Diabetes is a complex, chronic illness which requires continuous medical care with different risk reduction strategies beyond just glycemic control. Diabetes Mellitus is a group of diseases characterized by abnormal glucose metabolism in the following forms:
- Less production of insulin by the pancreas.
- Insulin that is manufactured is not utilized by the body.
Symptoms
The symptoms include hyperglycemia (elevated blood glucose), polyphagia (increased appetite), polyuria (increased urination), polydipsia (increased thirst), nocturia (excessive urination at night) and unplanned weight loss.
Factors Causing Diabetes
- Genes
- Obesity
- Stress
Classifications of Diabetes
- Type 1 (IDDM): Insulin Dependent Diabetes Mellitus commonly appears in youth but can occur at any age. It requires insulin to prevent ketosis.
- Type 2 (NIDDM): Non-Insulin Dependent Diabetes Mellitus usually appears in middle age.
- Type 3 (Gestational Diabetes): It occurs during pregnancy, but blood glucose level revert to normal after parturition.
- Type 4 (Secondary Diabetes Mellitus): It is a different type of diabetes which may be associated with pancreatic disease, drug reactions or hormonal changes, etc.
- Type 5 (Impaired Glucose Tolerance): With this type of diabetes, plasma glucose levels are abnormal, but not beyond the normal range to be diagnosed as diabetes.
Management of diabetes is essential since uncontrolled diabetes can lead to neuropathy (problems with nerves) and nephropathy (kidney disease or kidney damage). Individuals are also susceptible to elevated cholesterol levels which can further affect the heart.
Criteria for The Diagnosis of Diabetes
- 8 hours of fasting plasma glucose (7.0 mmol/l), or
- 2-h PG greater than 200 mg/dL (11.1 mmol/L) during an OGTT, or
- A1C greater than 6.5% (48 mmol/lL), or
- In a patient with classic symptoms of hyperglycemia (high blood sugar), a random plasma glucose greater than 200 mg/dL (11.1mmol/L).
Criteria for Testing for Diabetes or Pre-Diabetes in Asymptomatic Adults
#1. Testing should be considered in all individuals who are overweight and who have a BMI of over 25kg/m2 and have additional risk factors:
- Physical inactivity.
- Parents with diabetes.
- Women who delivered a baby weighing more than 9 lbs or who were diagnosed with gestational diabetes.
- Hypertension (blood pressure greater than 140/90 mmHg).
- HDL cholesterol below 35 mg/dL (0.9mmol/L) and/or a triglyceride level greater than 250 mg/dL (2.82mmol/L).
- Women with PCOS (Polycystic Ovary Syndrome).
- Other clinical conditions associated with insulin resistance such as severe obesity.
- History of cardiovascular disease.
#2. For all patients, testing should start at 45 years of age.
#3. If results are normal, testing should be repeated at a minimum of 3-year intervals. Those with pre-diabetes should be tested each year.
Lifestyle Management
The plan is to live a healthy life by maintaining your weight and working to reduce weight if you are currently overweight by eating healthy and exercising. You should try to exercise for 30-60 minutes per day for optimal health.
The regulation of your diet is a very important aspect of diabetic management. Some restrictions in carbohydrates and fat in the diet help in the treatment. Since there is no ideal percentage of calories from carbohydrate, protein and fat for individuals with diabetes, it always recommended to receive individualized nutritional advice and guidance from a registered dietitian. A general guideline for the distribution of calories is (shown as an approximate percentage of total daily calories):
- Carbohydrate (40%): this should include at least 20-35 grams of fiber. The most ideal sources of carbohydrates include fresh vegetables, fresh fruit, beans and whole-grain foods. Try to minimize eating processed and high GI carbs like pasta, white bread, white potatoes and sugary cereals.
- Protein (20-30%): if you have kidney disease, this total percentage should be lower. The most ideal sources of protein include wild caught fish (not farm raised), skinless chicken or turkey, non-fat or low-fat dairy products, tofu and legumes.
- Fat (30-35%): this should mainly come from mono-unsaturated and poly-unsaturated fats. The most ideal sources of fat include olive oil, canola oil, nuts, seeds and fatty fish like wild caught salmon. Saturated fat should be limited to 10% of total fat intake.
Carbohydrates
Complex carbohydrates (40-50 grams of fiber per day) and limited amounts of sugar can be consumed depending on blood glucose control. Carbohydrate intake from whole grains, vegetables, fruits, legumes and dairy products with foods high in fiber and lower in glycemic load, should be consumed over other sources. Individuals should aim for nutrient dense whole foods rather than the consumption of sugary beverages or other sugar-laden foods.
Protein
With people who have diabetes, ingesting protein appears to increase insulin response without increasing plasma glucose concentrations (0.8 to 1 gram per kg of body weight). Protein can be eaten unless renal disease is present.
Fat
A diet rich in mono-unsaturated fats may improve glucose metabolism and lower CVD risk (Cardiovascular Disease). Eating foods rich in long chain omega 3 fatty acids, such as fatty fish (EPA and DHA), along with nuts and seeds (ALA), is recommended.
Less Than 30% Fat is Allowed and Should Be Divided Into:
- <10% PUFA (Poly-Unsaturated Fatty Acids)
- <10% Saturated Fat
- 10-15% MUFA (Mono-Unsaturated Fatty Acids)
Cholesterol
Limit cholesterol intake to under 300 mg per day.
Sodium
3,000 mg per day is allowed. IDDM patients (Insulin-Dependent Diabetes Mellitus – Type 1) should eat meals on time and coordinate this with their insulin schedule.
Role of GI Foods in Controlling Diabetes
The glycemic index (GI) assigns carbohydrate containing foods a number based on how they affect your blood sugar, after you eat them. Foods with a GI less than 55 cause only a little increase in blood sugar, but those in the 55-70 range will raise it a little higher. Carbs with a GI of greater than 70 send blood sugar soaring. Nutrition experts say that low GI carbs are healthy and high GI carbs in excess are not. Foods with a lower GI are more slowly digested and absorbed and cause blood sugar to rise more gradually.
Glycemic Load
The glycemic index (GI) compares equal quantities of carbohydrates, but not quantity. The glycemic load (GL) of a typical serving of food is the product of the amount of available carbohydrate in that serving and the GI of the food. The higher the glycemic load, the greater the expected elevation in blood glucose and the insulinogenic effect of the food. The long-term consumption of a diet with a relatively high glycemic load is associated with an increased risk of type 2 diabetes and coronary heart disease. Glycemic load tells you how much carbohydrate is in food, rather than just how high or high rapidly it raises blood sugar levels.
Glycemic Load Formula
Multiply the glycemic index (GI) value of a food by the amount of carbohydrate per serving and divide the result by 100. The result for the glycemic load (GL) will be:
- 20 or more is high
- 11-19 is medium
- 10 or less is low
Glycemic Index and Glycemic Load at a Glance
The glycemic index (GI) measures the rate at which food converts to glucose. Higher numbers indicate a more rapid absorption of glucose, which is assigned a value of 100. The lower the GI or GL (Glycemic Index or Glycemic Load), the less it affects blood sugar and insulin levels.
Glycemic Index Food Chart
(Source: American Journal of Clinical Nutrition, vol.62)
| Food | Glycemic Index | Serving Size (grams) | Glycemic Load Per Serving |
|---|---|---|---|
| BAKERY PRODUCTS AND BREADS | |||
| Banana cake (without sugar) | 55 | 80 | 16 |
| Sponge cake (plain) | 46 | 63 | 17 |
| Barley bread (coarse) | 34 | 30 | 7 |
| White flour bread | 70 | 30 | 10 |
| Whole wheat bread | 71 | 30 | 9 |
| 100% whole grain bread | 51 | 30 | 7 |
| Corn tortilla | 52 | 50 | 12 |
| Wheat tortilla | 30 | 50 | 8 |
| BEVERAGES | |||
| Coca Cola | 58 | 250 | 15 |
| Apple juice (unsweetened) | 40 | 250 | 12 |
| Grapefruit juice | 48 | 250 | 11 |
| Orange juice (unsweetened) | 50 | 250 | 13 |
| Tomato juice (canned) | 38 | 250 | 4 |
| BREAKFAST CEREALS | |||
| All Bran | 42 | 30 | 4 |
| Coco Pops | 77 | 30 | 20 |
| Cornflakes | 81 | 30 | 21 |
| Muesli | 66 | 30 | 16 |
| Oatmeal | 58 | 250 | 13 |
| Instant oatmeal | 66 | 250 | 17 |
| Raisin Bran (Kellogg’s) | 61 | 30 | 12 |
| GRAINS | |||
| Pearled barley | 25 | 150 | 11 |
| Sweet corn on the cob | 53 | 150 | 17 |
| White rice | 64 | 150 | 23 |
| Brown rice | 55 | 150 | 18 |
| DAIRY PRODUCTS | |||
| Ice Cream (regular) | 61 | 50 | 8 |
| Milk (full fat) | 27 | 250 | 3 |
| Milk (skim) | 32 | 250 | 4 |
| Reduced fat yogurt with fruit | 27 | 250 | 7 |
| FRUIT | |||
| Apple | 38 | 120 | 6 |
| Banana | 51 | 120 | 13 |
| Dates (dried) | 103 | 60 | 42 |
| Grapefruit | 25 | 120 | 3 |
| Grapes | 46 | 120 | 8 |
| Orange | 42 | 120 | 5 |
| Peach | 42 | 120 | 5 |
| Pear | 38 | 120 | 4 |
| Prunes (pitted) | 29 | 60 | 10 |
| Raisins | 64 | 60 | 28 |
| Watermelon | 72 | 120 | 4 |
| BEANS AND NUTS | |||
| Baked beans | 48 | 150 | 7 |
| Black beans | 30 | 150 | 7 |
| Chickpeas | 28 | 150 | 8 |
| Kidney beans | 28 | 150 | 7 |
| Lentils | 29 | 150 | 5 |
| Soybeans | 18 | 150 | 1 |
| Salted cashews | 22 | 50 | 3 |
| Peanuts | 14 | 50 | 1 |
| PASTA AND NOODLES | |||
| Fettucini | 40 | 180 | 18 |
| Macaroni | 47 | 180 | 23 |
| Spaghetti (wholemeal) | 37 | 180 | 16 |
| VEGETABLES | |||
| Green peas | 48 | 80 | 3 |
| Carrots | 47 | 80 | 3 |
| White potato (boiled) | 50 | 150 | 14 |
| Sweet Potato | 61 | 150 | 17 |
| Yam | 37 | 150 | 13 |
| MISCELLANEOUS | |||
| Hummus | 6 | 30 | 0 |
| Pizza (Parmesan cheese and tomato sauce) | 80 | 100 | 22 |
| Pizza (Pizza Hut Super Supreme) | 36 | 100 | 9 |
| Honey | 55 | 25 | 10 |
Blood glucose is increased in individuals with diabetes in both fed and fasted states. It is due to insufficient insulin secretion, insulin resistance or a combination of both. Although dietary carbohydrate increases postprandial glucose levels, avoiding carbohydrate entirely will not return blood glucose levels to the normal range. Carbohydrate is an important component of a healthy diet as glucose is the primary fuel used for the brain and central nervous system. Carbohydrates also provide vitamins, minerals and fiber in our diet.
Obesity is quickly on the rise with the growing popularity of quick and convenient foods that are packed with sugar, fat and sodium. This can further lead to the rising epidemic of diabetes that can be fatal if not closely monitored and controlled. The serious health issues that come with diabetes along with the possibility of daily insulin injections is something you definitely want to avoid. That’s why it’s so important to try to follow a nutrient dense whole food diet along with performing daily exercise so you can live a long and healthy life!
