Insulin is a hormone produced by the β cells of pancreas. Insulin is like a key, which opens the door to allow glucose to enter the cells and be converted to energy and excess to be stored. It also helps to maintain energy stores by stopping excessive breakdown of fat and glycogen (stored form of glucose). The cells in the pancreas can sense the level of glucose in the blood and release the right amount of insulin into the blood.

Without insulin, the body is unable to convert the glucose into energy.

• After a meal the blood glucose (sugar) rises very high resulting in what is termed as hyperglycaemia.
• The excess sugar (glucose), which is not used for energy, cannot be stored in the liver and muscles for later use.
• The stored glucose in the liver and muscle is broken down, further increasing the blood glucose level.
• In the absence of insulin, the body breaks fat and protein and converts it into more glucose in the liver.
• Also fats are used for energy and ketones are produced.
• In absence of insulin, there is no utilization of glucose even when a meal has been taken, so the body is unable to use the energy from the meal, which leads to fatigue and sometimes weight loss.

Transplantation of the pancreas is being done in many centres abroad especially in patients also requiring kidney transplantation for diabetic end stage renal disease. It is usually reserved for complicated cases. It is a cumbersome procedure that requires prolonged treatment with immunosuppressant drugs to prevent rejection of the implanted organs. Pancreatic islet cell transplantation is still an experimental procedure, where only the insulin producing islet cells are injected into circulation. It is still an experimental procedure with patients requiring systemic immunosuppressants.

People with diabetes have the same nutritional needs as anyone else. Diet advised for persons with diabetes is a healthy diet and is suitable for all persons. The daily food requirements should be well distributed in 5-6 small meals. Diabetes meal plan avoids excess consumption of refined sugars and fats in general. A good diabetes diet means eating healthy foods in the right amounts and keeping the blood sugar and blood lipid level and weight under control. A person with diabetes can almost eat everything but moderation is the key to have good health.

There is as yet no strong scientific evidence to prove that bitter gourd, jamun or fenugreek seeds play a major role in bringing down blood sugar levels to any significant level. At the most they work just the same way as many other dietary fibres. It is also important to mention that there is no data to prove that they are harmful. So have them if you want to but do not discontinue the medications advised by your doctor.

A person with diabetes can enjoy all fruits. Some fruits are caloric dense, like banana, mango, grapes, sapota, seetaphal etc and it is important to understand their portion equivalents when compared to other fruits. Like ½ banana or 1 small banana is equivalent to 1 mediums size apple or orange.

Insulin is a natural lifesaving hormone produced by the body. When not produced in adequate amount it has to be given from outside. So when a person needs insulin, not taking insulin becomes life threatening. Don’t let your fear for insulin drive you to ill health. Many people with diabetes realise too late that insulin after all is not a bad thing to take. It is the substance that keeps all of us alive and healthy. Following the advice of the doctor is always beneficial.

Free foods are foods that are low in calories, can be eaten liberally and do not need to be counted in the diet. Note that many free foods like Lettuce, cucumber, tomato, cabbage etc may be taken up to 3-4 times a day. Other free foods are tea, (without milk or sugar), plain nimbu pani (lime juice without sugar).

The most common reasons for diabetes not being controlled are

• Excessive eating - more than required by the body, and advised by the doctor (portions may be large)
• No or limited physical activity
• Being overweight
• Any illness or infection
• Metal or emotional stress
• Hormonal changes
• Presence of other associated conditions e.g., thyroid problem, celiac diseases etc.
• Influence of medicines used for other disease e.g. asthma, allergy, thyroid, heart diseases etc.
• Inadequate insulin - the insulin prescribed is either not taken regularly at the advised time OR the quantity is not sufficient OR the medicine chosen for controlling glucose may not be the correct one for that type of diabetes and its grade of severity. There could be many reasons when you feel insulin is not working.
  • Check if it is the right strength, using the right syringe.
  • Check to see whether it is being administered in the right way.
  • If the insulin which is used is not post expiry.
  • If the insulin bottle is rolled/ shaken in the right way, i.e. it is well suspended.
  • Make sure that the insulin has been properly stored and not exposed to high temperature or frozen

Sugar free does not mean calorie free or carbohydrate free. It is advisable to keep a check on the calorie product of the food, before consuming it. This way the total calorie intake especially carbohydrate intake can be kept under control and this will help in keeping a check on the blood glucose levels.

The most important goal for people with diabetes is keeping near-normal blood sugar levels in order to feel well and avoid long-term diabetes complications. To do this, each person needs different amounts and types of food, activity, and medicines like insulin. Need of insulin may vary in different situations and increase in temporary situation like-

• Illness, Stress, Surgery.
• In people with type 1 diabetes insulin dose may increase as the child grows with increase in height and weight

To control one's blood glucose, all sources of carbohydrates must be controlled. Carbohydrates include starchy foods like pasta and bread as well as sugary foods like candy. Even juice, milk, and fruit contain carbohydrates, and they must be eaten in moderate amounts. With careful planning, small amounts of sugar can replace other carbohydrates usually eaten at a meal. Too much sugar is bad for everyone. It provides only empty calories.

The fact is that all foods provide carbohydrates. Whenever a person eats any carbohydrates- blood glucose rises. If there is enough insulin present in the body naturally or provided by injections, it will utilize the carbohydrates and consequently the blood sugar will not rise. However, if your body is producing less insulin or not utilizing it sufficiently, then blood sugar is bound to rise even if you do not eat sweets at all.

Meals should not be skipped, particularly for those who are on premixed insulin. Skipping meals can upset the balance between food intake and insulin. Even when you have no food, your body needs insulin for the sugars released from muscle and liver.

Type 1 Diabetes is an autoimmune disease, a condition in which the body's immune system destroys pancreatic ß-cells which produces insulin. People with type 1 diabetes need insulin from the beginning. As of now, one can never outgrow insulin injections, but treatment options are improving all the time and people with type 1 diabetes can lead full and active lives. In a 30 year study by the University of Pittsburgh, published in 2012, noted that people with type 1 diabetes born after 1965 had a life expectancy of 69 years*. New improvement in diabetes care every year brings a hope that people with type 1 diabetes can even live significantly longer than their siblings and friends because of following healthy and disciplined life style.

* Dr. Orchard, Aaron M. Secrest, Ph.D.; Ravi K. Sharma, Ph.D.; and Thomas J. Songer, Ph.D., University of Pittsburgh: Life Expectancy Increasing for Type 1 Diabetics, According to Latest Pitt Research. August 10, 2012

Although, both type 1 and type 2 diabetes are characterised by higher blood sugar levels, the cause and development of the conditions are different.

Type 1 Diabetes is an autoimmune disorder (body’s own immune system attacks and destroys the insulin-producing cells in the pancreas) that mostly affects children and young people. A person diagnosed with type 1 diabetes need to take insulin injections from the beginning and for life time. If the diagnosis or treatment is delayed because of any reason, the severe lack of insulin can result in life threatening condition called diabetic ketoacidosis (DKA). While the cause for type 1 diabetes is still not entirely understood, there is nothing one can do to prevent or get rid of it.

Type 2 Diabetes is usually seen in older people, nowadays due to sedentary lifestyle and higher obesity, it is increasing in young people including children and adolescents. Most people with type 2 diabetes mellitus are overweight or obese and have family history of type 2 diabetes. In this form of diabetes, the pancreas still produces some insulin. Treatment includes diet control, exercise and in some cases oral drugs or insulin. It is a progressive disorder and treatment keeps on changing. Although, we cannot change our family history but by adopting right life style which includes balanced diet, physically active life and keeping weight in normal range, one can definitely delay and to some extent prevent type 2 diabetes.

Artificial sweeteners are sugar substitutes that have fewer or zero calories and do not raise blood glucose levels through eating them. This makes them a preferable choice for people with diabetes. Before using any artificial sweetener, it is essential to know if they are medically safe for consumption by children and in what quantity.

Moreover, it is worth being aware of what the food you are eating contains. Sugar free does not mean calorie free or carbohydrate free. It is advisable to keep a check on the calorie value of the food, before consuming it. This way the total calorie intake especially carbohydrate intake can be kept under control and this will help in keeping a check on the blood glucose levels. Research has shown that increase in blood glucose levels is largely determined by the total amount of carbohydrate one eats, not the source of the carbohydrates eaten. It is also agreed that one can substitute small amounts of sugar for other carbohydrates, but it has to done judicially.

Mostly all needles and syringes are recommended for single use. However many people reuse syringes and needles to help cut costs. Reusing is not a bad idea but it is essential to keep in mind few things to have safe injection. It is essential to talk with your doctor or nurse before you begin reusing.

Do not reuse** if-

• You are ill,
• You have open wounds on your hands, or
• You have poor resistance to infection.

Here are some tips to keep in mind when reusing syringes:

• Keep the needle clean by keeping it capped when you are not using it.
• Never let the needle touch anything but clean skin and the top of the insulin bottle.
• Never let anyone use a syringe you've already used, and don't use anyone else's syringe.

**http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-storage-and-syringe-safety.html

It is always difficult to explain why type 1 diabetes occurred in any child. There is nothing parents could have done to prevent type 1 diabetes in their child . Although scientists think that it has something to do with genes or exposure to something like a virus , but still it is not confirmed. Even if there is a family member with type 1 diabetes, there's no reliable way to predict who can and will get type 1 diabetes.

Although it is confirmed fact that type 1 diabetes is not contagious and also eating too much sugar does not results in type 1 diabetes.