by Dr Fayaz Shawl
Practical adjustments to food composition, meal sequence, and post-meal movement can significantly improve daily glucose patterns, serving as an effective lifestyle complement alongside medical care rather than a substitute for treatment.
Diabetes is one of the largest chronic-disease challenges of our time. The World Health Organisation 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.
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 per cent but prediabetes in 11.64 per cent, 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. They 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.
Family Experience
When 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 per cent, well above the usual treatment target. Her seven-day continuous glucose monitor 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 per cent for at least three months without glucose-lowering medication. Even then, continued monitoring is necessary because high blood sugar can return.
A continuous glucose monitor is useful for recognising patterns and testing how an individual responds to meals. It does not by itself diagnose remission. 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.
A Practical Regimen
The steps in this evidence-based regimen are grounded in clear physiology. Every programme should begin with a thorough medical assessment to 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 per cent 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.
Using nuts as a measured food offers a natural brake. Walnuts and almonds provide unsaturated fat, fibre, magnesium, and protein. When the fat and protein reach the upper small intestine, they trigger gut hormones, including cholecystokinin and glucagon-like peptide-1. These hormones signal through the nerves of the gut to slow the emptying of the stomach, a feedback system known as the duodenal brake. A small serving of about 20 grams 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 randomised trial in Asian Indians with prediabetes found benefit from 20 grams of almonds taken 30 minutes before meals. Chew the nuts thoroughly, because breaking their cell walls happens in the mouth, not the stomach. Take them with a glass of water, which supports hydration and may help you feel full sooner, although it has not been shown to lower glucose further. Nuts are calorie-dense and should be counted within the daily food plan, whilst people with a nut allergy must avoid them.
Eating vegetables and protein before starch thickens the meal. Haakh, gogji, monji, and salad vegetables supply fibre. Soluble fibre, such as pectin, absorbs water and makes the stomach contents thicker. Thicker contents empty more slowly and mix less readily with digestive enzymes, so sugar from starch eaten later in the meal is absorbed more gradually. Insoluble fibre adds bulk and fullness. Much of the benefit also comes from the order itself, as the starch simply arrives later, after the body’s early hormonal response is under way. 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. A practical sequence is salad or haakh first, alone or mixed with a modest serving of plain unsweetened Kashmiri curd, then protein, and a limited amount of rice or bread last.
Choosing plain yoghurt when it fits the meal provides an early protein signal. Plain unsweetened curd or zamutdud supplies milk proteins, casein and whey, and generally causes only a small rise in blood sugar. Eaten at the start of a meal, these proteins stimulate an early release of insulin and glucagon-like peptide-1, so the body is already prepared when the starch arrives. In a clinical trial in type 2 diabetes, a whey protein drink taken before breakfast reduced the rise in glucose after the meal. Casein also forms soft curds in the stomach that empty slowly. In clinical observation with continuous glucose monitors, 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 remains a practical observation rather than a proven treatment. Always choose curd without sugar, honey, or sweetened fruit, and keep in mind that portion size and total calories still matter. People with lactose intolerance or dairy allergy will require an alternative.
Protein from fish, chicken, eggs, or dal slows stomach emptying further and stimulates gut hormones such as peptide YY, which act on appetite centres in the brain to increase fullness. Feeling satisfied sooner makes it easier to keep the rice or bread portion small. Dal also contains carbohydrate, so its portion counts towards the total for the meal.
By the time rice or roti is eaten last, the stomach is emptying more slowly, and the meal is thicker and richer in fibre, protein, and fat. The starch is still digested and absorbed, but more gradually. In studies, eating vegetables and protein before carbohydrate lowered the post-meal glucose peak by roughly a third and reduced the insulin response. Large, repeated swings in glucose after meals are associated with oxidative stress, which can injure blood vessels, so smoothing them may help protect the heart and arteries as well as improve glucose control.
The essential step is to reduce rapidly digested carbohydrates without unnecessary prohibitions. White rice, maida breads, sweetened bakery products, and sheermal can cause large glucose rises, especially in generous portions. The most important intervention is to reduce quantity and frequency. A small measured serving of rice or whole-wheat roti may fit an individual plan when eaten after vegetables and protein, whereas sheermal and other sweetened breads should be occasional foods, not daily staples.
Regarding cooled rice, when cooked rice is refrigerated, part of its starch changes into resistant starch, which is digested more slowly. In one study, white rice cooled for 24 hours and then reheated produced a smaller glucose rise than freshly cooked rice. Food safety matters, as cooked rice left at room temperature can grow bacteria whose toxin survives reheating. Put cooked rice into shallow containers and refrigerate it within two hours, keeping the refrigerator at 4°C or below. After about 24 hours, reheat only the portion you need until it is steaming hot throughout at 74°C, eat it promptly, and do not reheat it a second time. Portion size remains far more important than cooling.
Take A Walk
Walking after meals turns muscles into a sugar sink. In type 2 diabetes and prediabetes, the body responds poorly to insulin, mainly because the insulin signal inside the cell is impaired. Working muscle has a second route. During walking, signals within the muscle move glucose transporters called GLUT4 to the cell surface without needing insulin, letting sugar pass from the blood into the muscle to be used as fuel. This is why a short walk after meals lowers post-meal glucose and reduces how much insulin the pancreas must produce. A 10- to 15-minute walk soon after a meal can lower post-meal glucose effectively. A randomised crossover study found that short walks after each main meal improved post-meal glucose more than a single daily walk. Even two to five minutes of light walking helps, and in winter, walking indoors or climbing stairs works as well.
Hydration and continuous measurement remain central. Water is preferable to sweetened drinks, and dehydration can worsen illness when blood sugar is very high. Fluid intake must be individualised in people with heart failure, kidney disease, liver disease, or a tendency towards low sodium. Review continuous glucose monitor patterns over at least 10 to 14 days when available, confirm unexpected readings with a finger-stick meter, and repeat HbA1c after about three months. Follow weight, waist circumference, blood pressure, kidney health, and medication needs alongside glucose.
Do Not Stop Medicine
Do not reduce or stop prescribed medication or insulin on your own. Better food choices and more activity can lower glucose quickly, especially in people taking insulin or sulfonylureas such as glimepiride or gliclazide, and these medicines may need supervised adjustment to prevent hypoglycaemia. In my family member’s case, I made those adjustments myself as her physician, with continuous monitoring. Other medicines may remain important because they protect the heart and kidneys even when glucose improves.
Together, these steps make the rise in blood sugar after a meal smaller and slower. They do not stop sugar from entering the blood, nor do they make large portions safe. The family experience shows how quickly daily glucose patterns can respond to a disciplined routine, but it does not establish a cure. The clinically meaningful questions are whether the improvement is sustained, whether HbA1c falls over the next three months, whether medication can be adjusted safely, and whether cardiovascular and kidney risk factors also improve.
This is the second of the three-part series. Read the first and third parts here.
(The author is a renowned interventional cardiologist and heads the United States-based Fayaz Shawl Philanthropic Foundation. Ideas are personal.)
