280 Australians develop diabetes every day. That’s one person every five minutes! It is estimated that there are 1.7 million Australians with diabetes right now, and that number continues to grow.
National Diabetes Week (13-20 July) has just passed week, but it remains important to shed some light on this highly prevalent disease.
What is diabetes?
Diabetes is a condition characterised by the body’s inability to regulate blood glucose levels. In order for glucose to enter our cells and convert to energy, we rely on a hormone known as insulin. In diabetes, insulin production is either impaired (e.g. the pancreas doesn’t make any/enough) or cells fail to respond to insulin appropriately (known as insulin resistance).
There are 3 different types of diabetes.
Type 1 diabetes: This is the less common form of diabetes (approx. 10% of cases). Type 1 diabetes is an autoimmune condition in which the body’s immune system has attacked the pancreas and caused it to stop producing insulin. Insulin injections through an insulin pump and testing blood glucose levels are required in the daily management of Type 1 diabetes.
Unlike Type 2 diabetes, T1 is not linked to any modifiable lifestyle factors and cannot be prevented or cured. Without ongoing insulin injections, individuals with T1 diabetes are at risk of the life-threatening condition ketoacidosis.
Type 2 diabetes: This is the most predominant form of diabetes (approx. 85-90% of cases). T2 Diabetes is a progressive condition where the cells become less & less responsive to insulin and/or the pancreas loses its capacity to produce adequate insulin.
In its early stages, T2 diabetes is highly responsive to positive lifestyle changes such as regular physical exercise, weight reduction and healthy eating. The longer the condition goes without proper management, the more likely the need for oral medications and insulin injections become.
Symptoms of T2 diabetes include:
* Being excessively thirsty
* Passing more urine
* Feeling tired and lethargic
* Always feeling hungry
* Having cuts that heal slowly
* Itching, skin infections
* Blurred vision
* Gradually putting on weight
* Mood swings
* Feeling dizzy
* Leg cramps
The 3rd type of diabetes is Gestational Diabetes which occurs during pregnancy and often resolves after the baby is born.
So now that we know a bit more about diabetes, what’s next? Is it really as simple as eating well & exercising? Well – yes and no. Diabetes is a serious & complex disease and its effects can impact the whole body. While a healthy diet and regular exercise can definitely improve the condition, that doesn’t mean the same thing for everyone.
Here are my tips on how to manage (or prevent) T2 diabetes.
Everyone who exercises regularly will benefit in some way. This is also true for diabetics. In fact, exercise is integral in the presentation & management of many chronic diseases including diabetes.
A good goal to aim for is 30 minutes of exercise per day. This can be done in one continuous work out or in 3 x 10 minute intervals if required. If weight loss is the goal, increasing this time to 45-60 minutes may be necessary.
Exercise can include walking, swimming, gardening, golfing, yoga, cycling… the list goes on! Regular weight bearing/resistance training exercises improve insulin sensitivity (helps to regulate blood sugar) and actually reduces the incidence of developing T2 diabetes by a whopping 32%!
For a person with diabetes, regular exercise will help:
* Insulin to work better, which will improve your blood glucose management
* Maintain a healthy weight (reduce abdominal adiposity i.e. fat)
* Lower your blood pressure
* Reduce your risk of heart disease
* Reduce stress
If you already have diabetes, be mindful to consume adequate carbohydrates before & after exercise and take care of your feet (as ulcers/lesions to feet can be very dangerous for diabetics, particularly the elderly, and wound-healing is impaired in diabetes).
As usual – keep your water intake up, especially after exercise. When changing your routine to include more exercise, be sure to speak to your GP about monitoring your blood glucose (before, during & after exercise if possible) and adjusting your insulin dose (if you require it).
FOOD & DIET
Extensive study of individuals suffering with type 2 diabetes confirms that it is, in fact, a disease of diet & lifestyle. That being said, diet & lifestyle modification have been shown to reduce insulin resistance and improve general health in those with & without diabetes.
There are several terms you should be familiar with if you have been diagnosed with T2 diabetes. These include:
*Glycaemic Index- a way of ranking carbohydrate-containing foods according to their effect of blood glucose. The lower the number, the slower the rise in glucose (out of 100).
*Glycaemic Load- a measure of how much carbohydrate there is in a typical serving of a particular food (some foods may be high in GI but actually contain little carbohydrates so the effect on blood glucose may be minimal).
*Carbohydrate counting- a meal planning tool used in diabetes management to help optimize blood sugar control (1 serving of carbohydrate = 15g of carbohydrate).
As you can already probably tell, aiming for foods with low GI & GL is ideal. However, it is important to note that some foods that are high in GI, are actually low in GL – meaning they are still suitable (and good to include) in a diabetic’s diet e.g. pumpkin & carrot.
In addition to GI & GL, it is necessary to consider the degree of processing, ripeness, acidity and saltiness of a food. In short:
*the more processed/refined a food is, the higher its GI is
*the riper the food, the higher the GI
*more acidic foods slow stomach emptying and reduce the GI of a meal
*salt & salty foods increase the rate of starch digestion and glucose absorption and thus increase GI
The type of fibre, starch and sugar of a food/meal also impact on its GI rating:
*soluble fibre slows digestion of starches and absorption of glucose (lower GI)
*resistant starch is digested more slowly & releases glucose into the blood more slowly
💡 FUN FACT: cold cooked potato & pasta contain more resistant starch than their freshly cooked counterparts – meaning they are lower GI (& are great for your gut bacteria!)
*glucose (a type of sugar) has the most dramatic impact on blood glucose of all sugars (higher GI)
Food with a low GI is not necessarily a healthier choice (think chocolate bars, ice cream etc.), but may simply indicate a higher fat percentage. It’s important to consider the combination of foods eaten together as well, to get a more accurate understanding of its effect on blood glucose.
General dietary inclusions:
✅low GI/GL fresh fruits & vegetables
✅choose complex carbohydrates over refined/simple carbs
✅consume lean or vegetarian protein at every meal
General dietary exclusions:
❌avoid high GI/GL foods
❌avoid alcohol, refined foods, caffeine, sugar in any form (inc. artificial sources) & soft drinks (especially diet)
❌avoid trans fats, deep fried foods and oxidised oils
❌all smoked & cured foods
Low GI foods include (but are not limited to):
Fruits: grapefruit, peach, apricot, apple, pear, plum, orange, grapes, banana, cherries, mango, dates
Vegetables: sweet potato, cooled cooked potato, broccoli, cauliflower, kale, brussel sprouts, leafy greens
Legumes: kidney beans, soy beans, chickpeas, lentils, black beans
Bread: opt for wholemeal & wholegrain varieties
Grains: wholemeal pasta, quinoa, brown rice, rolled or steel cut oats, buckwheat
Have you heard that a ketogenic diet can help manage your diabetes? Well – in a way it can, but for how long? While a ketogenic diet may keep blood glucose levels low in the short term, it does nothing to actually improve insulin sensitivity in the long run. Once carbohydrates are reintroduced to your diet, it’s likely that the condition with re-emerge, unless other changes (weight loss etc.) have been made.
There are quite a few nutritional supplements that may assist with stabilising blood glucose levels and improving insulin sensitivity, when taken alongside medication or alone as a natural alternative.
Please keep in mind, nutritional supplements (nutritional medicines, really) should ALWAYS be prescribed by a healthcare professional such as a nutritionist like myself or a naturopath as even natural supplements can have side effects or adverse interactions with other supplements/medications.
When speaking to your natural health practitioner, they can assess your overall health and decide what nutritional supplements would suit you best and which dosage would be most effective.
Here are a few examples of nutritional supplements (micronutrients) that may help manage diabetes:
🔅Chromium- essential for glucose uptake into the cells
🔅Magnesium- deficiency of magnesium has been found to be related to poor glycaemic control and impairment of insulin secretion & function
🔅Vitamin C- involved in releasing insulin in response to glucose
🔅Vitamin D- supplementation has been shown to improve glucose & insulin control but also hypertension
🔅Essential Fatty Acids- EFAs (notably omega-3s) are required for energy & glucose regulation
🔅Coenzyme 10- CoQ10 may contribute to protection against metabolic syndrome (a cluster of conditions that increase the risk of heart disease, stroke and diabetes)
🔅Inositol- acts as an insulin sensitiser, which increases glucose uptake from the blood into cells
This list is by no means exhaustive, and it is important to remember that each micronutrient may interact differently with different people.
❗️Please always consult with a nutritionist or naturopath before commencing any kind of supplementation – particularly if you have been diagnosed with a chronic disease like diabetes.❗️
So what lifestyle factors should you take into account when diagnosed with diabetes (or to prevent its development)?
EXERCISE & IDEAL BODY WEIGHT
*Exercise directly improves insulin sensitivity & blood glucose control due to a combination of increased lean muscle mass & an improvement in muscle cell metabolism
*If overweight, a reduction of 5-7% body weight will be one of the most effective ways to improve insulin sensitivity & function
FOOD & DIET
*Food choices have a huge impact on diabetes management (or lack thereof) and is an integral factor in both the development & treatment of T2 diabetes
*As per our post 2 days ago re: food & diet, following a low GI/GL diet, with plenty of non-starchy vegetables and lean/vegetarian protein with every meal is a general guideline to stabilising blood glucose & reducing insulin resistance
MENTAL & EMOTIONAL WELLBEING
*It’s important to address any sense of disempowerment or helplessness associated with a diabetes diagnosis, through individual or group counselling (or support from a practitioner such as a holistic nutritionist like myself). Education + encouragement will lead to empowerment and responsibility for your own health.
*High stress levels are associated with higher blood glucose levels through increased cortisol and adrenalin (stress hormones). Therefore it’s critical to adopt stress-management techniques such as relaxation, meditation, yoga, counselling & exercise
🚫WHAT NOT TO DO🚫
It is recommended to avoid smoking, use of recreational drugs and alcohol (for obvious reasons).
A diabetes diagnosis is not the end of life as you know it. While there are definitely some lifestyle & dietary modifications to be made to manage your condition, life is still there for you to enjoy! I can help you get there and STAY there. Let’s chat!