the effects of high blood sugar levels happen in due course. Very high blood sugar levels can impair the blood vessels carrying oxygen-rich blood to the brain thereby resulting in insufficient blood supply which causes brain death. Termed as ‘brain atrophy,’  such a problem can affect cognition and memory capabilities causing vascular dementia.
 
Lack of sufficient sugar levels immediately stops the oxygen supply to the brain and the consequences are seen immediately unlike hyperglycemia which takes time to cause effects on the brain. Low sugar levels in the body cause symptoms such as dizziness, irritability, shakiness, and even trouble with talking and walking. Extremely low blood sugar levels can cause debilitating consequences including passing out, seizures, or even coma.
 
Accelerated Brain Aging & Cognitive Decline
 
Diabetes doesn’t come alone but leaves lasting impressions everywhere on the human body. The condition has the potential to affect the heart, kidneys, foot, eyes, oral health, and without any doubt, the central commanding system of our body—the brain. Almost 7% of the population worldwide suffer from type 2 diabetes mellitus (T2DM) and such patients are at an all-time risk of developing Alzheimer’s disease (AD) and dementia. Presently, there are more than 40 million individuals suffering from dementia and with the numbers expected to increase two-folds every decade, it is soon cross 100 million by 2050. AD is the most commonly seen dementia problem among people followed by vascular dementia.
 
There have been research happening continuously to explore the underlying connection between dementia and diabetes. A very big analysis of 14 studies that included more than 2 million individuals and covering millions of dementia cases across Asia, Africa, and Europe clearly found that diabetes increased the risk of dementia by 60% with a 40% risk associated with non-vascular dementia.
 
A huge cohort of human studies from the UK Biobank show that the T2DM accelerates normal brain aging and induces marked cognitive decline, especially in the executive functioning and the processing speed. Data obtained from the Swedish National Study on Aging and Care-Kungsholmen clearly had concrete evidence showing the impact of prediabetes and type 2 diabetes on cognitive decline.
 
There have also been studies analyzing the link between cognitive disease and type 1 diabetes. Results show that individuals with type 1 diabetes mellitus (T1DM) are at an increased risk of dementia compared to those without diabetes. One study result showed a 93% increased risk of dementia in those with type 1 diabetes. Another study on older adults who were hospitalized for either hyper- or hypo-glycemia were at a higher risk of dementia but those who suffered from both highs and lows were at a 6-times higher risk of dementia later in life. Impaired cognitive flexibility, reduced attention span, and decrease in thinking speed are some of the effects of T1DM.
 
Though both types, Type 1 and Type 2, had higher risks of dementia, T2DM showed 50% more risk for dementia comparatively.　
 
Conclusion
 
We have study results showing that type 2 diabetes increases the risk of dementia and cognitive decline but the awareness regarding this link among individuals is extremely poor.  Clinical interventions and recommendations for the same are also poorly available. For T2DM, incorporating rigorous lifestyle changes along with dietary modifications with the help of a reputed nutritionist/dietitian benefits the individual.
 
Individuals should focus more on staying on a healthy weight range, reducing blood sugar levels, ensuring that cholesterol levels are below recommended ranges, eating healthy food, exercising regularly, and sleeping well. Clinicians should focus on strictly controlling blood glucose levels to ensure that the patient’s cognitive skills remain intact.

​Many individuals around us suffer from diabetes and we feel sorry for them. But, most of us haven’t thought about this dreadful condition striking us and when it does, it is a gruesome shock for most. The very first question we tend to ask is ‘Why me?’ Once diabetes strikes, people go through emotional disturbances having feelings of shock, disbelief, anger, self-pity, and more. Sadly, many of these emotions don’t go away quickly but take time to heal. The only bright side here is that, you are not alone here and there are aplenty others who feel the same way. But, for some others, diagnosing the disease makes them heave a big sigh of relief as they now have answers to their previous symptoms and disturbances.
 
After a month or so, the reality sets in, we start admitting the presence of the disease, and look out for ways to live in peaceful co-existence with it. It does take time to come to this state, adapt to a diabetes-friendly lifestyle, and make everyday modifications to suit your health needs. It is an energy-consuming process that requires complete effort and ample energy. But, if you are consistent in putting efforts, it is possible to live with diabetes without completely shattering life.
 
Talking to your healthcare professional, meeting with a dietitian/nutritionist to plan everyday foods habits, and seeking guidance can help in simplifying things. Let’s see how to go about leading a life with diabetes:
 
Lifestyle Management
 
There is no choice here but to get going with the humongous task of managing diabetes. The biggest challenge here is to accept and adapt to the everyday lifestyle changes that occur as a result of diabetes. It starts from altering your breakfast timings, portions, and meal content to sleeping schedule, and even the exercise duration and types of exercise allowed. Keep a check on the following pointers to make life better comfortable and easy to lead:
 
Control Blood Sugar Levels: Any number beyond 170-180 mg/dL is high blood pressure (hyperglycemia) and we need the right medications, exercise, food portions, and insulin dose to keep it under control. Another condition called hypoglycemia (below 70 mg/dL) or low blood sugar levels are even more dangerous as the organs are at a risk of being compromised due to insufficient sugar levels. It is always advisable to monitor glucose levels multiple times daily to ensure control over glucose levels.
 
Follow a Disciplined Diet & Exercise Schedule: Food plays an integral role in managing diabetes and watching over your intake is the first recommendation given by any healthy physician. For this, reduce carbohydrates intake, increase the intake of fiber and whole grains, and moderate the consumption of dairy and proteins. Watch over the GI value of various foods before consuming them—a low GI number is good for diabetes while foods with high GI values must be avoided as much as possible. Such high GI-value foods include white grains, baked goods, processed foods, and starchy foods. Keep a tab on alcohol consumption and the standard suggestion includes avoiding the intake of alcoholic beverages as much as possible. There are greater chances of hypoglycemia a few hours after alcohol consumption. Hence, monitor blood sugar levels before and after consuming alcohol.
 
Exercising regularly must be an indispensable part of your daily routine as this helps to control glucose levels well. Practise any physical activity that interests you—it might be a sport, hitting the gym, going for a walk, or even swimming. But, before taking up any of them, consult with the healthcare professional and get a green signal for practicing the same as a daily routine.
 
Get Sufficient Sleep
 
Our body needs energy to pull us through the day efficiently. A good night’s sleep is the tonic for overcoming tiredness, staying calm, and being successful at what you do. Create an everyday sleep routine by going to bed and waking up at the same time daily, avoid taking naps during the say, try to limit caffeine consumption after 5 PM, and create the right setting for a peaceful sleep surrounding.
 
Avoid Stress
 
Stress is bad especially for people with diabetes as it brings changes in blood glucose levels. Being informed about the disease is a definite cause of stress but going on with such anxiety and stress is not going to lead you anywhere. Practice mindful exercising techniques such as breathing, meditation, and yoga to keep stress under control.
 
Choose to Be with People
 
Unity is power and never try fighting the disease alone if you have the luxury of including family and friends in this battle against diabetes. Make them understand your situation and how you would like their participation and support in this process. There are some who provide practical ways to control the disease by providing healthy food choices, give a shoulder to lean upon during emotional turmoil, and accompanying you for your everyday exercise routine. Choose the right person and be benefitted in the long run.
 
Plan Meticulously
 
Before doing any of the above, it is indispensable that you make a plan to manage diabetes in a smooth and efficient way. Bring about small changes and combine them to unravel a big change. Make regular appointments with your doctor and never miss out on them. Discuss, raise concerns, and get answers to queries with the physician. Build a relationship upon trust with some family members and friends about your condition and don’t miss to connect with other people with diabetes to relax your mind. Don’t miss out on social activities—having fun is never out of picture even when you are suffering from diabetes. The metabolic disorder is only one part of your life. Don’t ruin your whole life by letting diabetes control and overtake you.
 
The Bottomline
 
Adapting to a diabetes-friendly routine needs implementing mental, behavioral, and emotional changes to lead a normal and peaceful life. Besides taking care of the above, individuals also need to attend to skin, foot, and tooth care routines to avoid long-term complications. Diabetes can also have effect on the organs such as the liver, kidneys, heart, lungs, and feet if not kept under control. To avoid all these, it is necessary to maintain blood glucose levels in the right range and get an eye and foot test once a year.
 
Every person with diabetes is entitled to leading a normal life by making few changes in everyday routine. Make a plan that satisfies both physical and emotional health in order to succeed in your diabetes-friendly lifestyle. While doctors and family members are always there to shoulder support, sometimes they might not always have the time to do so. Hence, joining a peer group is very helpful as it has like-minded people who are undergoing your similar emotional turmoil and physical changes. Hence, they easily relate to your worries and come up with suggestions to overcome them. Peer support helps individuals share their knowledge and skills, experiences, and concerns over living with diabetes.

​Diabetes has been a non-reversible disease until sometime recently, but off late, we have various reputed health organizations and individuals claiming to enable diabetes remission/reversal. Reversal is nothing but helping diabetic individuals to stay within desired blood glucose ranges with the sole help of lifestyle changes. How do they achieve this? By lifestyle changes, it includes bringing changes to the food that we eat, engaging in regular physical activity, sleeping for desired number of hours, minimizing stress, and leading an active lifestyle. Choosing to eat the right foods is inevitable to control glycemic index and for this, it is necessary to pick those foods whose glycemic index (GI) values are in the admissible ranges. To achieve this, we must know the glycemic index of various foods.
 
Glycemic Index
 
Glycemic index is a number that’s assigned to various carbohydrate-containing foods depending on how much each type of foods affects blood sugar levels. Don’t misunderstand this as a diet plan but it is only a tool to accomplish your diet goals. Pure glucose has a GI value of 100 and other carb-containing foods are classified in comparison to glucose. GI values can be distinctly divided into three categories namely:

• Low GI (1-55): foods such as leafy greens, pulses, and most fruits
• Medium GI (56-69): raisins, raw pineapple, sweet corn, rye bread, and multigrain bread
• High GI (70 and above): white-flour products, processed foods, and white rice

 
Lesser the GI value, higher the healthy nature of the food. Eating foods with a high GI value instantly increases postprandial blood glucose values that decreases rapidly while eating low GI value foods leads to low blood sugar concentration which decreases more gradually.
 
Research Studies
 
We have various research results strongly proving that including a low-GI diet is a very good way to keep blood sugar levels under control and reduce the risk of type 2 diabetes in individuals. A long-term US study showed that increased consumption of refined carbs increases the prevalence rate of type 2 diabetes. Several cohort studies show that high GI diets increase the risk of diabetes. Also, obese individuals consuming high GI diets are at a 10-times increased risk of diabetes compared to their leaner counterparts consuming low-Gi diets. Contrarily, we do have some studies showing no clear association between GI and type 2 diabetes. Though not a popular part of the US dietary guidelines, Diabetes UK and the European Association for the Study of Diabetes have used low GI diets containing a major portion of whole grains and high dietary fiber as a part of their diabetes-prevention plan in individuals at a higher risk of diabetes.
 
GI Value of Various Foods
 
To incorporate low GI value foods in the diet and to understand how different foods consumed might affect your blood sugar levels, the table below might be helpful.

​The Bottomline
 
Though glycemic index is important, it should not be the only factor to consider while making food choices. The GI value of any foods doesn’t divulge any other nutrition-related information. Though one cup of whole milk has a low GI value of 4, it is not recommended for weight control/loss as it has high fat content. While the numbers here exist to suggest individuals with various food choices, these numbers might change depending on the way of preparation and several other factors. For instance, cooking starches for a longer period increases the GI value, ripened fruits have a higher GI value than raw ones, and the body’s reaction to carb also varies upon the age, how fast digestion happens, and your activeness quotient.
 
So, the presence of various nutrients such as vitamins and minerals, fat content of the food, and the food’s GI value is integral to pick the right foods. It is always recommended to combine high-GI foods with low-GI foods to find the right balance. Get in touch with a reputed dietitian/nutritionist to choose the right mix of foods to find nutrition balance and blood glucose stability. Don’t overthink and restrict yourself too much. Indulge in your favorite meal occasionally but choose smaller portions that satisfy taste buds while not causing erratic sugar spikes. By sticking to smaller portions, you get the privilege of picking high-nutrition content foods to provide a well-balanced diet.

Most of us are familiar with the terms hyperglycemia and hypoglycemia, especially in this diabetes-driven world. Hypo or hyper, the primary aim of any individual is refraining from entering into diabetes. Glycemia is the presence of glucose in the bloodstream and the difference set in depending on whether someone is suffering from hyper- or hypoglycemia.
 
Diagnosing the Inner Meaning
 
Hypoglycemia is derived from the Greek word ‘hupo’ meaning under or less. Hence logically hypoglycemia means ‘low blood sugar level.’ In contrast, hyperglycemia means ‘high blood sugar levels.’ Whatever might be the meaning, any individual’s primary goal includes being healthy maintaining consistent blood sugar levels.
 
Hypoglycemia happens when your blood glucose levels drop below the healthy range. Speaking in terms of numbers, we term it low blood sugar when the glucose numbers fall below 70 mg/dL. Commonly called as low blood sugar or low blood glucose, hypoglycemia becomes dangerous when the numbers stoop too low, even requiring immediate treatment.
 
Causes
 
There are multiple reasons behind the occurrence of low blood sugar levels and these include:
 

• Too much insulin levels in the body
• Insufficient consumption of carbs for the insulin levels consumed
• Variations in the time of consumption of insulin
• Due to the duration and type of physical activity performed
• Fat, protein, and fiber content of the meal consumed
• Menstruation
• Puberty
• Changes in the daily schedule
• Medical conditions such as hepatitis, tumor in the pancreas, or adrenal gland disorder

 
Hypoglycemia can occur with or without diabetes. In case of people without diabetes, there are chances of occurrence of hypoglycemia when individuals don’t eat for 8 hours or more. In such cases, the body lacks enough glucose to provide energy to the brain and body. Another way in which low blood sugar levels without diabetes might occur is when someone takes medications that lower blood sugars. Such medications include aspirin, steroids, birth control pills, certain antibiotics, and blood pressure tablets.
 
Symptoms
 
There are several symptoms that indicate the presence of hypoglycemia but they vary depending on the people being affected. It might start quickly but also provide clear signs that give sufficient warning that something must be done to curb its devastating effects on the body. Symptoms that commonly show the presence of hypoglycemia include:
 

• Having a shaky or jittery feeling
• Nausea, lightheadedness, or dizziness
• Nightmares
• Confusion, irritability, and impatience
• Nervousness, anxiousness, clumsiness
• Presence of sweatiness and chills
• Rapid heartbeat or unsteady heart beat
• Pale-colored skin
• Lack of energy/presence of weakness
• Numbness in the tongue, lips, or cheeks
• Loss of consciousness and seizures might occur when hypoglycemia worsens

 
Sometimes, symptoms might occur during sleep and those include nightmares, tiredness, weakness, crying out loud, and sweating through nightwear. There are some individuals who stay unaware of the presence of hypoglycemia as they don’t suffer from any of the symptoms. Called as ‘hypoglycemia unawareness,’ this is worse as we can’t detect any signs of the condition at an early stage and treat it. In turn, this increases the risk of several occurrences of low sugar levels which is dangerous for the individual. But, such unawareness might occur if you suffer from diabetes for more than 5 years, have frequent occurrence of low blood sugar levels, or consume some medications such as beta blockers.
 
During such instances, it is advisable to test blood sugar levels frequently to check whether or not the levels are too low. Never indulge in physical activity or drive any vehicle before confirming these and talking with your physician.
 
Types of Low Blood Sugar
 
Some might wonder how there can be types in low blood sugar levels. Yes, we have got different types. One is the night-time low blood sugar where sugar levels become low while sleeping. It might be due to having an active day, consuming too much insulin, drinking alcohol during the night, or doing physical activity before bedtime.
 
Another type of low blood sugar is severe low blood sugar which also has serious symptoms including incidents of seizures, feelings of confusion, acting strange, difficulty with vision, and feeling weak. Anything lower than 54mg/dL can be termed severe low blood sugar and such numbers result in passing out/fainting.
 
To avoid instances of night-time low blood sugar, try to eat a small snack before bedtime, eat your meals regularly and don’t skip any.
 
Treatment
 
Once diagnosed with hypoglycemia and if you suffer from any of the symptoms, it is necessary to take certain steps to treat it. If the blood glucose levels fall below 70mg/dL, do the following to treat the same:
 

• Follow the 15-15 rule: consume 15 grams of carbohydrates and check after 15 minutes to understand whether or not the numbers have changed. If there are no change in the numbers, have another serving and repeat the same until the glucose numbers step up to at least 70 mg/dL. Foods such as candies, fruit juices, or glucose tablets are preferred choices for instant rise in blood sugar levels
• When the next meal is an hour or so away, have some snack to maintain the blood sugar levels in a healthy range
• In case the medications taken lower blood sugar levels, take a glucose tablet or glucose gel immediately. There are other carbohydrate sources of foods, but they might not increase the blood glucose levels quick enough.

 
If none of the above treatment protocols work, it is better to get in touch with your healthcare provider who might provide a medication called glucagon—this might be injected or puffed into the nostril.
 
Conclusion
 
For someone experience low blood sugar levels, it is advisable that you have a record of the numbers, activity levels, exercise, insulin, and food habits. Consult a physician, review these data, and understand why the numbers become low. Maybe, the healthcare physician might adjust the insulin timings, exercise and meal timings, and snack routines to stabilize glucose numbers. Also, check your blood glucose numbers regularly to avoid severe consequences, consume meals at proper timings, and bring about small changes in lifestyle and exercise routines to avoid big damages to health and body.

​Are you one of those having a sweet tooth or craving for sugary indulgences? Even otherwise, it is a mammoth task to cut down sugar intake from your everyday meal plan. Rome was not built in a day, likewise, completely excluding sugar and sugar-based foods from your diet starting tomorrow is an impractical dream. The very first recommendation given when anyone wishes to cut down on dietary sugar intake is to choose sugar substitutes and artificial sweeteners. But, how familiar are we with these substitutes and their impact on our overall health?
 
In fact, replacing sugar with popular sweeteners available in the market has become an unwritten rule for those with diabetes or in pre-diabetes stage. It’s high time we accept the fact that any form of sugar is harmful to health, when consumed in high quantities. But, substituting sucrose with artificial and natural sweeteners is promoted these days as they are low in calories and don’t increase glycemic levels. Artificial sweeteners has been discussed as a standalone topic in the blog section and now, we would be focusing on the natural sugar substitutes available in the market.
 
The Best Natural Sugar Substitutes
 
Fruits: Fruits are one of the healthiest sources of natural sugar. They have no empty calories and the icing on the cake is that fruits come enriched with nutrients including fiber, vitamins, and antioxidants. Add some fresh pieces of berries, bananas, or avocados to your smoothies, top the unsweetened yogurt with your choicest exotic fruits, and sweeten the cereal with some blueberries, apples, or strawberries. In fact, you could enhance the flavor of the dish by adding vanilla extract, almond powder, cocoa powder, or even cinnamons. Once you regularly start substituting sugar/sweeteners with fruits, not only the real taste of the product is revealed but the sugar cravings start to sober down gradually.
 
Honey: Though we constantly read about substituting sugar with honey for the shakes, cereals, and more, the brutal truth is that honey is another form of sugar that is high in calories. On the brighter side, honey is equipped with antioxidants, oligosaccharides, and nutrients such as zinc, calcium, potassium, and vitamins. The bee variety and the plant components that contribute to honey production have weightage on the anti-oxidant and anti-inflammatory benefits provided by this golden liquid. Still, honey has a lower GI value than sugar but should not be consumed beyond 1-2 teaspoons a day.
 
Maple Syrup: The sponge cake soaked in maple syrup or the granola bar coated with maple syrup seem to tickle your taste buds and comfort the mind as maple syrup is yet another natural sweetener. Though this liquid has a lower GI than sugar, it does have higher quantities of sugar comparatively. Some of the commercially sold maple syrup brands are overloaded with high-fructose corn syrup that could lead to accumulation of belly fat, increased triglyceride levels, and belly fat. Containing nutrients such as zinc, potassium, manganese, calcium, and iron, this liquid also has anti-inflammatory and anti-oxidant properties. Though better than sugar, maple syrup does contain sucrose and should be used sparingly in your waffles, pancakes, and breakfast options.
 
Dates: Though dates are calorie-rich and contain sugar content, the good news is that including dates doesn’t affect blood sugar levels in the same way as table sugar—even a study including 100 participants showed that eating dates reduced bad cholesterol levels in the body without bringing any changes to HbA1c levels. The thick, sweet dried fruit of the palm trees come equipped with nutrients such as potassium, fiber, magnesium, manganese, carotenoids, vitamin B6, and antioxidant, thereby making them a good substitute for sugar in making energy bars, smoothies, and cookies. Make a paste of dates and use it sparingly as this is sweeter than sugar.
 
Monk fruit extract: Extracted from a fruit called the monk fruit which is a native of SouthEast Asia, this fruit is now being used to make natural sweeteners that are 300 times sweeter than normal sugar. The extract not only has zero calories but also doesn’t affect blood sugar levels—all these make it a preferred choice as a sugar substitute among weight watchers and those with diabetes. But be aware that there are no human studies that confirm the safety of this sweetener. Also, commercially sold monk fruit extracts always come in combination with other sweeteners. Hence, it is advised that you check the ingredient list before picking this natural sweetener from the grocery shelf
 
Agave nectar: Though popularly suggested as a natural sugar substitute, it is advisable to stay away from agave nectar as this sweetener is calorie-rich and has high fructose levels (even higher than corn syrup) increasing the risk of weight gain and obesity. Also, having better nutrients than normal sugar, still the nutritional content is lesser than honey. Tasting similar to honey, not leaving you with a bitter aftertaste, and having a long shelf life, we can use agave nectar for any sort of cooking purpose, but execute caution while adding this sweetener as it is flavor-rich and adding a small quantity brings about the desired taste to the dish.
 
The Bottomline
 
No sugar substitute, natural or artificial, is good for health, especially when consumed in excess. Instead of hunting for the so-called healthy and sugar-free sugar substitute find creative ways to reduce sugar intake and replace them with healthier fructose from fruits. It’s no sin to indulge in a small piece of sponge cake or the delicious mithai occasionally but never form a habit of consuming desserts and sweets regularly just because the ingredient list contains artificial or natural sweeteners.  Even in daily food preparations, enhance the flavor of foods using spices and add variety to the meal plan to keep it healthy and interesting. Get in touch with a reputed dietitian/nutritionist to make small tweaks to your everyday recipes to add nutrition and good health to diet plans without disturbing sugar levels.

The colorful chrysanthemums, yellow sunflowers, and the beautiful daisies are a pretty sight to behold. Can you believe that Stevia, a sugar substitute made from the stevia plant belongs to the same family (Asteraceae) as these beauties? Stevia rebaudiana is another unique member of the chrysanthemum family that offers trememndous difference in taste when grown at our home in contrast to the ones bought at the store. A native of South America, stevia is a small shrub that has been used for hundreds of years as a natural sweetener without any calories.
 
Produced from the leaves of the stevia plant, this sugar substitute is 100-300 times sweeter than table sugar but without the added worries about calories, carbohydrates, or other ingredients as it contains none of these. Doesn’t it sound inviting to immediately switch over to this magic potion? For some, it might be. But the hard truth is that not all individuals might like the taste of stevia as they find it bitter. Even more, some find it tasting similar to menthol. If you would like to understand whether or not you like the taste of stevia, it is better to use a small portion of it in your beverage or cereal before filling your kitchen cabinets with this sugar substitute.
 
Composition of Stevia
 
There are eight glycosides extracted from the plant namely Dulcoside A, Steviolbioside, Rebaudioside A, C, D, E, and F, and Stevioside. While commercial products are made from all of these, Rebaudioside A (Reb-A) is potentially the main ingredient in a majority of those manufactured. The Food and Drug Administration (FDA) recognizes Reb-A as safe for use in foods and beverages and it is 200-300 times sweeter than sucrose.
 
At the same time, whole leaf or crude stevia hasn’t been approved by the FDA for use in food products as their safety and authenticity hasn’t been proved until now. There are even concerns regarding their effect on kidney, cardiovascular, and reproductive health besides posing concerns on blood sugar control.
 
Research Data on Stevia & It’s Effect on Health
 
There have been numerous research done on stevia providing us with various results and conclusions. One study clearly proved that including stevia in beverages could be a good alternative for normal sugar in those with diabetes as it has no effect on blood sugar levels, lipid, HbA1c, and insulin levels. Studies have shown that diabetic people recommended to follow a strict diet can use stevia as an alternative sweetening agent to normal sugar. It’s also been seen that stevia leaves could be used as a sweetener in beverages and food products for those who have a sweet tooth. The plant is not only useful for controlling glycemic levels but also shows positive effects on treating skin diseases and has anti-inflammatory, anti-bacterial, diuretic, and antiseptic property.
 
In recent times, we’ve also had results positively backing up the use of stevia for reduced energy and sugar intake thereby preventing rise in obesity. We have studies showing the impact of stevia on gut microbiota as well. Some studies show that stevia is harmful for gut microbiota health while there are some that portray the benefits of adding stevia. But, we need more studies and research to understand the long-term outcomes of stevia on human health.
 
Advantages of Stevia
 
The name Stevia is instantly associated with zero calories. But besides this, there are many other benefits of this category of sugar substitute called the novel sweetener. Stevia has been used for decades in South America and Asia as a sweetening agent in beverages such as teas and coffees. Commercial products including flavored water and beverages contain stevia. There are some studies that show their benefits in patients with diabetes helping them control their blood sugar levels. Also, as it has antioxidant properties, it has been proposed to reduce the risk of cancer.
 
Another major advantage associated with stevia is its contribution to effective weight loss. As it has no sugar and very few calories, stevia has been a personal favorite not only for those with glycemic instability but also for many health-conscious individuals who want to reduce/maintain their weight. One study showed that consuming stevia increased the HDL cholesterol levels while lowering LDL and triglyceride levels.
 
Side Effects of Stevia
 
The FDA has approved only the use of stevioside (the purified form of stevia). So, if you find any products in the grocery shelf labeled with whole-leaf stevia or crude stevia extract, it is better to avoid them altogether. That’s mainly because there are concerns regarding raw stevia’s effect on the kidneys, cardiovascular system, and reproductive system. It might even react with medications for blood pressure or lead to low blood pressure levels. Also, some individuals complain of dizziness, bloating, numbness, and muscle pain after using Stevia.
 
Sometimes, stevia is used in combination with sugar alcohols and this might cause digestive problems such as bloating and diarrhea in some individuals. Above all, not all are fans of this bitter-tasting sweetener. Coming with a very mild bitter taste, this non-nutritive sweetener’s addition doesn’t give pleasure to all those who use it in beverages and dishes. So, before choosing to go with stevia, try tasting some beverages and decide whether or not this sweetener should be your choice.
 
Presently, stevia is widely used in the preparation of smoothies, cereals, hot beverages, yogurt, and baked goods. But baking using this sweetener might be tricky as it does not leave you with the desired texture. Hence, it’s been recommended that you either add 50% of stevia choosing an alternative sweetening agent instead. This way, it is easier to come up with the desired texture and taste.
 
The Bottomline
 
Regardless of the research results, millions of people worldwide have been using stevia as a sweetening agent for years together. Though a non-nutritive sweetener that’s low in calories, there are no serious evaluations or concrete long-term research results giving a go ahead sign to use stevia regularly. Moreover, it is always better to minimize sugar intake and consume sweet delicacies in moderation to stay healthy and control glycemic levels. It is better to get in touch with a dietitian/nutritionist who might be able to guide you in planning a well-balanced diet for diabetes and also recommend whether or not sugar substitutes should find a place in your daily diet.

​Having diabetes or not, small fluctuations in blood sugar levels are a common occurrence in individuals due to the different foods consumed. Any number between 60 and 140 mg/dL is considered to be a normal range but those having anything beyond 140 mg/dL is termed as hyperglycemic.
 
Hyperglycemia
 
Derived from a Greek word, hyperglycemia means high (hyper) sugar (glykys) blood (haima). If we look into the details, a fasting blood sugar number beyond 125 mg/dL and a 2-hour postprandial level beyond 180 mg/dL is termed as hyperglycemia. A person is said to be in the prediabetes range (known as impaired glucose tolerance) if the blood sugar readings are between 100 mg/dL and 125 mg/dL.
 
Factors Contributing Toward Hyperglycemia
 
There are a number of reasons that result in hyperglycemia and those include:

• Individuals with type 2 diabetes sometimes have insulin but not sufficient enough to be effective
• Eating foods beyond the normal intake
• Not doing physical activity that compensates for the food consumed
• Stress—this is a major factor that lurks as the primary reason for many individuals succumbing to hyperglycemia. The stress might be due to family situations, personal conditions, or even due to infections such as cold, etc
• Use of certain medications like estrogen and glucocorticoids

 
Hyperglycemia could happen with/without the presence of diabetes. In the presence of diabetes, hyperglycemia occurs when the pancreas doesn’t produce sufficient levels of insulin to stabilize blood sugar levels. In the absence of diabetes, hyperglycemia could be the result of medical conditions such as Cushing’s syndrome, PCOD, some infections that release excess stress hormones which cause hindrance to the working ability of insulin, and also due to excess weight or decreased physical activity.
 
Risk Factors of Hyperglycemia
 

• Family history of type 2 diabetes
• Individuals of certain origins including Hispanics, Native Americans, African Americans, and Asian Americans
• Hypertension or hyperlipidemia
• Obesity/overweight

 
In recent times, the incidence rate of hyperglycemia has increased multifold times due to decrease in physical activity, increase in sedentary lifestyle, overweight/obesity, and increase in ageing population. In fact, its occurrence is predominantly seen in middle- to lower-income countries such as India, Brazil, and China.
 
Symptoms
There are various symptoms that denote the onset of hyperglycemia:
 

• Increased thirst or hunger levels
• Fatigue and tiredness
• Blurred vision
• The presence of sugar in urine
• Headache
• Too much hyperglycemia could result in polyuria, polydipsia, and loss of weight

 
Treating Hyperglycemia
 
First and foremost, the best way to treat hyperglycemia is to rectify the symptoms related to it. Besides this, exercising regularly helps in maintaining normal blood sugar levels. Try to workout for at least 30 minutes 5 times a week. A word of caution here, having blood sugar levels above 240 mg/dL increases the risk of ketones in the urine. In the presence of ketones, it is always recommended to refrain from exercising as doing so might lead to further increase in blood sugar levels in the body.
 
The next best treatment for hyperglycemia includes following a well-balanced diet plan that includes healthy portions of various foods. For planning your meal, it is recommended that you get in touch with a registered dietitian nutritionist. Also, stay hydrated.
 
Your doctor might also bring in changes to your medical routines to adjust blood glucose levels and normalize it.
 
But prevention is always better than cure, and hence, try avoiding hyperglycemia in the first place by adhering to certain guidelines. Take your insulin medications as prescribed by the physician, adhere to a healthy lifestyle by consuming a healthy diet, avoid consumption of sugary beverages, exercise regularly, avoid stress, and never fail to meet your doctor as per the appointment schedule.
 
Conclusion
 
Hyperglycemia is a serious problem, when left untreated. Any failure in acknowledging the disease and correcting it might lead to a condition called as ketoacidosis (diabetic coma) where the individual loses consciousness and remains unaware of anything happening around him/her. But, according to the American Diabetes Association (ADA), ketoacidosis primarily affects people with type 1 diabetes and rarely impacts those with type 2 diabetes.
 
Understand when hyperglycemia is an emergency with warning signs such as nausea, shortness of breath, coma, and fruity-smelling breath, and take action immediately by calling emergency. Learning to recognise the symptoms during normal times and during times of emergency, knowing the right treatment methods, and taking timely actions help avoiding life-threatening consequences of the problem.
 
Monitor blood sugar levels regularly and keep them controlled to avoid debilitating consequences of hyperglycemia including eye, nerve and kidney damage, stroke, prolonged healing time for infections, and heart attack. In short, eat healthy, exercise daily, sleep well, avoid stress, and be hydrated to minimize the risk of altered blood glucose levels.

A number of tests help us diagnose diabetes and confirm its presence. Once an individual becomes a diabetic, the need for such testing doesn’t stop but becomes a continuous process. Only then we can  be sure of controlled blood glucose levels in our body and avoid any hazardous consequences. Glucose monitoring is suggested for individuals suffering from diabetes to help them manage their health. Making use of monitoring devices is a good way to understand whether the sugar levels in the body are too low or high as neither of them are good for health.
 
Getting a good understanding of your blood glucose levels is inevitable to know how your lifestyle routines, food habits, exercise activities, and medications impact diabetes. Every time there is a need to check the glucose levels, you cannot rush to the laboratory. These days, many individuals have glucometers at their home—with a small prick, the meter tells the blood glucose readings. But, off late, another new device has made its grand entry into the healthcare industry—none other than continuous monitoring devices or CGMs that have become the latest passion among diabetics.
 
What’s the difference between blood glucose monitoring and continuous glucose monitoring? Which of the two is better for long-term use and practical application? Read further to understand better. But before choosing any monitoring device, it is recommended to talk to your healthcare physician to know whether or not you must check blood glucose levels regularly—this is mainly because such devices and monitoring systems are recommended only for some individuals including pregnant women, individuals taking insulin, having low blood sugar levels, finding difficulty in reaching necessary blood glucose levels, or those whose levels shoot up or drop suddenly without any notice.
 
Blood Glucose Monitoring (BGM)
 
BGM looks out for specific patterns/changes in blood glucose readings as a result of exercise, dietary restrictions, and medications. If you take a blood glucose test at home, it is generally referred to as a capillary blood glucose test (CBG) where a small blood sample is collected with the prick of a finger using a lancet. BGM can be done using a glucometer, a lancet, and test strips. Glucometers these days are sophisticated needing just a teeny tiny drop of blood and have bluetooth compatibility to synchronize data onto smartphones using paired apps. There are some apps that go a step further and help in recording the meals consumed, types of physical activity performed, and the medication doses taken, thereby giving a clear history to the physician to decide upon the next course of treatment.
 
Continuous Glucose Monitoring (CGM)
 
Helping to monitor blood sugar levels 24 hours a day, CGM is used these days by very many people irrespective of understanding whether or not it is essential to use it. Want to check the glucose levels this very minute, simply peep into your CGM readings as the device takes a reading every 5-15 minutes. It works with the help of a tiny sensor that’s placed under the skin of your belly or arms generally. The sensor tracks the intestinal blood sugar readings every couple of minutes and sends the data to the monitor, a standalone device or a part of your insulin pump that must be carried along with you.
 
Besides blood glucose readings, the device also keeps track of diet, medications, and physical activity performed. The user is informed about too high or low blood glucose levels using an alarm sound. There are some models which can send the notification to a second person, maybe a parent in case the user is a child, or in general, a partner or a caretaker.
 
Earlier, only doctors were able to view the readings but now, the data is simply available to the user directly on the smartphone, on a handheld device (like a smartphone), or an insulin pump depending on the type of the device. The sensor must be replaced every 7-14 days depending on the type of the device. There are a couple of long-term CGM devices for which the physician changes the sensor at their clinic a couple of times annually.
 
Difference Between A CGM & BGM
 

• While the CGM measures the blood glucose levels in the interstitial fluid (present between the cells in the body), BGM measures the glucose level in the blood. Hence, the measurements of both aren’t the same always as the measurements are done in two different body parts.
• A CGM machine is comparatively complex to understand and use compared to BGM. It takes some time to get a hang of the device, understand its technical aspects, and insert the sensor correctly.
• A CGM shows the reading taken 5-10 minutes back but a fingerstick check shows accurate readings as it measures the sugar levels in the blood unlike a CGM that measures blood sugar levels under the skin
• Accuracy-wise, BGM is better on any given day compared to a CGM
• While blood glucose monitoring provides accurate readings of instant blood glucose levels, it does not give any info about changes in the glucose levels over time. Whereas, CGM provides both present as well as changes in the glucose readings over time

 
It’s Time to Announce The Winner
 
Alas, there is no winner here as both the monitoring devices serve different purposes. While CGM is suggested for patients requiring insulin therapy and those who have erratic blood glucose levels, many don’t value CGM as an accurate measure as glucose makes its appearance in the blood before reaching the intestinal fluid. Also, CGM’s expensive costing doesn’t make it reachable for all.
 
But, getting data every 5 minutes or so makes it invaluable to individuals who need change in medications regularly as their blood sugar levels keep fluctuating often, have bouts of low glucose levels, and whose healthcare physician recommends using one. Else, it is essential to stick to BGM as its rate of accuracy is better, economical, and keeps you free from the stress of having to check the glucose levels often and getting anxious about the readings.
 
CGM can never be a total replacement for BGM or other monitors but can only coexist with them to reduce drastic effects of changing blood glucose levels. Apart from these, it is essential that individuals with diabetes follow a well-balanced diet, exercise regularly, sleep well, and minimize stress to keep their blood sugar levels under control. Getting in touch with a reputed nutritionist/dietitian can make the diabetic’s job simpler as all that’s left to do is to follow the diet plan and lifestyle modifications suggested by the expert.

​Diabetes is one of the most-commonly prevalent metabolic diseases worldwide—this might sound like a cliché, but sadly not many are taking steps seriously to overcome this problem. But, on the brighter side, it is also seen that individuals are more focused on lifestyle changes, diet modifications, and physical activities as a good remedy for diabetes control rather than leaning toward clinical solutions.
 
Enter any clinical setting and the first words any diabetes patient hears is about controlling blood sugar levels. But, it has been clearly proved that rather than modifying blood sugar levels we should primarily focus on sorting problems linked to insulin resistance, the root cause behind diabetes.
 
Providing Assistance to Address Insulin Resistance
 
Though there aren’t very clear research studies and evidences proving the causes behind insulin resistance, researches are almost certain that obesity/overweight and lack of physical activity are some major factors behind the problem. Insulin resistance occurs when the cells in the muscles, fat, and liver don’t respond as they should to the insulin hormone secreted by the pancreas. As a result, the pancreas keeps secreting insulin to help the glucose enter the cells. In course of time, the blood sugar levels spike up resulting in diabetes.
 
The phenomenon explained above proves without doubt that the reason for increase in blood sugar levels is insulin resistance and hence, solving this issue is the first step toward finding a solution for diabetes/pre diabetes.
 
There are a couple of factors that must be dealt with in order to stop insulin resistance:
 

• The very first one is to stop consuming foods that increase insulin production. Choose healthier foods and plan a well-balanced diet
• Indulge in physical activity everyday to make the body better sensitive to insulin—this recommendation is suitable in general for good health and one needn’t be diagnosed with diabetes to start exercising
• Losing weight is yet another tactical strategy to control diabetes and avoid insulin resistance. The NIH-funded diabetes study showed that people at an increased risk of developing diabetes were able to minimize the risk after losing 5-7% of their starting weight

 
We cannot decide whether someone has insulin resistance or not simply by looking at them. A blood sugar test is also used for generally confirming the presence of diabetes/pre-diabetes while tests for insulin resistance are more complicated and used mostly for research purposes only.
 
Diet for Insulin Resistance
 
A healthy diet exists as the cornerstone for controlling diabetes. Recent studies show that succumbing to increased intake of animal foods while decreasing the intake of veggies is a sure risk factor for diabetes. Individuals with insulin resistance generally suffer from haphazard insulin levels  and planning an optimized diet is the key toward staying healthy.
 
As the American Diabetes Association (ADA) rightly said, there is no ‘magic’ diet for diabetes as each person responds differently to different foods. The bigger picture is to include more fruits, vegetables, and whole grains, decrease the consumption of processed and starchy foods, unhealthy sugars and fats, and to include dairy and proteins in moderation.
 
Cut down on carbs but don’t eliminate them from the diet completely. Make smart choices with carbs picking healthy ones present in veggies, whole grains, and fruits. Choose lean proteins from lentils, chicken without skin, low-fat cheese, etc. Go for low-fat dairy and choose healthy fats instead of saturated/trans-fat foods as these help in lowering insulin resistance. Never go near sweetened beverages, highly processed foods, or those loaded with unhealthy fats as these can shoot up blood glucose levels instantly.
 
Make Everything Count
 
Besides having a good diet plan it’s necessary to focus on the quality and the quantity of foods that we consume. Don’t adopt a monotonous diet but mix different foods and choose those foods rich in vitamins, minerals, and fiber.
 
Never go for some crash diet but adopt a healthy diet with the help of a registered dietitian nutritionist to follow it on a long-term basis. Make lifestyle changes to become sensitive to insulin once again. Some lifestyle changes that are doable and sustainable include:
 

• Avoid a sedentary lifestyle and start becoming more active. Even a small stroll after the meal or a short walk in the park can improve blood sugar levels
• Include physical activity as a regular part of daily life
• Sleep well
• Avoid stress by doing yoga or meditation
• Be cautious of what you do—take the stairs instead of the elevator, pop up a couple of nuts or berries instead of chips during snacks, and sip some green tea or water instead of sodas and sugar-laden beverages

 
Conclusion
 
It is always smarter to solve the underlying case of the problem instead of beating around the bush trying to lower some risk factors. With diabetes too, the same holds good. Solve the underlying problem of insulin resistance by adopting a healthier lifestyle, eating foods that keep insulin production in the right levels, and exercising regularly. Take baby steps, be in touch with a support group, and get help from a dietitian/nutritionist to make diet modifications for addressing insulin resistance.

​Frequent visits to the restroom, unquenched thirst, tiredness, a tingling feeling in the feet and hands, and loss of weight without trying might immediately make people wonder whether they have diabetes. These are some of the common symptoms of the disease which is well-known universally. But, there are some signs and symptoms that are lesser known to all and one of the commonest of all is their impact on the skin. Diabetes can have intense effects on different parts of the body including the skin and any signs/symptoms on the skin is a clear indication that the blood sugar levels might be higher than normal. Such signs could mean that the individual is suffering from pre-diabetes, undiagnosed diabetes, or the diabetes treatment procedure needs to be changed.
 
Any signs/symptoms of the following on the skin is a warning that you need an immediate consultation with the physician:
 
Acanthosis Nigricans (AN): Appearing in the creases of the body such as the neck, groin, and armpits, the skin here becomes a dark patch of velvety band denoting the presence of excess insulin in the body. AN is one of the very first signs that someone might be suffering from diabetes or prediabetes. Most commonly observed in obese people, using few creams can improve the coloring of the skin. But, it is rather better to address the root cause of the problem which includes obesity or insulin resistance. For this, bringing about lifestyle changes, doing physical activity regularly, and eating a well-balanced diet is the key.
 
Necrobiosis Lipoidica: Initially misunderstood for pimples, the skin starts having small solid bumps that are raised. In due course, they become hard and swollen with yellow, brown, or reddish patches. Some key features of this condition includes itchy and painful skin, prominently visible blood vessels, a shiny appearance in the surrounding area, and the disease going into dormancy and activeness in cycles.
 
A rare condition, it is more commonly seen in women compared to men when there are evident changes in the fat and collagen layer of the body beneath the skin’s surface. Though steroid creams might be of help here, it is better to get in touch with a medical physician for the right treatment protocol.
 
Bullosis Diabeticorum: Commonly called as diabetic blisters, the condition often manifests in the legs and feet more commonly than your hands and arms. The lumps are quite huge and look scary but are not painful. They also tend to heal on their own in some weeks (usually 3 weeks or so). Though their root cause remains unknown, they can appear without any prior injury and are indications of higher blood sugar levels on the skin.
 
As these heal by themselves, all we must do is to observe for early symptoms and take required steps to avoid higher glycemic levels.
 
Digital Sclerosis: Starting with the hands and fingers joints, the skin here becomes thick and waxy spreading to the shoulders, upper back, and feet in due course. Uncontrolled digital sclerosis results in skin thickening, swelling, and hardening giving a feeling of a pebble-like presence in the fingertips. In worse cases, the swelling can also spread to the chest and face. In whichever place it appears, the thickened skin feels like an orange peel making it quite difficult to bend or straighten the legs, foot, and arms. The condition often manifests in those people with diabetes-related complications or where the treatment is quite difficult.
 
Eruptive Xanthomatosis: Mostly looking like small pimples predominantly in the buttocks, elbows, back of the knees, feet, arms, and legs, this condition is commonly witnessed in young males who suffer from type 1 diabetes. Causes itchiness, the small reddish-yellow bumps are due to high levels of cholesterol and triglycerides in the body. The treatment here includes diet and lifestyle changes to lower cholesterol levels and control them.
 
Bacterial Infections: There are higher chances for skin infections and dryness when the body’s immune system is compromised which is very much possible with higher blood sugar levels. it’s mainly because bacterias grow well when there is higher glucose levels and the most common bacteria causing infections is the staphylococcus (staph). When bacterial infections strike, the tissues become swollen, red, hot, and inflamed, and causes pain. The infection commonly occurs in the eyelids, fingernails, or hair follicles. Antibiotics are provided to curb the spread and treat the infected site. Besides that, eating a healthy diet, following an active lifestyle, and doing physical activity regularly help control blood sugar levels.
 
Fungal Infections: Occurring in the moist fold areas of the skin including the area under the breast, between fingers and toes, around the nails, and near the corners of the mouth, fungal infections cause itchiness, rashes, and small red blisters and scales. Athlete’s foot, ringworm, vaginal infections, and jock itch are some common fungal infections. Take it up with the physician to treat fungal infections which mostly respond to over-the-counter medications. Avoid such infections in the first place by maintaining blood sugar levels under normal ranges.
 
Diabetic Dermopathy: Popularly known as shin spots, this problem is harmless without causing itches or pain but commonly seen in people with diabetes. Diabetic causes changes in the blood vessels which in turn causes the diabetic dermopathy skin problem. As the name suggests, the problem is commonly seen in the shins but could also occur in the thighs, trunk, arms, and other parts of the body. It needs no treatment but if you are concerned, there is no harm in talking to your doctor.
 
Dry & Itchy Skin: Though a common skin condition found in everyone including those without diabetes, dry, itchy skin is more common in those with high blood glucose levels. Excess sugar in the blood is removed by producing enough urine which can induce dryness to the skin. Poor circulation or skin infections could also lead to dry, itchy skin. Using mild soaps and lotions, and limiting shower time might help. But, the best help could be reducing high blood sugar levels. Exercising also helps in improving the circulation besides assisting in achieving glycemic control.
 
Follow Good Skin Care Protocols
 
Our skin is a great indicator of overall body health and observing skin health is essential to understand that your body is in good health. Maintain good skin hygiene by keeping the skin dry and smooth, use mild shampoos and soaps, avoid dry skin by moisturising them, try avoiding very hot showers, and attend to cuts and bruises immediately. See your doctor to avoid complications in the skin by getting an early diagnosis. Maintain blood sugar levels under normal ranges to avoid skin infection-related aggresions. You can do this by getting in touch with a dietitian/nutritionist who could help in planning a well-balanced diet plan and physical activity schedule. 

Diabetes is an evil disease that can debilitate your quality of life. While 85% of the individuals suffer from type 2 diabetes (T2D), the rest are victims of type 1 diabetes. The general advice given by physicians to patients suffering from T2D is to keep their blood sugar levels under control. Only by doing this, these people can feel healthier mentally and physically, and above all, avoid from getting into complications such as nerve damage, heart diseases, eye problems, stroke, and more. For this, the primary suggestion given by experts in this field includes controlling the intake of sugary foods, choosing fiber-rich foods, and forming a well-balanced diet plan that doesn’t compromise on macro and micro nutrient intake.
 
Should We Be Concerned Over Carbs?
 
There have been aplenty discussions regarding the impact of carbohydrates on high blood sugar levels. These nutrients get converted into sugars after digestion and this is the primary reason why physicians, dietitians, and nutritionists recommend diabetics to control their carb portions while increasing the intake of fiber-rich foods. Don’t panic as there are a number of healthy foods as well that increase blood glucose levels in people suffering from type 2 diabetes. The only difference is that all the carbs consumed by us get converted into sugar in our body while proteins, fat, and fiber have an impact on glycemic levels.
 
Let’s look at some of the foods that spike glucose levels drastically:
 
White Grains: During recent times, we’ve heard repeatedly that white is bad! This includes white rice, sugar, refined flour, and more. The American Diabetes Association (AMA) states that foods such as white pasta, bread, and rice are perfect examples of carbs whose fiber content is completely removed while processing them. It doesn’t mean that you must eliminate these foods totally from your diet. Rather, choose small portions of white grains pairing them with the perfect blend of nutritious choices such as whole-wheat pasta, bread, brown rice, and other whole-grain options such as quinoa, buckwheat, amaranth, and more.
 
Junk Food: Surely, fast food is an enemy to weight loss efforts and obese/overweight individuals are recommended to stay away from mega-sized burgers, yummy pizzas, and lip-smacking french fries in their pursuit to weight loss. But, how many of you know that most fast food products are also extremely high in sugar content and carbohydrates? The U.S. Department of Agriculture (USDA) quotes that McD cheese burger contains up to 10 grams of sugar and 43g of carbohydrates when compared to normal-sized snicker bar that contains up to 29g of sugar and 35g of carbs. It doesn’t mean that you must stay away from all the fries, condiments, sweetened beverages, and baked goods forever. If you desire for a treat, go for a small-sized product, a lighter dressing for the salad, or the burger without the extra cheese.
 
Starchy Veggies: Potatoes, yam, and colocasia are often a no-no among individuals with diabetes as these are rich in carbohydrates. The glycemic index of starchy vegetables is high, especially that of baked potato which has the potential to skyrocket blood sugar levels even beyond a yummy donut.
 
Surprisingly, chilled potatoes have a lower GI value than warm ones but choosing to eat green veggies, crucifers, and others provide better nutrient content than starchy vegetables. Consuming potatoes or yam occasionally is not a problem. But during such times pair them with low GI foods that are high on nutrients.
 
Fruits: Firstly, don’t ever think that eliminating fruits from the daily diet is going to work wonders on the blood glucose levels. Never eliminate any food group entirely but keep a tab on portion sizes. Mangoes and jackfruits can be sugar-rich but don’t forget to pop a juicy piece of mango fruit during the hot summer months neither neglect the golden jackfruit. Being rich sources of vitamins, minerals, fiber, and antioxidants, fruits play an integral role in maintaining the nutrient requirements of the body. To know your intake, understand that one tennis-ball-sized piece of fruit is one serving. Any fruit is ok to eat until it is fresh or frozen as these are not processed nor contain any extra sugar. A fan of dried fruits? It’s better to be cautious as dried fruits can increase blood sugar levels despite having no added sugars. Because they are dried, these fruits pack ample sugar content in small portions. For example, a fresh apricot contains only 3 grams of sugar in comparison to only 2 tablespoon of dried apricots that contains the same.
 
Some Nondairy Products: Dairy is an integral part of a well-balanced diet and is necessary for good bone health. Nowadays, lactose-intolerant people have aplenty options right from almond and soy milk to oat milk. The Harvard Medical School tells that while dairy milk is a carb-containing product, they are not rich in carbs unlike non-dairy milk like oat milk that that are overladen with sugar. Rice milk has the highest sugar content amond nondairy milk with a GI of 86, almost equivalent to sugar. So go for those products such as unsweetened soy milk that’s high in proteins as well as low in sugar content having only 1 g of sugar.
 
Alcohol: Alcoholic beverages not only account for empty calories but are also sugar-rich but sadly, not many consider the sugar content of these drinks. The sugar content is even more when you mix the drinks with carbonated beverages. Understand that the effect of alcohol on blood sugar is dangerous, especially for people with type 1 diabetes as their glucose levels might drop to extremely low levels suddenly. People with diabetes are not curbed from touching alcohol but should take a few cautious steps to not go overboard. Pairing the drink with food, consuming it slowly, avoiding mixing them with other sugary drinks, and restricting alcohol consumption to not more than a glass or two in a day is mandatory to stay within recommended blood glucose limits.
 
Sweetened Beverages: Consuming solid food is different from drinking up a beverage as we can gulp down up to 2-3 bottles of our fizzy drink or sweetened beverage at a time. It is very difficult to keep a check on blood glucose levels when someone has the habit of consuming sweetened beverages. Such drinks have close to zero proteins, fat, or fiber content. In fact, people with severe hypoglycemia are sometimes recommended to consume a small serving of such beverages to raise glucose levels instantly. Instead of such zero-nutrient, sugar-overloaded sweetened drinks, mix up a few pieces of fresh fruit with water and drink it up every now and then to stay hydrated and to satisfy flavor needs.
 
The Bottomline
 
Eating healthy is not a grave task at hand but a simple one if you know how to tackle your desires and control your taste buds. All the glucose-enriched foods mentioned above make one thing clear--to avoid picking stuff from the middle of the grocery store. Instead, choose to pick from the corners of the shopping mart where you can find fresh produce, proteins, and meat stacked neatly on the shelves. Avoid processed foods and if you have any doubts regarding the food’s nutritive value, always look into the nutrition label for some help.
 
At the end of the day, all we want is to eat healthy and have something nutritious close by to help us nibble through the evening without leaning over to processed foods to satisfy our hunger or taste buds. Getting in touch with a nutritionist/dietitian can help in planning a well-balanced diet chart that’s easy to follow and offers variety too. Pursue a healthy lifestyle and exercise regularly to stay fit and keep diabetes under control.

The human microbiome is one of the most-happening topics of discussion among healthcare practitioners, scientists, and even health-conscious people during recent times, especially after various research have clearly proved its effects on human health and obesity risks. The latest fascination that’s caught everyone’s attention is how the gut microbiota’s composition could play a substantial role in contributing toward diabetes.
 
Diabetes is one of the most common metabolic diseases that has a debilitating impact on human health. According to the World Health organization (WHO) and the International Diabetes Federation (IDF), there is a staggering increase in diabetes levels and by 2045, the numbers are expected to go as high as 700 million.
 
Almost 80-85% of the world’s population is affected by type 2 diabetes mellitus (T2DM) and the common controllable factors behind this disease’s profound presence include unhealthy eating habits, sedentary lifestyle, excess body weight, and irregular sleeping patterns. Besides these, some uncontrollable factors such as heredity and ethnicity seem to increase the risk. While we can’t do anything about such factors, we can always do something about controllable factors to keep diabetes at bay.
 
The Human Gut
 
The human gut is a complex collection of trillions of microorganisms that coexist peacefully in the gastrointestinal tract. Every human being has a unique microbiota composed of microorganisms from the environment, during delivery from the birth canal, and through breast milk. Though the initial set of microorganisms found in the infant are exclusively dependent on the ones found in the mother, environmental exposure and the diet regimen determine the microbiome’s composition as the child grows up.
 
The gut microbes play a crucial role in affecting the immune, metabolic, and neurobehavioral traits besides ensuring the smooth functioning of different body operations. Recent studies and research point towards the fact that the gut microbiota has a definite role in inducing the risk of T2DM. Though the initial studies were not conclusive, varied in results, and were not large-scale one, we have long-term research done during recent times in various geographical locations that clearly observed that different microbes showed the same outcomes in various geographical areas.
 
Relationship Between T2DM & Gut Microbiota
 
Of all the studies that dealt with the relationship between T2DM and gut microbiota, most of them have clearly found a strong association between specific groups of microorganisms and their impact on diseases. Genera of Ruminococcus, Blautia, and Fusobacterium trigger the risk of diabetes while the genera of Faecalibacterium, Akkermansia, Roseburia, Bifidobacterium, and Bacteroides don’t pose a threat to the disease. Among the studies, the Lactobacillus genus seem to provide inconclusive results in most studies. Moreover, Bifidobacterim seem to contain microbes that offer protection against the development of T2DM.
           
Another research found that there was a huge difference in the microorganism composition of individuals with and without diabetes. The research showed that those with obesity problems have a gut composition that increases the likeliness of developing diabetes. The bacteria of those individuals with diabetes evolved from the intestine and has the tendency to become more permeable when someone suffers from obesity.
 
On the brighter side, we have a large-scale study that distinctly showed that increased presence of 12 taxa benefited the risk of type 2 diabetes and insulin resistance. The greater the diversity between the microorganisms in the gut, the lower the risk of T2DM independent of food intake, exercise routine, sleep activity, and use of medications. Especially the presence of butyrate-producing bacteria increased the protective quotient against diabetes. 
 
The microbiota might influence proinflammatory activities, body weight, bile-acid metabolism, modulate gut hormones, and insulin resistance resulting in the pathogenesis of T2DM. It’s here that prebiotics, probiotics, antibiotics, and fecal microbiota transplants might lead to improvements in insulin resistance and glucose metabolism.
 
How Does the Gut Microbiota Change Glucose Metabolism?
 
There are multiple ways in which the gut microbiota affect insulin and glucose metabolism:
 

• Inflammatory cascades are activated thereby leading to cytokines hormone release
• metabolites production while fermentation and the secondary effects they produce
• triggering toxins inflow by affecting the permeability of the intestinal mucosal barrier
• Using incretin secretion as a medium for direct signalling action

 
Altering the Gut Composition with Diet
 
The presence of a well-balanced microorganism population is a sure guarantee for good gut health. Any disturbance to the composition of the gut microbiome can lead to fatigue, affect mental health, bring about mood changes, decrease immunity, and increase the risk of stress and cancer. Considering these, there are increased chances of the occurrence of multiple hormonal and metabolic disorders including diabetes, hypertension, obesity, insulin resistance, PCOS, and cardiovascular disease.
 
The big question mark now is balancing the microbiome composition to maintain body health. Besides genes, the environment, and use of medication, a popular factor that controls the diversity of the gut microbiota includes the types of food consumed. Any diet rich in fiber content has a profound effect on the quantity and type of gut microbiota in the intestines. We must understand that the enzymes from the microbiota of the colon are solely responsible for breaking down and fermenting dietary fibre which releases short chain fatty acids (SCFA). Such SCFA are released when consuming indigestible fibres and carbohydrates such as gums, inulin, resistant starches, and fructooligosaccharides which fall under the category of ‘prebiotics.’
 
It is also suggested to include fermented foods such as yogurt, kefir, pickled veggies, kimchi, kombucha tea, saurekraut, and miso to include probiotics in the diet. Please don’t consume too much of these foods suddenly as they can cause bloating and gas. Gradually include high-fiber foods in daily diet and witness improvements in gut microbiota composition.
 
Conclusion
 
Currently, our knowledge is restricted to the understanding that there is a link between gut microbiota composition and pathogenesis of type 2 diabetes. We need more detailed research to understand the intricate relationship between the gut, the host, and the evolvement of T2DM so that we can move ahead to the next step of developing efficient treatment methodologies for attacking diabetes.
 
There are indications that the gut microbiota might be valuable for procuring drug therapy for T2D. But, there have only been a few studies that have dwelled into this area of how changing the gut composition changes the effects of the anti-diabetic drugs. Researchers are hoping that in the future, coming up with a personalized and precise diagnosis alongside diabetes treatments plans would become a reality using gut microflora interventions. So, we can hope for a day where the gut composition doesn’t stay as a biomarker for diabetes but also provides help in treatment procedures.
Until then, take up the responsibility of managing a healthy gut composition by eating fiber-rich and healthy foods, exercising regularly, and leading an active lifestyle. Get in touch with a dietitian/nutritionist to help you plan a well-balanced diet plan that ensures good overall health including gut health and decreased risk of diabetes.

Just like how weight shifts in a beam balance when we add or remove something, the remarks about artificial sweeteners keep swinging between their benefits and disadvantages. There have been constant worries over their long-term effects on health but presently, many individuals do prefer these sweeteners to extend their everyday meal choices and avoid intake of normal sugars. Artificial sweeteners are very many times sweeter than normal sugar but contain considerably lesser or zero calories besides imposing no hazards to glycemic values.
 
Artificial sweeteners can be divided into two namely intense and bulk sweeteners. Intense sweeteners are more commonly used in making processed foods such as baked goods, beverages, candies, jellies, and other canned foods. As the name suggests, these have intense sweetness and although don’t cause calorie rise they have the ability to increase the appetite of an individual. Some commonly used intense sweeteners include saccharin, aspartame, sucralose, thaumatin, neohesperidin, and potassium acesulfame.
 
Bulk sweeteners, in contrast, contain less sweetness than sucrose. More commonly used in foods such as ice creams, preserves, jams, marmalades, baked foods, breakfast cereals, and other desserts some of the most common bulk sweeteners are sorbitol, xylitol, maltitol, erythritol, lactitol, mannitol, and isomalt. Let’s look at some of the common sweeteners in detail below:
 
Saccharin: More lovingly called as ‘Sweet ‘n’ Low,’ saccharin was the first low-calorie sweetener approved by the Food and Drug Administration (FDA) that can be used in hot and cold food. The sweetener is 300-700 times sweeter than sucrose and the recommended daily intake is not more than 5 milligram for every kilo of body weight. Very popular among those individuals dieting in the 60s, saccharin was into controversy in the 1970s as some research linked its use to the increased risk of bladder cancer in lab rats. But there have been more than 25 studies showing that the same risk is not replicated in humans and it’s safe to use. Still, breastfeeding and pregnant women are advised against using saccharin.
 
Aspartame: The name ‘Equal’ sounds more familiar right? Yes, aspartame is more commonly called by names such as Equal, NutraSweet, and Sugar Twin containing about 200 times more sweetness than normal sugar. Approved in the year 1981 by the FDA, the recommended daily intake is not more than 50 milligrams for every kilo of body weight. The sweetener is predominantly used to sweeten beverages such as coffee and tea, dairy products, chewing gums, cold cereals, and gelatins. As aspartame does not stay stable under heat, it is not used to sweeten baked goods.
 
Sucralose: Also known as ‘Splenda,’ this sweetener is 600 times sweeter than sugar. Individuals feel that the taste of sucralose is quite close to sucrose and there is no denying that—it’s mainly because Splenda is made from sugar. Don’t be shocked as it’s altered such than only 15% of it is stored in the body and converted into energy. But, to remove the calories from the remaining quantity as well, the ‘hydroxyl’ group is replaced with chlorine atoms in the sugar molecule. The acceptable daily intake stands at 5 milligram for every kilo of body weight and the USFDA has approved its use as a general-purpose sweetener.
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​Neotame: Sold under the brandname ‘Newtame,’ this agent has been approved as a non-nutritive sweetener. One can use it generally to sweeten foods and enhance the flavor of various foods except for meat and poultry. Neotame is also suitable for baked goods as it is stable under heat. The FDA has claimed Neotame to be safe for use as there have been more than 100 studies on animals and humans. Compared to other sweetening agents, neotame is sweeter as it adds up to 7000-13000 times sweetness and is about 30-60 times sweeter than sugar and aspartame.
 
Acesulfame-k: Commonly mentioned in the ingredient list as acesulfame potassium, acesulfame K, or Ace-K, this sweetener is marketed using brand names such as Sweet One and Sunett. The FDA approved its use in the year 1988 as a non-nutritive sweetener which could be used for sweetening general products and enhancing their flavor. Just like Neotame, acesulfame is heat stable and hence, can be used as a sugar substitute while making baked goods. There have been close to 100 studies that prove the safety of this sweetener and it is commonly used to sweeten candies, desserts, beverages, and frozen desserts.
 
Conclusion
As such, sugar is advisable to use only in limited quantities and no sugar substitutes are healthy when consumed in excess. Instead of choosing sweetened beverages, go for plain water, infused water, or non-sweetened tea or coffee. If you have been drinking beverages with sugar, try to decrease sugar quantity slowly. For instance, reduce the one teaspoon of sugar intake to half a teaspoon and so on. Even when picking foods at the grocery shop, make it a habit to read the food label and choose wisely.
 
The kind of sweetener added in any food product would surely be mentioned in the nutrition label. As artificial sweeteners contain minimal or zero calories and don’t have sugar content, their everyday use has increased monumentally in recent times. But, there are safety issues that remain as a question mark despite research evidences as they can never replace natural ingredients nor prove to be zero risky when they are substitutes for the white poison (sugar). Make a detailed meal plan with the help of a dietitian/nutritionist, workout daily, and lead a healthy lifestyle that minimizes sugar intake to keep diabetes under control or to stay away from the deadly disease.