DIABETES
Diabetes is a chronic disease where the body does not make enough insulin, or becomes insensitive (resistant) to the insulin that is produced. According to the Canadian Diabetes Association, over two million Canadians have diabetes, and this figure is expected to rise.
When we consume food, it is broken down into glucose, which causes a rise in blood glucose levels. Insulin is a hormone secreted by the pancreas in response to that rise in blood sugar. Insulin’s role is to transport glucose from the bloodstream into the cells to be used for energy.
There are three main types of diabetes. Type 1 diabetes is responsible for approximately 10 percent of cases and occurs when the pancreas produces little or no insulin. The exact cause of type 1 diabetes is unknown, but it is thought that the immune system attacks and destroys the insulin-producing cells of the pancreas. Genetics may also play a role. Type 1 diabetes was previously known as juvenile diabetes or insulin-dependent diabetes because it typically appears during childhood or adolescence, and people who get this form require insulin injections to manage their blood sugar.
Type 2 diabetes is the most common form, accounting for about 90 percent of people with diabetes. This form occurs when the pancreas does not produce enough insulin or when your cells become resistant to the action of insulin. Obesity, inactivity, and poor diet (eating too many high-glycemic foods) are some of the causes of type 2 diabetes. Other risk factors are discussed below. In the past, type 2 diabetes affected primarily adults. However, a growing number of children and adolescents are being diagnosed today.
The third type of diabetes is gestational diabetes, a temporary condition that occurs during pregnancy. It affects approximately 3.5 percent of all pregnancies and involves an increased risk of developing diabetes for both mother and child.
All forms of diabetes can have serious consequences if left untreated. There is no cure for diabetes, but there is much that can be done from a lifestyle perspective to improve blood sugar control and prevent potentially life-threatening complications.
SIGNS & SYMPTOMS
Blurred vision: High blood sugar causes fluid to be pulled from all tissues, including the lenses of the eyes, which can affect vision.
Fatigue and irritability
Hunger: Your muscles and organs become energy depleted because insulin is not able to move glucose into your cells, which can trigger persistent hunger.
Impaired wound healing or frequent infections.
Increased thirst and frequent urination; as excess sugar builds up in your bloodstream, fluid is pulled from your tissues, which can make you thirsty, so you may drink and urinate more than usual.
Weight loss: Even though food intake may be increased, weight loss can occur because your muscles and fat stores may shrink because they are not getting the necessary glucose.
Some people with type 2 diabetes develop patches of dark, velvety skin in the folds and creases of their bodies, usually in the armpits and neck. This condition, called acanthosis nigricans, is a sign of insulin resistance. However, it is important to realize that many people who have type 2 diabetes have no symptoms until complications develop.
DIABETIC COMPLICATIONS
If left untreated, diabetes can lead to serious complications. Uncontrolled high blood sugar can cause damage to blood vessels throughout the body. Diabetes dramatically increases the risk of heart disease and stroke. In fact, about 75 percent of people who have diabetes die of some type of heart or blood vessel disease. Other complications include kidney and eye disease, nerve damage (diabetic foot and erectile dysfunction), and increased risk of infection.
RISK FACTORS
Age: The risk of type 2 diabetes increases with age, especially after age 40. Aging does not cause diabetes, but people tend to exercise less and gain weight with age.
Diet: Studies have shown that people who eat high-glycemic diets (lots of quick-release carbohydrates) are at increased risk of type 2 diabetes.
Gestational diabetes: Developing diabetes during pregnancy increases the risk of developing type 2 diabetes later in life.
Heredity: Having a parent or sibling with either type 1 or 2 diabetes increases the risk.
Inactivity increases the risk of type 2 diabetes; conversely, physical activity improves insulin sensitivity and reduces the risk.
Obesity greatly increases the risk of type 2 diabetes because carrying excess body fat reduces insulin sensitivity.
Race: Those of Aboriginal, Hispanic, Asian, or African descent are at greater risk.
DOCTOR’S ORDERS
People with type 1 diabetes require insulin injections in order to manage blood sugar. In the past the only way to get insulin was through injection with a needle and syringe. Now there are insulin pen devices and pumps that are more convenient and less painful. There are also several types of insulin that vary in their onset and duration of action. Your doctor will help devise a plan based on your needs.
Some people with type 2 diabetes can manage their blood sugar with diet and exercise alone, but in some cases, medication or insulin is required. There are a variety of oral medications used for diabetes. These drugs work by stimulating the pancreas to produce and release more insulin, inhibiting the production and release of glucose from your liver (so that less insulin is needed to transport sugar into your cells) or increasing tissue sensitivity to insulin.
A number of factors can affect blood sugar levels such as diet, activity level, illness, medication, alcohol, and stress. Careful monitoring is essential to ensure that your blood sugar levels are within the recommended range. Depending on your situation, your doctor may advise you to check your blood sugar once a day or more often. Fasting blood glucose levels should be between 4 and 7 mmol/L. The recommended range two hours after meals is between 5 and 10 mmol/L.
In addition to daily blood sugar monitoring, your doctor may recommend an AlC test, which measures your average blood sugar level for the past 120 days. This test indicates how well your diabetes treatment plan is working overall. The recommended AlC level for diabetics is 7 percent or less.
HYPOGLYCEMIA
Hypoglycemia or low blood sugar occurs when your blood sugar drops to less than 4 mmol/L. Symptoms include shakiness, lightheadedness, irritability, confusion, racing heart, and sweating. Hypoglycemia can result from not eating at regular intervals, intense physical activity, taking too much medication, or drinking alcohol. Blood glucose levels can drop quickly, and in severe cases can lead to loss of consciousness and seizures, so it is important to act quickly and eat or drink a fast-acting carbohydrate such as glucose tablets, honey, juice, or candy to raise blood sugar levels.
Dietary Recommendations
Foods to include:
• Cinnamon contains compounds that work synergistically with insulin, helping to reduce blood sugar levels. One study found benefits with just Vi tsp daily. Add cinnamon to your cereal, oatmeal, or breakfast shakes.
• Chromium is essential for blood glucose regulation. It is found in brewer’s yeast, whole grains (especially wheat germ), onions, and garlic.
• For a natural and healthy sugar substitute, try stevia or xylitol.
• High-fibre, low-glycemic (slow-release) carbohydrates such as whole grains (whole wheat, oats, brown rice, spelt), vegetables, fruits, and legumes help to balance blood sugar.
• Protein (lean poultry, meat, and fish) and healthy fats (nuts, seeds, olive oil, and flaxseed oil) in each meal will slow carbohydrate digestion and promote better blood sugar control.
Note: To promote steady blood sugar levels, eat small, frequent meals (every three hours).
Foods to avoid:
• Alcohol can cause either high or low blood sugar depending on how much you drink and if you are eating while drinking. Limit alcohol intake to no more than two drinks daily.
• High-glycemic (quick-release) carbohydrates such as white bread and baked goods, refined cereals, potatoes, white rice, and sugar (candy, cookies, soda) cause rapid and profound increases in blood sugar, creating a problem for diabetics. Studies have also found that those who eat high-glycemic diets are also at increased risk of developing type 2 diabetes.
• Saturated fat (animal products such as meat and dairy) can worsen blood glucose control.
Lifestyle Suggestions
• Lose excess weight. Being overweight can impair insulin sensitivity.
• Get regular physical activity. Aim for 30 minutes to one hour of moderate intensity activity each day, such as brisk walking, cycling, or swimming. Exercise helps with weight management and also improves blood glucose control and insulin sensitivity.
• Don’t smoke. People with diabetes who smoke are at greater risk for heart, kidney and eye disease, and nerve damage.
• Manage your stress. Stress triggers the release of hormones that impair insulin sensitivity. Try yoga, meditation, and other relaxation techniques.
• Practise good oral hygiene. Brush your teeth at least twice a day and floss daily to reduce the risk of gum infection. Visit your dentist regularly for professional cleaning.
• Take care of your feet. Diabetics are prone to nerve damage, which can make sores on the feet unnoticeable and delay wound healing. Inspect your feet daily for blisters or cuts. Apply moisturizer particularly to your heels. See your doctor if you develop any sores that do not heal within a few days.
• Have regular physicals and eye exams to screen for potential complications.
Top Recommended Supplements
Alpha lipoic acid: A powerful antioxidant that can help improve insulin sensitivity and reduce the risk of diabetic complications such as neuropathy and nephropathy (kidney disease). Dosage: 600-1,200 mg daily.
Chromium: An essential trace mineral that plays a role in sugar metabolism. It helps improve insulin sensitivity and glucose tolerance. Some studies have found that diabetics are deficient in chromium, and that supplements can help improve blood sugar management. Look for chromium picolinate as this is the most widely studied form of chromium. Dosage: 400-1,000 meg daily.
Fibre: Helps improve blood glucose control and weight management. Studies involving fibre supplements of psyllium, oat bran, and glucomannan have shown benefits for diabetics. Dosage: Varies with product and formulation. Follow instructions on label and take with plenty of water.
Complementary Supplements
B-vitamins: Essential for proper nerve function and energy metabolism. Take a B-complex or a multivitamin that contains at least 50 mg of the B-vitamins.
Fenugreek: Seeds and supplements containing this herb have been shown to lower blood sugar and improve insulin sensitivity. Dosage: 15 g of powdered seeds with a meal or 1 or 2 g of an extract daily.
Fish oil: Helps improve glucose tolerance, reduce triglycerides and cholesterol levels, and may help improve diabetic complications (neuropathy and nephropathy). Dosage: Look for a product that provides at least 400 mg EPA and 200 mg DHA per dosage, and take three times daily.
Gymnema: Preliminary research shows that this herb can help stimulate insulin secretion and improve blood glucose control in those with both Type 1 and Type 2 diabetes. Dosage: 400 mg once or twice daily of a product standardized to 25 percent gymnemic acid.
Magnesium: Required for energy metabolism and nerve function. People with diabetes tend to have low magnesium levels and a deficiency is associated with insulin resistance. Supplements can help improve insulin sensitivity and glucose control. Dosage: 200-600 mg daily.
Phase 2: White kidney bean extract that reduces starch digestion. Studies have shown that it can lower after-meal blood sugar levels. Dosage: 500-1,000 mg before starchy meals.
Vitamin E: Helps to improve glucose tolerance and reduce glycosylation (binding of sugar to proteins in blood vessels). Many studies have found that it can prevent and reverse nerve damage and help protect against retinopathy and nephropathy. Dosage: 800 IU daily.
FINAL THOUGHTS
To improve blood sugar control and reduce the risk of diabetic complications, consider the following:
1. Eat small, frequent meals with low-glycemic, high-fibre carbohydrates, protein, and healthy fats. Add cinnamon to your diet.
2. Avoid eating fast/processed/refined foods, alcohol, and saturated fat.
3. Reduce your stress and aim for at least 30 minutes of activity daily.
4. Maintain good oral and foot hygiene and see your doctor regularly for checkups and blood glucose testing.
5. Consider supplements of alpha lipoic acid, chromium, and fibre.
