Living with Diabetes  

By Lovely Ranganath, Dietician, Al Zahra Hospital, Sharjah 

If you, your child or another family member has just been diagnosed as having diabetes, your reaction is probably one of shock and bewilderment. This is a common reaction that most people with diabetes and their relatives experience. However…though diabetes cannot be cured it can be controlled. With treatment and ongoing self-management, the person with diabetes can enjoy good health and lead a full, productive life. Your doctor, diabetes nurse educator, dietician and other members of the diabetes health care team will help and guide you.

What Is Diabetes?

Diabetes is a condition in which the body is deprived of energy because too much glucose stays in the blood. The reason for this is a lack of insulin-a hormone or substance produced by the pancreas. Some of the foods we eat (the carbohydrates or starchy foods) are changed into glucose by the digestive juices in the stomach. This glucose is the fuel our bodies run on. It provides the energy for our body to function (just like petrol in a car). Everyone has some glucose in their blood stream all the time. The healthy blood glucose range is 4 to 8 mmol/L (Don’t worry about the mmol/L, just remember 4 to 8. Ideally 5 to 6 mmol/L on waking). Insulin’s job is to transport glucose from the blood stream out to the body’s cells were it is used for energy or stored for future needs.

Our Fuel System:

Insulin (the key) transports Glucose (petrol) from the Bloodstream (petrol tank) out to the Body cells (motor).

Without insulin, the glucose cannot flow from the bloodstream into the body’s cells.

There are 2 Main Types of Diabetes.

In Type 1 Diabetes: The pancreas fails to produce insulin and insulin must be given at least daily by injection. This is also known as Insulin Dependent Diabetes Mellitus (IDDM) and is more common in children and younger adults.

In Type 2 Diabetes: The pancreas is still making insulin but the production is sluggish or the person’s body is resistant to it. Being overweight makes the body resistant to insulin. This type of diabetes usually affects older people, (age 40 plus), and is likely to run in families.

The common factor in both types is that the blood glucose level rises too high (hyperglycemia). If high blood glucose levels are allowed to continue, (for a long period of time, i.e. months or years), damage or the complications of diabetes can develop.

Remember people with diabetes are not sick. They have a condition which requires management, but they can lead a full and active life.

What suits one person is not appropriate for everyone. Successful management of diabetes is about finding the appropriate mix of food and insulin for the person’s lifestyle. 

The person with diabetes therefore plays a major role in the management of his condition. Remember, on-going care is a partnership between the concerned individual and his GP/ Practice Nurse and the Diabetes Team.

FOOD AND DIABETES

Most importantly – there is no such thing as a diabetic diet! What is suitable for the person with diabetes is good for everyone. There is no reason to prepare special meals. Healthy eating is important for us all.

Just like cars, our bodies require different amounts of fuel depending on our build and activity levels. (Mini’s require less fuel than Ferrari’s or BMW’s).

Ideally, all people with diabetes should see a dietician when diagnosed to have their “fuel” requirements assessed and to have guidelines on how to spread their food intake evenly throughout the day.

Remember – we are balancing food, exercise and insulin to keep the blood glucose level as close to normal as possible.

With diabetes it is now a manual system – insulin is injected daily (in two or more injections). The insulin is then in the body and will transport glucose from the blood stream out to the body’s cells to provide energy. It is important that food is put in at regular intervals for the insulin to work on.

Ideally, a person who requires insulin should have three meals and three snacks with no longer than about three hours in between to maintain the balance between food, exercise and insulin.

If the person has an extra-active day or plans to play sport, extra food (carbohydrates) will be required to “top up” the fuel supply. Again it can be likened to a car – the faster you drive a car the more fuel you will use. It is the same with our bodies. Your diabetes health care team can help you assess what increases in fuel will be required during periods of increased activity.

The following facts about food and healthy eating will help you understand the requirements of a healthy food plan to maintain the balance required in managing diabetes.

There are 3 main food groups (nutrients): 

CARBOHYDRATE; PROTEIN; FAT

Insulin is required for the body to be able to utilize these nutrients. These nutrients are all essential to maintain good health but we require more of some than the others.

Carbohydrate foods are the body’s first and preferred source of fuel for energy. These are the foods we will mainly be concentrating on to balance with insulin.

Protein foods are required for tissue building and repair. Growing children require more protein than adults. Any excess protein intake is converted to glucose in the body and can be used as an alternative source of fuel.

Fats are a vital nutrient for our body to function properly and are a concentrated source of fuel for energy. Too much fat however increases blood cholesterol and the risk of coronary heart disease. It also leads to excessive weight gain and poor control of diabetes. 

A dietician will assess your food requirements and give guidelines to ensure your food plan contains approximately the right amounts of these nutrients to maintain good health.

Your healthy food plan should therefore be something like this:

At each meal and snack: Have some complex carbohydrate or starchy foods, e.g. whole meal bread, wholegrain cereals, fruit, potato, pasta, rice, legumes.

These are the fuel foods that we have to balance with insulin and it is important that these foods are spread evenly throughout the day to ensure the injected insulin has something to work on.

Too much carbohydrate at one time will push the blood glucose level up too high. Too little carbohydrate will allow it to drop too low.

If you are regularly eating the recommended amounts of carbohydrate your Diabetes Health Care Team can more readily assess how much insulin is required to maintain the blood glucose at a good level.

At two meals a day:

Have a small / moderate serving of low fat protein foods, e.g., lean meat, chicken, fish, eggs, low fat cheese.

As well, fill up your plate with green or salad vegetables. These foods provide minerals ad vitamins to keep us healthy but will not affect the blood glucose level.

Drinks

Water, tea or coffee (without sugar). Diet drinks, e.g., diet soft drinks, diet packet drinks.

Avoid sugary foods (simple sugars) e.g., sugar, jam. Marmalade, syrups, honey, cakes, puddings, sweet biscuits, sweetened condensed milk, lollies, chocolate, ice cream, beer, cordials, fruit juice, sweet sherry and wines, soft drinks, sweetened tinned fruit.

These products are also carbohydrate foods but they contain refined sugars therefore raise the blood sugar level faster than the injected insulin can cope with it.

While these products are best avoided it does not exclude their use for an occasional treat. However, if you had large servings of these products and omitted complex carbohydrate foods, the blood glucose level would rise very quickly, but after an hour or two when the insulin has caught up with the sudden intake of glucose, the blood glucose level can then drop too low(hypoglycemia).

Avoid foods high in fat.

Visible fat products include:

Butter, margarine, oils, lard, dripping, peanut butter, visible fat on steak or chops, skin on chicken.

Many foods contain hidden fat, e.g, processed meat, sausages, salami, luncheon sausage, cheese, cakes, pastries, chocolate, ice cream, potato chips, crisps and corn chips, gravies, sauces, salad dressings and mayonnaise.

The golden rule is use as little fat as possible when preparing or cooking food and choose low-fat alternatives whenever you can.  

IDEAS FOR MEALS

Some Breakfast ideas

·        Fresh fruit

·        High fibre cereal or porridge with skimmed or semi-skimmed milk

·        Whole meal bread or rolls with low-fat spread or sugar-free jam

Some snack / in-between meal  ideas

·        Soup e.g., lentil, broth, split pea

·        Wholemeal sandwich or roll or baked potato with a choice of filling such as cottage cheese with pineapple, tuna with low calorie mayonnaise and green peppers, baked beans and low fat cheese.

·        Fresh fruit

·        Diet yogurt

·        Wholemeal scone or biscuit 

Some main meal ideas

·        Vegetable curry with rice, baked or grilled chicken/ fish,

·        Fish and potato pie, stir-fried chicken and vegetables,

·        Chicken risotto with brown rice and vegetables, etc.

Fresh fruit, unsweetened stewed fruit, sugar free crumble(with wholemeal topping) with natural yogurt or unsweetened custard.

Tea, coffee, low calorie drinks and mineral water can be taken at any time.

COPING WITH DIFFICULT MEALTIMES

THE BUSINESS LUNCH: The key to the successful business lunch is to see it as a treat.

Apertif – Have a large glass of mineral water, which will start to fill you up so that you will eat less.

Starter – Choose one of the following:

Vegetable soups, smoked salmon, fruits, a gorgeous salad (ask for the dressing on the side so that you can add only what you want), fresh prawns (without mayonnaise or butter), eat the bread roll if it’s wholemeal, but no butter.

Main course – Choose one of the following:

Steamed or grilled fish, grilled chicken breast (no skin), a vegetarian dish, at least four vegetables (exclude potatoes this time, they help to satisfy you so eat them FIRST), No creamy sauces, any amount of salad.

Dessert – Fresh fruit is the best option but choose the most appetizing and exotic, for example papaya, passion fruit, guavas, raspberries and strawberries out of season. Or you could simply opt for a fresh fruit salad.

Avoid cheese and biscuits – they are high in calories.

Wine – One glass of white or red.

Water – Drink a glass of water for every glass of wine, plus an extra glass of water.

Coffee – Take this without cream or sugar.

Digestive Liqueurs – Pass on the port, brandy and sweet liqueurs.  

FOOD ON THE RUN:

Keep a piece of fruit and / or a small piece of low fat cheese handy.

Buy 0.25kg (1/2 lb) of your favourite fruit or a low-calorie cereal bar and eat them on the run.

Drink 0.25 litre (1/2 pint) of skimmed or semi-skimmed milk.

Have a pot of very low-fat flavoured yogurt and a plain wholemeal roll.

Have a portion of any salad, but leave as much of the dressing as you can.

Avoid salads with mayonnaise dressings.

Don’t eat crisps: they are high in fat and salt.

Don’t be tempted to eat chocolate bars or biscuits.

Sandwiches – Make your own sandwiches or ask the sandwich bar to make them using:

·        Wholemeal or granary bread or rolls.

·        No butter or margarine.

·        No dressing of any kind

·        Lots of black pepper (if liked).

Take-out food

·        Drop into a Greek takeaway and grab a pita bread with a little lean meat, chicken or hommous, and lots of salad.

·        If you are having an Indian meal, just ask for a dish of dhal or vegetables and a chappati or rice.

·        When having a Chinese takeaway, ask for a dish of mixed vegetables and plenty of rice.

·        Avoid fried takeaway foods such as egg rolls and fish and chips entirely. 

SICK DAYS:

·    Substitute liquids if solids are not tolerated.

·        Sip 8oz (240 ml) of fluid every hour; each hour alternate a calorie containing fluid such as juice or regular soda with a non-caloric beverage such as water, diet soda or tea.

·        SUGGESTED FOODS – unsweetened fruit juice, ginger ale, apple sauce, custard, regular gelatin, sugar-free popsicle, low fat yogurt. 

HANDY TIPS 

WAYS OF REDUCING FAT

• Use tomatoes and herbs or low fat yogurt rather than cream, when making sauces.
• Grill, poach, boil or microwave foods rather than frying.
• Trim visible fat off meats.
• Replace whole milk with skimmed or semi-skimmed milk
• Spread soft margarine thinly.
• Skim excess fat off mince, casserole, etc.

WAYS TO REDUCE SUGAR INTAKE

• Use alternative sweeteners in drinks instead of sugar. Better still, don’t take either!
• Try mineral water or low calorie drinks instead of sweetened squash and fizzy drinks.
• Try tinned fruit in natural juice rather than fruit tinned in syrup.
• Buy fresh fruit rather than sweets and chocolate.
• Use less sugar in recipes. They still work!

WAYS TO INCREASE YOUR FIBRE INTAKE

• Choose high fibre breakfast cereal
• Have wholemeal granary bread instead of white bread.
• Try wholemeal flour in baking. Start by using half wholemeal bread and half white flour.
• Try wholemeal pasta and brown rice instead of the white version.
• Try adding dries beans and peas to casserole, to replace some meat.

GENERAL SUGGESTIONS

• Make a shopping list and plan meals ahead if possible.
• Try lemon juice on salads instead of salad dressing.
• When making gravy, always allow the fat to settle, then pour off first.
• Try fish wrapped in foil and baked with little seasoning.

Diabetes Management - your Role

You must take control of your diabetes on a day-to-day basis. This will be easier the more you learn about your diabetes. Follow good lifestyle practices. These include choosing the right food, maintaining a healthy weight, getting regular exercise and avoid smoking.

Photo courtesy: ismanet.org

Ms Lovely Ranganath, Dietician, M.Sc (Food Science & Nutrition), Dip. Fitness & Nutrition, Al Zahra Hospital, Sharjah and Al Zahra Medical Centre, Dubai will be regularly writing on Diet and Nutrition on womenone.org.