Q	I am supposed to undergo surgery. I also have diabetes. What should I do?
A	Trust your doctor and your surgeon, and follow their advice. Do not press them for early discharge. Follow your diet and medication instructions meticulously. In general for major surgery the doctor may prefer to admit you for a few days before surgery to stabilise your blood glucose in case its control has not been good. Well-controlled persons with diabetes can even be admitted just a day before operation. For minor surgery it is often not even necessary to admit the patient to hospital, and the surgery can be done as an outpatient procedure.	Top
Q	Why do I get cramps in my legs?
A	There are several causes for getting cramps in the legs. This can occur due to diabetes. It can also be caused because of deficiency of some salts like potassium, magnesium and calcium due to excessive sweating or vomiting or diarrhoea. Rarely it may reflect a serious underlying disease, so if cramps are a regular feature of your life you should consult your doctor and try to seek an explanation for the problem in your case.	Top
Q	Does the flocking of ants at the area of urination mean a symptom of diabetes?
A	Yes, flocking of ants at the area of urination could be a sign that the person has sugar present in the urine and thus has diabetes. But only flocking of ants does not confirm diagnosis, so you need to get your blood sugar tested to check if you really do have diabetes.	Top
Q	Is diabetes contagious?
A	No, diabetes is not a contagious disease. It cannot be transmitted from one person to another on regular contact.	Top
Q	Is diabetes a disease?
A	No, diabetes is not a disease. It is a metabolic disorder that occurs due to less supply of insulin in the body or the available insulin not functioning properly leading to high blood sugar (glucose) level.	Top
Q	Is having a neurological problem a sign of diabetes?
A	Yes, having a neurological problem could be a sign of diabetes. Numbness or inability to feel pain or temperature changes, tingling, burning, or prickling sensation are neurological problems that could be a sign of diabetes. This is because high blood glucose causes chemical changes to occur in the nerves.	Top
Q	When is insulin started in persons with diabetes?
A	Insulin is a natural life saving hormone, produced by the pancreas and helps the body to use glucose. If your doctor feels that your body is not producing insulin in adequate amounts or the insulin produced is not working properly then he may advise you to take Insulin. Persons with Type1 diabetesare dependent on insulin injection as their pancreas is unable to produce insulin. In Type 2 diabetes when blood sugar is not well controlled with optimal doses of oral medications insulin is started	Top
Q	Since insulin is expensive, can I substitute insulin with oral antidiabetic tablets?
A	No, insulin cannot be substituted for tablets. If your body does not produce adequate insulin, then there is no alternative and insulin has to be given from outside. Although insulin may appear expensive, the cost of insulin is not that high. An average daily cost of treatment with insulin is less than the cost of smoking 5-6 cigarettes a day or drinking 3-4 cups of tea or coffee.	Top
Q	How many times can I use the same syringe and needle?
A	Ideally you should use a disposable syringe and needle only once. However it is all right to use the same needle for the same patient more than once. It depends on when the needle starts causing pain while injecting.	Top
Q	How will I know that my diabetes is under control?
A	When your blood sugar values are normal and you do not suffer from any symptoms, feel energetic and healthy then your diabetes is under control. However do not rely on symptoms alone, please check your blood sugar level frequently.	Top
Q	What is the role of alternative systems of treatment in diabetes?
A	While many alternative systems are available and many folklore medicines are used traditionally to treat diabetes, none have been tested scientifically for their efficacy and safety. Just because they are traditional or herbal medicines does not mean they are safe. Some of them are based on natural food products that human beings eat normally and these can be taken as an adjunct but certainly not as the main treatment. So far the best treatment for diabetes management is eating the right food, exercising regularly and taking the appropriate oral diabetes medicines or insulin as advised by your doctor. Close monitoring, learning, understanding and participating in the care of your diabetes with a positive attitude is all that is required to manage diabetes well.	Top
Q	Is it helpful to use some indigenous medicines along with established diabetes treatment?
A	The efficacy and mechanism of action of most indigenous drugs is not clearly understood, it is also not clear how they interact with other established medicines. There is a false notion that herbal / indigenous medicines have no side effects. Any substance that is effective can also cause harm, so if it is claimed that they effective we must also accept that they have potential to cause harm. While some of these medicines maybe apparently safe and harmless their interaction with the established treatments may render such treatment less or more effective and in both cases lead to problems. It may not be advisable to use indigenous medicines along with other established treatments without consulting your doctor and informing him about the same.	Top
Q	What is the role of meditation in controlling diabetes?
A	Meditation helps to reduce stress. Reduction of stress leads to reduction of stress hormones in the body. Once the stress hormones are reduced, the effect of insulin on the blood sugar becomes more effective. Thus by helping to lower the blood sugar level, meditation improves the state of diabetes. However please do not discontinue your medication as the effect of meditation on diabetes may alone not be enough to keep your condition under check.	Top
Q	Will spiritual practice help in controlling diabetes?
A	Depending on one's personal beliefs spiritual practice may help reduce stress and provide solace. Reduction of stress leads to reduction of stress hormones in the body. Once the stress hormones are reduced, the effect of insulin on the blood sugar becomes more effective. Thus by helping to lower the blood sugar level, spiritual practice helps improves the state of diabetes. However please do not discontinue your medication as the effect of spiritual practice on diabetes may alone not be enough to keep your condition under check.	Top
Q	Does yoga help people with diabetes?
A	Yoga is an ancient Indian practice that blends physical exercise, stretching and meditation. It has been shown to be beneficial for stress relief and some chronic conditions. A person with diabetes without any complications can do most yogic exercises. It is important to go to a good yoga teacher and ask him/her to draw out an individual plan on what forms of yogic exercises you can do. Also discuss with your doctor. When you do yoga please do not discontinue your medications without your doctors advice.	Top
Q	Apart from blood glucose tests are there any other less expensive way to check if my blood sugar is under control?
A	While blood sugar testing provides the most accurate assessment of blood sugar control, urine sugar test may be done, as slightly cheaper, but less accurate surrogate test. Urine sugar will be positive only when the blood sugar value is high usually above 180 mg%, urine sugar will never be able to indicate whether the blood sugar is normal or low.	Top
Q	Which is the appropriate time to collect urine for testing?
A	Urine sugar testing is a simple and easy test to do. Depending on whether you want to check fasting or post prandial value, urine can be checked first thing in the morning -fasting or before meals or two hours after meal. It needs to be checked as often as the doctor advises. As urine formation is continuous the bladder contains urine that may have been formed several hours ago and may contain sugar spilled earlier. So when collecting urine make sure to collect a second void specimen. Pass urine, do not collect this sample, drink a glass of water wait for half an hour and urinate again. Collect and test the second specimen. The second sample contains urine formed in the last half hour and so is better reflective of blood sugar level at the time of urine test.	Top
Q	I am feeling very depressed because of my diabetes. I don't know what to do.
A	It is natural for you to feel upset and depressed because of diabetes. Many people get the same feeling. Getting upset and depressed will not be of any help. The only thing that will help you is to understand diabetes and take charge. You cannot let diabetes rule your life. Don't blame yourself or others because you got diabetes. You may generally be more prone to it because of your family background or because of our stressful sometimes-unhealthy life-style. Think of this as a wake up call. It is an opportunity to do something about it. You may have heard nasty things about diabetes, yes sure, some of them may be true, but these things happen because people do not take care of themselves. On the other hand people with well-controlled diabetes live a healthy and active life. There are many young people with diabetes who do not let it affect them. People like the famous cricketer Wasim Akram, Olympic swimming champion Gary Hall, Miss America 1999 Nicole Johnson are among those who have not allowed diabetes to affect their lives negatively. You can control and overcome diabetes if you take charge and do not let depression and dejection get over you. Discuss your fears and doubts with a counsellor, follow proper advice and be realistic. You must also seek one to one guidance from your doctor and other health professionals. With proper care treatment, diet, exercise and education you can take care of your diabetes well.	Top
Q	If I have high blood pressure, does it mean that I will get diabetes?
A	No, just having high blood pressure cannot cause diabetes. However, both diabetes and high blood pressure share the same risk factors like stress, overweight, smoking, lack of physical activity etc. and therefore the two conditions do co- exist. Also diabetes can be a risk factor for developing high blood pressure.	Top
Q	How long does it take for a diabetic's wound to heal?
A	Wound healing depends on how good is the blood supply to the area around the wound and how good the blood sugar control is. If diabetes is under control and there is good blood supply in the area of the wound, the healing time is similar to what it would take for a non-diabetic person.	Top
Q	Why does the level of blood glucose increase whenever I am under stress?
A	When you are under stress, the body releases more stress hormones. These reduce the effect of insulin, thereby worsening diabetes. Poor control causes more stress and a vicious cycle sets in. Many times it may not be possible to control stress so it is better to increase dose to keep the diabetes under control and work at reducing the stress. Reduction of stress leads to reduction of stress hormones in the body. Once the stress hormones are reduced, the blood sugar comes under control and the dosage can be again reduced.	Top
Q	My diabetes was detected only when the glucose level had already reached above 300-350 mg/dl, and remained uncorrected for a long time. Is it true that if the diabetes was diagnosed early and treated more aggressively, I would not have had to get on to insulin this soon.
A	Yes, you are right. The insulin producing cells in the pancreas are severely stressed due to high blood sugar. Apart from the stress of coping with increased need for insulin, high blood sugar is also toxic to the insulin producing cells causing irreparable damage. So the earlier the condition is diagnosed and the better it is treated, there is a greater chance of saving the insulin producing cells from permanent damage. By giving insulin in the early stages, the stressed insulin producing cells get time to rest and recover and the body's needs are provided through an insulin injection. The blood sugar levels are brought down quickly and the chances of complications are reduced. When we have a fracture, the fractured limb is put in a cast, so that we may not use it and injure it further and allow the body time to heal. So also giving early insulin helps the insulin producing cells in the pancreas to recover quickly from the stress and the patient is taken off insulin.	Top
Q	Does diabetes affect memory and makes people ill tempered?
A	Stress can make anyone short tempered and irritable. Living with diabetes and the daily chores such as monitoring, diet, blood sugar and medications and not being in control can make people anxious. Persons with diabetes need a warm and comfortable atmosphere at home. They need help and understanding to overcome their problems and allow them to follow their diet, exercises, and medication as well as learn to cope with their stress. Well-controlled diabetes does not affect memory, however when diabetes is poorly controlled or when somebody suffers from repeated episodes of severe hypoglycaemia memory loss can occur. An already compromised brain blood flow due to aging, arteriosclerosis or high blood pressure can be made worse by poor or erratic blood glucose control.	Top
Q	How do I know my blood sugar has increased?
A	When the blood sugar is high some people get clear symptoms. These are: excessive thirst, excessive hunger, polyuria (passing large amounts of urine), tiredness, often accompanied by a feeling of weakness and irritability, weight loss for no apparent cause, skin infections especially in the genital area, blurring of vision etc. Symptoms vary considerably in their severity and some may not have any symptoms at all. Although you know your body and how it reacts you have to remember that the body may soon get used to high blood sugar and you may not get the symptoms, despite very levels. Do not rely merely on symptoms to assess whether your blood sugar is under control or not. To confirm how high is the blood sugar it is important to test your blood.	Top
Q	Is it not a good sign, my blood sugar has never gone down.
A	In a person maintaining his blood sugar within normal levels it is good he has never got hypoglycaemia, but in case the blood sugar levels are in the high range it is important that the blood sugar level come down to within the normal range despite causing an occasional hypoglycaemia.	Top
Q	There are so many products in the market that claim to cure diabetes. How far are these effective?
A	As of now there are no known drugs, which can cure diabetes. If there were medicines, which could cure diabetes, they would be used by every person with diabetes. Unfortunately many of these claims are unfounded and do not have any scientific basis to support them. They are mere myths.	Top
Q	Is it okay if I continue my indigenous medicines to control diabetes, now that I am starting Insulin?
A	No, it is not appropriate to continue your indigenous medicine along with insulin. We do not know how some of the indigenous medicines would react if taken together with insulin. Some of them may contain substances that may be dangerous to your health.	Top
Q	Are OHAs (Tablets) useful for all persons with diabetes?
A	No. They are effective only in people with Type 2 diabetes with some residual and functioning insulin producing cells. In Type1 diabetes, and in some persons with Type 2 diabetes, OHAs (Tablets) do not work, as the pancreas is incapable of secreting any insulin. Therefore no amount of stimulation by oral drugs would help these patients.	Top
Q	How do OHAs (tablets) work?
A	OHAs work by either stimulating the pancreas to increase insulin production or by improving the effectiveness of the insulin secreted by the pancreas, or by delaying the absorption of ingested carbohydrates. Irrespective of their mechanism of action it is imperative that the patient's pancreas is capable of secreting insulin for any OHA to work.	Top
Q	What are Sulphonylureas? How do they work?
A	Sulphonylureas are oral drugs used in the treatment of type2 patients. Sulphonylureas stimulate insulin secretion from pancreas.	Top
Q	What are Biguanides? How do they work?
A	Biguanides act by increasing the peripheral glucose uptake, delay absorption of carbohydrate in the gut, and suppress glucose production by the liver. Biguanides also need the presence of insulin for their actions.	Top
Q	Can a person with diabetes donate blood?
A	Yes, a person with diabetes can donate blood.	Top
Q	What is the latest in treatment with oral insulin?
A	Insulin is a protein [polypeptide] hormone and is destroyed in the acidic medium of the stomach. It therefore cannot be given orally as such, and is currently given by injection [usually subcutaneous]. However as many persons, especially small children; are afraid of injections, and because oral medicines are preferred to injections by most people; researchers are looking for a way to make insulin such that it escapes destruction in the stomach, and remains active after being absorbed into the blood stream. No great breakthrough has yet been reported, but the search continues.	Top
Q	What is the latest in treatment with Insulin patch?
A	Delivery of drug through the skin has been viewed as an important method by which constant level of drugs can be maintained in the blood. Several researchers have tried to devise an insulin patch or an adhesive layer of special material that contains the active drug, which can be stuck on to hair free skin, and which will release the drug constantly into the blood stream through the capillaries (small blood vessels) of the skin. Because of the erratic absorption no insulin patch is yet ready for commercial application, because none has yet demonstrated effectiveness in lowering blood glucose.	Top
Q	What are the new developments in insulin therapy?
A	Most persons with diabetes do well with the insulin currently available provided they are educated well by their doctor regarding how to monitor blood glucose and adjust the dose of insulin appropriately. However there a few well motivated patients who can attempt better blood glucose control and they may benefit from further advances in insulin therapy viz. by the use of rapid acting and long acting insulin analogues [an analogue is a substance closely related but not exactly the same as the prototype]. By the use of such insulin analogues it is possible to further improve blood glucose control in the already well controlled, well-motivated, and compliant patient. Another advance that is in the news these days is the development of 'inhalation' insulin that can be inhaled as a deep breath through the mouth using an inhaler. The device is undergoing clinical trials, and is likely to be available in a few years if large clinical trials confirm its efficacy and safety.	Top
Q	What are new oral drugs available in treatment of diabetes?
A	The new oral drugs that have recently been approved for use in the management of Type 2 diabetes are given below. No changes in existing treatment should be made based on the information given below. Consult your doctor and seek his advice to make any changes. Repaglinide [NovoNorm®] is a short acting insulin secretion inducer that produces better blood glucose control at lower risk of hypoglycaemia or 'hunger' in-between two meals. It is therefore able to control blood glucose better than long-acting sulphonylureas and allows flexibility in meal timings. Because it works rapidly it is given just before a meal. So if meal is delayed medication is delayed, if meal is missed medication is missed. This allows great freedom and flexibility for a person with diabetes. It is best used alone in the newly diagnosed patient, and it may be combined with metformin in the patient who has had diabetes for 5-10 years. Glimepiride [Amaryl®] is a long-acting sulphonylurea that has to be taken once a day in doses of 1-4 mg or twice if higher doses [maximum 8 mg] are required]. It is believed to be safer than glibenclamide and other sulhonylureas in terms of its affect on the heart. However it has similar disadvantages of a long acting sulphonylurea viz. continuously stimulating insulin secretion, and similar risk of hypoglycaemia. Rosiglitazone [Avandia®] is an insulin sensitiser that produces a modest reduction in blood glucose and blood fat levels, and is useful for overweight and obese patients. Its use requires monitoring liver function tests every two months for the first year and periodically thereafter. Pioglitazone [Actos®] is another insulin sensitiser that has been used to reduce blood glucose. Available as15, 30 and 45 mg tablets to be taken once a day. Liver function needs to be monitored every two months for the first year and periodically thereafter.	Top