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Claire Turnbull: Diabetes - 8 November


Next week is Diabetes Awareness week in NZ, and today we welcome healthy food guide nutritionist Claire Turnbull who is going to tell us what we need to know when it comes to diabetes!

1. What is diabetes and are there different types?

                                                
With diabetes, people are unable to regulate the amount of sugar in their blood. When people have too much sugar in their blood it can cause all sorts of issues including blindness and problems with the kidney and feet.

Diabetes is our nation's fastest growing chronic disease, and it is affecting teenagers and children as well.

Around 270,000 New Zealanders have type 2 diabetes and although it's most commonly diagnosed in people over 30 years old, increasing numbers of teenagers and children are developing the disease. A few years ago, type 2 diabetes was virtually unknown in teenagers, but it's now estimated around 500 young people aged between 10 and 18 years old have the disease.

Around 15,000 New Zealanders have type 1 diabetes, and although the numbers here for gestational diabetes are not known, in Australia it's estimated five per cent of women will develop it.

No one has yet discovered the answers that will lead to a cure, but the scientific community has made substantial progress. Here is an update of the latest medical advice.

2. Can you tell us more about what diabetes actually is? And are there different types?

Normally in someone without diabetes what happens is that when you eat carbohydrate containing foods (show examples)&this carbohydrate gets broken down and turns into sugar in your blood. The amount of sugar that stays in your blood is regulated by a hormone called INSULIN.

In someone without diabetes, the right amount of insulin is produced to match the amount of carbs eaten and the amount of sugar in the blood is maintained at a healthy level.

In someone with diabetes, this process doesn't work properly and people can end up with too much sugar in their blood which can cause a number of health problems.

The two main types of diabetes are type 1 and type 2. Neither should be considered 'mild' or less serious than the other. They are different.

In type 1 diabetes, the immune system destroys the insulin-producing cells of the pancreas. This is known as an autoimmune condition. Insulin is the hormone which helps lower blood glucose levels after eating. If you aren't able to produce insulin, it means your blood glucose levels can get dangerously high. People with type 1 diabetes, therefore, have to inject insulin to survive. With support and guidance, people with type 1 diabetes can live very normal lives.

In the case of type 2 diabetes, the pancreas is either unable to produce enough insulin to manage blood glucose levels, or the pancreas is actually pumping out more insulin than it needs but the body is unable to respond as well to the insulin produced. This is known as insulin resistance. Insulin resistance is often associated with carrying extra weight. Type 2 diabetes might be considered mild because often in the initial stages it can be managed with diet and exercise. However, type 2 diabetes is progressive, and often people will require medication and eventually possibly insulin to help manage their blood glucose levels. It is important for people with type 2 diabetes to get regular checkups and look after their eyes and feet as these parts of the body can be affected.

3. Let's talk a bit more about type 2 diabetes as this is such a growing problem in NZ. Who is at risk of developing type 2 diabetes?

Among the risk factors for diabetes are:
- ethnic background. Maori, Polynesians and Asians are more at risk
- being overweight
- having a blood relative with type 2 diabetes
- women who have had a baby weighing more than 4kg (9lbs)
- an inactive lifestyle.

A high-sugar diet is certainly not healthy and may result in someone carrying more weight than is healthy, but it is likely that you are affected by other risk factors from this list which has resulted in your development of diabetes.

4. How do people know if they have it?

Some common symptoms of diabetes include:
- increased thirst
- frequent urination
- blurred vision, dizziness and headaches
- feeling tired and lethargic
- unintentional weight loss (particularly type 1 diabetes)
- weight gain (type 2 diabetes)
- irritability and mood swings

5. What types of foods do you need to eat if you have Type 2 diabetes?

When you have diabetes, you are simply looking for healthy, balanced meals with plenty of vegetables and a moderate amount of carbohydrate (about the size of your fist) which are low in fat, especially saturated fat. This type of meal is what anyone who wants a healthy lifestyle aims for. You don't need special meals or try to eat separately from the family provided they are eating healthy meals. A good guide is the 'ideal plate':

- half plate of low-starch vegetables, eg. broccoli, carrots, capsicum, onions, mushrooms
- quarter plate of carbohydrate (palm size), eg. pasta, rice, potatoes, kumara, green banana, yams
- quarter plate of protein, eg. meat, chicken, fish, eggs.

If you are eating a 'mixed' meal and it is difficult to work out if it fits into the half, quarter, quarter model above, look at the ingredients in what you are eating and add extra vegetables/salad or a small potato or grainy bread if required. See a dietitian for an individualised eating plan.

6. Do people with Type 2 need to buy special foods?

Part of managing diabetes is aiming for a healthy, balanced diet. This doesn't mean you need to rush out and buy special 'diabetic foods'. It is more important to focus on balancing your overall diet and including plenty of vegetables, around two to three pieces of fruit each day (spread throughout the day), whole grains, legumes (such as chickpeas and lentils), low-fat dairy products, lean meat and fish.

Rather than looking for special items, here are a few tips on normal everyday foods:
- Bread: the grainier the better.
- Jam: just use a scrape. A reduced-sugar jam may be helpful, but is not essential.
- Canned fruit: go for fruit in natural juice or 'lite' versions.
- Biscuits: if they are 'sugar-free' they are likely to be high in fat. Go for a healthier snack or have one plain biscuit and call it a day.
- Sauces and dressings: go for low-fat versions and use in limited amounts.
- Dairy products: go for low-fat options (cottage cheese is great), and use hard cheese (such as edam) sparingly.
Learning how to read food labels is an important step to making everyday healthy food choices.

7. Is exercise important?

Do some form of moderate-intensity aerobic exercise such as walking, cycling or swimming for at least 150 minutes each week (ie. 30 minutes, five days of the week).

Include resistance training three times per week. This can help control blood glucose levels and blood pressure, and improve blood cholesterol levels. Consult your doctor first before participating in resistance training exercises - some complications related to diabetes can mean certain exercises may not be appropriate.

8. Anything else people with diabetes need to do?

Don't smoke
If you smoke and you're struggling to give up the habit, there are a number of options available to help you, including counselling, patches and medications. Speak to your doctor or call Quitline on 0800 778 778 (or visit www.quit.org.nz).

Have regular tests
These tests are to monitor diabetes control and detect any complications:

HbA1c (a measure of your average glucose levels over the past two to three months): Have this test every three to six months. Generally, people with diabetes should aim for an HbA1c below 53mmol/mol (or seven per cent), but discuss this with your doctor.

Blood fats (including cholesterol and triglyceride levels): Have this test at least yearly, or more often if you are outside the target range. If LDL ('bad') cholesterol levels are greater than 2mmol/L and/or triglyceride levels are greater than 1.7mmol/L following lifestyle changes, medication may be needed.

Blood pressure: Have this test every time you visit your doctor. A blood pressure reading of greater than 130/80 (or 125/75 if you have proteinuria - protein in the urine) indicates the need for medication.

Kidney function: Have this test annually. A simple urine test looks for very small amounts of protein leaking into the urine - a sign that the kidneys are not working properly.

Eye examination: Have this test soon after a type 2 diabetes diagnosis, and within five years of diagnosis for type 1 diabetes, then every one to two years, or more frequently if problems are found. Speak to your optometrist or ophthalmologist.

Feet examination: Have this test once per year, to check for any circulation or nerve problems which could contribute to ulcers. If problems are detected, regular check-ups with a podiatrist are commended. It is also important to check your feet daily at home.


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