Whether you have been diagnosed with Type 1 or Type 2 Diabetes, it can come as a bit of a shock. Suddenly, you are being asked to understand and measure your blood sugar, keep it within a healthy range, perhaps you have tests to do or meds to take or have also been told to lose weight… All in all it can be overwhelming.
DIABETES T1 and T2
Diabetes, or as doctors call it ‘Diabetes Mellitus’, is a condition in which the body either cannot produce enough of the hormone insulin, or the cells can’t ‘read’ the message it sends. This is important because insulin tells the body to remove excess sugar from the blood and too much sugar in your blood is dangerous.
High blood sugar can cause damage to:
- Veins and arteries in your whole body
- Eyes (if blood vessels in the retina are damaged this can cause blindness)
WHAT ARE THE SYMPTOMS OF DIABETES T1?
Common symptoms are:
- Feeling thirsty all the time
- Having to go to the loo a lot especailly at night (due to drinking large quantities of liquid to satisfy your thirst)
- Feeling tired
- Weight loss
- Recurrent thrush or Itchyness ‘down below’
- Blurry vision
- Slow healing ofcuts and grazes
Type 2 Diabetes
You can still make insulin, but your cells become ‘resistant’ to it, that is they do not respond. Blood sugar stays high, so the body realeases more insulin to lower it. Nothing happens and it releases more insulin and so on and so on. Not only is high blood sugar dangerous, but high insulin is also a risk factor for disease too.
Type 2 diabetes, if untreated, can turn into Type 1. However, the good news is Diabetes T2 is reversable. If you take steps to reduce the sugar in your diet, lose weight and exercise your T2 may disappear.
WHAT ARE THE MAIN RISK FACTORS FOR T2
- Someone else in your family has diabetes
- You are overweight or obese
- High sugar diet (this includes white bread, pasta and rice as well as sweets and cakes
- High alcohol intake (alcohol breaks down into sugar in the body)
- Not exercising regularly (exercise has been shown to help reduce high blood sugar)
WHAT ARE THE SYMPTOMS OF T2
- Tiredness during the day, especially after meals
- Hungry after eating
- Irritability if you don’t eat regularly
- Skin conditions such as psoriasis, Acanthis Nigricans (skin discolouration under arms, neck or groin) or skin tags.
HOW DO YOU TEST FOR DIABETES T1 AND 2?
You can be tested for Diabetes T 1 & 2 via your GP, hospital or these days also at some chemists. Initially, you will be asked questions about your diet, lifestyle and family history to establish whether you are at risk of diabetes.
You may be weighed and your height measured. This may seem a bit intrusive, but the ratio of your height to waist measurement can be a good indicator of your risk of diabetes. The larger your waist compared to your height, the higher your risk.
THE WAIST SIZE TEST
You can do this for yourself at home, although quite often people make a mistake in their measuring. If you are apple shaped or a man with a beer belly, it’s tempting to sit the tape under your tummy. The right way to do it is to find the bottom of your ribs and your hip bone and put the tape around yourself midway between the two.
You are at increased risk of diabetes if you are:
Man – waist more than 94cm (37 inches)
Woman – waist more than 80cm (31.5inches)
The next stage is to complete an Oral Glucose Test (referred to by doctors as the OGT or OGTT). This test measures how well your body deals with sugar.
WHAT HAPPENS IN THE OGT
You will be asked not to eat or drink anything for 8 – 12 hours before the test, then just before the test you will have a blood test to measure your ‘fasting’ glucose level. You will be given a glucose drink (usually Lucozade) to drink. Further blood samples will be taken at 30 or 60 minute intervals up to two hours, or you may only have one final blood test. Be prepared for a lot of sitting around!
HOW TO UNDERSTAND YOUR OGT TEST RESULTS
You are not diabetic if:
- Fasting Value (blood sugarbefore test) less than 6 mmol/L
- At 2 hours under 7.8mmol/L
You may have insulin resistance/diabetes T2 if
- Fasting Value: 6.0 – 7.0 mmol/L
- At 2 hours: 7.9 – 11.0 mmol/L
You may be Diabetic T1 if
- Fasting value: more than 7.0 mmol/L
- At 2 hours: more than 11.o mmol/L
WHAT TREATMENT WILL I BE OFFERED?
TREATMENT FOR DIABETES T1
There is no cure for diabetes T1, but you will be iven medication to replace the insulin you are not producing enough of . You may also be given meds to control symptoms that could affect your health in other ways.
The primary treatment for diabetes T1 is insulin therapy. This means injecting yourself every day with insulin. To begin with a doctor or nurse will show you how to do this, so you can do it yourself. An alternative is to nominate a member of your family to do it for you.
Don’t worry if you are afraid of needles as insulin injections are actually delivered by an insulin pen or an ‘auto-injector’ rather than a foot long hyper dermic.
You will probably be three diferent sorts of insulin
- Long acting (lasts a whole day)
- Short acting (lasts up to 8 hours)
- Fast acting (works immediately but doesn’t last)
The idea is you combine these different sorts of insulin every day , depending on what you are eating, the size of your meals and to a certain extent convenience, to keep your blood sugar table.
INSULIN PUMP THERAPY
This is an alternative to injecting yourself with insulin. You have a pump delivering a variable dose constantly into your system. This means a needle is inserted under the skin, often of the stomach. This is connected by a tube to the pump which is about the size of a pack of cards which you can turn up or down depending upon how much insulin you need.
An insulin pump can be more convenient than injections, but not everyone is suitable, so talk to your GP or diabetes team.
KEEPING YOUR BLOOD SUGAR STABLE
The point of taking insulin is to help stablise the sugar levels in your blood. However, certainly early on, you may find this quite tricky. Trying to estimate how much insulin you will need and which type is not that easy. Other factors like stress, illness, other meds and for women what time of the month it is can all effect blood sugar. Certain foods you might not expect to raise blood sugar (like steak) can also give you a shock.
Monitoring your blood sugar levels several times a day is essential to help you make insulin dose decisions and to avoid hypos (your blood sugar crashing) or hypers (your blood sugar going too high).
HOW TO DO THE FINGER PRICK GLUCOSE TEST
You should be given a glucose meter and glucose testing strips by your diabetes team.
- Wash your hands in warm soapy water, then dry them.
- Rub your hands together to warm them up to increase blood flow to your finger
- Get out a testing strip (make sure to seal the packet/bottle of remaining strips to keep them airtight).
- Put a clean lancet into the pricking device.
- Prick the side of your finger, not the top as this will hurt too much .
- Put your finger on the testing strip and squeeze out a drop of blood .
- Put the strip into the meter and wait for the result.
- Write it down! With the time of day, when you last ate, if you’ve exercised, how you feel. This is so you can track the effect of your insulin therapy to get it just right.
You should be given a glucose meter and glucose testing strips by your diabetes team.
HOW TO INTERPRET YOUR FINGER PRICK RESULTS
The test measures mmols/L. You should aim for a reading of 4 – 7 before meals and less than 9 (less than 10 for children) 2 hours after a meal.
Less than 3.6 means you are hypoglycaemic (your blood sugar has dropped too low)
IF YOUR BLOOD SUGAR AFTER A MEAL IS HIGH
- Your meal was too large
- You’ve eaten the ‘wrong’ food (too many simple carbs)
- You need more medication
WHAT YOU CAN DO:
- Reduce the size of your meals
- Reduce the amount of simple carbs you are eating
- Exercise more
- Increase your insulin
TREATMENT FOR DIABETES T2
The most effective way to improve and even reverse T2 is through diet and exercise. T2 is strongly associated with obesity, particularly ‘central adiposity’, that is fat round your middle. If you can manage to shift your muffin top, you may find your T2 improves or even disappaers. Exercise has also been shown to independenly improve insulin resistance.
WHAT YOU CAN DO:
- Lose weight. Yes, it’s boring, but weightloss is the single most important thing you can do to improve your T2. Unlike T1 which may be genetic or just bad luck, T2 is related to belly fat. So getting rid of this will help you.
- Exercise for 30 – 60 minutes a day. It doesn’t have to be jogging, but it does need to raise your heart rate. Ambling to the park with the dog will not do it. Put your trainers on and walk fast, until you feel a bit hot and sweaty.
If you are diagnosed with T2, you will not normally be given insulin. Instead, you will given drugs to increase your own insulin production, such as Metformin (see below). You may also be given medications to treat conditions associated with your diabetes or being overweight. These include
- A statin – to reduce your cholesterol
- ACE or A2RB Inhibitor to reduce high blood pressure
- Aspirin to reduce risk of stroke,
This is the most commonly prescribed drug for T2. It makes tissues more responsive to insulin. This lowers blood sugar levels. It may also help you lose weight which in itself can improve T2.
You will probably be given tablets of 500mg once or twice p/day. There are some side effects though
METFORMIN SIDE EFFECTS
- Loss of appetite (which you may think of as a good thing!)
- Metallic taste in the mouth
To reduce these, don’t take it on an empty stomach.
You may also be prescribed one of the following:
This is what is called a ‘sulphonylureas’. It acts on the pancreass to make it release more insulin. The dose is usually 160mg with breakfast or if you are prescribed a higher dose, you will be asked to split this between breakfast and dinner.
GLUCIAZIDE SIDE EFFECTS
- Weight gain (the last thing you may feel you need!)
GLUCAGON-LIKE PEPTIDE RECEPTOR ANTOGAONISTS (GLP1s)
Brand names include Exanatide (Byetta) and Liraglutide (Victoza). They mimic the effect of a naturally occuring substance falled GLP-1 which stimulates the release of insulin. They are not tablets, but are given by injection and are usually given in addition to Metformin.
GLP1s SIDE EFFECTS
- Weightloss (again, probably welcome).
These are the main ones, although your doctor may also prescribe Sitagliptin, Linaglyptin or Dapagliflozin
THE RIGHT FOOD TO EAT IF YOU ARE DIABETIC.
Whether you are T1 or T2, the key to managing your diabetes is to eat foods that don’t raise your blood sugar too much. The easiest way to do this is to adopt a Low Glycaemic Index Diet. The Glycaemic Index was developed by doctors specifically to help diabetics. It ranks food in order of how quickly they raise blood sugar. A handful of Haribo is obviously at the top of the scale, while a steamed fillet of cod is way, way down.
Still, it’s more than common sense. The GI scale reveals some susprises. For example, adding fat to a food lowers the GI. So, a baked potato with no butter (one of those 1980s diets favourites) is very high GI. Adding a knob of butter to it lowers the GI and makes it a better choice for diabetics.
Ah, but for T2s who may need to lose weight, there is an obvious problem here. If they need to select foods that are both low GI and slimming, should they really slap a geat wodge of cheese (another high fat food that lowers the GI of other foods) over everything? Hmm, the plot thickens, as they say.
To simplify things, here are some high, medium and low GI foods
High GI (Avoid)
Cakes, biscuits, sweets
Puddings and ice-cream
White rice, pasta,bread, couscous, anything with pastry (white flour), potatoes
Dried fruit and fruit juices
Medium GI (Use cautiously)
Wholegrain pasta, rice, bread
Sweet potato, swede, pumpkin, turnip
Whole fruits (watch your serving size)
Low GI (Eat more of these)
Lean proteins (chicken, fish, beef, lamb)
Dairy foods (milk, yoghurt, cheese),
Whether you are T1 or T2, it may be beneficial to you to eat five small meals, rather than three big ones. You should also avoid snacking if these snacks are high sugar ones (cereal bars, sweets) and try to aim for balanced meals of a small amount of complex carbs, some lean protein and good fats from things like avocado, nuts and seeds.
AUTHOR: Nutritionist Lowri Turner
If you are diabetic T1 or T2 and would like help managing your diabetes through food, why not come and see me for a free Initial Assessment.