Diabetes

According to WHO, diabetes is a growing public health threat, affecting an estimated 177 million people worldwide in 2000, up from an estimated 30 million in 1985. Type 2 diabetes, formerly considered a disease of older adults and largely thought due to obesity and sedentary lifestyle, has grown at epidemic rates in recent years and is occurring increasingly among young adults and even children.

Diabetes is a leading cause of end-stage kidney disease, heart attacks, strokes, eye disease and blindness, diabetic foot disease and other costly complications. Research has clearly demonstrated that expert diabetes care that keeps blood glucose near normal can reduce the risks of developing complications, and can markedly slow the rate at which complications progress. Studies have shown that people at risk for diabetes can reduce their risk of developing the disease by over 50 percent by losing modest amounts of weight and exercising regularly. 

Diabetes tends to run in families. According to the Joslin Diabetes Center Boston which is affiliated with Harvard Medical School, those most at risk for developing diabetes are people who:

  • are 45 or older
  • are overweight
  • are habitually physically inactive
  • have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
  • have a family history of diabetes
  • are members of certain ethnic groups (including Asian, African, Hispanic and Native American, Australian Aboriginal, Indian and those of Middle Eastern descent)
  • have had gestational diabetes or have given birth to a child weighing more than 9 pounds (4 kg)
  • have elevated blood pressure
  • have an HDL cholesterol level (the "good" cholesterol) of 35 mg/dl (1.94 mmol/L) or lower and/or a triglyceride level of 250 mg/dl (13.9 mmol/L) or higher
  • have polycystic ovary syndrome
  • have a history of vascular disease

Insulin is a hormone that enables cells to extract glucose from the blood and use it for energy. When a person has diabetes, either their pancreas does not produce the insulin they need - Type 1 diabetes mellitus (DM1), or their body cannot use this insulin effectively - Type 2 diabetes mellitus (DM2). Both types of DM mean that there is too much sugar in the blood. 

The aim of treatment for DM is to lower blood glucose to within normal limits. 

Treatment for DM is diet, exercise and weight control. Tablets and/or injections may also be required. People with DM1 will require insulin injections daily for life.

Diet

The Joslin Diabetes Center guidelines recommend the following: 

Carbohydratesshould provide 40% of energy intake :

  • consisting mainly of low glycaemic index (GI) foods – leafy greens, carrots, cauliflower, cabbage, mushrooms, onion, ginger, garlic, radish, zucchini, eggplant, celery etc
     
  • higher GI foods (refined carbohydrates or processed grains and starchy foods especially pasta, white bread, low fiber cereal and white potatoes) should be consumed in very limited quantities

Protein should provide 20-25% of total daily energy (fish, meat, chicken, milk, cheese, soya bean products).

Fat should provide 30-35% of total caloric intake:

  • Monounsaturated:15-20%
  • Polyunsaturated:10%

There should be very little refined carbohydrates (sugars) and alcohol in your diet.

Supplements

Vitamin B6 and Magnesium 

When too little Vitamin B6 (pyridoxine) is obtained, an essential amino acid from complete proteins – tryptophane – is not used normally. Instead it is changed into a substance known as Xanthurenic acid. 

If deficient in Vitamin B6, Xanthurenic acid becomes high and damages the pancreas which in turn raises blood sugar. 

Magnesium decreases the body’s need for Vitamin B6 and if increased in the diet, Xanthurenic acid is reduced. 

Saturated fats increase the need for Magnesium. 

High protein, high caloric diets increase the body’s demand for Vitamin B6 and accelerate the harm to the pancreas if the vitamin is deficient. 

Consumption of excessive sugar particularly increases the body’s need for both insulin and Vitamin B6. 

Persons mildly deficient in Vitamin B6 excrete Xanthurenic acid long before any other signs of the dietary insult appear. All Diabetics appear to excrete large amounts of Xanthurenic acid which would indicate the pancreas is being further damaged. 

All B vitamins are water soluble and are readily lost in the urine. The more urine excreted, the greater the losses. 

Deficiencies of certain minerals, such as potassium, magnesium, and possibly zinc and chromium, may aggravate carbohydrate intolerance. 

It has been recommended in the literature that all people with diabetes or a family history of diabetes may be wise to take 10mg of Vitamin B6 and 500mg Magnesium daily

In general, we should seek foods that are whole and unrefined not only because refined foods are depleted in micronutrients, but there are also frequently harmful additives or processes that have been employed – e.g. bleach in rice and flour, high fructose corn syrup, monosodium glutimate (MSG) – taste enhancer which causes obesity, insulin resistance, hyperglycemia and glycosuria. 

There is no reason to recommend that people with diabetes avoid naturally occurring fructose in fruits, vegetables, and other foods, however, added fructose as a sweetening agent is not recommended. 

Foods containing carbohydrate from whole grains, fruits, vegetables, as well as healthy fats such as cold-pressed virgin olive oil, coconut oil, flaxseed oil, nuts, avocado, plain unsweetened probiotic yoghurt (e.g. kefir) and oily fish should be included in a healthy diet. Three to four servings of fish per week provides desirable dietary Omega 3 polyunsaturated fat.

Foods labelled 'low-fat' should be avoided. 'Low-fat' means the product has added sugar - even 'low-fat' milk. Carbonated soda drinks should be avoided, especially those labelled 'zero' calories or sugar as it contains artificial sweetener which is poisonous to the body and causes weight gain. The best beverage of course is water. 

A healthy balanced reduced-starchy-carbohydrate diet, with little to no added sugar, when maintained long-term contributes to modest loss of weight and improvement in dyslipidemia.  

Exercise and behavior modification are most useful as adjuncts to other weight loss strategies. Exercise is helpful in maintenance of weight loss. Standard weight reduction diets, when used alone, are unlikely to produce long-term weight loss. Structured intensive lifestyle programs are necessary. 

If individuals choose to drink alcohol, no more than two alcohol containing drinks per day for adult men and no more than one drink per day for adult women is recommended. 

If too much insulin is given or too little food is eaten, the symptoms of low blood sugar – weakness, nervousness, wooziness, headache, trembling hands, and loss of consciousness or blackout – can be brought on with such lightning speed that they are spoken of as ‘insulin shock’. 

If insufficient insulin is given, sugar cannot enter the cells. Fat alone must be used for heat and energy, yet it cannot be burned efficiently with out sugar. Certain acids and acetone, formed from incompletely utilized fat, accumulate in the body and cause acetone acidosis. The acids are neutralized by combining with sodium and potassium, and the salts thus formed are excreted in the urine. Acteone, partly thrown off with exhaled air, give the characteristic fruity odor to the breath of patients with uncontrolled diabetes. 

Even mild acidosis can cause fatigue, nervousness, headache and nausea. Severe acidosis can rob the body of so much potassium that unconsciousness, diabetic coma and even death can result.

Associated Conditions

Associated with Diabetes are obesity, hypertension and dyslipidaemia, which together with diabetes has been termed the “Deadly Quartet”. In the presence of these risk factors, there is a substantial increased likelihood for a major cardiovascular event including stroke and myocardial infarction.

Obesity

Obesity is defined by WHO as having a Body Mass Index (BMI) of > 30.
You can calculate your BMI by dividing your weight in Kg/height (m)2.

Smoking

Smoking represents a major risk factor for a large number of respiratory and vascular diseases. People who have DM should not smoke.

Lipid Status

The CVD risk relating to high total cholesterol is refined by considering cholesterol fractions, namely elevated LDL and depressed HDL. Elevated triglycerides are also a CVD risk factor, especially when combined with low HDL cholesterol as often occurs in DM. 

The class of drug known as statins are commonly prescribed for high cholesterol.

Hypertension

Elevated blood pressure presents a significant risk factor for cardiovascular and renal disease. The class of drug known as anti-hypertensives are commonly prescribed for high blood pressure. ACE inhibitors are the drugs of choice for renal problems.