The word “Diabetes” has now become one the most popular household disorder probably after BP[blood pressure] and Heart problem. Managing BP well is usually possible with medications with little effort from the patient themselves, as what we expect is only patient compliance & regular checkups. But, unlike any other chronic disease like BP, Thyroid, Heart problems, etc.,  managing diabetes well is not possible only with only patient compliance & regular checkups, but need significant effort from the patient to change the life style.

Hence, the CAR analogy is introduced here to understand better the need for developing partnership with the patient for optimally managing their diabetes.

If I ask ;

  1. How many wheels does the car have? The answer is simple FOUR.
  2. Which is the most import  wheel ? Some would say front but the intelligent ones would say all FOUR. Even if one / any tyre is punctured the car would wobble and stop moving sooner or later.
  3. Which is under your control ? The answer would definitely be the FRONT ones, but its important to know that the back ones would always follow the front ones, always….

4 wheel

Lets rephrase them as below w.r.t Diabetes.

  1. How can I manage diabetes well?

The answer is to do the FOUR simple things:

a. Healthy Eating,

b. Active living[walk,exerercise]

c. Regular medications

d. Regular “ABC” checks


     2. Which is the most import among the above four ? Some would say medication or diet but the intelligent ones would say all FOUR. Even if one / any of these is not done, then managing diabetes would not only become tough, but would end up in complications sooner or later.

     3. Which among them is under your control ?

The answer may be variable, but its important to know that the Balanced healthy diet and regular walk/exercise are the 1st pillars for sugar management that is under your control. Healthy eating and active living would also help in reducing BP, Heart, Kidney,Liver, Bone & joint related problems. It will also improve mood and enhance work capacity.

Like in the Car the back tyres would always follow the front ones, always…., the number and dose of medications would follow the lifestyle changes. The role of medicines is to either reduce resistance to insulin action { eg.Metformin, Pioglitazone etc } or increase insulin secretion from the pancreas ( Glimepiride, Gliclazide, Gliptins ).


The fourth wheel is monitoring “ABC”: the key to good Diabetes care:

A = A1c : Glycated Hemoglobin (HbA1c) test. This blood test gives an estimate of your average blood glucose during the past 3 months. HbA1-C levels should be monitored once in 3-6 months.  HbA1-C level <6.5-7% indicates excellent control of diabetes.

This would be achieved by keeping the blood sugars levels i.e fasting blood glucose(AC or FBS) between 80 – 130 mg/dl and 2 hour post meal sugar (PC or PPBS) btwn 110-180 mg/dl.

B = BP (Blood Pressure): Maintain BP below 140/90 mmHg

 C = Cholesterol & Creatinine : Lipid profile should be monitored once in 6-12 months. Serum Creatinine  <1.2 mg% should be monitored once in a year and if >1.3 mg% should be monitored once in 3-6 months.

And C also for complication assessment 1. Urine protein/albumin should be monitored once a year (normal <30 mg / gram creatinine). 2 . Foot examination and 3 . Annual eye check up.

4 wheels diabetes

To know more you may read the other blogs & diabetology sections on healthy eating and exercise. But remember to periodically  monitor blood sugars and follow up with your family physician.


We hope your would drive your vehicle well and optimally control diabetes together as partners.