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You are what you eat: Thoughts on the diabetic diet

By Sue Marshall

Diabetes is on the increase — it’s like Invasion of the Body Snatchers. Now 1 in 40 in the UK population has a form of the condition. With more reason than most, people with diabetes have to watch what they eat.

Some people with diabetes are controlled via diet alone, encouraged to take less sugar and fat and to follow a low GI diet. Others must inject insulin and do blood tests as well as be aware of what they eat. Central to controlling the condition — it used to be called a disease, it’s now called a ‘chronic condition’ — is testing and controlling of blood sugar levels. For people with diabetes, your blood sugars very directly reflect what you eat.

There’s never been a better time to have diabetes, not only because of the fact that much more is known about treating the condition than ever before, but there’s much more information available to those who have it. Also, there are more people who have it, so you’re less isolated. There’s also a lot of quite funky kit out there with which to help people with diabetes to control their condition.

Among the tools available are blood test machines, many of which are no bigger than a mobile phone. Several come with their own software, which means that you can keep a list of your results on your home or work PC, saving you the tedium of writing down the results all day long. There are insulin injection pens that look just like posh writing instruments and even the painful art of finger pricking (necessary to get the drop of blood used for testing how much sugar is in your bloodstream at any one time) is improving with a new device from Roche called the Multiclix which changes lancets for you without the need to handle the lancets themselves, nor a need for a ‘sharps’ disposal bin. All in all, far easier than old-fangled devices! Doing blood tests is a necessary evil for those who have diabetes, but they are faster to do than ever before, with tests taking on average only 5 seconds before you get your result.

The insulin injection device has also moved on a long way since the use of glass or plastic syringes and vials of insulin. Most people with diabetes use insulin ‘pens’ which have cartridges of insulin and disposable replaceable needles. Some of these are even quite smart – the new one from Eli Lilly, the Humapen Luxura is as posh as the name suggests. A more modern insulin delivery innovation is the insulin pump which drips a continuous flow of insulin into the body, with extra doses given at meal times. The pump reservoir delivers insulin to the body by a thin plastic tube called an ‘infusion set’ which is permanently in place.

No matter which tools you use, the other knowledge you will need to get a good handle on if you are diagnosed as having diabetes is how your diet affects your blood sugars.

Put very simply, people with diabetes cannot control their blood sugars. In ‘normal’ people, blood sugar is controlled by the pituitary gland, an endocrine gland attached to the base of the brain the secretions of which control the other endocrine glands and influence growth, metabolism, and maturation. Among other things, it regulates the uptake of energy from digesting food and the release of energy from the liver.

To counter these releases of energy which make the blood sugar rise, the pituitary sends a signal to the pancreas to release the hormone insulin, which helps to bring blood sugar levels down. This process occurs automatically in non-diabetics, without any noticeable signs that the process is underway. Those who have the condition have to inject insulin in order to mimic that same control. That means knowing about what you are eating, the likely impact a certain food will have on your blood sugar levels, such as how quickly it will be absorbed, and judging how much insulin to take, bearing in mind what kind of energy expenditure you’re anticipating in the next few hours.

THE DIABETIC DIET
The great thing about the diet recommended for people with diabetes is that it’s about as healthy as it gets – low in sugar, low in fat and yet with plenty of variation allowed within those parameters.

The GI Diet, which has had a lot of coverage recently, was originally conceived to help people with diabetes understand how the food they eat affects their blood sugar levels. The Glycaemic Index is a measure of how quickly sugars in foods are released into the blood stream. The index alone is not a diet. Knowing which foods give which peaks, using the GI, can be a great help in maintaining more consistent blood sugar levels. All foods have different sugar contents. Some of them are classed as carbohydrates, and of these some are referred to as complex carbohydrates.

Complex carbs, like porridge and bananas, have a slow release pattern, which gives a more stable blood sugar level over a period of time. Labels on foods are an increasingly helpful tool for this, once you learn how to read them. People with diabetes also need to be aware that combining foods (a cheese and tomato sandwich for example) gives a Glycaemic Load. This means that the fat content of the cheese might combine with the carbs in the bread to slow down the release of energy from the carb (as cheese has no carbs but as a protein it does have an energy value for the body).

It sounds confusing and it can be, but a diabetic watching their blood sugars is able to see what effect certain foods are having on them. If I have a meal that’s either unusually big meal, or indulge in a pudding where I normally abstain or make do with a spoonful of someone else’s if they let me, I make the best judgement I can about the food I’m having but will do an extra test shortly afterwards to see how I’m doing. Giving myself too much or too little insulin can have undesirable consequences and I’d rather be safe than sorry.

BLOOD SUGAR RATINGS
For someone without diabetes, you can have a can of coke and your body will metabolise it so well that while you’ll have an energy boost, it will soon be under control. A person with diabetes would have a much rougher time of it. Normal blood sugar levels are approximately between 4 and 8 millimoles per litre (mmol/L).

For people with Type 1 diabetes (also known as insulin dependent diabetes) it’s recommended that you test your blood sugar at least three times a day. Any change in routine — exercising more than normal, eating less than usual or travelling — is another good reason to test your blood sugar. If you have type 2, which means you take oral medication alone or oral medication as well as insulin to manage your diabetes you may only need to test your blood sugar once a day. In general, if you’re able to control your blood sugar with diet and exercise — without the use of medication — may not need to test your blood sugar as often.

In the UK, about 4% of the population has some form of diabetes, and it’s on the increase. Roughly 25% of all those diagnosed have Type 1 diabetes, with more and more Type 2 diabetics being treated on insulin, so having to inject and do more frequent blood tests. But while it’s a shame it’s on the rise as a medical condition, at least it’s controllable. With some good advice, some understanding of what you’re eating and the effect it has on your blood sugars, and a healthy dose of discipline you can find a balance between having a chronic condition and having a life. Like any way of life, once you get used to it, it isn’t all that bad. Certainly food needn’t be something that you have to stay away from, you just need to know what you’re dealing with.

Symptoms

The main symptoms of diabetes are*:
• increased thirst
• going to wee all the time – especially at night
• extreme tiredness
• weight loss
• blurred vision.

Type 2 diabetes develops slowly and the symptoms are usually less severe. Some people may not notice any symptoms at all and their diabetes is only picked up in a routine medical check up. Some people may put the symptoms down to ‘getting older’ or ‘overwork’.

Type 1 diabetes develops much more quickly, usually over a few weeks, and symptoms are normally very obvious.

In both types of diabetes, the symptoms are quickly relieved once the diabetes is treated. Early treatment will also reduce the chances of developing serious health problems.
*Information from Diabetes UK

Contacts
Diabetes UK
020- 7424-1000
www.diabetes.org.uk

Further reading:
• The GI Diet by Rick Gallup published by Virgin Books or www.gidiet.com
• Easy GI Diet by Helen Foster published by Hamyln
• GI Guide: How to Succeed Using the Glycemic Index Diet (Collins Gem S.) published by Collins

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