Our Dietitian Shares 5 Key Points To Managing Type 2 Diabetes
So, your dietitian or GP has recently diagnosed you with Type 2 Diabetes. What now? What does this all mean?
Diabetes mellitus (or diabetes) is a rapidly growing epidemic both worldwide and in Australia, with around 1.7 million Australians suffering from the disease, and 300 million people worldwide estimated to have diabetes by the year 2025. You are not alone.
Type 2 diabetes, which accounts for 90-95% of all diabetes cases, usually develops in people over 40 years of age when the insulin-producing cells of the pancreas progressively lose their function with age.
Your body breaks down carbohydrates into glucose, which then enters the bloodstream (at which point we commonly give it the name ‘blood sugar’) and is then distributed around to your body‘s cells to be used as energy.
In order for your cells to take in the glucose from the bloodstream, they need insulin, a hormone that acts as the carrier of glucose from the blood to the body cells. A shortage of insulin being produced means glucose stays in the blood, which then causes hyperglycaemia (high blood sugar)- the main characteristic of diabetes.
Diabetes is generally associated with obesity and sedentary lifestyles, both of which are modifiable and, to some extent, preventable risk factors Adam Pavlovski. Northern Spinal Clinic Dietitian. Melbourne.
Although it may all sound daunting, being diagnosed with diabetes does not mean the end of the world- with the right support and education, many people with the condition can live a full life with minimal complications.
Here are five fundamental factors to take into consideration when managing Type 2 diabetes:
1- Carbohydrates in your diet
As any dietitian would agree, food items that contain carbohydrates are made up of glucose- whether it be complex carbohydrates, such as bread or pasta, or simple sugar, i.e. lollies and soft drinks. Put simply, glucose is the fuel that the brain and muscles need to function.
That being said, carbohydrates are the foods that have a direct impact on blood sugar levels, and therefore must be managed accordingly to prevent any undesirable spikes or dips in blood glucose.
Gone are the days of doctors advising patients to completely cut things like desserts, bread, pasta, and even fruit out of their diets because of their effects on blood sugar. Thankfully, research has progressed and a more measured approach is adopted when managing carbohydrates in the diet.
Three things to consider when eating carbohydrates:
- Amount: With carbohydrate intake directly impacting blood glucose levels, it goes without saying that a can of Coke (which contains a massive 40g of sugar!) will have a bigger impact on blood glucose than, say, a banana, which has around 14g of sugar. Larger amounts of carbohydrates eaten in the one sitting will cause a spike in blood glucose levels, which in turn can cause unwanted symptoms, such as dizziness and dehydration.
- An Accredited Practicing Dietitian (APD) can help you determine what your overall carbohydrate intake should look like, and the amount you should have to maintain a blood glucose level within the healthy range. You can also speak to our in house dietitian “Adam Pavlovski” about your dietary needs
- Timing: In order to maintain a steady blood glucose level, timing of carbohydrate intake is also fundamental. There is a time and a place to have both larger and smaller servings of carbohydrates- the key is to ration this out appropriately throughout the day, avoiding huge binges of carbohydrate rich foods while also not going for hours on end without some sort of replenishment. An APD can provide guidance in establishing eating patterns that will both suit your lifestyle, and help you maintain a healthy blood glucose range.
- Type: Different types of carbohydrates will release glucose into the bloodstream at different rates, mainly due to the time that it takes for them to digest.
This is known as the Glycemic Index (GI), whereby the lower the GI of a carbohydrate, the longer it will take to enter the bloodstream.
These types of carbohydrates (i.e. whole grains) are the preferred choice due to their slower effect on blood glucose, and are less likely to have you craving that mid-afternoon sugar hit than higher GI alternatives (i.e. cakes, pastries).
2- Your Overall Diet
The overall diet of somebody with diabetes shouldn’t differ much to that of a healthy individual. The Australian Dietary Guidelines are an excellent point of reference, providing recommendations on servings from the five food groups that can help minimize the risk of developing further chronic diseases, such as heart disease and obesity.
Here are some tips for an overall healthy diet that will have you keeping your blood glucose levels in check:
- Avoid skipping meals: Spread your meals evenly throughout the day.
- Include Low GI carbohydrate source at each meal: This is fundamental for healthy blood glucose control, and includes options such as wholegrain bread, rolled oats, long grain rice, and sweet potato.
- Increase vegetable intake: Vegetables are an excellent option, due to their high fibre content and minimal effect on blood glucose. Try to include at least 5 serves a day
- Don’t avoid Fruit: Contrary to some beliefs that fruit has a detrimental effect on blood glucose levels because of its sugar content, fresh fruit should be included in your diet whenever possible. The added sugar in fruit juice can, however, impact blood glucose (it has a much higher GI than fruit itself), and should be limited.
- Eat Protein: Protein is essential for growth and repair, and does not have an effect on blood glucose levels. Low fat protein sources include lean meat, fish, eggs, low fat dairy, nuts and seeds. Aim for 1 serve at each main meal.
- Alternative sweeteners are okay: It’s perfectly fine to have foods and drinks with artificial sweeteners every now and then, however they shouldn’t be at the expense of more nutritious foods and drinks.
- Avoid sweets & soft drinks: Chips, chocolates, and sugar filled soft drinks or cordial can wreak havoc on blood glucose levels if they are eaten in large amounts. Try to avoid such foods as much as possible, and have small amounts in moderation if you choose to indulge.
- Limit Alcohol: Drink alcohol in moderation. If you choose to drink, avoid high sugar pre-mixed drinks.
3- Your Weight Vs Physical Activity
Maintaining a healthy weight is essential in successfully managing diabetes. The good news is that it’s never too late to shed those extra kilos and reap the associated health benefits! Along with the many benefits of regular exercise that you’re probably aware of (i.e. healthy weight management, feeling of general health and wellbeing), it has a positive effect on your body’s insulin sensitivity, meaning that your cells are more responsive to insulin.
As a result, glucose is transported from your bloodstream to your cells more efficiently (which is excellent for somebody with diabetes, whose insulin producing abilities are compromised), thus lowering your blood glucose levels.
Additionally, carrying extra weight will cause a higher insulin demand, which will only put more stress on your body. If you are currently overweight, aim for an initial body weight loss of 5-10%- any small amount of weight loss will be of benefit, although you will find more advantageous metabolic impacts with larger, long-term weight loss.
4- Blood Glucose control
While self-monitoring of blood glucose is not routinely conducted by all adults with Type 2 diabetes (of course there are some exceptions, in which case your Doctor or Diabetes Educator will advise otherwise), regular testing and recording provides an indication of the effect your lifestyle choices are having on blood glucose control, and can alert you of any need to modify your management of diabetes.
With normal blood glucose levels ranging between 4.0-7.8mmol/L, target levels for people with Type 2 diabetes are:
6-8mmol/L before meals
6-10mmol/L two hours after starting meals
An HbA1c test is a good indicator of the long term overall control of blood glucose levels, and should be conducted every 3-6 months. Targets for this test will range from 48-58 mmol/mol (or 6.5-7.5%), depending on medications.
In any case, your Doctor or Diabetes Educator will explain which target is suitable for you and prescribe the appropriate medication, if necessary.
5- Your Support team
You don’t have to tackle diabetes on your own. A number of health professionals & dieticians are available to assist, guide and educate you to make lifestyle changes that will have you managing your diabetes with minimal fuss or complications, including your General Practitioner, Dietitian, Diabetes Educator, Podiatrist, Pharmacist and Endocrinologist.
Support from family and those close to you can also be beneficial- don’t be afraid to get them involved!
We’re all different and our bodies are unique, thus treat this article as general advise only. Before you embark on your journey to getting better, we urge you to speak to your GP or our dietitian for a more personalised plan that suits your needs.