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Do I have type 2 diabetes?

Q: I am 34 years old, weighing 67.5 kg. I have recently been diagnosed with type 2 diabetes. My readings on fasting are sugar: 331 mg/dl and urine: 1.0%, acetone absent. After food my readings are sugar: 445 mg/dl and urine: 2.0%, acetone absent. When I got this report I immediately started my diet, stopping all sugar intake and have replaced rice with chapattis. My BMI is normal 22.0. I even started brisk walking for 30 minutes. I again tested for the same after a week without any medicine. My fasting results are sugar: 266 mg/dl and urine: 0.5%. After food, my results are sugar: 432 mg/dl and urine: 2.0%. I am not still convinced that I am diabetic. Initially, I felt very thirsty and lost weight. My problem started only last month. During this summer I had lot of tang juices. Can you please suggest me some precautions that I need to take. As for my family history, nobody in my family has diabetes, BP, or any other problems. My job involves lot of travelling and leads to stress. I am a South Indian, and my diet includes idli, dosa, rice, sambar, dal and roti. I also take fruits like apple, banana and papaya. I take fruit juices, health drinks (only in summer), milk and dahi. In non-vegetarian food, I only take fish (once in a month). I am a regular reader of your site, where I found some articles on stress-induced diabetes. Do you think I fall under this category? What kind of tests do you suggest I take?

A:Diet should contain 55% carbohydrate and mostly complex carbohydrates; 30% fat and 15% protein. You should take carbohydrates with low glycaemic index (GI), which includes most of the fruits. Different carbohydrate foods have different capacity to raise our blood glucose levels. Foods that raise sugar quickly, like sugar or glucose, have GI of 100 compared to vegetables that have GI of around 40 or lower, while fruits have GI of around 50. Low glycaemic index food are those that have GI lower than 60. If you choose low GI carbohydrates, then it will cause small fluctuations in your blood glucose and insulin levels, which can have a long-term effect on developing heart disease. For example, use breakfast cereals based on oats, barley and bran or use breads with whole grains, whole meal roti instead of maida. Reduce the amount of potatoes. Eat all fruits and vegetables that have low glycaemic index. It's a myth that you should not eat sweet fruits, as they have high fibre content besides high fructose (rather than glucose)content. Fruits have a very low GI whichever way you consume them. In fact, watermelon (thought to be safest in India for diabetes) has the highest GI and should be avoided in large quantity. You can eat half a mango, apple, orange (not extracted juice) or banana. Sweet potato (again a myth that it should not be taken) is good for you and better than potato, as it has high fibre content and low GI. Take brown rice instead of polished rice. You should eat plenty of salad vegetables. Fish is very good for you. It is ok to eat idli, dosa, rice, sambar, dal and roti, but you should take large amounts of vegetables and legumes so that glycaemic index of food comes down. For example, if you take large amounts of refined carbohydrates with large amounts of vegetables, then it lowers glycaemic index of food. In summary, you should eat unprocessed foods, which are natural like whole meal roti instead of maida, suji or wholesome oranges rather than orange juice. I have slight doubt about the diagnosis of type 2 diabetes as your BMI is just 22. It can be type 1 diabetes. Please take the opinion of an Endocrinologist. You can start a trial of oral hypoglycaemic agents, but consult your doctor about it, as it is usually not used in type 1 diabetes. You can also get an antibodies test done, which might help distinguish between type 1 and type 2 diabetes. Although there is no diagnostic test, type 1 diabetes is suggested by the presence of serum autoantibodies to islet cells (IAC), glutamic acid dehydrogenase (GAD) or tyrosine phosphatase (IA2) and/or insulin. The absence of serum autoantibodies does not rule out the possibility of type 1 diabetes. Stress alone cannot induce diabetes (type 2), but it can contribute towards causing diabetes in a person who has a risk of developing it. In addition, approximately 30 per cent of individuals with the classical appearance and presentation of type 2 diabetes have positive autoantibodies.

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