Handling Diabetes Under Special Situations

Apart from handling diabetes on a day-to-day basis, there are some situations/ conditions that requires special care.Here are a few of them….

1.How to handle hypoglycemia– Even though Diabetic people have excess  sugar in their blood stream, sometimes they go into a condition called – Hypoglycemia, where the blood sugar levels goes exceptionally low.

Symptoms include

• Hunger pains
• Sleepiness / giddiness / loss of consciousness
• Blurring of vision
• Excessive sweating
• Anxiousness
• Trembling
• Palpitation
• Weakness
• Headache/ irritability / confusion.

[Please note that the symptoms of  ketoacidosis- increased blood sugar also mimics hypoglycemia and many tend to get confused]

The causes of hypoglycemia may be due to one of the following

• Overdose of medication [oral drugs / insulin]
• Injecting insulin and the meal gets delayed at being served
• Reduced intake of food
• Excessive exercise / physical work
• Excessive intake of alcohol.Here the alcohol reduces glucose production and interferes with the mechanism that corrects hypoglycemia.
• Kidney disease may prolong the effect of diabetic drugs

Mild hypoglycemia is sometimes self limiting.But in severe conditions,it may result in coma / death.

How to manage  hypoglycemia:

• First of all the patient has to identify the symptoms of hypoglycemia and know what to do when it strikes.
• Carry a medical ID card stating that you are a diabetic, Doctor’s name, your residence phone number or the number of your spouse ,the medications you are put on.
• The family and close friends have to be educated about the symptoms and how to deal with it so as to help the you if need arises.
• Always carry a couple of sweets in your pocket / bag.When you feel the hypoglycemic symptoms, pop a candy/ chocolate into your mouth.This should be followed by a carbohydrate rich meal.Rest for a while. 
• Space out meal and time them correctly.As far as possible eat at the same time everyday.Spread the menu into 5-6 small meals.
• Be sure to note and discuss the number of hypoglycemic incidences with you Diabetologist / Physician every time you go for a visit so that the dose of the medication can be altered and the diet can be modified.
• If you are on insulin, discuss with your Physician and keep a dose of glucagon injection handy to use in emergency.Glucagon is a hormone produced in the body just like insulin but its action is opposite to that of insulin.When the blood sugar is very low, glucagon increases the blood sugar level b stimulating the body’s natural mechanism.

 2. Diabetic Ketoacidosis: This is the opposite of hypoglycemia.Here the blood turns acidic and the sugar levels are very high.This too is a serious condition and has to be treated immediately.

Causes / situations that lead to ketoacidosis:

• Skipping or irregular intake of medicines
• Stressful situations / illness
• Rapid weight gain
• Physiological changes like menstruation and growth spurt.

Symptoms :These are not to be confused with hypoglycemia.

• Excessive thirst
• Excessive urination
• Nausea,vomiting,abdominal pain
• Deep rapid breath with fruity odor.
• Mental confusion.

If any of these occur, rush to the hospital immediately.

3.Illness:Mostly when one falls sick, the diet may not be palatable and therefore many skip medications.In such cases talk to your Physician about food intolerance and get the dosage adjusted.Do not stop medications on your own.Take more fluids if solids are not easy to take in.If you experience symptoms of  ketoacidosis rush to the hospital.

4.Eating out : Many of us are fond of eating out.If not everyday some families love to dine out on weekends.It not just for relaxation or tasting something new,eating out can also be when you are invited to a party.At those times wondering what to eat takes away most of the time.Here is what you can do…

• Keep the dishes plain and simple while eating out..DO not venture into unknown territory,meaning if you do not know what the dish is made of , don’t select it just because it has a fancy name.There may be so many hidden dangers in that food!
• Try to avoid rich and oily foods.Go in for baked , grilled or steamed vegetables instead of deep fried snack and buttery gravies.
• Choose clear soups over creamy soups
• Plain lemon juice with a dash of salt is a better option than milkshakes and carbonated beverages.
• Select salads without a rich dressing.
• Instead of ice cream or dessert , opt for a small portion of fruit salad or coffee/ tea without sugar.
• While ordering food at a restaurant, ask for the dishes to be made without butter/ ghee,ask for the dressing on the side[If you really need a tasty salad,just touch the dressing with the salad instead of soaking the salad in the dressing.]
• Avoid or limit alcohol.
• Watch out for words like –  jumbo, giant, deluxe, biggie-sized or super-sized etc as they are larger portions and hence carry more calories. 
• If you have to take fat-foods or other food stuffs that are not so healthy, balance your meal when you eat at home.
• Ask the restaurant manager if the dishes you ordered will take extra time to get ready.If you are on insulin then select according so as to minimize waiting time.
• If any of these are not possible to choose from [because the host does not know about the health condition,or because the restaurant only caters super ‘rich’ foods] eat in moderation.

• If you are traveling by air,state your food preference clearly while booking the ticket.Most of the flights cater diabetic meals.But do check if you will like to dishes on the menu.I once ordered a diabetic meal for MIL on flight without checking the menu.She got a western diabetic meal which did not have anything palatable for her.So we had to exchange with mine as I did not want her to go into hypoglycemia.From then whenever we travel, I order normal Indian meal for her and ask her to select the healthy ones from it.
• Carry a few healthy snacks in case you get hungry before the meal is served.
• Try to follow the diet tips mentioned above while eating out.
• Always carry your prescription and a set of extra medicines while traveling.In case you you have to stay away longer and cannot get the prescribed medicines in the place where you are traveling, you can always use the extra ones.
• Always carry your medical identity card / medical records in case you need to use them in an emergency.
• In case you check your blood sugar at home, take the testing kit with adequate strips/ lancet.
• If you fall sick during travel, contact your Physician as to how to proceed with the diabetic treatment / illness treatment.

6.Fasting :  Fasting is spiritually important for certain people.When it becomes absolutely necessary to fast, consult the Physician regarding medicines and also be aware of hypoglycemia and its management.


Earlier in this series on Diabetes…

Diabetes – An introduction
Gestational Diabetes-Part I
Gestational Diabetes- Part II
Exotic Diabetic Cooking-Book Review

2010 – Algerian cucumber Yogurt Soup

2009 – Roundup for Tasty Bites for toddlers event

Live Healthy, Live Happy…