Healthier You Facts : DIABETES MELLITUS
Types of diabetes
- Type 1 – develops when the pancreas stops making insulin completely. People with type 1 diabetes must take insulin to help get the sugar into the cells. It often starts in younger people or in children. Researchers believe that it may occur when something goes wrong with the immune system.
- Type 2 – occurs when the pancreas cannot make enough insulin or the body becomes resistant to the insulin that is produced. Insulin resistance is often a result of being overweight or obese. This can happen in any age.
Prevention strategies consist of one of the following:
- control risk factors associated with diabetes through weight reduction (if overweight or obese), stress management and active lifestyle especially when one has a family history of diabetes and is age 45 and above.
- delay or stop progression of prediabetes to diabetic stage by adhering to a calorie-controlled diet , regular physical activity and exercise, reducing stress, and modifying behavior
- prevent acute and chronic complications of diabetes i.e. hypoglycemia, ketoacidosis, hyperglycemia, retinopathy, cardiomyopathy, nephropathy, neuropathy, by balancing medications , diet, and physical activity.
Hyperglycemia (high blood glucose)
Hypoglycemia (low blood glucose)
Pre-diabetes is a condition that comes before diabetes. It means that blood sugar levels are higher than normal but are not high enough to be called diabetes. One can have prediabetes and not know it. About 10 % of those with pre-diabetes can develop complications. Hence, even if one is younger than age 45, consider getting tested for pre-diabetes
if overweight/obese ( BMI ≥ 23 ) and ……..
- physically inactive ≥ three times a week
-has a parent, brother, or sister with diabetes
-has high blood pressure, abnormal waist circumference ( WC)
(for Asians, WC ≥ 35 / ≥ 31in , men/women, respectively)
-has abnormal levels of HDL/LDL cholesterol or triglycerides
-has gestational diabetes (diabetes during pregnancy) or gave birth to a baby weighing more than 9 pounds
-African American, Hispanic/Latino, Asian American, or Pacific Islander
-has polycystic ovary syndrome
-has dark, thick, velvety skin around the neck or in the armpits
-has blood vessel problems affecting the heart, brain, or legs
Gestational diabetes mellitus ( GDM) is typically diagnosed during the 24th to 28th week of pregnancy. The pancreas is unable to produce the extra insulin that is needed during the last part of a pregnancy. It usually disappears after the baby’s birth. Women who have had GDM still have a high risk of developing type 2 diabetes within 5 to 10 years.
Lifestyle choices can influence risk of both diabetes and cancer. Many strategies that promote control of diabetes also decrease risk of cancer : reduce excess body fat, at least 30 minutes/day of moderate intensity physical activity, and emphasis on minimally processed, fiber-containing plant foods ( 14 g fiber/1000 calories).
High protein diets (>20%) are not recommended. A moderate carbohydrate intake ( 45-65%), no less than 130 g daily ( 175 g for GDM), is appropriate.
The strongest evidence supports an increased intake of whole grains and dietary fiber to improve insulin sensitivity and reduce the risk of complications.
Exercise significantly increases insulin response, decreases hemoglobin A1c, and decreases plasma triglycerides. This is associated with a reduction in visceral and subcutaneous adipose tissue.
Myths about Diabetes
Carbohydrates are bad for diabetes
In fact, carbohydrates -- or "carbs" as commonly called -- are good for diabetes. They form the foundation of a healthy diet as the main source of fuel ( energy) to the body. Carbohydrate is the only energy-producing nutrient that raises blood sugar levels , which is why one should plan and monitor how many carbohydrates to have and have been eaten at each meal/snack . Note that only carbs get stored in the muscles as glycogen and depleted muscle glycogen stores are associated with fatigue.
Protein is better than carbohydrates for diabetes.
Because carbs affect blood sugar levels so quickly, a person with diabetes is tempted to eat less of them and substitute more protein. Hence, guidelines have been set up by experts to achieve a balanced diet with proportionate amounts of energy-giving nutrients: carbohydrates, protein, and fat. What is important is to count carbohydrates and match it with the medications and physical activity.
One has to give up refined sugar and desserts .
The well-documented “ carbohydrate counting” does not eliminate any food, even confectioneries. Studies show blood glucose levels peak at about the same time regardless of the carbohydrate source. On the other hand, strategies can be worked out to include desserts: use artificial sweeteners, cut back on the amount of dessert, use less sugar and add whole grains, nuts, fresh fruits. Try diabetic recipes-substitutions from cookbooks. Or visit www.food.com
Artificial sweeteners are not safe for persons with diabetes.
Artificial sweeteners are much sweeter than the equivalent amount of sugar.
They contain little or no calories at all. The American Diabetes Association approves the use of artificial sweeteners : saccharin (Sweet'N Low), aspartame (NutraSweet, Equal), acesulfame potassium (Sunett),sucralose (Splenda). Regarding stevia, the US FDA has approved its use as a dietary supplement added to food and drinks. The manufacturer of a dietary supplement is responsible for making sure it is safe before it is sold..
One needs to eat special diabetic meals.
The truth is that there really is no such as thing as a "diabetic diet." The foods that are healthy for people with diabetes are also good choices for the rest of the family. There is no need to prepare special diabetic meals. However, unlike a normal diet, consistency in amount of carbohydrates, time when meals and snacks are eaten, and portion sizes must be consistently maintained everyday. No meal must be skipped or delayed.
Diet foods are the best choices for diabetes.
Just because a food is labeled as a "diet" food does not mean it is a better choice.. In fact, "diet" foods can be expensive and no more healthy than foods found in the "regular" sections of the grocery store. Read labels carefully , the nutrition facts including size per serving and the total carbohydrates. This is the best choice for persons with diabetes.
People with diabetes do not have to worry about eating fat because it does not have much of an effect on blood glucose.
Fat, found in oils, margarines, and salad dressings, has little immediate effect on blood glucose levels. However, eating a fatty meal can slow down digestion and make it harder for insulin to work. This causes a delayed high blood glucose level hours after a fatty meal. Furthermore, some fats raise blood cholesterol, while others contain trans fatty acids which raise “ bad” LDL cholesterol, lower the “good” HDL cholesterol. Fat is calorie-dense, hence, not for one who is trying to lose weight.
Frequently Asked Questions
What can I eat?
Persons with diabetes can now make choices that include their favorite foods. There is no “one-size fits all diet.” A registered dietitian can help plan one’s meals. Nutrition basics still have to be taken into account:
- eat a variety of foods i.e. include vegetables, fruits, whole grains, lean meats or meat substitutes, non-fat dairy foods, “good” fats.
- avoid eating too much or too much of one type of food.
- space meals evenly throughout the day without skipping any meal.
What is carbohydrate counting?
Oftentimes called carb counting, it is a meal-planning tool that tells how many grams or choices of carbohydrates one can have at each meal/snack. About 15 grams of carb equals one choice. The goal is to control blood glucose more easily than if one ate random amounts of carb throughout the day. It also facilitates insulin and carb adjustment within a meal.
What is glycemic index (GI)?
It is a method of ranking carbohydrate foods on a scale ( 0-100) according to how rapid a particular food is converted to glucose. The higher the GI value, the greater the body’s ability to rapidly raise the blood glucose levels The lower GI foods ( ≤ 55) consisting of complex carbohydrates and high fiber foods like whole wheat bread, brown rice, legumes, nuts, etc . They are slowly digested and absorbed leading to better control of blood. GI “fine-tunes” food choices to produce modest improvement in postmeal blood glucose level. While GI is a helpful tool, what is important is to control amount of carbohydrate that one eats.
I have been prescribed insulin. Am I a “ bad diabetic?”
If you have type 1 diabetes, you must take insulin to survive. If you have
type 2 , starting insulin treatment means you are aware of the importance of good glucose control and realize that going on insulin offers better control over blood glucose. Other benefits include: cardioprotection, anti-inflammation, vasodilatation, prevention of lipolysis and ketogenesis.
Insulin preserves beta-cell function.
American Institute of Cancer Research ( AICR) www.aicr.org
The Calorie King. Calorie Fat & Carbohydrate Counter. 2010 ed. www.CalorieKing.com
Powers, M. 2003. The American Dietetic Association Guide to Eating Right When You Have Diabetes.
American Diabetes Association. What can I eat? The Diabetes Guide to Healthy Food Choices. 2010
American Diabetes Association/American Dietetic Association. Count Your Carbs: Getting Started. 2010