Understanding Diabetes starts with the foundational knowledge around how Diabetes works in the body and differentiating between the two types. Type 1 Diabetes and Type 2 Diabetes. The reason why we need a clear point of difference between the two is because they have such different origins, with Type 2 Diabetes considered a lifestyle disease, whereas Type 1 Diabetes is an Autoimmune life-long condition that stops your body from producing insulin. Unfortunately at this stage there is no cure for Type 1 Diabetes but there are great ways to manage it through Nutrition, Physical Activity and Mindset. Type 2 Diabetes on the other hand can be reversed through key lifestyle changes and more specifically dietary changes that include managing carbohydrate intake.
What is the difference between Type 1 Diabetes and Type 2 Diabetes?
Type 1 Diabetes occurs due to a deficiency in insulin and this is brought about by the destruction of insulin producing beta cells in the pancreas.
Type 2 Diabetes and pre diabetic levels of high blood sugars (hyperglycaemia) occur due to insulin resistance when the cells don’t properly respond to the signal for glucose to uptake from the bloodstream.
Diabetes is often diagnosed when:
HBA1C is measured at 48mmol/mol or above.
Or when Fasting Plasma Glucose (FPG) test results are over 6mmol/l.
Pre Diabetes is often identified and diagnosed when:
HBA1C is between 42mmol/mol and 47.9mmol/mol
Or when Fasting Plasma Glucose is between 5.5mmol/l and 6.0mmol/l.
There are quite a few tricky words to understand when it comes to the words used to describe Diabetes and often you will find them abbreviated too. Below are some of the most commonly used words and what they mean:
HBA1C (Glycated Haemoglobin (Hb) Haemoglobin is a protein found in red blood cells. Glucose attaches to the red haemoglobin forming A1c and this forms HBA1c. Expressed as mmol/mol.
FPG (Fasting Plasma Glucose) refers to the amount of glucose molecules found in a liter of blood plasma following 8 or more hours of fasting (not eating any food) Expressed as mmol/l.
Bolus (Short Acting insulin taken before eating)
Basal (Long Acting insulin taken 1 - 2 x a day depending on your routine)
MDI (Multiple Daily Injections)
Pump (Insulin Pump that infuses insulin non stop)
What are the signs and symptoms?
Some of the signs and symptoms of type 1 and type 2 diabetes are:
Unexplained weight loss
Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin)
Frequent infections, such as gums or skin infections and vaginal infections
What is Insulin?
Our bodies need a constant supply of energy to function and stay alive and because of that we need a certain base amount of insulin in the blood to signal the cells to absorb glucose from the food we consume.
In healthy people glucose and insulin levels go up and down however in Type 1 Diabetes the pancreas produces small amounts or no insulin and in Type 2 Diabetes blood glucose levels are much slower to return to the baseline between meals which results in an increase in both and over time this results in high blood sugars (hyperglycaemia) and high insulin levels (hyperinsulinemia)
Understanding Healthy Glucose Metabolism
Glucose is an important source of energy for the body and the brain. Homeostasis (the tendency towards a relatively stable equilibrium between interdependent elements, especially maintained by physiological processes which enables the human body to maintain a constant state” This is especially important for normal blood glucose levels which is quite narrow and too much or too little can have detrimental and even fatal consequences. Normal levels for non-diabetics (after 8 hours of not eating) should be between 3.9 and 5.9mmol/l. For diabetics this fluctuates and it is critical to take insulin via either MDI (Multiple Daily Injections) or via an Insulin Pump.
The important fundamentals of Diabetes Management
Now that you have a better understanding of insulin, some of the lingo often associated with Diabetes and how healthy glucose metabolism plays a role in the development of Type 1 Diabetes and Type 2 Diabetes.
I'm now going to introduce to you what I believe are the core pillars of long term health success and longevity with Type 1 Diabetes and Type 2 Diabetes. These pillars support long term successful diabetes management alongside an insulin regimen and or other medications that you may be taking to manage diabetes.
Healthy nutrition is more than just eating fruit and vegetables. It is a commitment to maintaining balance throughout your diet. On a more basic level our food is made up of nutrients and these are essential to maintain life and normal body functions.
A healthy nutrition plan and eating habits can be the difference between feeling amazing and feeling average and low in energy. Food is a powerful medicine rather than something we just do out of convenience, such as eating out of packets, takeaways and quick ready made meals which are usually low in nutrients and high in calories.
Protein - needed for growth and muscle function. It is also vital for many body processes like maintaining or building and maintaining muscle tissue, making hormones, enzymes and a source of essential amino acids. In general, we do eat more protein than we need to because of our over consumption of meat and related products. It is important to balance meat based sources of protein and vegetarian food to have a complete amino acid profile in the diet. Red meat should be consumed in moderation and although it does have a number of benefits it is also acidic. It is recommended that less than 500g of red meat is consumed weekly with it being a part of a weekly diet 1 - 2 x a week.
Some examples of good quality protein include:
Fish (white fish - of any variety, salmon, sardines and any other type of seafood)
Chicken (organic preferably and not corn fed)
Red Meat (sirloin, eye fillet and other leaner cuts)
Lamb (limit as this is high in fat)
Tip: Take a look at the main protein sources you currently consume. Make a note of the different types and how often you consume them during the week.
Carbohydrates - sugar and starches are a source of fuel in the body including supplying the brain with vital glucose. Carbs have their place in the diet but in Diabetes it is very important to be “carb aware” and be able to differentiate between a carb that will support healthy blood sugars and one that won’t. There definitely can be balance between the two but overall lower G.I carbs are more beneficial for people with Type 1 Diabetes and Type 2 Diabetes. Fibre is something I am sure you have heard over and over. It is another type of carbohydrate critical for optimal bowel health and plays a role in helping us feel fuller for longer.
Low GI vs High GI
As you can see from this graph - the lower the glycemic index of the food the less of a response on blood sugar levels. This means that the impact it has on how you feel, your daily blood sugar control and on a 3 monthly basis your HBA1c which is a breakdown of your blood sugar control over a 3 month period.
Low GI foods include:
Whole Grain bread
Chickpeas, kidney beans, lentils
Apples, pears, grapes, kiwifruit
Pasta, noodles (in moderation and wholegrain preferably)
High GI foods include:
White and some wholemeal breads
Short-grain white rice
Puffed wheat, cornflake, rice flake cereals
Fat -is a vital source of energy. They contain essential fatty acids that are required to keep our skin, cells and brain structure healthy. Fat is a source of essential fatty acids, which the body cannot make itself. Fat helps the body absorb vitamin A, vitamin D and vitamin E. These vitamins are fat-soluble, which means they can only be absorbed with the help of fats. Fat is essential in the diet to support cell growth. Fat comes in a few different ways. Unsaturated, Saturated, Polyunsaturated, Monounsaturated and Trans fats are examples of some of the fats found in our diet. We want to limit or completely avoid Trans fats (this is a type of fat that is chemically derived and is often in store bought products like cakes, biscuits, chips and pizza. Monounsaturated Fat derives from oils such as olive oil, canola oil and sesame oil. Polyunsaturated derives from Salmon, some nuts and seeds and some oils. Meat products contain both unsaturated and saturated fat. It is important to include a variety of fats but to have a balance between polyunsaturated and monounsaturated fats.
Vitamins and Minerals
Vitamins and minerals are essential substances that our bodies need to develop and function normally. The known vitamins include A, C, D, E, and K, and the B vitamins: thiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxal (B6), cobalamin (B12), biotin, and folate/folic acid. Vitamins and Minerals are in a range of foods so it is important to include a balanced and varied selection of food.
2. Physical Activity
Just like Nutrition Physical Activity and overall Movement play a vital role in your overall health and wellbeing. Physical activity comes in a variety of forms. The four main types of physical activity are aerobic, muscle-strengthening, bone-strengthening, and stretching.
We will focus primarily on aerobic (or cardio) and anaerobic (muscle strengthening) These are both critical for long term health and wellbeing. Cardio is particularly beneficial for strengthening the heart and any muscle strengthening exercises such as lifting weights is very beneficial as we age and has benefits for the immune system, weight loss (as the more muscle you have the more calories you burn at rest) and a range of other positive benefits. I will be going into more detail in my other blogs on how you can change up your diabetes management with physical activity.
Examples of weekly exercise
Walk - 30 mins a day
Strength Train at home or in the gym
The most important part of adding exercise in is doing something you enjoy and can stick to.
I am sure you have heard it before about the importance of sleep. Sleep helps the body to restore and regulate itself. When we sleep there are changes in our brain and muscle activity. But did you know that people with poor sleep habits have a greater risk of developing a number of health issues such as Diabetes, Obesity and Heart Disease.
But how much sleep do you need?
18-65 yr olds - 7-9hours
65+ yr olds - 7-8hours
Sleep Quantity vs Sleep Quality
Sleep quantity vs sleep quality don't always go hand in hand. Consider how much time you spend asleep vs how long you are in bed dozing / relaxing. There is quite a difference between the two. Make a note for a week or so how much quality sleep you are getting. Sleep hygeine is also very important and this comes down to the type of habits you incorporate on a daily basis.
These are some of my tips:
Limit Naps - set alarms for no more than 30 mins. I find 20 mins is adequate.
Avoiding stimulants such as caffeine after 11am - 12pm.
Exercise daily including both strength and cardio based exercises.
Avoid foods that disrupt your sleep such as spicy curries if you find they interrupt your sleep
Get daily exposure to natural light early in the day and expose your eyes as much as possible.
These are some of my tips to getting started with understanding your diabetes and if you can add a few of these into your daily routine your management will improve and you will see changes in your everyday health and wellbeing.
For more tips and info check out my other blogs.