WHAT IS DIABETES?
In simple terms diabetes prevents your body converting sugars and starches in your food into energy. The body uses insulin to do this. When diabetes is present the body fails to produce insulin or the insulin it does produce doesn’t work properly (insulin resistance).
When we eat food some special cells in our pancreas should produce insulin. The insulin transports glucose, made from carbohydrates (e.g. complex bulky sugars, which the body breaks down to use for energy) in the food, into the cells, where it can be used by the body for energy. Sugars and starches are the most efficient source of food energy and are carried in the blood as glucose.
If insulin is not produced, or does not work, the glucose builds up in the bloodstream instead of getting into the cells, causing the common symptoms of diabetes:
Lethargy: carbohydrate cannot be converted into energy.
Frequent passing water: the body flushes excess glucose down the toilet.
Thirst: the body attempts to replace lost fluid.
Repeated infections: bugs love sugar.
Weight loss: predominantly in type 1 diabetes.
Visual changes: due to temporary changes in lens shape.
Symptoms are more often to be found in people with type 1 diabetes. People with type 2 diabetes may have no, or very few symptoms, prior to diagnosis.
WHAT ARE THE DIFFERENT TYPES OF DIABETES?
In type 1 diabetes the pancreas fails to produce insulin and insulin therapy is required for life.
In type 2 diabetes the cause is generally weight related. If you are slim, it is likely your body is not producing enough insulin to convert the carbohydrate you eat into energy. You may need tablets and/or insulin to help. If you are overweight, it is more likely that insulin resistance is responsible.
Reducing your weight and being physically active will reduce your insulin resistance and could lead to remission, but you may need medication or have to inject insulin to help.
There are other types of diabetes, but they are unusual conditions and specialist care should be provided to support you with these.
CAUSES OF DIABETES
The cause of type 1 diabetes is unknown, but it is thought to be an auto-immune process. In effect the body produces antibodies to the pancreas, damaging it and preventing it producing insulin. Type 1 diabetes only affects about 10% of all people with diabetes and it usually starts below the age of 40.
Type 2 diabetes is more likely to affect older people, although it is being found increasingly in younger people – especially if they are overweight and lacking in physical activity.
Type 2 diabetes is strongly linked to obesity and tends to run in families. It is more prevalent in people of South Asian and Afro-Caribbean descent. Many people with type 2 diabetes have high blood pressure and cholesterol. They may need medication to help control these, to help reduce the risk of damage to key blood vessels alongside glucose lowering treatment.
Type 1 diabetes is always treated with insulin.
The backbone of treating type 2 diabetes is always healthy eating plus physical activity.
But type 2 diabetes is a progressive condition and, in time, tablets and/or other forms of medication may be likely to become necessary and may even progress to insulin injections.
Most people with diabetes require medication to control their condition yet fewer than half remember to take them as prescribed. When you agree to take medication make sure you know what each tablet is for, any side effects to be expected and when to have a review. Your medication is designed to prevent complications in the future even if you feel well now.
If we all ate the diet recommended for people with diabetes the health of the nation would be improved. The size of the plate matters too. If food intake exceeds physical activity undertaken, weight is likely to increase. A healthy, balanced diet is also recommended as part of a healthy and active lifestyle.
TOP TIPS TO MANAGE DIABETES AND IMPROVE YOUR HEALTH:
- Maintain a healthy Losing weight, if you are overweight, improves overall health and diabetes control.
- Be physically Physical activity improves insulin sensitivity.
- Keep blood glucose levels under This helps protect the eyes, kidneys and feet.
- Know your cholesterol Cholesterol lowering treatments (like statins) helps protect the heart.
- Have your blood pressure checked Good blood pressure levels protect the heart and kidneys.
- Do not Smoking is highly damaging, but much more so when combined with diabetes. Both thicken the blood, encourage clot formation, and put a strain on the heart.
A HEALTHY DIET AND DIABETES
Healthy eating is important for everyone, and a healthy diet is a key part of the treatment for diabetes. It answers the questions about what healthy eating is and why we should all be eating a healthy balanced diet.
Healthy eating for people with diabetes is important because it can help:
- Maintain blood glucose control and thereby reduce the risk of complications
- Reduce the risk of cardiovascular disease and the tissue damage associated with high blood glucose levels
- Support management of body weight
- Maintain quality of life and general health
A healthy diet is higher in vegetables, fruits, whole grains, low-fat dairy products, seafood, legumes and nuts; lower in red and processed meat; low in sugar-sweetened foods and drinks and refined grains.
The main type of nutrient in food that raises blood glucose levels is called carbohydrate, often referred to as ‘carbs’. Carbohydrates are found mainly in starchy and sugary foods. All carbohydrates, whether sugar or starch, processed or unprocessed, will affect blood glucose levels. Examples of foods containing carbohydrate are:
- Starchy foods including bread, potatoes, pasta, noodles, rice and all foods made with flour
- Pulses such as lentils, peas and beans including baked beans, chickpeas and mushy peas
- Sugary foods including cakes, chocolates, jams, squashes and fizzy drinks
- Foods containing natural All fruit contains a natural sugar called fructose. Milk contains a natural sugar called lactose
Recent evidence suggests that unprocessed and wholegrain carbohydrates (vegetables, fruit, wholegrain cereals) are healthier than potatoes and processed starches such as white bread, pasta and rice. Including some of these wholegrain starchy foods is a useful way of providing your body with the essential energy that it needs.
WHAT ABOUT SUGAR?
Sugar should be kept to a minimum in both the general population and people with diabetes. The maximum recommended amount for adults is approximately 6 teaspoonfuls a day. If you are attempting to lose weight you would be advised to keep sugary foods to a minimum.
Sugar substitutes and sweeteners
Non-nutritive sweeteners, commonly called artificial sweeteners, have little effect on blood glucose levels. There are other sweeteners known as nutritive sweeteners e.g. sorbitol and fructose. These nutritive sweeteners have some effect on blood glucose levels and provide calories so are not recommended for weight loss.
TOP TIPS FOR HEALTHY EATING:
Manage your weight
If you have type 2 diabetes and are overweight, losing weight will have a significant positive effect on your blood glucose control and cardiovascular risk, and may even put your diabetes into remission.
Studies show that there is not one ideal diet for weight loss and many different strategies including calorie counting, low fat diets, low GI (glycaemic index) diets, low carbohydrate diets, Mediterranean-style diets and attending slimming clubs are all effective. The best diet is the one that suits your lifestyle and which you are able to adopt long-term.
Many people are aware that they should be eating five or more portions of fruit and vegetables daily for good health.
There is growing evidence that a plant-based diet including at least five portions of fruit and vegetables daily reduces the risk of heart disease and cancer. A portion is about 80 grams (3 ounces) and you should try to eat a variety of fresh, frozen or canned (without added sugar) fruit and vegetables daily.
Potatoes are classed as starchy foods and do not contribute to your five-a-day. Remember fruit, and particularly fruit juices, contain natural sugars and will raise blood glucose levels but most vegetables, especially green and salad vegetables will have minimal effect.
Lower your risk of heart disease
A Mediterranean-style diet offers the greatest protection from heart disease and the key features are:
– Replacing saturated fats (found in red and processed meats and butter) with unsaturated fats (found in olive, rapeseed, sunflower and corn oils, nuts and seeds)
– Eating a plant-based diet of wholegrains, fruit and vegetables, nuts, seeds and legumes or pulses (peas and beans)
– Eating 2 or more portions of oily fish each week See figure 2
– Eating less red and processed meat, refined carbohydrates and sugar sweetened beverages
– Eating less salt (best achieved by reducing processed or convenience foods)
Lower alcohol intake
Recent guidelines state that there is no safe limit for alcohol, but that adults can lower risk by drinking no more than 14 units each week spread out over 3 days or more. Here is a rough guide to alcohol units:
– A pub measure of spirits (25ml): 1 unit
– Half a pint of ordinary strength beer, lager or cider (4%): 1 unit
– 1 small bottle (330ml) strong beer, lager or cider (5%): 1.5 units
– 1 small bottle (330ml) extra strong beer, lager or cider (6-7%): 2 units
– 1 medium glass (150ml) wine: 2 units
It is advisable to drink alcohol with or after foods containing carbohydrate. Alcohol is high in calories and can raise blood pressure, so keep drinking to a minimum. Also, remember that alcoholic drinks containing large amounts of sugar will raise blood glucose levels.
Adopting a healthy diet can help you manage your blood glucose levels, maintain a healthy weight and reduce the risks of cardiovascular disease and cancer. But remember, it’s not all about the food you eat — activity can help with weight and diabetes management.
DIABETES AND EXERCISE
Exercise is so important for people with diabetes. People who exercise have lower blood pressure, lower heart rates and improved circulation. They also have lower cholesterol and less body fat, as well as higher rates of metabolism and consequently better weight control. They sleep better, have more energy, are less stressed/anxious and are happier and more confident.
Why is exercise important for someone with diabetes?
Unlike medication, exercise is low cost and side-effect free. Those with diabetes who don’t exercise are three times more likely to have poor diabetes control and more likely to suffer related complications. Exercising regularly, apart from getting the benefits listed above, improves sensitivity to a range of metabolic hormones and the body becomes better at transporting glucose. This happens because exercise stimulates the body’s muscles.
Exercise also reduces the level of fat in the body, particularly round about the tummy area. It is thought that it is this mobilization of the body’s fat stores, by exercising, that might improve blood glucose control. Less glucose in the blood, because it’s now stored in the body’s muscle, means the blood flows better and some of the blood vessel complications, associated with diabetes, may be avoided.
How long do these effects from exercise last for?
The good news is that if someone regularly exercises these benefits can be permanent, and for someone with diabetes it can mean reducing their medication. If younger members of families with a predisposition to diabetes exercise regularly they could avoid diabetes altogether.
Even a little bit of exercise is better than none at all, and a little and often approach to exercise can be of benefit.
HOW MUCH EXERCISE SHOULD I BE TAKING?
Adults should be aiming to exercise at a moderate intensity for 30 minutes five days (but preferably most days) of the week. However, the same health benefits can be gained by breaking this down into 10 minute bouts of moderate activity. The overall aim should be to accumulate 150 minutes (2 1/2 hrs) of moderate activity per week.
What do we mean by moderate activity?
A scale known as Borg’s scale of Rate of Perceived Exertion (RPE) is used to rate how hard the exerciser is working. Moderate activity means the exerciser should feel some breathlessness, be aware that his/her pulse is raised, be sweating, know that he/she is using his/her muscles, but still be able to hold some brief conversation.
What types of exercise should be performed?
Three S’s make up the components of all-round exercise. These are strength, suppleness and stamina. To gain the benefits of exercise all these components should be included in the exercise routine.
Traditional exercise prescriptions focused on aerobic exercise, but it is now recognized that health benefits, particularly for people with diabetes, are best built upon by doing some strength (resistance) exercises too.
TOP TIPS TO GET STARTED:
- Start with small bouts of exercise of low intensity and build up gradually. Start with 5-10 minutes of activity per day for the first week, then add on 5 minutes per day until the target goal of 150 minutes (2 1/2 hrs) of moderate activity is
- Find an exercise partner
- Choose something you enjoy, as you are more likely to stick with
TOP TIPS TO EXERCISE SAFELY
- Build up
- Don’t ever try to lift maximum weights and never breath-hold when doing any weight or resistance-based exercises.
- Don’t try to do too much, stick to moderate intensity
- Don’t exercise when you are feeling ill, you are vomiting or have an
- Ensure that your footwear won’t cause blisters and practice good foot
To have all the benefits of exercise you must do it regularly and stick with it, so make sure you find something which is enjoyable and fun, it is not supposed to be a chore. Taking up exercise or becoming more active won’t just benefit diabetes it can also impact on any other disease and age-related problems you may have or could be at risk of.
HOW DO I MAKE SURE I’M EXERCISING SAFELY?
To prepare the body for exercise there must always be some kind of warm-up which involves gently raising the pulse and getting the muscles warm for 5-10 minutes before the main exercise activity.
It is also important to cool-down following exercise, to avoid feeling faint and dizzy and to help the body return to a resting state. Spend 5-10 minutes repeating the activities undertaken in the warm-up.