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Diabetes types, blood glucose targets, lifestyle control and practical day-to-day management checklist.
Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. India has 101 million diabetics (IDF Atlas, 2024) — second highest globally after China. Understanding the types, risk factors, and diagnostic criteria is essential for prevention and management.
| Feature | Type 1 Diabetes | Type 2 Diabetes | Prediabetes (Impaired Glucose) | Gestational Diabetes (GDM) |
|---|---|---|---|---|
| Cause | Autoimmune destruction of pancreatic beta cells; no insulin production | Insulin resistance + progressive beta cell dysfunction; relative insulin deficiency | Insulin resistance; beta cells still functioning but not adequately compensating | Placental hormones cause insulin resistance; pancreatic beta cells cannot compensate |
| Onset | Usually childhood/adolescence (peak 10-14 yrs); can occur at any age | Usually 30+ years (increasing in teens); gradual onset over years | No symptoms usually; detected on routine screening; reversible if addressed | During pregnancy (typically 24-28 weeks); resolves after delivery in most cases |
| Prevalence (India) | 0.5-1% of all diabetes; ~1-1.5 million Indians | ~8-10% of adults; 101+ million Indians (IDF 2024) | ~15-20% of Indian adults; ~150+ million Indians — MASSIVE hidden burden | 5-10% of all pregnancies; ~3-5 million affected pregnancies/year in India |
| Body Weight | Usually normal or thin at diagnosis | 80%+ overweight or obese; central/visceral adiposity | Often overweight; higher waist circumference; metabolic syndrome features | Variable; higher risk with obesity and PCOS |
| Autoantibodies | Present (anti-GAD, anti-IA-2, anti-insulin, anti-ZnT8) | Absent (no autoimmune component) | Absent | Absent |
| Insulin Production | None — absolute insulin deficiency | Reduced — relative insulin deficiency; hyperinsulinemia initially then decline | Normal or slightly elevated (with insulin resistance) | Variable — insulin resistance dominant |
| Symptoms | Polyuria, polydipsia, polyphagia, unexplained weight loss, DKA, fatigue | Same but more insidious; may have no symptoms for years; recurrent infections, slow wound healing, blurred vision | Usually asymptomatic; occasional acanthosis nigricans; fatigue | Often asymptomatic; detected on OGTT screening |
| Diagnosis | FPG above 126 OR HbA1c above 6.5% OR random glucose above 200 with symptoms | Same criteria as Type 1; often diagnosed on routine screening | FPG 100-125 mg/dL OR HbA1c 5.7-6.4% OR 2-hr OGTT 140-199 mg/dL | OGTT at 24-28 weeks: 1-hr above 180 or 2-hr above 153 mg/dL (IADPSG criteria) |
| Treatment | Insulin injections (lifelong); insulin pump; CGM; carbohydrate counting | Lifestyle first, then metformin, then additional oral meds, then insulin if needed | Lifestyle modification (diet, exercise, weight loss); metformin sometimes used; 70% can prevent progression | Diet control, exercise, glucose monitoring; insulin if needed; resolves post-delivery in 90% |
| DKA Risk | HIGH — DKA is common presenting feature; lifetime risk 30% | LOW — HHS more common; DKA only in severe stress/infection/SGLT2i use | None | Rare |
| Long-term Risk | All complications (micro + macrovascular); hypoglycemia from insulin therapy | All complications; higher cardiovascular risk; progressive beta cell failure | Progression to Type 2 diabetes (5-10% per year); cardiovascular risk even before diabetes diagnosis | 50% risk of Type 2 DM within 10 years; future cardiovascular risk; recurrent GDM risk |
HbA1c (glycated hemoglobin) reflects average blood glucose over the preceding 2-3 months. It is the gold standard for monitoring long-term glycemic control. One HbA1c point corresponds to approximately 30 mg/dL average glucose.
| HbA1c (%) | Category | Estimated Average Glucose (mg/dL) | Action Required | Risk Level |
|---|---|---|---|---|
| Below 5.7% | Normal | Below 117 | Maintain healthy lifestyle; retest annually | Low |
| 5.7 - 6.4% | Prediabetes | 117-137 | Intensive lifestyle modification; retest every 3-6 months; consider metformin if high risk | Moderate — 5-10% annual progression to diabetes |
| 6.5 - 6.9% | Diabetes (Early/Well-Controlled) | 137-152 | Continue current treatment; lifestyle reinforcement; retest every 3 months | Managed |
| 7.0 - 7.5% | Diabetes (Target for Most Adults) | 154-169 | Optimal target for most adults; reassess treatment if consistently above | On Target — ADA recommends below 7.0% for most non-pregnant adults |
| 7.5 - 8.0% | Diabetes (Needs Adjustment) | 169-183 | Review medications; intensify treatment; evaluate diet and exercise adherence | Above Target — treatment adjustment likely needed |
| 8.0 - 9.0% | Diabetes (Poorly Controlled) | 183-212 | Significant treatment intensification needed; add or change medications; endocrinology referral | High Risk — urgent optimization needed |
| Above 9.0% | Diabetes (Very Poorly Controlled) | Above 212 | May need insulin initiation; urgent endocrinology consult; risk of acute complications (DKA, HHS) | Very High — acute complication risk; requires immediate attention |
| Patient Group | HbA1c Target | Rationale | Notes |
|---|---|---|---|
| Healthy Non-Elderly Adults | Below 7.0% (53 mmol/mol) | Prevents microvascular complications; ADA/IDF standard | Tighter control (below 6.5%) may benefit young, recently diagnosed, no CVD |
| Elderly (65+ years) | Below 7.5-8.0% | Prevents hypoglycemia (dangerous in elderly); balances benefits and risks | Relax targets if frail, cognitive impairment, limited life expectancy, or hypoglycemia history |
| Pregnant (Pre-existing Diabetes) | Below 6.0-6.5% | Prevents congenital malformations, macrosomia, stillbirth | Very tight control required; frequent monitoring; pre-conception counseling essential |
| Gestational Diabetes | Below 6.0% (if measured) | Fasting below 95, 1-hr below 140, 2-hr below 120 mg/dL (ADA targets) | Diet-controlled first; insulin if targets not met; metformin/glyburide as alternatives |
| Children & Adolescents | Below 7.5% | Allows for growth and activity; minimizes hypoglycemia risk | Lower if achievable without hypoglycemia; CGM recommended for Type 1 |
| Limited Life Expectancy | Below 8.0-8.5% | Focus on quality of life and avoiding hypoglycemia and symptomatic hyperglycemia | Avoid complex regimens; simplify treatment; focus on comfort |
| Severe Hypoglycemia History | Below 7.5% | Safety-first approach; each hypoglycemia episode increases mortality risk | CGM with alerts; adjust insulin/basal; reduce sulfonylureas; patient education |
Regular blood glucose monitoring is the foundation of diabetes self-management. Understanding your glucose patterns enables better treatment decisions, dietary adjustments, and prevention of both hyperglycemia and hypoglycemia.
| Test | Timing | Normal Range (Non-Diabetic) | Diabetes Target (ADA) | Frequency |
|---|---|---|---|---|
| Fasting Blood Glucose (FBG) | After 8+ hours overnight fast; morning before food/medication | 70-100 mg/dL | 80-130 mg/dL | Daily (Type 1); 3-7x/week (Type 2 on insulin); weekly (Type 2 on oral meds) |
| Pre-Meal (Preprandial) | Before breakfast, lunch, and dinner | 70-100 mg/dL | 80-130 mg/dL | Type 1: before every meal. Type 2: vary based on treatment |
| Post-Meal (Postprandial) 2-Hour | Exactly 2 hours after starting the meal | Below 140 mg/dL | Below 180 mg/dL (ideally below 160) | 2-3x per week; rotate which meal you test after |
| Bedtime | Before going to sleep | Below 120 mg/dL | 100-150 mg/dL | If on insulin or sulfonylureas; to detect nocturnal hypoglycemia risk |
| 3 AM (Nocturnal) | 3:00 AM during sleep | 70-100 mg/dL | Above 90 mg/dL | If waking with high morning sugars (dawn phenomenon vs Somogyi effect) |
| Random Blood Glucose | Any time, regardless of meals | Below 140 mg/dL | Below 200 mg/dL | When symptoms occur: dizziness, sweating, palpitations, confusion |
| HbA1c | Any time (reflects 2-3 month average) | Below 5.7% | Below 7.0% | Every 3 months if not at target; every 6 months if stable at target |
| Pattern | What You See | Likely Cause | Action |
|---|---|---|---|
| Dawn Phenomenon | High fasting glucose (above 130) DESPITE good bedtime glucose (below 140); morning highs every day | Natural increase in growth hormone, cortisol, and glucagon between 3-8 AM; liver releases glucose | Adjust basal insulin timing (earlier evening dose); small protein/fat snack before bed; metformin at bedtime; avoid late dinner |
| Somogyi Effect (Rebound) | High morning glucose following LOW overnight glucose (hypoglycemia below 70 during night); counterregulatory hormone surge | Too much evening insulin/sulfonylurea causes nocturnal hypoglycemia; body releases glucose-raising hormones | REDUCE evening insulin/dose; bedtime snack with complex carbs + protein; check 3 AM glucose for 3 nights to confirm |
| Post-Meal Spike | Normal fasting/pre-meal but 2-hr post-meal above 180; readings drop by 4 hours | Too many carbs at meal; wrong insulin timing; rapid absorption; inadequate insulin-to-carb ratio | Reduce carb portion; add protein/fiber; walk 10-15 min after eating; adjust rapid insulin timing (10-15 min before meal) |
| Fasting Hyperglycemia Only | Consistently high fasting (above 150) but acceptable daytime readings | Inadequate basal insulin; hepatic gluconeogenesis overnight; not enough metformin | Increase basal insulin or add evening metformin; ensure adequate evening protein intake; rule out dawn phenomenon |
| Recurrent Hypoglycemia | Frequent glucose below 70; symptoms: sweating, tremor, confusion, hunger, palpitations | Too much insulin/sulfonylurea; skipped meals; unexpected exercise; alcohol without food; renal impairment | Reduce insulin/dose; never skip meals; carry fast-acting glucose; reduce basal insulin by 10-20% during increased activity |
India's dietary staples — rice, wheat, potatoes — are high glycemic index foods. The key to diabetes management in an Indian diet is not elimination but smart selection, portion control, and food combining to lower the overall glycemic impact of each meal.
| Food | GI Value | GL per Typical Serving | Safe Serving Size | Best Preparation | Pair With |
|---|---|---|---|---|---|
| White Rice (Ponni/Sona Masoori) | 70-80 (High) | 28-32 (high) | 1/2 cup cooked (100g) | Cook with extra water; cool and reheat (resistant starch); add dal | Dal, sabzi, curd, salad — never eat rice alone |
| Basmati Rice | 50-58 (Medium) | 18-22 (moderate) | 3/4 cup cooked (150g) | Use aged basmati; lower GI than regular rice; parboiled is lower still | Rajma, chole, fish curry, mixed vegetables |
| Brown Rice / Hand-Pounded | 45-55 (Low-Medium) | 14-18 (low) | 1 cup cooked (170g) | Soak 4-6 hours; pressure cook; chew thoroughly; nuttier flavor | Same as white rice; slightly higher fiber; better for glucose control |
| Ragi (Finger Millet) | 70-80 (High GI) | 11-14 (moderate GL) | 1 roti or 1/2 cup porridge | High GI but small usual serving = moderate glycemic load; rich in calcium and iron | Ragi dosa with chutney; ragi porridge with nuts |
| Jowar (Sorghum) | 55-70 (Medium) | 14-18 (moderate) | 2 rotis (60g flour) | Good for rotis; gluten-free; moderate GI; higher protein than rice/wheat | Vegetable sabzi, dal, raita |
| Bajra (Pearl Millet) | 55-65 (Medium) | 15-19 (moderate) | 2 rotis (60g flour) | Winter grain; high iron; slightly bitter taste; good for rotis | Garlic chutney, ghee, dal |
| Whole Wheat Roti (Chapati) | 45-55 (Low-Medium) | 12-16 (low-moderate) | 2-3 rotis per meal | Use whole wheat flour (atta) not maida; add bran or multigrain; fresh is lower GI | Dal, sabzi, curd — always pair with protein |
| Poha (Flattened Rice) | 45-55 (Medium) | 16-20 (moderate) | 1 bowl (150g cooked) | Add peanuts, peas, onions; squeeze lemon; high in iron; lower GI than rice | Peanuts (protein + fat), lemon juice (acid) |
| Idli | 55-65 (Medium) | 10-13 (low-moderate GL) | 2-3 idlis | Fermented; protein from urad dal lowers GI; steam-cooked; add vegetables in batter | Coconut chutney, sambar (dal-based — protein) |
| Dosa | 60-70 (Medium) | 12-16 (moderate GL) | 1-2 dosas | Fermented batter lowers GI; thin dosa lower GI than thick uthappam; add methi seeds | Sambar, coconut chutney, vegetable filling |
| Moong Dal (Cooked) | 18-25 (Low) | 4-6 (very low) | 1 katori (150g) | Lowest GI dal; easiest to digest; high protein + fiber; excellent glucose stabilizer | Rice, roti, khichdi, soups |
| Rajma (Kidney Beans, Cooked) | 18-28 (Low) | 7-10 (low) | 1 katori (150g) | Very low GI; high protein + fiber; rich in iron; best with rice for complete amino acids | Rice (small portion), salad, onion |
| Chana (Chickpeas, Cooked) | 22-35 (Low) | 7-11 (low) | 1 katori (150g) | Low GI; high fiber (12g/cup); excellent for glucose control; versatile (chole, hummus, salad) | Rice, roti, salad, pita bread |
| Paneer (100g) | Near 0 | Near 0 | 50-100g per meal | Very low GI; high protein (18g/100g); satiating; minimal glucose impact | Salad, vegetables, roti (small portion) |
| Curd / Dahi (Plain) | 28-35 (Low) | 2-4 (very low) | 1 katori (150g) | Probiotic; low GI; high protein; contains lactic acid (lowers meal GI when eaten with carbs) | After meals; with rice; as raita; lassi (no sugar) |
| Potato (Boiled, Cooled) | 45-55 (Medium) | 10-14 (moderate) | 1 medium potato (100g) | Cooling after cooking creates resistant starch (GI drops 30%); avoid frying; never eat alone | Dal, vegetables, salad, curd |
| Sweet Potato | 44-50 (Low) | 9-12 (low) | 1 medium (130g) | Excellent low-GI carb; rich in beta-carotene; boiled is lower GI than baked | Dal, salad, small amount of curd |
| Banana (Slightly Green) | 30-42 (Low) | 8-12 (low) | 1 medium banana | Underripe banana has resistant starch and lower GI; rich in potassium; natural pre-workout food | Nuts, peanut butter, curd |
| Ghee (1 tsp / 5g) | Near 0 | Near 0 | 1-2 tsp per meal | No carbohydrates; pure fat; slows glucose absorption when eaten with carbs | On roti, dal, rice — improves satiety and slows glucose spike |
Diabetes medications work through different mechanisms: increasing insulin sensitivity, stimulating insulin secretion, reducing glucose production, slowing glucose absorption, or providing exogenous insulin. Understanding how each class works helps you understand side effects and expected outcomes.
| Drug Class | Generic Names (India) | Mechanism | HbA1c Reduction | Key Benefits | Side Effects | Cost (India, per month) |
|---|---|---|---|---|---|---|
| Biguanides | Metformin (Glycomet, Glucophage) | Reduces hepatic glucose production; increases insulin sensitivity in muscle; decreases intestinal glucose absorption | 1.0-2.0% | First-line for Type 2; weight neutral or mild weight loss; cardiovascular benefit; safe for most | GI upset (nausea, diarrhea, bloating) — improves over time; B12 deficiency with long-term use; rare lactic acidosis | ₹30-100 (very affordable) |
| Sulfonylureas | Glimepiride, Gliclazide, Glipizide, Glibenclamide | Stimulates pancreatic beta cells to release more insulin; insulin secretagogue | 1.0-2.0% | Rapid glucose lowering; widely available; inexpensive; second-line after metformin | Weight gain (2-4 kg); HYPOGLYCEMIA (most common cause of drug-induced hypoglycemia); possible cardiovascular concern (older agents) | ₹20-80 (very affordable) |
| DPP-4 Inhibitors (Gliptins) | Sitagliptin, Vildagliptin, Linagliptin, Saxagliptin | Prevents breakdown of GLP-1 (incretin hormone); increases insulin release and decreases glucagon in glucose-dependent manner | 0.5-1.0% | Weight neutral; low hypoglycemia risk (glucose-dependent); well tolerated; oral; once daily | Upper respiratory infection; rare pancreatitis; joint pain; expensive; modest efficacy | ₹400-1,200 |
| SGLT2 Inhibitors (Flozins) | Empagliflozin, Dapagliflozin, Canagliflozin, Ertugliflozin | Blocks glucose reabsorption in kidneys; excretes 50-80g glucose/day in urine; also reduces BP and weight | 0.5-1.0% | Weight loss (2-3 kg); BP reduction; cardiovascular mortality reduction; heart failure benefit; renal protection | UTI, genital mycotic infections (Fournier gangrene — rare but serious); polyuria; DKA risk (euglycemic DKA) | ₹300-1,000 |
| GLP-1 Receptor Agonists | Liraglutide (Victoza), Semaglutide (Ozempic), Dulaglutide (Trulicity), Exenatide | Mimics GLP-1; increases insulin, decreases glucagon, slows gastric emptying, reduces appetite in the brain | 1.0-2.0% | Significant weight loss (5-15 kg); cardiovascular benefit; A1c reduction comparable to insulin; once-weekly options | Nausea (most common, improves over time), vomiting, diarrhea; rare pancreatitis; thyroid C-cell tumor risk (rodent studies); injection required | ₹2,000-10,000+ |
| Alpha-Glucosidase Inhibitors | Acarbose, Miglitol | Delays carbohydrate digestion and absorption in small intestine; reduces postprandial glucose spike | 0.5-1.0% | Excellent for post-meal spike control; safe for elderly; does not cause hypoglycemia alone; affordable | Severe flatulence, bloating, diarrhea (uncomfortable but not dangerous); take with first bite of meal | ₹100-400 |
| Thiazolidinediones (TZDs) | Pioglitazone, Rosiglitazone (restricted) | Activates PPAR-gamma receptors; increases insulin sensitivity in muscle, liver, and adipose tissue | 1.0-1.5% | Durable glucose lowering (does not cause beta cell burnout); once daily; oral | Weight gain (3-5 kg); fluid retention/edema; increased fracture risk (women); heart failure risk (avoid in NYHA III-IV); bladder cancer concern | ₹50-200 |
| Insulin (Basal) | Glargine (Lantus), Detemir (Levemir), Degludec (Tresiba), NPH | Provides 24-hr background insulin; controls fasting glucose; mimics basal pancreatic insulin secretion | 1.5-3.5% | Essential for Type 1; most potent glucose-lowering agent; no maximum dose; any HbA1c can be reached | Weight gain (2-4 kg); hypoglycemia (especially NPH); injection site reactions; cost; requires monitoring | ₹200-800 per vial (1000 IU) |
| Insulin (Rapid/Bolus) | Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra), Regular (soluble) | Rapid-acting: 10-15 min onset, peak 1-2 hr, 4-6 hr duration. Covers meal-related glucose spike | Dose-dependent | Essential for Type 1; flexible meal timing (rapid analogs); precise dose matching to carb intake | Hypoglycemia; weight gain; lipodystrophy at injection sites; must be taken before or with meals | ₹300-1,000 per vial |
Exercise is as effective as metformin for preventing Type 2 diabetes (Diabetes Prevention Program, 2002; confirmed in 2024 meta-analysis). Regular physical activity improves insulin sensitivity by 40-50%, lowers HbA1c by 0.5-1.0%, and reduces cardiovascular risk by 30-40%.
| Exercise Type | Effect on Blood Sugar | Duration & Frequency | Intensity | Precautions |
|---|---|---|---|---|
| Brisk Walking | Decreases glucose by 30-50 mg/dL during and after exercise; improves insulin sensitivity for 24-72 hours | 30-45 min, 5-7 days/week; minimum 150 min/week (ADA guideline) | Moderate (able to talk but not sing; HR at 50-70% max) | Carry fast-acting glucose; wear good footwear; check feet after exercise; avoid if fasting glucose below 100 |
| Resistance Training (Weights) | Increases muscle mass = more glucose storage capacity; improves insulin sensitivity for 24-48 hours; lowers glucose long-term | 20-30 min, 2-3 non-consecutive days/week; target major muscle groups | Moderate (8-12 repetitions; 2-3 sets; challenging but manageable) | Avoid heavy lifting if retinopathy; start with bodyweight exercises; progress gradually |
| Yoga | Reduces cortisol (which raises glucose); improves insulin sensitivity; reduces stress-related eating; lowers HbA1c by 0.5% | 30-60 min, 3-5 days/week; Surya Namaskar especially effective | Light-Moderate (hold poses comfortably; coordinate with breath) | Avoid inversions if retinopathy; modify if neuropathy (balance issues); best morning or evening |
| Cycling / Swimming | Full-body cardiovascular; decreases glucose; low impact on joints; excellent for overweight/diabetics with foot issues | 30-45 min, 3-5 days/week | Moderate (sustainable pace; conversation possible) | Check feet after cycling; monitor for hypoglycemia during prolonged sessions; carry glucose tablets |
| HIIT (High-Intensity Interval) | Rapid glucose drop; improves insulin sensitivity dramatically; EPOC (afterburn effect) continues glucose utilization post-exercise | 15-25 min, 2-3 days/week; alternate 30-60 sec hard / 60-90 sec easy | High (85-95% max HR during intervals; breathless, sweating) | NOT for beginners; NOT if cardiac disease, retinopathy, or neuropathy; check with doctor first; higher hypoglycemia risk |
| Post-Meal Walk | Reduces post-meal glucose spike by 30-50%; most evidence-based practice for postprandial control | 10-15 min walk within 30 minutes of eating; any meal | Light-Moderate (strolling pace) | Easiest to implement; walk after lunch and dinner for maximum benefit; no special equipment needed |
| Timing | Glucose Level | Recommendation | Snack Before Exercise? |
|---|---|---|---|
| Before exercise | Below 100 mg/dL | Eat 15-30g carbs before starting (banana, toast, biscuits); wait 15 min, recheck | YES — mandatory; exercise with low glucose = hypoglycemia risk |
| Before exercise | 100-180 mg/dL | Safe to exercise; no snack needed unless exercise will be vigorous or longer than 60 min | Usually NO; optional if exercise is intense |
| Before exercise | Above 250 mg/dL + ketones | Do NOT exercise; check urine/blood ketones; exercise with ketones increases DKA risk | NO — and do not exercise until glucose and ketones normalize |
| Before exercise | Above 300 mg/dL without ketones | Light exercise OK if no ketones; monitor glucose; avoid vigorous exercise | NO; light activity only; stay hydrated |
| During exercise (1+ hr) | Any | Check glucose every 30-60 min; if below 90, stop and have 15g fast-acting glucose | Carry glucose tablets/drink; do not exercise alone if on insulin |
| After exercise | Below 90 mg/dL | Have 15-30g carbs with protein; delayed hypoglycemia can occur 4-12 hours post-exercise | YES — protein + carb snack (banana + peanut butter, milk, cheese sandwich) |
| After exercise | 90-180 mg/dL | Monitor; no immediate action needed; be aware of delayed hypoglycemia risk with insulin | Optional protein snack for muscle recovery |
Hypoglycemia (blood glucose below 70 mg/dL) is the most common acute complication of diabetes treatment. It can be life-threatening if untreated. Every person with diabetes on insulin or sulfonylureas must know how to recognize and treat hypoglycemia.
| Severity | Glucose Level | Symptoms | Treatment | Follow-Up |
|---|---|---|---|---|
| Mild | 54-70 mg/dL | Shakiness, sweating, hunger, tingling, rapid heartbeat, anxiety, pale skin, irritability | 15g fast-acting glucose (3-4 glucose tablets OR 4 oz juice OR 1 tbsp sugar/honey); wait 15 min; recheck | Eat protein+carb snack if next meal more than 1 hr away; document event; review medication timing |
| Moderate | 40-54 mg/dL | Confusion, difficulty concentrating, blurred vision, slurred speech, drowsiness, mood changes, weakness, headache | 15-20g fast-acting glucose; repeat if no improvement in 15 min; if unable to swallow safely: glucagon gel inside cheek or honey under tongue | Once above 70: complex carb + protein snack; do not drive for 60 min; call doctor; review all medications |
| Severe | Below 40 mg/dL | Unconsciousness, seizures, inability to swallow, bizarre behavior, loss of coordination | CALL 108 or emergency services. If unconscious: DO NOT give anything by mouth. Position on side. If available: Glucagon injection 1mg IM (thigh) or nasal glucagon (Baqsimi 3mg). | Hospital evaluation required; identify and correct cause; review entire medication regimen; diabetes education |
| Cause | Example | Prevention |
|---|---|---|
| Too Much Insulin | Miscalculated dose, wrong insulin type, accidental double dose | Double-check dose; use proper technique; insulin pen safety features; never reuse needles (dose inaccuracy) |
| Missed or Delayed Meal | Took insulin but got busy/distracted and did not eat within 30 min | Eat within 15-30 min of rapid insulin; set meal reminders; never skip meals when on insulin/sulfonylureas |
| Unexpected Exercise | Spontaneous physical activity without adjusting insulin or eating extra carbs | Check glucose before exercise; carry glucose; reduce insulin on active days; eat extra carbs for unplanned activity |
| Alcohol Without Food | Beer, whiskey, wine on empty stomach; alcohol inhibits hepatic gluconeogenesis for 12-24 hours | Never drink on empty stomach; eat carb-containing food with alcohol; limit to 1-2 drinks; check glucose before bed |
| Medication Interactions | New medication (fluoroquinolones, quinine, some antifungals) potentiates sulfonylureas/insulin | Inform all doctors about diabetes medications; check interactions; monitor glucose more frequently when starting new drugs |
| Renal Impairment | Decreased insulin clearance as kidney function declines; hypoglycemia risk increases as CKD progresses | Reduce insulin doses as eGFR declines; more frequent glucose monitoring; adjust sulfonylurea doses (avoid glibenclamide in CKD) |
Diabetes complications are the leading cause of blindness, kidney failure, amputations, and cardiovascular death worldwide. The good news: consistent control (HbA1c below 7%, BP below 130/80, LDL below 70) reduces complications risk by 50-70%. Prevention is better than treatment.
| Complication | Risk Factor | Screening Test | Frequency | Target | Prevention Action |
|---|---|---|---|---|---|
| Diabetic Retinopathy | HbA1c above 7%, duration of diabetes, hypertension, pregnancy | Dilated retinal exam by ophthalmologist | Type 1: within 5 years of diagnosis. Type 2: at diagnosis, then annually | No retinopathy or mild NPDR only | HbA1c below 7%; BP below 130/80; annual eye exam; quit smoking; control lipids |
| Diabetic Nephropathy (Kidney) | HbA1c above 7%, hypertension, duration above 10 years, Indian ethnicity | Urine albumin-to-creatinine ratio (UACR) + eGFR | Annually (starting at diagnosis for Type 2; 5 years for Type 1) | UACR below 30 mg/g; eGFR above 60 mL/min | SGLT2 inhibitor (empagliflozin/dapagliflozin) for renal protection; ACE-I or ARB for BP; limit salt below 5g/day; avoid NSAIDs |
| Diabetic Neuropathy (Nerve) | HbA1c above 7%, duration, smoking, alcohol, B12 deficiency | Monofilament 10g foot exam + vibration (128 Hz tuning fork) + pinprick | Annually; comprehensive foot exam every visit | No sensory loss; normal reflexes | HbA1c below 7%; daily foot inspection; proper footwear; B12 supplementation; pain management (gabapentin, duloxetine) |
| Cardiovascular Disease | HbA1c above 7%, LDL above 70, BP above 130/80, smoking, obesity | ECG, Echocardiogram, Stress test (if symptoms), Carotid Doppler (if risk) | ECG annually; echo if symptoms; cardiac evaluation before vigorous exercise program | LDL below 70; BP below 130/80; no smoking; HbA1c below 7% | Statins (atorvastatin 40-80mg for all diabetics above 40); ACE-I; aspirin if CVD risk high; exercise; weight management |
| Peripheral Arterial Disease | Smoking, hypertension, dyslipidemia, duration of diabetes | Ankle-Brachial Index (ABI) + pedal pulse palpation | Annually; ABI if decreased pulses or non-healing wound | ABI 0.9-1.3 | Quit smoking; statins; antiplatelet if PAD diagnosed; daily foot care; proper footwear; never walk barefoot |
| Diabetic Foot Ulcer | Neuropathy, PAD, poor glucose control, poor foot hygiene, inappropriate footwear | Comprehensive foot exam at every clinical visit | Every visit; annual detailed foot exam by podiatrist | No ulcers, infections, or deformities | Daily self-exam (mirror for soles); moisturize (not between toes); proper footwear; trim nails straight; never self-treat corns/calluses; see podiatrist immediately for any wound |
| Dental/Gum Disease | Poor glucose control, smoking, dry mouth, poor oral hygiene | Dental exam and cleaning | Every 6 months | No periodontitis; healthy gums | Good oral hygiene (brush 2x, floss daily); control glucose; visit dentist every 6 months; avoid tobacco |
| Non-Alcoholic Fatty Liver (NAFLD) | Obesity, insulin resistance, high triglycerides, sedentary lifestyle | Liver enzymes (ALT, AST), ultrasound, FibroScan (if available) | Liver enzymes annually; ultrasound if elevated or high risk | ALT/AST within normal; no fibrosis on FibroScan | Weight loss (7-10% body weight); exercise; limit sugar/fructose; avoid alcohol; control metabolic parameters |