IN MY first article on diabetes, I wrote about the disease from a medical point of view, and only briefly about how it should be managed by the individual who is affected. This time, I will concentrate on the lifestyle changes needed to combat diabetes, and in researching for this article, one thing has become clear to me: I need to make these changes as well!
I am overweight – four out of five people diagnosed with diabetes are – and carrying extra weight, especially around the waist, causes the insulin the body produces to work less effectively, which is how diabetes begins. I am in my 40s and my family has a history of diabetes … so I am a prime candidate to develop not only diabetes but high blood pressure, dyslipidemia and heart disease among others. This has now been given a medical term, Metabolic Syndrome and will be the ‘plague’ of the 21st century, with the advent of the so-called ‘Nintendo Children’ leading to obesity through inactivity, and unhealthy eating patterns. So, although this article targets Diabetes specifically, much of it is definitely aimed at everyone who wants to live a long and HEALTHY life.
Living well with diabetes means avoiding the problems which arise from prolonged hyperglycaemia (elevated blood sugar levels), or repeated episodes of hypoglycaemia (low blood glucose levels), and involves several factors that work in opposite directions. For example, activity, insulin and the passage of time, all lower blood glucose, whereas food and stress can elevate it. Thus, to achieve the right balance, diabetics need to regulate their habits on a daily basis.
Caring for diabetes is difficult for a number of reasons. Ideally, when we have to learn new and complicated routines, we prefer to try these out in a gradual way until they replace the old ones. Research has shown that, in general, changes occur best when simple changes are made at first and then gradually over time. But with diabetes, the individual has to learn and try to manage a large number of new behaviours very quickly and start to use them immediately – this usually includes self testing, dietary modifications, use of medication or insulin and exercise. Another principle of successful behavioural changes is the opportunity to take breaks or a ‘time out’ from these new routines, but unfortunately there are no weekends off, holidays or retirement from this disease, as self-care has to be constant.
Another important influence is the emotional and social impact diabetes has on the individual. The disease may be perceived as a burden, and can be hard to accept, which may lead to depression through feeling overwhelmed, anxiety through fear of complications, and frustration due to the demands of having diabetes. Social problems include the fact that this disease does not only affect the individual, but also has implications for family members and friends. To a certain extent, depending on their relationship with the diabetic, they also have to be educated about this illness and it may also mean a drastic change in lifestyle revolving around the diabetic. For example, the family with a diabetic child will need to be heavily involved in all aspects of treatment, from medication, glucose testing with interpretation of the results, diet, exercise, the signs and symptoms of hypo and hyperglycaemia and how to treat these potentially life threatening situations.
Many people think that the treatment for diabetes is very straightforward once the right medication has been given, not realising that, as well as the daily routine of medication or insulin, there is self testing of glucose levels which can be at various times of the day, depending on the severity of the diabetes, plus a specific diet and exercise. They find it difficult to understand the needs of someone who is diabetic and, even if they mean well, they may act in ways that are not supportive, for example, encouraging a diabetic to eat something they should not – “once cannot hurt”!
In my first article on diabetes I explained what diabetes was, how it affected the body, and the treatment available. Another very important aspect of treatment is diet. For many years people who suffered from diabetes were advised to avoid sugars and sweets, but the thinking today is that the impact of sugars, sweets and starches on blood glucose is quite similar. Therefore, they are now advised that priority should be given to the total amount of carbohydrate in the diet rather than the source of the carbohydrate and, for this reason, sugars and sweets can be part of the diabetic diet.
There are three main nutrients in food – carbohydrates, proteins and fats. Carbohydrate foods most often come from plants such as fruit, vegetables and grains. We all need energy and your body needs fuel to create the energy – carbohydrate is that fuel, the nutrient that converts to energy. Carbohydrates are chains of sugar molecules so they have the greatest effect on the blood sugar levels when these chains are digested (broken down).
There are three main groups of carbohydrates: Complex carbohydrates are longer chains of sugar, which means they are absorbed more slowly into the blood, therefore causing a slower change in blood sugar than simple carbohydrates. Examples of complex carbohydrates include the starch found in potatoes, rice, pasta, peas and whole grain bread. Examples of simple carbohydrates are fruit juices, jams, sweets, cakes and ice cream. The third group is fibre, which is very complex and cannot be broken down by the digestive tract. It aids in weight loss and delays sugar absorption into the blood stream.
Ninety to 100 per cent of carbohydrates eaten are converted to sugar (glucose) within 15 to 90 minutes whereas only 58 per cent of protein and less than 10 per cent of fat are converted into sugar within several hours after consumption.
Due to this new school of thought on monitoring carbohydrates, various guidelines have been drawn up to help the diabetic in choosing what is a healthy balance for them in maintaining good blood glucose control, weight management, and control of blood fats such as cholesterol and triglycerides. Diabetics are encouraged to visit a dietician to help them with this very important aspect of their disease. One such guideline is the Diabetic Food Pyramid that divides food into six groups. These groups or sections on the pyramid vary in size, with the largest group, grains, beans and starchy vegetables on the bottom. This means that you should eat more servings of this group than any other. The smallest group with fats sweets and alcohol is at the top of the pyramid, and should be eaten sparingly. The exact number of servings needed depends on the individual, their diabetic goals, calorie and nutritional needs, lifestyle, and the foods they like to eat. In practise, it is important to try to eat a similar amount of carbohydrates every day and spread the intake over the course of the daily meals.
Another method of controlling carbohydrate intake is to choose those that have a low GI (Glycaemic Index). This is a way of ranking foods that contain carbohydrates to show their effect on glucose levels. Choosing high GI foods produces a large fluctuation in the blood glucose and insulin levels, whereas choosing low GI carbs produces only small fluctuations in the blood glucose and insulin levels and is one of the secrets to long term health. This leads towards a reduction of heart disease, diabetes and sustainable weight loss. Some examples of low GI foods are apples, pasta, porridge and beans. High GI foods include white and wholemeal bread, white rice and baked potatoes.
Nowadays, greater emphasis is placed on the benefits of regular exercise and weight management. Overweight diabetics who lose the extra weight will make the disease easier to control. The body’s resistance to insulin will improve and, therefore, there will be more effective control of the blood glucose level. Losing weight, even a small amount will help:
• Reduce the risk of heart disease
• Lower blood pressure and blood fats (cholesterol and triglycerides).
• Improve mobility and reduce stress on the joints.
• Increase energy levels and improve
As one of the most serious long-term risks of diabetes is cardiovascular disease, keeping a healthy stable weight and eating a balanced diet will help to reduce the overall risk.
Exercise, combined with diet, is also essential to the diabetic as they both play an important role in regulating blood sugar. Again it also helps delay or stop cardiovascular disease.
There are many great benefits of exercise and physical activity:
• Reduces the risk of coronary heart
• Reduces the risk of high blood pressure, colon cancer, and diabetes.
• Can help reduce blood pressure in some people with hypertension.
• Helps maintain healthy bones, muscles, and joints.
• Reduces symptoms of anxiety and depression and fosters improvements in mood and feelings of wellbeing.
• Can take some glucose out of the blood to use for energy during and after exercise.
• Helps control weight, develop lean muscle, and reduce body fat.
Before beginning an exercise programme, anyone with diabetes should have a thorough medical examination.
In conclusion, I would like to say that even though I am not a diabetic, I have been following many of the above guidelines, swapping high GI foods for low, making sure I select the right food groups and upping my exercise levels. I have found that using these methods has lead to a steady loss of weight (eight kilos in two months so far) and a steady increase in wellbeing which, in the long run, I hope will help stave off many of the health risks I may face later on in life, including diabetes. As with diabetics, I have also taken on a different approach in that I am not on a diet, but have modified many of my lifestyle habits to achieve my goals.
Luzdoc Practice Nurse.
Diabetic Clinic Nurse