How often are you able to identify the effect of your feelings of hunger and satisfaction levels, and the emotional triggers that make you overeat and how your blood glucose responds to different foods?

I am sure the answer would be “hardly”. Many a times when I ask my patients why did you end up eating 6 slices of Mango when the agreed plan was not to have more than 2 slices at a time, the answer I hear is ‘ I was too happy sharing a big meal with my family...; I was nervous for my interview .... etc.

Our feelings, emotions and social environment play a big role when it comes to eating. That's where food journaling comes in. Food logs can be a helpful, cost-effective tool in improving skills in managing blood sugar on a daily basis.  

I often tell my clients that controlling blood sugar levels to prevent highs and lows is an important aspect of diabetes self-management and that keeping a food diary/ log, in the form of a physical book or journal, a computer software program, a website or app, or even a digital photo gallery, can play a key role.

What all you should Log?

• Detailed record of what you have eaten and drunk over a period of time usually in the last 24 hours;
  • Each meal and snack to be recorded in detail in terms of quantity / portion and time (including beverages). Along with the cooking method like baked/ boiled/ fried/ steamed etc.
  • Try and record  travel/ fasting/ weekday/ weekend food record also
  • Some things that can be tracked with a food diary:
    •     Fat grams, carbohydrates, protein, fiber, etc.
    •     Identify danger zones in alignment with blood glucose  
    •     response following quantity and quality of a meal
    •     Pinpoint lapses

It helps in correlation of blood glucose response on a mixed meal, with special consideration on carbohydrate content of the food. Based on observation of blood glucose values and food eaten for that particular meal, correct the carbohydrate content (%) of a meal.For e.g. If my clients want to have a sugar laden dessert, I ask them to check their pre-meal blood glucose levels and 2 hours after eating the food they crave for. It gives you an idea what that particular food does to your blood sugar levels and why needs to be avoided and the results are in front of their eyes. So my work becomes easy.

• Activity record:
  • Keep a note of major activities / exercise you do in a day. Keep all records including household chores like sweeping/ mopping/ gardening etc.
  • Record the time of activity
  • Correlate hypo/ hyperglycemia ( low or high blood sugar) or associated symptoms to food intake and activity level

Record feelings behind eating. Ask yourself why you eat the way you do? You may wish to spend more reflective time in your diary. After you have eaten, write down why you ate (hunger, boredom, etc.) and how you feel afterwards (guilty, deserving, etc.) How were you feeling before you ate?
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For example :

• Did you feel "gut hunger?"
• Who were you with?
• Did you eat hurriedly or calmly?
• Can you recall everything you ate?
• Did you eat normal portions?
• Were you doing an activity while you were eating?
• How do you feel now (e.g. satisfied, healthy, guilty)?
• Overall was this a positive or negative eating experience?

I believe that maintaining a food log is a must for people who are on Insulin and/or have difficult to control sugar levels. This gives a freedom to understand a correlation between food and activity routine to blood sugar levels and helps make necessary adjustments when needed.

Try and maintain the log for minimum 7 days and get it reviewed by your health care provider who can help you identify the gap initially, and as you master keeping a record you can manage your health on your own.
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So, just identify a way you would like to keep a record. You can maintain a log as a journal or mobile phone app. These apps are found to be more effective than computer-based programs for diabetes self-care. The mHealth apps also gives the opportunity to take a more active role in your health management while keeping it fun.

Getting diagnosed with pre diabetes is a serious wake-up call, but it doesn't mean you will definitely get diabetes. There is still time to turn things around. It’s an opportunity to initiate lifestyle changes or treatment and potentially retard progression or even prevent diabetes.

Moderate physical activity of about 30 minutes a day for at least five days a week is recommended for patients with diabetes or for any individual who aims to prevent diabetes and stay healthy.

I have seen my patients becoming over conscious as soon as they hear a wakeup call that their blood sugars are borderline or they are pre-diabetics.  The very next day they would want to go on a strict “diet” and hit the gym to take control. The result is only de-motivation or ending up with unwanted muscle injuries as they did not prepare their body for a particular set of exercise.

You need to start getting fit in small, short term goals to achieve your bigger goal of controlling your blood sugar to normal.

Ideal physical activities for any individual must be customized to one’s physical strength and likes and dislikes. It’s as important as a proper warm up and cool down period is to any exercise session.

Staying active throughout the day can have a great response on your blood sugar. You could also increase activity and movement while doing your daily chores by following some tips like:

• Get up to change the TV channel rather than using the remote.
• Stand up and walk in place while watching television (or at least during commercials).
• Ride a stationary bike while you are watching TV, reading a book, or talking.
• Limit TV and computer use at home. Reduce it by 30 minutes daily.
• Try taking stairs instead of an elevator or escalator whenever possible. If going up steps is too hard, start by only walking down stairs.
• Get up and move for 3–5 minutes after every 30 minutes of a seden­tary activity.
• Stand up or take a short walk during work breaks instead of remaining seated.
• For every extra calorie you eat, add 20 steps to your daily total exercise.
• Park your car further from your destination and walk the rest of the way
• Get off the bus early and walk the rest of the way
• Do some house work: cooking; cleaning; dust the stress off with dancing; watering the plants etc.
• Choose active hobbies like outdoor sport. You could also plan an outing to park, zoo, museum, sports event.

The following activities can help increase strength of your muscles

• Carrying groceries
• Carrying a suitcase
• Carrying kids
• Walking with a backpack
• Pushing a stroller/pram

Few tips on incorporating exercise regimen safely in your daily routine:

• Get a detailed health check done to know the status of your body before you pick up any exercise package with a fancy gym.
• Do not get tempted with “fancy weight loss programs” promising you 10kgs weight loss in 2 months; believe me it does not work and if does the weight bounces back faster than even you can think.
• Think of staying FITT, so set FITT goal for being physically active.

 
Talk to your doctor or physiotherapist to set FITT goals:
 
F=Frequency: How often you should start exercising? 2- 3 -4 days per week?
I= Intensity: what should be the Intensity? For example you want to start a cardio program; check what should speed you should be exercising at (10mp/hr etc?)
T= Time: What is an ideal time to begin with? 10 min? 20 min? etc. I always begin with a new exercise for 10 mins in the first week and then increase it by 5 min per week.
T= Type: Which is the best exercise for me to begin with? Is it aerobics/ cardio; strength training  or weight training; yoga or simple stretches?
 
Rule of thumb:

• Warm up and cool down is a must. A warm up should consist of 5-10 minutes of aerobic activity (walking, cycling, etc) at a low –intensity level. The warm –up session is to prepare the muscles, heart, and lungs for a progressive increase in exercise intensity. A cool down should be structured similarly to the warm up. The cool down should last about 5-10 minutes and gradually bring the heart rate down to its pre- exercise level.
• Stay hydrated and nourished! 
• A Diabetes identification medical ID tag, bracelet, necklace should be clearly visible when exercising. (Tag should state that you are a pre-diabetic, your name, contact phone numbers of family members and Physician).
• Proper foot care is essential and especially important for individuals with diabetic neuropathy, which can cause feet to lose sensation and hence result in injuries. Wear cotton or woolen socks and correct athletic shoes.
• Exercise with a friend. Make sure that he is familiar with the warning signs of hypoglycemia like nervousness, excessive sweating, dizziness etc.
• During exercise if you feel shaky, confused, nervous, then stop doing exercise and take some sugar (3tsp) or drink half cup of fruit juice or non-diet soda. Inform your friend and family member. Report to your doctor.