WORLD DIABETES DAY 2020 is being celebrated today. Every year "World Diabetes Day" is celebrated on the 14th of November. Each year there is a separate theme to highlight the significance of a particular intervention that could bring betterment the diabetes patients' quality of life.

This year the theme is "The Nurse and Diabetes". Last year, it was "The Family and Diabetes". Both the themes are similar in the sense that the family of the diabetic and the nurse/ doctor of the diabetic play a very important part in the life of the patient with Diabetes.

In our real-world practice, when treating a patient with diabetes, we primarily focus on six different factors that are important for managing  diabetic patient:

1. Compliance with a Diabetic Diet
2. Regular Exercise
3. Monitoring of blood glucose
4. Compliance with medications
5. Managing stress
6. Monitoring for complications

All these factors require the participation of the family members and the nurse. A diabetic nurse can formulate a diet plan as per the social norms, counsel the patient about regular exercise, stress on the adherence to diabetes medications, talk about stress factors that could result in dysglycemia, and monitor for diabetes-related complications. Different guidelines recommend different strategies. Here I outline the advice I give to my patients.

What is a diabetic diet?

This is the most important question that every diabetic is keen to know. Although, very few diabetic patients follow these dietary recommendations. I advise all diabetic patients to strictly avoid "Bakery Items".

These include all foods that directly contain sugar in one form or another. Examples include sweets, cakes, sugars, juices, chocolates, etc. Regarding fruits, I ask them to take one fruit daily.

One fruit here means an amount that is equal to the amount of a fist. It can be mixed fruit such as a fruit chart. Older diabetic patients may take two fruits (each equivalent to the amount of a fist).

Bananas, mango, dates, and grapes are a few commonly used fruits that I ask them to totally avoid. Furthermore, I ask them to take a fruit but never make juice of it or even a milkshake. I also ask diabetic patients to eat rice less frequently. I allow them a bowl of rice once a week. I also advise them not to eat full stomach.

How much walk/ exercise is recommended for diabetic patients?

The ADA recommends a minimum of thirty minutes of brisk walking daily. Most patients think they don't need to walk since they do their household activities. It is important to note that household activities are not equivalent to a brisk walk at the scheduled time.

Patients are reluctant sometimes. I advise them to start with a minimum of five minutes walk every day for one week. Increase the time to ten minutes after a week and so on until thirty minutes. An early morning walk is also important for patients who are anxious and depressed.

How frequently should you monitor your blood glucose?

This is different for different diabetic patients. Type 1 diabetic patients need to check two or three blood sugars daily initially. Once their blood sugar targets are achieved, they may need to check their blood sugars once or twice every other day.

Type 2 diabetic patients who have well-controlled diabetes or are on oral antidiabetic medications with mild to moderately uncontrolled diabetes may check their blood glucose on weekends.

I tell most patients to check pre meals blood sugars thrice daily on Saturdays and post meals sugars (two hours after each meal) thrice daily on Sundays. Most patients send me their six blood sugar readings on Monday and I make adjustments to their medications.

How frequently should you monitor for complications of diabetes?

Patients should be monitored for eye-related complications at least once yearly. Diabetic kidney disease should be screened for with a spot urinary microalbumin or urine albumin to creatinine ratio once every year.

Patients who have microalbuminuria should be tested after 6 weeks to confirm and label the patient as having diabetic nephropathy stage III. Urinary microalbumin may be tested frequently in patients who have established diabetic kidney disease.

Patients should be examined for diabetic neuropathy with a monofilament at each visit or at least six monthly. Cardiac evaluation via yearly ECG and/ or stress testing is mandatory yearly.

Stress, Anxiety, and Depression:

Although, this is the neglected part. However, probably, this is the most common complication and comorbid state in patients with diabetes. Patients with diabetes should be screened for comorbid depression on diagnosis and at each OPD visit.

When your patients' blood sugars fluctuate frequently or do not achieve your glycemic targets, always consider comorbid depression. Most patients need counseling. I also ask every diabetic patient to go for an early morning walk.

Early morning walk is ten times more potent than taking an antidepressant

In conclusion:

These are a few of the common and important questions that every diabetic patient needs to know. The nurse, doctor, friends, and all the family members need to play their roles in improving the quality of life of a diabetic patient.

It is unfortunate that we could not celebrate "World Diabetes Day 2020" this year because of the COVID-19 pandemic. I just wanted to contribute and share some important messages with the audience. I, along with my whole family tested positive for COVID-19.

Luckily, today is the 14'th day since the onset of symptoms. This is another reason for not celebrating "WORLD DIABETES DAY 2020".