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. It is because the pancreas doesn't produce any insulin or not enough insulin. Insulin is a hormone that facilitates glucose transfer from the blood to the cells (to provide energy to the cells). In some cases, the produced insulin 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. Over time, it cannot 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 appropriately 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 significant risk factor for diabetes.
- Age: The risk for type 2 diabetes increases with age, especially after 45 years of age.
- Family history: You and your doctor need 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:
- Polydipsia (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:
Carbohydrates: Carbohydrates are classified into 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 bread, maple syrup, etc. People with diabetes should go easy with simple carbohydrates. Refined sugar is something that needs to be entirely out of the diet. If required, one can opt for the natural sources of sugar like jaggery and organic honey but should be careful with consuming and complement it with a fibrous meal to take care of the blood sugar.
- Complex carbohydrates take longer to digest as they are packed with fibre. E.g., Whole grains, legumes, sweet potatoes, vegetables, millets, oatmeals, etc.
- Resistant Starch: A significant proportion of starch in the regular diet escapes digestion in the stomach and small intestine and is labelled 'resistant starch', but this portion is difficult to measure and depends on several factors including the form of starch and the method of cooking before consumption. Resistant starch may modify the postprandial glycemic response, prevent hypoglycemia (drop in blood sugar), reduce hyperglycemia (spikes in blood sugar). Examples of resistant starch are raw potatoes, unripe green bananas, cooked brown rice stored for some time. For a diabetic person, the focus should be more on complex carbohydrates as it helps in the gradual release of sugar in the blood. Simple carbohydrates can be consumed in combination with complex carbohydrates (fibre) and resistant starch. Moreover, the diabetic diet should include more of low to moderate glycemic index foods.
- Glycemic index (GI) is a ranking system for carbohydrates based on their 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.
Proteins: Proteins help reduce the meal's glycemic index in which they are present in adequate amount and the next meal, as they are processed slowly in the body. Thus, adding a fair amount of protein in every meal is of great help when regulating the blood sugar level. Proteins are made from the pool of amino acids. They 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 complete it is to combine it with other second-class protein sources. E.g. A cereal-pulse combination makes a complete protein (brown rice and kidney bean combo/Roti and dal/Moong khichdi/Sprouts-nous cous salad).
Fats: Like proteins, fats also help reduce the current meal's glycemic index and the next meal. It's essential to choose the right 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.
Vitamins and minerals: There are certain trace minerals which help to improve 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.
Functional foods: Some superfoods provide benefits beyond essential nutrition. E.g. Fenugreek seeds, cinnamon powder, green coffee, paneer Phool (Indian rennet), Jamun seed powder, psyllium husk (fibre), bitter gourd, etc. These foods need to be essentially added to a diabetic diet as they have some significant 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 physical activity will increase insulin sensitivity and lower insulin resistance. As simple as a brisk daily walk 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 the last line of treatment. The person can be on OHA's (oral hypoglycemic drugs) or insulin or both. In the 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.
