Last Updated on September 19, 2023 by Shabnam Sengupta
Diabetes is a significant contributor to various health complications, including blindness, kidney failure, heart attacks and strokes, and lower limb amputations. In the year 2019, diabetes played a direct role in 1.5 million fatalities, with 48 per cent of these individuals succumbing to diabetes-related issues before reaching the age of 70. Additionally, diabetes was responsible for an additional 460,000 deaths due to kidney disease, and elevated blood glucose levels accounted for approximately 20 per cent of cardiovascular-related fatalities. Therefore, diabetes management is essential for people struggling with the condition. To discuss the role of diet in diabetes management, THIP Media spoke to Chhavi Kohli, an experienced Nutritionist and diabetes educator.
With over 15 years of experience, Chhavi Kohli is the Chief Diabetes Educator and Nutritionist in the Division of Endocrinology and Diabetes at Medanta the Medicity, Gurgaon. She is passionate about helping people with diabetes and protecting them from the perils of medical misinformation.
What are some biggest challenges people with diabetes face and how do you help them overcome these challenges?
Chhavi Kohli: People generally think that diabetes is a problem that can happen to only middle-aged or old people. So, whenever it strikes at a younger age, the biggest challenge that people face is acceptance. We see a lot of times that in spite of the diagnosis, people are unable to accept it. As a result of this lack of acceptance, they are unable to take care of themselves the way they should.
Another thing that a lot of people think is that if they are diagnosed with diabetes, they have to change their lifestyle completely. They feel that they are the victim of some big problem and there is no solution to it. This affects their diabetes management journey, their parameters, their enthusiasm and their motivation.
To help patients deal with this, we always tell them that this journey is about understanding your own body, how it behaves and how you can create a balance of things that are good for your health and things that you enjoy and are not so good for your health. It is not very different for any of us. We are all in the same boat. These are the things through which we help them to get themselves motivated and teach them how they can take care of themselves so that they get that pleasure of taking care of themselves as well as enjoying things.
How do you motivate and educate your patients to make lifestyle changes that can help manage their diabetes?
Chhavi Kohli: It’s about talking to them. Listening to them is very important. When a new person visits our clinic or in the hospital, the purpose is not that we should be able to tell them ten different things or a list of things they should do to manage their diabetes. The first and foremost thing is to try to understand that person, what that person feels, what are the barriers that person is facing, what is the mental state where that person is or what are the challenges that person faces.
So, rather than developing a love-and-hate relationship with food, we should look at food with gratitude. Because when we change the feelings, we change the perception and that is the only source of nutrients. So, the first step is to think about the source of nutrients and quality of meals instead of restrictions. When we take food in the right proportion, when our body is nourished, definitely we will get to see different results.
How do you involve family members or other caregivers in the diabetes management process? And do you think it is important?
Chhavi Kohli: Yes, family members are pivotal to a person’s process of diabetes management. They play a crucial role in the management of diabetes. So often when we talk to people we have to take care of certain things. A lot of people say that it is a challenge for them as they tried it before and it didn’t work after following it for a short period of time.
Then when we discuss it at the core level, I usually ask them to think about the youngest in the family, the kids, instead of themselves. Because generally, they are the ones who are most affected. Why? Because that will be the next generation. They will have more burden of hereditary risk. Also, children are more at risk as they are exposed to advertisements for unhealthy food wherever they see and go. Along with it, they also have to deal with a lot of peer pressure, due to which they may engage in unhealthy habits. Therefore, if you want to protect them, you will want to plan a strategy which will work at the family level. We can formulate certain rules for the family that all the members will eat healthy together. Again, the idea is not to restrict them from any kind of pleasure related to food. The idea is to teach them a healthy lifestyle including eating habits, which can save them in future.
How do you create a personalised diabetes management plan or curate a specific diet that can manage diabetes?
Chhavi Kohli: It is specific to person to person. When we curate a plan, the idea is not to change everything in one go, because we have to think about the practical ways to educate them. The main goal is that they should be able to stick with whatever plan is set for them.
Keeping this in mind, when a person with diabetes visits, we try to understand the major issues and factors. For example, the stage of diabetes, severity, complications, food availability, work schedules, etc. Considering all these things, we try to find a middle path to plan their diet plans. There are a lot of new medications wherein people don’t have to eat every now and then to manage their sugar levels.
Medicines can be adjusted according to the patient’s lifestyle. It can help them to curate their own plan that is comfortable for them to follow. In this process, we also at times discuss these things with the concerned doctor and then the medicine plan and the dietary plan are created accordingly. There are various stages of the diabetes management plan. If a person’s sugar is very uncontrolled, then we may follow a strict approach for a few days. Once it is stable, we change our approach. Following up with them is very important as tracking and keeping a record of the changes in the numbers helps us to manage the parameters of the patient.
What are the most common myths you have encountered during your practice and how do you manage these challenges?
Chhavi Kohli: One of the biggest and most common myths that I already discussed previously is that ‘diabetes occurs in middle-aged or old people’. This myth results in a lack of acceptance in people if diabetes occurs at a younger age. Another myth is that regular insulin injections result in addiction. Similarly, I have heard people say that they don’t want to take insulin because once on insulin, they have to be on insulin for the rest of their lives. This is not true for everyone. It varies from case to case. Some others are ‘Everybody can reverse diabetes’ and ‘A child has diabetes just because they consumed a lot of sweets’. These are some of the common misconceptions that I have come across.
To deal with misinformation, I try to educate people and make them aware of diabetes and ways to manage it. This can get difficult in certain situations. However, regular counselling sessions and discussions help us to fight against these things. Awareness is the first step. The second step is when a child or any younger individual is diagnosed with diabetes, we enrol them on our support group so that they get support and acceptance from their peers as well who have similar struggles.
The only thing is we have to make sure that they stay with us so that they are not misinformed, and they have confidence in us. When they have confidence in the healthcare provider, there are chances that they will not fall for any misinformation completely. They will at least go and discuss it with their healthcare provider. Hence, we try to be in touch in different ways so that we can sort out their issues.
Can any person with diabetes live a normal life if they are following the right steps?
Chhavi Kohli: I always have this approach. I always tell my patients that just because have diabetes, it doesn’t mean that you cannot eat sweets. Just because they have diabetes, it doesn’t mean that they cannot enjoy festivities or socialize. Just because they have diabetes, it doesn’t mean that they should not like or should forget about their favourite foods. It is not a journey of restrictions. It is the journey to understand ourselves. And it is similar for all of us.
The idea is to create that balance. How much to eat and when to eat. And for that, they need a diabetes educator. With that person, they can sit and discuss their issues. So, I always encourage people to go and talk to a diabetes educator. One should never think that their questions are silly and what the doctor will think about it. If you have something in mind, just write it down. And whenever you go for your next visit, discuss it, even if it’s for a few minutes. That will give you the confidence to take care of yourself well. Leaving everything that you like just because you have to manage your sugar levels since you have heard it somewhere will drive you towards the wrong path. It can give you unnecessary anxiety too.
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