0Diabetes It is a metabolic disorder and not a disease. It is a condition where the amount of glucose in our blood is too high because the body cannot use it properly. This is because the pancreas doesn’t produce any insulin, or not enough insulin. Insulin is a hormone which facilitates the transfer of glucose from the blood to the cells (to provide energy to the cells). In some cases, the insulin that is produced may not function properly or the cells are not sensitive to insulin (known as insulin resistance or insensitivity). There are majorly three types of diabetes: Type 1 Diabetes: In type 1 diabetes, the body does not produce insulin. The body breaks down the sugars and starches you eat into a simple sugar called glucose, which it uses for energy. However, since there’s a lack of insulin in the body, the glucose is not taken to the cells and hence the blood glucose levels stay elevated. Type 2 Diabetes: In type 2 diabetes, the body does not use insulin properly. The cells are not sensitive enough to insulin and hence don’t take up the glucose that is carried by the insulin. This is called insulin resistance. At first, your pancreas makes extra insulin to make up for it. But, over time it is not able to keep up and can't make enough insulin to keep your blood glucose at normal levels. Gestational Diabetes: During pregnancy, usually around the 24th week, many women develop gestational diabetes. A diagnosis of gestational diabetes doesn't mean that you had diabetes before you conceived, or that you will have diabetes after giving birth. This can be temporary and reversible too. Causes and risk factors Insulin resistance - Insulin resistance is a common condition in people who are overweight, obese and are physically inactive. Muscle, fat, and liver cells stop responding properly to insulin, forcing the pancreas to compensate by producing extra insulin. When insulin production falters because of beta cell dysfunction, glucose levels rise, leading to prediabetes or diabetes. Obesity and Physical Inactivity - An imbalance between caloric intake and physical activity can lead to obesity, causing insulin resistance. Central obesity, in which a person has excess abdominal fat, is a major risk factor for diabetes. Age: The risk for type 2 diabetes increases with age, especially after 45 years of age. Family history: It is important for you and your doctor to know if diabetes runs in your family. Your risk for diabetes is higher if your mother, father or sibling has diabetes. Stress: Stress leads to the release of cortisol hormone which favours fat deposition thereby increasing insulin resistance Signs and Symptoms • Polydypsia (Increased thirst) • Polyuria (Urinating often) • Polyphagia (Increased hunger) • Feeling very tired • Losing weight • Sores that heal slowly • Dry, itchy skin • Tingling sensation • Blurry eyesight Diagnostic tests Test Normal range Fasting 70-100mg/dl Post Prandial Less than 140 mg/dl HbA1C Less than 6.3% Random sugar level Less than 140mg/dl Nutrition and Lifestyle Therapy Nutrition therapy and counselling are an integral part of the treatment and self-management of diabetes. The goals of nutrition therapy are to maintain or improve quality of life and nutritional and physiological health. Following is the triad of diabetes: . Diet A. Activity B. Drugs . Diet: 1. Carbohydrates: Carbohydrates are classified in two major parts: • Simple carbohydrates are broken down and digested very rapidly. E.g: Refined sugar, honey, jaggery, fruits and fruit juices, molasses, rice, refined products like breads, maple syrup, etc. Diabetics should go easy with the simple carbohydrates. Refined sugar is something that needs to be completely out of the diet. If needed, one can opt for the natural sources of sugar like jaggery and organic honey but should be careful with the time of consumption and must compliment it with a fibrous meal to take care of the blood sugar. • Complex carbohydrates take longer to digest as they are packed with fiber. E.g: Whole grains, legumes, sweet potatoes, vegetables, millets, oatmeals, etc. • Resistant Starch: A significant proportion of starch in the normal diet escapes digestion in the stomach and small intestine and is labeled 'resistant starch' but this portion is difficult to measure and depends on a number of factors including the form of starch and the method of cooking prior to consumption. Resistant starch may modify postprandial glycemic response, prevent hypoglycemia (drop in blood sugar), reduce hyperglycemia (spikes in blood sugar). Examples of resistant starch are raw potatoes, green unripe bananas, cooked brown rice stored for some time. For a diabetic person, the focus should be more on complex carbohydrates as it helps in gradual release of sugar in the blood. Simple carbohydrates can be consumed in combination with complex carbohydrates (fiber) and/or resistant starch. Moreover, diabetic diet should include more of low to moderate glycemic index foods. Glycemic index (GI) is a ranking system for carbohydrates based on their effect on blood glucose levels. Glycemic index is categorized as low, moderate and high GI. E.g: Low GI Foods (GI of 55 or less) - Most fruits (apple, orange, peach, citrus fruits) and vegetables (except potatoes, watermelon), whole cereals, legumes/pulses, milk, yoghurt, foods that are extremely low in carbohydrates (fish, eggs, meat, nuts, oils), nuts and seeds, mushrooms, etc. Medium GI Foods (GI of 56 to 69) - Whole wheat products, basmati rice, sweet potato, muesli, banana, unpeeled boiled potato, etc. Low GI Foods (GI of 70 and above) -Refined sugar, baked potato, watermelon, croissant, white bread, extruded cereals (e.g. rice crispies), etc. 2. Proteins: Proteins help to reduce the glycemic index of the meal in which they are present in adequate amount and also of the following meal, as they are processed slowly in the body. Thus, adding a good amount of protein in every meal is of great help when it comes to regulating the blood sugar level. Proteins are made from the pool of amino acids and are divided into two categories: First class proteins contain all the essential amino acids. E.g. Meat, fish, chicken, eggs, dairy products Second class proteins lack one or two amino acids: E.g. Cereals, pulses, soya, etc. It’s best to consume the first class proteins to reap the benefits of all the amino acids. If the meal contains a second class protein source, then the only way to make it complete is to combine it with other second class protein source. E.g. A cereal-pulse combination makes a complete protein (brown rice and kidney bean combo/Roti and dal/Moong khichdi/Sprouts-ncous cous salad). 3. Fats: Like proteins, fats also help to reduce the glycemix index of the current meal and the following meal. It’s important to choose the good fats (MUFA and PUFA) and go easy with the bad ones that disturb the blood lipids (saturated fats, trans fats, etc). Bad fats tend to increase insulin resistance and decrease in insulin sensitivity. • It’s best to choose lean cuts of meat. • Avoid deep frying the foods. Instead, you can bake, broil, grill, roast, or boil/steam or stirfry. • Choose low-fat or fat-free dairy foods. • Pick unrefined oils and not the refined ones. 4. Vitamins and minerals: There are certain trace minerals which help improving the insulin sensitivity. Few examples are selenium, chromium, zinc, magnesium. These are found in whole grain cereals, legumes, dairy products. Though they are required in small quantities, they play an indispensable role in regulating the blood sugar. 5. Functional foods: There are some super foods that provide benefits beyond basic nutrition. E.g. Fenugreek seeds, cinnamon powder, green coffee, paneer phool (Indian rennet), jamun seed powder, psyllium husk (fiber), bittergourd, etc. These foods need to be essentially added to a diabetic diet as they have some wondrous effects on blood sugar. Nature offers a lot that can cure/heal/improve the condition without being dependent on the medications that usually have side-effects in the long run. B. Activity: Any kind of physical activity will increase insulin sensitivity and lower insulin resistance. As simple as a daily briskwalk for 30-45 minutes serves the purpose too. A regular exercise routine can help one reduce the dosage of insulin releasing pills or insulin shots. Exercise opens up the cell receptors to pass the sugar from the bloodstream to the cells. C. Drugs: Drugs should be last line of treatment. The person can be on OHA’s (oral hypoglycemic drugs) or on insulin or on both. In case of insulin, it has to be administered exogenously in the subcutaneous fat. Nutrition and lifestyle therapy works the best! It can be used in line with the medical treatment and one can be slowly weaned off the medicines over time.
