FAQ about Diabetes

The cornerstone of diabetes management revolves around an appropriate diet or medical nutrition therapy. It must be stressed that dietary modifications play a vital role at all stages of diabetes and is compulsory irrespective of oral medications or Insulin being used for treatment. Diet is also an important intervention to prevent diabetes. The greatest long term health benefits occur when modifications are initiated straightaway from the time of diagnosis of diabetes.

Dietary recommendations in diabetes have to be individualised. However, certain basic principles have to be remembered. The total caloric requirement in an Indian setup would include 60% carbohydrates and the remaining equally split between proteins and fats. The importance of dietary modifications ensures a reduced glucose excursion especially in the post meal state which lead to reduced diabetes complications, reduced lipid elevations and ensure weight stability.

Foods with a low glycaemic index and glycaemic load are preferred in individuals with diabetes. Glycaemic index (GI) refers to the measure of the relative impact of carbohydrate containing food on blood glucose elevations (Low GI <55; Medium GI 56-69; High GI >70). Glycaemic load incorporates the quality and quantity of carbohydrate consumed (product of GI and carbohydrate content)

Amongst carbohydrates, simple sugars including sugar syrup, fruit juices, sugary drinks, honey, sweets, toffees, jaggery, ice cream, desserts etc are best AVOIDED due to the high GI causing the blood sugar levels to rise precipituously. Limit consumption of starchy carbohydrates like white rice, white pasta, potatoes, refined wheat flour products and refined grains with a high GI. Complex carbohydrates have more fibre and the glucose excursions are more delayed making them an ideal carbohydrate choice. Brown rice, parboiled rice, whole grain bread, oatmeal, barley and millets are prefered carbohydrates.

Fats should be restricted to <20% of calories with avoidance of saturated fats especially deep fried food with oil, butter and ghee. Fatty red meat, processed snacks, deep fried snacks (pakoras, vada, bajji, samosas), dessert creams and high fat cheeses are to be restricted as these pose risk by raising bad cholesterol and thus block the blood flow to the heart, brain and limbs leading to heart attack, stroke and limb amputations. Milk has a low GI but a low fat milk is ideally preferred. Vegetables contain a lot of fiber and have a low GI with a low glycaemic load and are recommended for people with diabetes. Limitation of the portion size and eating in moderation form an essential part of a diabetes diet.

Some studies have interestingly revealed that a higher consumption of certain fresh fruit like berries, apples and grapes is associated with a lower risk of diabetes in comparison with low fruit eating individuals. High consumption of fruit juices in these studies however, increased the risk towards diabetes.

Eating whole fresh organic fruits are important for people with diabetes. Fruits form an essential source of vitamins, minerals, fibre, flavonoids and antioxidants. All fruits have carbohydrates and they too can elevate sugar levels when consumed. However, this is variable and depends on the total carbohydrate content and glycaemic index of the fruit.
The carbohydrate content of a fruit increases by processing (concentrating and refining), drying (resins) and converting them to juices. All these forms of fruit including ripening have a higher GI which would increase the sugar levels. Fruit juices are devoid of fiber, flavanoids and have a high GI.
Fresh fruits with a low carbohydrate content like berries, apples, pears, papaya, guava, pomegranate and oranges have a low glycaemic index. They form the ideal fruit choices and consumption time is ideally in between major meals instead of snacks and includes 2 to 3 fresh servings.

Some fruits like bananas (30 g carbohydrate) and mangoes (50 g carbohydrate) have a high GI which are equivalent to 6 to 9 spoons of sugar. Ideally these high GI fruits are avoided. If these fruits were to be consumed they would have to be counted as part of the total daily carbohydrate in the meal plan for the day and restricted to 10 to 15g (equivalent of 1/3 banana).

Exercise is a vital lifestyle method, which controls blood sugar levels in diabetes. Exercise or physical activity reduces post meal blood glucose levels by causing an enhanced glucose uptake into the muscles by improving insulin sensitivity. This improved insulin action and blood sugar lowering effect could even last for more that 24 hours after the exercise session.

Muscle contractions during physical activity also take up glucose by an insulin independent mechanism. In the immediate short term this results in lowered glucose levels. If exercise is continued regularly this improves blood glucose for the long term and lowers the HbA1C and benefits the heart by reducing complications.

Exercise for diabetes doesn’t include walking, jogging, swimming, cycling, dancing etc. An increase in physical activity including avoiding prolonged sitting especially in front of a TV, walking upstairs instead of using a lift, gardening, dancing are important and must be a natural way of life.

Exercise intensity should be started gradually and increased in a slow and sequential manner setting realistic goals. The recommended baseline exercise for diabetes is moderate physical activity of 150 minutes per week or 30 to 60 minute sessions on most days of the week. Exercise/physical activity should be fun and enjoyable and should not be considered as a punishment for diabetes.

When choosing the types of exercise speak with your health professional for the ideal options especially if there are heart, kidney and eye related complications of diabetes.

If on Insulin, precautions for a hypoglycaemia (low blood glucose

Foot care and footwear is essential for all people with diabetes. It is important to remember to check the feet before and after exercise especially in individuals with peripheral neuropathy – a complication of diabetes affecting nerves. These individuals have lost the sensory perception at the feet and hence they could injure their feet leading to devastating foot ulcers if they are not careful with their footwear.

Diabetes associations like the American Dibates Association allow alcohol in moderation in diabetes. However, alcoholic beverages are best avoided as they can accelerate diabetes related nerve damage, affect blood sugars by making them erratic and also affect blood pressure. Smoking in diabetes has to be STOPPED completely as it poses the greatest risk for serious complications to the heart and the kidney. SMOKING KILLS by causing an enhanced multi-fold risk for a heart attack. Smoking also worsens blood glucose control and worsens diabetes related eye complications. Smoking also damages the nerves to the arms and legs and decreases circulation to the feet leading to foot ulcers and amputations. Smoking cessation has the greatest health benefit to all subjects irrespective of diabetes and is strongly recommended.