People with diabetes should try to maintain a healthy weight and eat a diet that What is diabetes? Type 1 diabetes usually develops in a few weeks and the …
DIABETES
Key points Diabetes develops when the body cannot use glucose properly Around 14 million people in the UK have diagnosed diabetes, of whom around 1 million have type 2 diabetes In addition, there are a large number of people who may have unrecognised diabetes Eating a healthy balanced diet, taking regular physical exercise, and maintaining a healthy body weight can help to prevent or delay the onset of type 2 diabetes People with diabetes should try to maintain a healthy weight and eat a diet that is low in fat particularly saturates and salt but contains plenty of fruit and vegetables at least five portions a day and starchy carbohydrate foods such as bread, rice and pasta particularly whole-grain versions What is diabetes? Diabetes or diabetes mellitus to use its full name is a condition in which the amount of glucose in the blood is too high The process of moving glucose from the blood into the bodys cells relies on a hormone called insulin When insulin levels are too low or are not effective, blood glucose levels can rise and this may result in diabetes The symptoms The main symptoms of untreated diabetes are: increased thirst need to pass urine much more often,
especially at night weight loss tiredness blurred vision itching of the genital organs Insulin The hormone insulin is made by the pancreas, a gland lying just behind the stomach Insulin is one of the hormones that help to control the level of blood sugar, glucose, which is a vital fuel for cells Insulin clears glucose from the blood and helps it to enter the cells, such as in muscles, liver and adipose fat tissue It is important that insulin works properly because both low and high levels of blood sugar are harmful to the body A low level of blood glucose is called hypoglycaemia while a high level is called hyperglycaemia
TYPE 1 DIABETES What is type 1 diabetes? Type 1 diabetes is also known as insulin-dependent diabetes It is an auto-immune condition in which the immune system of the body that protects the body against infection and disease turns against itself As a result most, or all, of the insulin-producing cells of the pancreas are destroyed and the pancreas is not able to produce enough insulin How the insulin-producing cells are damaged is not very well understood but it may be due to a viral or other infection, coupled with a genetic predisposition Without insulin,
the body is neither able to use glucose as a fuel for the cells causing rapid weight loss nor control the level of blood glucose As a result, the level of
blood glucose can become too high Type 1 diabetes usually develops in a few weeks and the symptoms are very obvious, but they can quickly be relieved by treatment Type 1 diabetes usually occurs in people under the age of 40, often in early childhood Treatment It is important to maintain the bodys blood glucose level in order to eliminate the symptoms and prevent long term consequences of high blood glucose levels, particularly circulation problems, and damage to nerves, kidneys and eyes Type 1 diabetes is managed by injections of insulin coupled with a healthy diet People with diabetes are given individual advice on how to inject themselves with insulin, what type of diet to eat and how to check the level of glucose in their blood and urine Insulin injections Insulin injections are vital for survival Insulin cannot be taken by mouth because it would be destroyed in the stomach There are different kinds of insulin treatments available Insulin is usually injected 1-4 times per day depending on the type of insulin quick-acting or
slow-acting and the daily routine of the person The amount and timing of insulin injections are adjusted depending on the timing, amount and type of food eaten mostly the amount of carbohydrates, ie starches and sugars and the frequency, timing and quantity of exercise taken The aim is to avoid wide swings in the blood sugar level after and between meals, as these are associated with a greater risk of complications later in life TYPE 2 DIABETES What is type 2 diabetes? Type 2 diabetes also sometimes referred to as non-insulin dependent diabetes occurs when the body does not produce enough insulin or the insulin produced does not work properly this is known as insulin resistance Type 2 diabetes usually develops in middle-aged people over the age of 40 and later life, but has been seen in younger adults particularly South Asian and AfricanCaribbean people and also recently amongst teenagers in the UK It can be managed by diet and exercise alone or in combination with tablets or insulin injections Diabetes is diagnosed when fasting plasma glucose concentration values are equal to or exceed 70 mmol/l whole blood greater than or equal to 61 mmol/l or a random venous plasma glucose
concentration of equal to or greater than 111 mmol/l If type 2 diabetes is treated properly from the early stages of the disease, the risk of any longterm complications is reduced These complications include heart disease, stroke, high blood pressure, circulation problems, and damage to the nerves, kidneys and eyes Regular medical check-ups are very important for people with diabetes and also for those who are at high risk of diabetes Prevalence of type 2 diabetes Type 2 diabetes is increasing rapidly both in the UK and in the world in general This is thought to be linked with the fact that the population is getting fatter more than half of adults in the UK are overweight, and about one in five are obese There are currently around 14 million people with diagnosed diabetes in the UK, of which around 1 million have type 2 diabetes In addition, there are a large number of people who may have unrecognised diabetes An estimated 120 million people world-wide are affected by type 2 diabetes but this has been predicted to almost double to 215 million by 2010
Who is at risk of type 2 diabetes? There are several risk factors for type 2 diabetes of which inherited predisposition, obesity and
physical inactivity are the most important Hereditary factors are more significant when diabetes is diagnosed at younger age But when diabetes is diagnosed at older age, life-style factors are more relevant The rise in obesity rates in the UK is a main contributor to the rapid increase in the prevalence of diabetes Obese people are often insulin resistant Most people with newly diagnosed type 2 diabetes are overweight or obese
Dietary factors can contribute to the development of type 2 diabetes The most significant factors are a diet high in energy, fat especially saturates and low in fibre This kind of diet is harmful because it causes weight gain and also impairs insulin action Lack of exercise is harmful because it can promote weight gain and it also impairs insulin action Regular exercise has many benefits Apart from improving the ability of insulin to act, it also helps overweight people to lose weight Everyday activities, like cycling or walking to work, or walking up the stairs instead of taking the lift, can be helpful
Treatment Diet modification and physical activity are the two main approaches in the treatment of type 2 diabetes The aim of the treatment is to help
the patients to control blood glucose level and also to help overweight patients to lose weight Usually it is possible to control diabetes by diet and activity but, still, some people may need tablets or insulin injection, about 30 of cases are managed by diet and insulin injections The recommended diet for patients with type 2 diabetes is the same the healthy diet recommended for all people Patients with diabetes are given individual dietary guidance by State Registered Dietitians Prevention A healthy balanced diet, taking more physical exercise and losing weight if necessary may delay the onset of diabetes Regular consumption of whole-grain foods has been linked by researchers to a reduction in risk of several diseases including type 2 diabetes, heart disease and cancer Whole-grain foods provide many nutrients such as fibre, resistant starch, and certain minerals and vitamins They also contain several compounds such as antioxidants and phytoestrogens which may be important in disease prevention Some of these nutrients may be lost in the refining process DIETARY MANAGEMENT OF DIABETES The dietary advice for people with diabetes has changed considerably over the last century At one
point people with diabetes were told to starve themselves Some years later people with diabetes were told to eliminate all sugar and sugary foods from their diet This resulted in people with diabetes buying special diabetic foods to replace everyday sugar-containing foods Today, however, the most important message for people with diabetes is to eat healthily, in exactly the same way that is recommended for the whole population that is a balanced diet based on starchy foods and plenty of fruit and vegetables, and is low in fat, salt and sugar This means that a small amount of sugar and sugar-containing foods can be eaten, preferably as part of a healthy meal Special diabetic cakes, biscuits or pastries are of no particular benefit and they may contain a lot of fat
People with type 2 diabetes are at greater risk of cardiovascular disease than the general population Dietary advice should therefore focus on reducing cardiovascular disease risk Complex carbohydrate, such as that found in whole-grain foods, is absorbed more slowly This prevents rapid rises in blood glucose levels, which is particularly important for people with diabetes
Alcoholic Drinks Advice on alcoholic drinks is
the same as for the general population up to 3 units a day for women and up to 4 for men Alcohol can have both hypo- and hyperglycaemic effects, depending on the amount consumed, the type of drink and whether it is consumed with a meal In studies in people with diabetes, alcohol had no acute effect on blood glucose or insulin levels, indicating that such beverages should be regarded as additional items rather than substitutions for foods Epidemiological studies in non-diabetic subjects suggest that light-to-moderate intake is associated with increased insulin sensitivity and decreased risk of type 2 diabetes, coronary heart disease and stroke, but chronic excess intakes 30-60g/day increase blood pressure in men and women The cardioprotective effects of alcohol do not appear to be associated with a particular type of alcoholic beverage, despite the fashion to advocate red wine
IN SUMMARY: Recommendations for diabetes treatment and prevention 1 Maintain a healthy body weight BMI 20-25kg/m 2 Keep physically active 3 Eat a healthy, balanced diet 4 Eat more starchy foods, like potatoes, rice, pasta, bread and breakfast cereals 5 Choose high fibre, wholemeal products 6 Eat more fruits
and vegetables, aim for at least 5 portions a day 7 Eat fewer fatty and sugar-containing foods, eg chips, sweets or pastries 8 Choose lean meat, poultry, fish, beans and alternatives, instead of fatty meat or meat products 9 Choose low-fat dairy foods, like skimmed or semi-skimmed milk or low-fat yoghurt 10 Use vegetable oil in cooking but only in small amounts 11 Choose products lower in salt and use less salt in cooking British Nutrition Foundation 2004
