Q: I am 31 years old and was diagnosed with type 2 Diabetes 2-3 years ago and have been on medicines: Glycomet (twice a day) and Glycigon (once a day). Now my blood sugar levels have come to normal level. How often do I have to go the lab to do a sugar test? I want to know whether I will have to continue taking medicines throughout my life? I have been extremely careful in having sugar food items and have avoided the same but is it okay to have something like ice-creams once in a month or once in 2 months? Bread (salted bread/sandwich bread) which we buy from the bakery is baked with slight sugar in this, so is this a problem?

A:You must have a clear understanding of the mechanism of diabetes to be able to make a change. If you have Type 2 diabetes then your body no longer produces enough insulin on demand to keep blood glucose levels within the normal range and to cope with the sharp rise in blood glucose that happens after a meal. Choosing food types that are more slowly digested can reduce the post-meal spike in blood glucose, which in turn reduces the demand on the beta cells for insulin. The overall effect of a meal on the blood glucose level will depend on the different types of foods making up the meal. Carbohydrate foods have the greatest effects on blood glucose levels because they are mostly digested to glucose, which is absorbed from the intestine straight into the bloodstream. Different types of carbohydrate foods are digested at different rates and therefore have different effects in terms of raising the blood glucose level after a meal. Some foods are quite rapidly digested to glucose (e.g. cornflakes), whilst others take longer for the glucose to hit the bloodstream (e.g. whole wheat flour, rajmah etc). The effect of different carbohydrate foods on blood glucose levels has been quantified by the Glycaemic Index (GI). Foods with a low GI cause less of a spike in post-meal blood glucose than those with a high GI. You probably avoid eating sugar because it causes a rapid increase in blood glucose levels. This is not true! Table sugar, which we sprinkle on our cornflakes, actually causes less of a spike in blood glucose than the cornflakes themselves. Sucrose (table sugar), surprisingly, has a lower GI than cornflakes. So it’s not just the sugar you need to cut out but also all high Glycaemic index foods. You could look up http://www.mendosa.com/gilistold.htm for a list of the glycemic index of foods. Avoid the foods with higher numbers. Ice cream once in two months is Ok if not combined with other high glycemic index foods in the same meal. A three-pronged attack on the situation can help you to control your blood glucose levels: - Increase your daily level of activity this helps to reduce insulin resistance - Reduce your daily calorie intake and try to lose some weight this helps to reduce insulin resistance - Choose carbohydrate foods that are digested more slowly this takes the strain off the beta cells after a meal. Use self blood glucose monitoring to find out whether your diet and exercise approach is working; make a note in your diary of the changes you made and learn from experience. The most informative times to test are first thing in the morning, before eating and 1 - 2 hours after your meal. Do a lab test at least once a month. If you are taking tablets to help control your blood glucose level then you will need to eat regular meals and make sure that you take your tablets at the times prescribed. Remember, your tablets will only be successful in controlling your diabetes if you pay attention to your diet and engage in regular exercise. Take the following food items, everyday: - Freshly crushed raw garlic 3-4 gms a day - Raw onions 20-25 gms a day - Raw salads with lettuce, cabbage, cauliflower, carrots, brussel sprouts, radish, turnip, mustard, cucumber, etc. according to the season. 100-125 gms a day - Bran supplement (oat bran, wheat bran) 10 gms a day Gradually increase the proportion of the following foods in your diet: - Fresh seasonal fruits of the area. - Soybean, in some form or the other, i.e., tofu, tempeh, soy milk, nutrinuggets, soy powder, plain cooked soybeans or soybean sprouts. Include one of these in one meal on at least 4-5 days a week. - Carrot, spinach and all other vegetables which are yellow or orange in colour, or have green leaves high in chlorophyl. - Vegetable juices, not strained. - Sprouts-sprouts of mung and alfalfa are easy to make and are very nutritious. Reduce the intake of the following foods - Non-vegetarian foods. Try to stop the intake of all red meats altogether, immediately. Become a vegetarian. If you cannot become a pure vegetarian, then gradually reduce poultry and eggs also so that you take only low protein fish or seafood only on 1 or 2 days a week during the interim period. - Whole milk and its products. Take skimmed milk or up to 2% fat milk and their products instead. Processed cheeses must be replaces by low fat cottage cheeses. - Tea and coffee. Do not exceed 2 cups a day of conventional tea or coffee-decaffeinated, if possible. If you need more, try herbal teas. - White flour and its products. Replace these with whole grains, whole wheat or soya breads, unpolished rice etc. Use whole wheat bread instead of white bread. Water Intake: - Flush your system by taking water copiously.