 Hello, good afternoon. My name is Dr. Karthik Prabhakar, I am consultant and head of the Department of Diabetes at Manipal Hospital. Now, I am going to talk about coronavirus and diabetes. The reason we are talking about it is the pandemic of coronavirus that has taken over the world right now. It's affecting people all over and in particular we would like to concentrate on patients with diabetes because the data so far suggests that patients with diabetes are at risk of getting more severe disease that could affect the morbidity and the mortality. So far there is no definite evidence to say patients with diabetes are at higher risk of getting infection because their infection rate may be similar to other people. Having said that patients with diabetes, particularly those with uncontrolled diabetes tend to have impaired immune system or the body defense mechanism. Therefore, patients with poorly controlled or uncontrolled diabetes are at risk of getting any infection, but similar to that their infection rate with coronavirus or COVID-19 is more as well. Because of their impaired defense mechanism and perhaps they will have other comorbidities like blood pressure or they may have cardiac problems or kidney problems, they tend to suffer more severe problems if they were to get infected with coronavirus. So, what do we advise for our diabetic patients? In general, like anybody else, they need to take precautions such as hand hygiene, making sure they wash their hands for at least 20 to 30 seconds with soap and water to ensure their hands are clean. That is whenever they get back into the house after being outside and particularly if they were to have any cough, cold or sneezing, they ensure that they cover their nose, mouth and they cough on a tissue and then dispose the tissue off in a hygienic way into a closed bin or if they are coughing, they cough or sneeze on their folded elbow, for example, like this and ensure that the droplet infection does not spread to others in case they are infected and ensuring they clean their clothes, they keep their personal hygiene up to date, making sure they are adequately hydrated because hydration is an important factor. Having said that, if they were to develop symptoms such as high fever, cough, cold or breathlessness, they need to seek medical advice. It's very important that they take precautions like anybody else so that they reduce the risk of catching the infection and spreading the coronavirus infection and coming to the specific aspects for a diabetic patient. As we tell patients, a good control of diabetes is very important because it avoids not only long-term complications related to eyes, kidneys, nerves, heart, etc. In the current situation, a good diabetes control reduces the risk of infection happening. Therefore, they need to ensure they get their diet, exercise and medications on a regular basis. When it comes to diet, we always tell patients to have a low sugar, low fat diet with good amount of vegetables and fruits to ensure they get adequate and appropriate nutrition. Good protein diet is important because adequate amount of protein in the diet boosts the immune system or the body defense mechanisms so that they have a better ability to fight infections. And then, coming to exercise. See, in the lockdown situation we are in, going out and exercising, for example, going out for a walk in the park or going out to do gym, etc., is not suitable because of the lockdown. So, whatever exercises that can be done indoors, we do encourage our patients to do it. It could be walking indoors for about 20 to 30 minutes a day. It's still a good thing. If they have access to staircase and they can climb the staircase safely, climbing up and down few times a day is also an important form of exercise. If somebody can do exercises such as skipping, push-up against the wall, push-up on the floor, or doing regular yoga for that matter, all these are different forms of exercise they can do. If they have access to treadmill or exercise bike, they can definitely do that. Then, doing exercises such as strengthening exercises like doing dumbbells, that is moderate weightlifting, it can be done as well. So, there are lots of exercises. Apart from this, they can do stretching exercises, which is part of yoga asana, surya namaskar. All these are important exercises that one can do, keeping their joints supple and mobile and equally keeping themselves physically active so that diabetes control will be easier. And then in terms of diet, patients sometimes may struggle to get hold of the right type of dietary ingredients from groceries only because of these restrictions. Our suggestion is not to get disheartened. Patients with diabetes should have a balanced diet. Their carbohydrate intake should be around 50% of their diet. The remaining 50% being contributed to by protein intake of about 30%, 15-20% of healthy fat intake with high-fiber vegetables and fruits as a part of their diet. Nut raisins can also be included in the balanced diet. What is important, therefore, is ensuring they eat on a timely basis and also not get perturbed that if they can't get hold of, for example, let us say patients used to eating broken wheat, I mean dalia or millets, if they are not able to get hold of everything that they usually eat, not to get disheartened, but try to focus on having high-fiber, low-carbohydrate diet. It could be red rice, brown rice for that matter. And eating chapatis, roti, better than eating of plain atta if possible because multigrain atta is supposedly better in controlling blood sugar level because of fiber content. And then taking medications, please ensure that the diabetic patients get their medications on a timely basis. That could be either tablets or insulin or a combination of both. What's important is that they monitor their sugar readings, particularly those patients who have access to glucometer, they should monitor their finger prick glucose readings to ensure pre-meal readings on the finger prick are between 80 to 130 and two hours after meal or random or bedtime readings are between 140 to 180. Getting a good control of diabetes in this situation is going to ensure the risk of developing new problems or complications related to diabetes are much lesser. So therefore, ensuring diet, exercise indoors and regular medications and monitoring certainly helps. If they are able to be in touch with their medical practitioners either via telephone or telemedicine, which has been recently approved by the Indian Medical Association to deal with diabetes related problems during the COVID season, they should access it. For example, a video conference with their doctor, what we call as video consultation could be very helpful as well. So it's important that patients with diabetes control their readings well in control, keep their health in good control so that they don't run into trouble and they access medical professionals help if required. Please make sure they have adequate medications, whether it is tablets or insulin. Moreover, if they run into trouble and if they get into a stage where their health deteriorates, please don't delay. Get to the nearest medical facility or emergency services so that their health issues can be looked at. If the diabetic patient is an elderly patient or somebody who needs help, family members who are young and who are healthier, they should take the opportunity to get their medications sorted. Also, in case of shopping and going out, because I mentioned earlier that patients with diabetes and patients who are elderly above 65 years are at risk of developing more problematic issues with coronavirus, somebody younger and healthier could help them out with shopping and also procuring medications and to ensure they get their medications on a timely basis. At the end of the day, it's not only diabetics, patients without diabetes are also at risk of getting problems but diabetic population presents an important challenge. A good control of diabetes becomes very important. If the finger prick readings continually exceed 250, they need to have their urine ketones checked so they may need to approach a nearest lab for urine test for ketones as well. That's mainly for type 2 diabetic patients. Type 1 diabetic patients are the ones who are on insulin for life. So, it's important they manage their diabetes better as well because type 1 diabetics are also at risk of fluctuating sugars. They need to monitor their blood sugar levels regularly and seek medical help if required. Again, type 1 diabetic patients can develop a complication called diabetic ketoacidosis wherein blood sugar levels go very high when insulin is not adequate or insulin gets missed and they develop ketones in the urine which, if it progresses, can call ketoacidosis. So, type 1 diabetic patients should follow sick day rules if they were to become unwell but make sure they don't miss their medications. Another important thing to bear in mind is the stress or the psychological problems that may happen to patients due to lockdown. Patients feel that they are stuck and they may feel frustrated, feel depressed. It's important that they keep their mood in good way knowing that we will all overcome this problem with coronavirus with precautions and regular medical advice. It's only a matter of time until things get better, until medical experts say things are better enough, the lockdown may continue. So, one need to accept this as a short-term bitter treatment so that long-term health and wealth of the patients and the country will be better. So, in case patients start feeling frustrated, infuriated, helpless, depressed in this situation, yoga and meditation may help. But if it gets to a stage where they need medical help, please seek professional advice because at the end of the day, the health is not just the physical well-being, it's the mental well-being as well. So, medical advice along with regular basic precautions, I'm sure diabetic patients can deal with their diabetes well and professional help is always around. Thank you.