Living with type 2 diabetes - 12 + 1 major steps to help you manage your blood sugar
Diabetes Mellitus is a common non-communicable metabolic disorder characterized by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action or both. It is a leading cause of morbidity and mortality, and affects over 285 million people worldwide. Uncontrolled diabetes is associated with macro-vascular complications including cardiovascular disease (CVD), stroke and peripheral vascular disease leading to heart attacks, hemiplegia and amputations, and micro-vascular complications including neuropathy, retinopathy and nephropathy causing foot ulcers, blindness and kidney failure. Diabetes has also been associated with sexual dysfunction and depression as a result of reduced quality of life.
According to the World Health Organisation (WHO) diagnosis of diabetes can be made under any of the following circumstances:
- Fasting plasma glucose of 126mg/dL or greater
- 2-hour plasma glucose of 200mg/dL or greater following an oral glucose tolerance test
- Glycated Haemoglobin (HbA1c) of 48mmol/mol (6.5%) or greater
Type 1 Diabetes Mellitus
This type of diabetes is an autoimmune disease characterised by destruction of insulin producing cells of the pancreas. It has an unknown cause; however genetic factors and certain viruses may play a role in its development. It usually presents in children and young adults and accounts for approximately 10-20% of diabetes cases. It is treated with a combination of insulin replacement therapy and lifestyle modification.
Type 2 Diabetes Mellitus
This is most frequently diagnosed in middle aged or elderly people and is caused by a combination of impaired insulin secretion and resistance to the action of insulin. Although it has a strong genetic component it is highly associated with obesity and low levels of physical activity. Although it is most commonly diagnosed in people over the age of 40 years, it is now being increasingly diagnosed in obese children and adolescents.
Symptoms associated with diabetes
Insulin is the hormone responsible for regulating blood glucose levels (transports glucose to liver, muscle and adipose tissue cells to be utilised as energy) and is automatically released as blood glucose levels rise following carbohydrate intake. Carbohydrate is found in starchy foods including bread, pasta, rice and potatoes, in sugary foods such as sweets, chocolate and cakes, and as natural sugars in animal-derived milk and fruits.
Lack or impaired action of insulin leads to sustained hyperglycaemia, which in turn causes symptoms such as polyuria, polydipsia, fatigue, weight loss and increased susceptibility to infections. Since glucose cannot be utilised as energy when diabetes is uncontrolled, people rely mostly on fat stores and its by-products known as ketones for energy production. However, excessive production of ketones can cause acidity in the body and result in diabetic ketoacidosis, which can lead to coma and even death.
Why is good blood glucose control important?
The target for good control is HbA1c of less than 48mmol/mol, which reduces the risk of developing macro- and micro-vascular complications. In the short-term, good glycaemic control will enable the diabetic patient to have more energy, more restful sleep, improved physical performance and concentration, more stable moods and emotions and healthier skin and gums. Good glycaemic control is achieved by a combination of diet, pharmaceutical treatment and a healthy lifestyle.
People with diabetes have a two fold increased risk of cardiovascular disease (CVD) . As such, nutrition recommendations for diabetic patients are similar to those with an established heart disease (See below). In general, to reduce the CVD risk, it is recommended to improve blood lipid profiles and reduce blood pressure.
People with type 2 diabetes should eat a healthy diet, the same as somebody without diabetes. After being diagnosed with type 2 diabetes many people falsely believe that they should limit their carbohydrate intake to manage their blood glucose levels. This is not the case since someone with diabetes requires the same amount of carbohydrates per day as someone without diabetes. Of course the amount of carbohydrate eaten at each meal is the most significant predictor of blood glucose concentration; however, how much insulin the body still produces and how the body responds to it, the physical activity levels, the type of carbohydrate that is consumed, and the timing of carbohydrate intake, are also important factors that affect glycaemic control.
Carbohydrate counting and insulin adjustment
To achieve glycaemic control people with type 2 diabetes treated with insulin replacement therapy, should give emphasis on matching insulin to carbohydrate intake on a meal by meal basis. This process is known as carbohydrate counting and insulin adjustment, and requires one to calculate the amount of carbohydrate they consume at each meal and inject the appropriate amount of insulin. Calculating carbohydrate intake can be achieved using a variety of teaching aids including food exchange lists, picture charts, phone applications, food photographs and food models. Your current doctor will decide the amount of insulin you need to inject, and your registered dietitian will further educate you on how to count your carbohydrate intake on a meal by meal basis.
Dietary approach for the prevention and management of type 2 diabetes
- Weight management
Weight reduction in overweight or obese individuals is the dominant factor for type 2 diabetes prevention, with weight losses of 5-10% significantly lowering the risk. Lately, and as reported by Diabetes.co.uk, it has been shown that a balanced vegan diet can be an effective dietary strategy for weight loss and diabetes risk reduction. Researchers have shown that people with diabetes who eat a plant-based diet also lower their cholesterol and improve kidney functioning. Click here to find our guide and learn more on how to embrace a healthy, plant-based lifestyle.
- Glycaemic index (GI) of foods
Glycaemic index is a scale that ranks carbohydrate-containing foods based on how much they raise blood glucose levels. High GI foods cause large fluctuations in blood glucose, while low GI foods cause smaller fluctuations. It has been repeatedly shown that low GI diets can significantly improve glycaemic control and reduce hypoglycaemia in people with diabetes. Swap refined carbohydrates including white bread and pasta with wholegrain options, legumes, fruits and vegetables. You may also try to replace white pasta with pseudo-cereals such as millet, amaranth, quinoa and buckwheat. Ask your dietitian for a detailed list of foods with low, medium and high GI.
- Fat intake
Reduce your intake of all fats but especially saturated fats (e.g. butter, cheese, processed meat and pastry) since they increase blood cholesterol. It is recommended that saturated fat should make up less than 10% of daily energy intake, so as to reduce cardiovascular disease risk. Replace saturated fat with monounsaturated and polyunsaturated fats found in olive oil, avocado, almonds, walnuts, hemp seeds, chia seeds, flax-seeds, sunflower seeds, pumpkin seeds etc.
- Dietary fiber
There is not much evidence to support that dietary fiber aids in good glycaemic control, however there is a growing body of research suggesting that fiber, and especially soluble fiber, helps to reduce total and LDL cholesterols and prevent certain forms of cancer. Replace meat with beans, pulses and lentils to reduce fat and to increase the fiber content of your meals. Try adding legumes instead of meat to soups and stews.
- Omega-3 fatty acids
Oily fish like mackerel, sardines or salmon is a good source of the heart-protecting omega-3 fatty acids. If you are vegan or do not eat fish plant sources of omega-3 fatty acids include walnuts, hemp seeds, chia seeds and flax seeds. An omega-3 supplement derived from algae oil may also appear useful.
- Plant stanols and sterols
Plant stanols and sterols found in manufactured foods including margarine, yoghurt and yoghurt drinks can significantly lower cholesterol levels by at least 10% when taken at doses of 2g/day or greater.
- Fruits and vegetables
Aim for at least 5 portions of a variety of fruits and vegetables per day. Each portion corresponds to approximately 80gr of fruits or vegetables. Ask your dietitian what corresponds to a portion of fruit, since although fruits are highly nutritious, they also contain carbohydrates and affect blood glucose levels.
- Sugar intake
Sugar can be eaten if you have diabetes but you should not overdo it. Bear in mind that sugar sweetened beverages have been associated with obesity, type 2 diabetes and cardiovascular disease. Keep foods containing sugar to an occasional treat (i.e. once every week) and choose sugar free drinks. Artificial sweeteners including aspartame are safe to use and hence can replace table sugar.
- Salt intake
Be careful with how much salt you consume, especially if you have a high blood pressure. Most guidelines recommend reducing salt intakes to 5-6gr per day. Avoid or reduce using salt when cooking and avoid obviously salty foods like savory snacks and highly processed food products.
- Diabetic foods
Foods labelled as ‘diabetic’ offer no special benefits and there is no need to have them. They are often high in calories, may increase your blood glucose level and have a laxative effect. Ordinary products, eaten as part of a healthy diet, are best.
- Be more active
Being active is an important part of a healthy lifestyle and can help prevent heart disease, maintain your weight and make you feel good. For people with type 2 diabetes the benefits of exercising are clear and include improved glycaemic control and reductions in cardiovascular risk via improving blood lipids and blood pressure. If you are on an insulin replacement therapy, it can be challenging to balance your food, insulin and exercise to keep your blood glucose in the normal range. Your diabetes team will work with you to help you to achieve this balance.
- Drink enough fluids
Aim to drink at least 8–10 glasses of clear fluids per day. Water is best, but tea, coffee, herbal teas, sugar free squash and diet fizzy drinks can all contribute.
You can still drink alcohol if you have diabetes, unless you have been advised not to or you are under age. The safe limits for alcohol are 1-2 units/day with at least 4 alcohol-free days a week. Alcohol can lower your blood glucose and hypoglycaemia may develop up to 16 hours after you have stopped drinking. Avoid drinking alcohol on an empty stomach to prevent severe hypoglycaemia from occurring.