Understanding Diabetes

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Diabetes is the name given to a condition where there are large amounts of glucose (a type of sugar) in the blood. If left untreated, diabetes can be a serious condition as consistently high levels of glucose in the blood can damage blood vessels affecting the heart, kidneys, eyes and nerves. The good news is though that though diabetes can’t be cured, it can be controlled with the right treatment and lifestyle changes.

WHAT IS GOING ON IN MY BODY WHEN I HAVE DIABETES?

All the foods and liquids we eat are broken down in the gut and turned into glucose. From the gut the glucose moves into the blood and is carried into the body cells with the help of insulin, a hormone made by the pancreas, much like a key unlocks a door. After entering your body cells, the glucose is used to make energy for your body to function.

When you have diabetes your pancreas effectively goes on ‘strike’- either it does not make enough insulin or it is not able to use the insulin in makes properly. Because of this glucose cannot move into your cells to be used as energy, and accumulates in the blood causing abnormally high glucose levels. This is why feeling tired and weak is one of the first symptoms of diabetes. Other signs and symptoms of diabetes include going to the toilet more often than normal, always thirsty, eating more than usual, blurry vision, wounds that heal very slowly, itchy skin, and sexual dysfunction.

TYPES OF DIABETES

Type 1 diabetes                     This type of diabetes mostly occurs in young children when the pancreas does not make any insulin at all. The exact causes of type 1 diabetes are still largely unknown, but it is thought that the body sees the pancreas as ‘foreign’, and thus mistakenly attacks the cells responsible for insulin production. A person with type 1 diabetes will need to use insulin (in the form of an injection) for the rest of their lives.

Type 2 diabetes                     This type of diabetes is the most common type and generally occurs in adults over the age of 40 years (though increasing rates of childhood and teenage obesity have seen diabetes become increasingly common in children and young adults). The type 2 diabetic’s pancreas can make some insulin, however it is usually not enough insulin.

This type of diabetes is as a result of a combination of genetic and environmental factors, and is the type of diabetes referred to in the remainder of this article. Patients are usually overweight, have wounds that fail to heal, blurred vision, and are very thirsty and hungry. Often there are no symptoms though and as a result it takes several years for the condition to be detected.

Gestational diabetes            Sometimes pregnant women may get diabetes during her pregnancy, though once the mother has given birth, glucose levels return to normal. Diabetes during pregnancy puts a woman at an increased risk for developing diabetes later on in life, as well as increases the child’s risk for developing diabetes, too.

WHAT CAUSES DIABETES?

Diabetes is not caused by eating a specific type of food. Diabetes can affect anyone at any age, and people from any population or racial group. Also, it is often believed that a high intake of sugar is what causes diabetes- this is not true. Rather, diabetes is a genetic disease. Experts believe that there are several genes involved in diabetes, with each resulting in a small effect on the risk for diabetes. These genes coupled with certain environmental and lifestyle factors can be turned ‘on’ or ‘off’, putting you at a higher or lower risk for developing disease Risk factors for diabetes include:

• Family history of diabetes
• Older age
•  Being overweight or obese
• Smoking
• A sedentary lifestyle
• History of diabetes in pregnancy (gestational diabetes)

The above mentioned risk lifestyle and environmental factors combined with a genetic predisposition are necessary to develop diabetes. Scientists explain the rise in diabetes rates (at least partly) with the so-called “thrifty gene” theory. Thousands of years ago our ancestors were exposed to sporadic periods of food shortages and other periods of an abundance of food. In order to deal with this potentially life threatening calorie variability, genes adapted and became ‘thrifty’ allowing for the accumulation of fat during times of famine, a survival advantage.

However, our modern diets see an abundance of food all year round, so while food variability has changed our genes have not, as so the thrifty genes continue to accumulate calories in the form of fat. The same genes that were necessary for survival thousands of years ago now expose the 21^st century human to becoming overweight. Overweight is worrisome as it is a very big predictor of developing diabetes.

It is widely agreed upon that the alarming increase in rates of diabetes is linked to the changes in our food intake and lifestyle. However, these changes trigger diabetes only in those who are genetically predisposed to get diabetes. It is important therefore for those with a known genetic predisposition to diseased to make the appreciate lifestyle changes to at least delay the onset of diabetes.

TREATING AND MANAGING DIABETES WITH LIFESTYLE CHANGES

The good news is that if you have risk factors for diabetes, type 2 diabetes responds incredibly well to changes in diet and lifestyle. It is possible to dramatically reduce the risk of developing diabetes with the appropriate corrective measures, with lifestyle changes being twice as effective as medication. It then stands to reason that a healthy and balanced diet, weight control and regular exercise are the cornerstones in the treatment and management of diabetes.

1.    Lose weight

A weight loss of as little as 7% can have a significant difference in blood glucose levels by improving insulin sensitivity. Understanding the importance of weight loss in preventing diabetes is great motivation to follow a good weight loss program. Be sure to set realistic weight loss targets and ultimately aim for a healthy body weight.

2.    Get moving

Being active helps the body utilise glucose much more effectively and therefore helps in controlling blood glucose levels. Also, exercise helps in maintaining and attaining a healthy body weight, as blood glucose levels become less controlled as weight increases. Aerobic exercise and weight training has positive effects on glucose levels. Also, regular physical activity is also beneficial for heart health.

3.    Eat more fibre

High fibre diets have been shown to improve blood glucose control. Fibre works much like a traffic light, slowing down the absorption of glucose into the blood stream. Also, fibre keeps you feeling fuller for longer which helps in weight loss. Follow these hand tips to increase your fibre intake.

Aim to eat at least 5 portions of fruit and vegetables each day.

• Fresh or frozen vegetables are good options. Eat a wide variety of vegetables by eating several different colours. Canned vegetables are generally high in sodium.
• Again, chose a variety of colours of fresh fruits. Tinned fruit is high in added sugar so rather avoid these. Be wary of high intakes of dried fruit and fruit juice. Though nutrition, portion sizes should be watched.
•  Eat fruits and vegetables (where possible) with skins, pips and seeds to further increase fibre intake. 

Choose whole-grain over foods made with refined grains and flours.

• Try brown or wild rice, whole wheat pasta, whole wheat or whole grain bread, rye, and whole grains like barley, buckwheat, triticale, bulgur, millet, sorghum and quinoa.
• Switch from sugary cereals to whole-grain breakfast options like oats, All bran flakes or Special K.

4.    Watch your fats

Though fats are important as part of a healthy diet, fat intake should only be between 25 and 35% of total calories consumed. The type of fat is just as important as the amount of fat consumed. Saturated fats are artery-clogging, cholesterol raising monsters and it is best to lower this kind of fat intake. Sources of saturated fat include full-cream dairy (milk, yoghurt cheese), fatty meat, lard, and many baked goods. Rather, choose heart-healthy fats such as nuts and the associated oils, olives and olive oil, fatty fish (include in your diet twice a week). Remember when switching to healthier fats it is still important to watch portion sizes in order to prevent weight gain.

Here are some more tips to cut down on your fat intake:

•   Avoid cooking methods that use oil, margarine, butter and cream. When preparing foods, use avocado, olive or canola oil.
• Avoid frying and deep-frying foods. Rather boil, steam, grill, bake or microwave your food.
• Instead of using full-cream dairy products (milk, yoghurt and cheese) use low-fat (2%) or non-fat (skim) dairy.
• Choose lean cuts of meat.
• Trim all visible fat from meat during cooking.
• Remove skin from chicken before eating.
• Add plant-based proteins to your diet on a regular basis such as beans and lentils.
• Include a variety of fish in your diet as fish in naturally lower in fat.
• Cut down on pre-prepared meals/ convenience foods and take-aways.
• Pack a lunchbox everyday from home. Cafeteria food and take-aways are often high in fat, sugar and salt.

For more information on diabetes, visit Diabetes South Africa.

References

American Diabetes Association position statement: Diagnosis and classification of diabetes mellitus. 2010. s Diabetes Care; volume 33 (1).

Diabetes South Africa. http://www.diabetessa.co.za

South African Sugar Association pamphlets.