PART AIMPROVING GLUCOSE CONTROL THROUGH FOOD CHOICES AND POST-MEAL ACTIVITYMagnitude of diabetes in Kashmir, India and AsiaDiabetes is one of the largest chronic-disease challenges of our time. The World Health Organization reports that approximately 830 million people worldwide are living with diabetes, most in low- and middle-income countries. Asia carries a major share: the ICMR-INDIAB study estimated that India alone had approximately 101 million people with diabetes in 2021. Each number represents a person at risk of heart attack, stroke, kidney disease, visual loss, neuropathy and premature death. [8,9]Kashmir is not protected. Precise valley-wide totals remain uncertain because studies use different populations and diagnostic methods. A study of 6,808 tribal adults from the Gujjar and Bakerwal communities across five districts of Kashmir found diabetes in 1.26 percent but prediabetes in 11.64 percent, about nine times as common. The authors warned that this pattern points to a rise in diabetes in the years ahead. These findings cannot be extrapolated to every Kashmiri, but they demonstrate a meaningful local burden and explain why the Fayaz Shawl Philanthropic Foundation is developing this education series: to promote earlier testing and practical guidance on food, portions, meal sequence, medication safety and activity alongside medical care. [10]

A family experienceWhen someone close to us develops poorly controlled diabetes, prompt action matters, and so does accuracy. A close member of my family in Kashmir had an HbA1c of 8.9 percent, well above the usual treatment target. Her seven-day continuous glucose monitor (CGM) report for September 6–12, 2026 showed an average glucose of 181 mg/dL, with evening averages reaching 205 and 220 mg/dL.Alongside her medical care, we made structured changes to meal composition, portion size, food order and post-meal activity, with close supervision and continuous glucose monitoring. Her next seven-day report, for September 14–20, 2026, showed an average glucose of 133 mg/dL, a fall of 48 mg/dL, with three-hour averages between 115 and 147 mg/dL. As her glucose improved, I reduced her glucose-lowering medication, including insulin, under close supervision.

The response is encouraging, but medication, activity, adherence, sleep, illness and other factors also affect glucose. It is not proof that diabetes has been cured or reversed. HbA1c reflects glucose exposure over about three months, so a repeat laboratory HbA1c is essential. International consensus defines type 2 diabetes remission as an HbA1c below 6.5 percent for at least three months without glucose-lowering medication, and even then, continued monitoring is necessary because high blood sugar can return. [1]A CGM is useful for recognizing patterns and testing how an individual responds to meals. It does not by itself diagnose remission, and a single low or normal reading should never be treated as proof that diabetes has disappeared.My purpose in sharing this experience is practical: relatively simple habits can improve daily glucose patterns, but they must complement appropriate medical treatment rather than replace it.

Practical evidence-based regimen1    Begin with a medical assessment. Confirm the type of diabetes and review HbA1c, fasting glucose, kidney function, urine albumin, blood pressure, lipids, weight and current medication. An HbA1c of 7 percent or higher deserves active treatment and follow-up. Lifestyle measures may improve control, but medication may still be necessary to protect the heart, kidneys, eyes and nerves.2    Use nuts as a measured food. Walnuts and almonds provide unsaturated fat, fiber, magnesium and protein. A small serving taken 20 to 30 minutes before a meal may reduce the post-meal glucose rise in some people, particularly when it replaces biscuits, sweets or bakery bread. A randomized trial in Asian Indians with prediabetes found benefit from 20 grams of almonds taken 30 minutes before meals. [2] Take the nuts with a glass of water and chew them well. Water supports hydration and may help you feel full sooner, but it has not been shown to lower glucose further. People who have been told to restrict their fluids should follow the advice in step 7. Nuts are calorie-dense and should be counted within the daily food plan. People with a nut allergy should avoid them.3    Eat vegetables and protein before starch. Small crossover studies show that eating non-starchy vegetables and protein before carbohydrate can reduce the immediate rise in glucose and insulin after a meal. [3] Fiber, protein and fat slow digestion, so glucose enters the blood more gradually. A practical sequence is salad or haakh first, alone or mixed with a modest serving of plain unsweetened Kashmiri curd (dahi or zamutdud); then protein; and a limited amount of rice or bread last.4    Choose plain yogurt when it fits the meal. Plain unsweetened yogurt or zamutdud supplies protein and generally causes only a small rise in blood sugar. [12] In my clinical observation with CGMs, mixing a modest serving of plain curd with haakh or other non-starchy vegetables at the start of the meal was associated with a smaller post-meal glucose rise. This combination has not been tested in a controlled trial, so it is a........

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