1. Daily estimation of blood sugar levels Daily estimation of blood sugar levels is necessary in all cases of diabetes - three times a day i.e. fasting, before lunch and dinner. However, at least twice daily measurement of blood sugar levels must be taken - fasting and before dinner. All diabetics are advised to use a blood glucose meter at home for a regular check-up of their blood sugar levels.

If a diabetic finds more/elevated sugar in his blood, he should analyse as follows:

(i) What has he been doing for the last 2 hours? He may be under stress.

(ii) Did he eat more?

(iii) Did he get less insulin/oral drug?

He should act as follows:

(i) If the result is mild sugar, do exercise, jump, walk; the sugar will thus get consumed or dissipated.

(ii) Avoid stress.

(iii) If the quantity of sugar is high, he should regulate his subsequent diet, exercise and drugs.

(iv) If the sugar is alarmingly high, he should consult his physician immediately.

2. Self-insulin injection

If the patient is on insulin injections, he should preferably learn the technique of self-injecting insulin into the various sites of his/her body. In such cases one should know about the proper sterilisation of syringes, needles, or preferably use disposabl~ syringes as well as needles which are available particularly for injecting insulin. A device such as NovoPen 3, like a pen loaded with penfill (refill containing enough insulin which can be used for many days depending on the need of the patient) can also be used for administering the daily dosages of insulin, under the direction of the physician. The penfill can be replaced when exhausted.

3. Prevent diabetic coma

A diabetic should avoid fasting. Even if a diabetic is get ting diarrhoea/vomiting/both, he should take the insulin/oral drug along with glucose/sugar dissolved in water as soon as the situation permits. In advanced cases, referral to a hospital is important for glucose therapy along with parenteral insulin. If the above is not strictly followed, it will lead to diabetic coma which is a medical emergency.

4. More about diabetic coma

It occurs when the blood sugar level becomes below normal (hypoglycaemic coma) or very high (hyperglycaemic coma). In the former case the patient say have taken more than the prescribed dosages of antidiabetic drugs in over-enthusiasm to make the blood sugar levels normal, or he may have taken meagre food with the same dosages of antidiabetic drugs. In the latter case, the patient either misses the drug, or takes heavy food as well; the chances are much more when there is some infection in the body.

The symptoms / signs of both the above types of coma are different. In hypoglycaemic coma, the skin is moist with profuse perspiration which can be noticed even by a person standing nearby. All diabetics should be aware of these symptoms and as soon as they start perspiring, they should start taking sugar cubes which every diabetic is required to keep in his pocket. In hyperglycaemic coma, the skin is dry. To meet this emergency efficiently, diabetics are required to keep a card in their pockets indicating that they are diabetic, so that on reaching the hospital, the doctor on duty can immediately ascertain the cause of coma and start treatment.