Q: I am 37 years old. I am 6 feet 1 inch tall and weigh 100 kg. On a recent health check up, my blood sugar readings showed a fasting number of 139 mg/Deca Lt and a postprandial of 219. I also had a severe cold with a heavy head and profusely running nose that day. My blood pressure was 130-90, with normal ECG and TMT (with excellent tolerance for exercise); good cholesterol was 36, bad cholesterol was 161 and total cholesterol was 173. Doctor said that I am absolutely normal except that I have Type II diabetes and suggested Metaformin Hydrochloride (Glydimet) tablets 500 mg to be taken twice a day with a diabetic diet of 1400 calories. I walk briskly for 45 minutes everyday early in the morning and also walk for 10 minutes after every meal. Is it possible to revert to normal sugar levels with moderate exercise and strict diet regimen? Can I stop having tablets once my sugar levels are normal consistently for 3-4 weeks and continue only with my exercise and diet regimen? I have a fairly physically active life despite my high weight and used to exercise regularly in the past. I do not take soft drinks, junk food and I do not eat non-vegetarian food.

A:Diabetes is a chronic disorder caused by the inability of the body to either produce or properly utilise insulin, the hormone responsible for sugar metabolism. As a consequence, the blood sugar levels rise and persistent elevation affects blood vessels, eyes, kidneys, heart, nerves etc. Type 1 diabetes is an auto immune disease in which the body's immune system produces antibodies, which destroy the cells producing insulin in the pancreas. It has an acute onset and is usually seen in children. Due to absence of insulin, patients need lifelong insulin injections. Type 2 diabetes, in contrast, begins as a resistance of the body to the action of insulin. This necessitates increased insulin production but finally this decreases and diabetes develops. Type 2 diabetes is usually seen in adults and people who are overweight. But with increasing obesity, this is occurring more often in young people. Criteria for diagnosis of diabetes:

• Random blood glucose > 200 mg/dl* with symptoms (increased thirst, increased urination and unexplained weight loss)
• Fasting blood glucose > 126 mg/dl*
• 2 h blood glucose > 200 mg/dl* following an oral challenge with 75 g glucose * This should be repeated on another day to confirm

Treatment aims to maintain:

• Hb A1C < 7 %
• Fasting blood glucose 90 - 130 mg/dl
• Peak post-prandial blood glucose < 180 mg/dl (usually 1-2 h following a meal)
• Blood pressure < 130 / < 80 mmHg
• LDL Cholesterol < 100 mg/dl
• HDL Cholesterol Men > 40 mg/dl Women > 50 mg/dl
• Triglycerides < 150 mg/dl

Healthy diet, increased physical activity and weight loss can prevent or delay diabetes and its complications. Lifestyle changes need to be individualised by tailoring the goals and targets to the patients preferences and progress. You need to discuss all this with your doctor before starting medication.