Q: I am 37 years old, weighing 69 Kg with a height of 176 cm. In the past six months I have lost 6 Kgs. During 3 routine fasting blood sugar tests, my sugar levels have been 160, 183, 223 respectively and I have seen that my sugar levels are increasing. My father, who is about 65 years of age, also experienced weight loss and when investigated he was found to have high blood sugar levels. Subsequently, he took ayurvedic medicine and his blood sugar levels have become normal now. I am doing exercises & diet control now. I am told that weight loss is because the body cells are actually starving due to inability of the body to absorb glucose properly. Is this true? Do I need to take protein & vitamin supplements to make up for the nutrition loss if any?

A:More than 90% patient with diabetes are overweight but unfortunately in Indians (most Asians) can get this even if their weight is slightly high. Your current body mass index is 22.3 and in Indians it should be less than 23. Your waist size may be high (should be less than 88 cms) or you may have lost weight due to diabetes. Many patients with type 2 diabetes have a family member with type 2 diabetes or conditions commonly associated with diabetes, such as high blood lipid levels, high blood pressure, or obesity. As an example, 39 percent of patients with type 2 diabetes have at least one parent with the disease. The lifetime risk for a first-degree relative (sister, brother, son, daughter) of a patient with type 2 diabetes is five to ten times higher than that of a similar age and weight person who has no family history of diabetes. The likelihood of developing type 2 diabetes is greater in Asians. The common symptoms of poor diabetes control are passing large amounts of urine and weight loss. The reason why you make a lot of urine and become thirsty is because glucose leaks into your urine, which pulls out extra water through the kidneys. Due to this you can lose weight but this is not the right way of losing weight as you are underutilising carbohydrates. To assess your overall control you can get your haemoglobin A1C test (HbA1C) should be done. This test measures the average blood glucose level during the past two to three months. It is used to monitor blood glucose control in people with known diabetes. The values for A1C should be around 6 to 7%. You are on the right track (diet and exercise) to control your diabetes, but inspite of good diet and exercise very often you need medication to control your sugar. The usual fasting we would like to achieve should be around 90-130 mg/dl/. There are few Ayurvedic medicines, which can be helpful but you will have to be more clear about, which one your father has taken. But as a rule none of these medicines (Ayurvedic or any other) can completely cure diabetes as it is a chronic disease. The ratio of carbohydrates, protein, and fat is important to long-term health. Current recommendations are as follows: Carbohydrates - 45 to 65 percent of the total calories. Protein - 5 to 20 percent. Fat - 25 to 30 percent (mostly monounsaturated or polyunsaturated, not saturated fat). The most important thing is to control blood sugar levels, which might prevent further weight loss. Burning sensation in patients with diabetes is due to neuropathy secondary to poor diabetes control (sensory neuropathy). This is the most common type of nerve damage in diabetes. It usually affects nerves in the feet and legs but can sometimes affect nerves in the hands and arms too. Sensory neuropathy can cause a feeling of numbness, tingling or ‘pins and needles’. Some patients develop a feeling as if they are walking over sharp stones. Neuropathy may also cause burning pains in the legs, especially in bed at night, shooting pains, or sometimes over-sensitivity to even slight touch. This is why it is sometimes called “painful neuropathy”. However in many cases, patients may not notice any symptoms but can still have signs of sensory neuropathy when their feet are tested at the clinic. This lack of sensation can sometimes lead to problems with foot ulcers. Taking good care of the feet is the best way to avoid foot ulcers. This is why you are advised on foot care when you are declared a diabetic. You can cut your risk of developing neuropathy by keeping your blood glucose (sugar) levels under control. If you already have neuropathy, keeping blood glucose (sugar) levels under control will prevent it from becoming worse.