India is infamous as the diabetes capital of the world due to the growing number of diabetes cases every year. Diabetes is a diseases that impacts how the body utilises blood sugar called glucose. It adversely affects the body’s ability to produce or utilise insulin, a hormone produced by the pancreas. Insulin acts a carrier that transports glucose or energy to different cells in the body. Hence, if a person is diabetic it implies that there is excess glucose in his blood which can cause medical complications.
There could be various reasons behind impaired insulin production or utilisation:
- The pancreas is unable to produce insulin at all.
- The pancreas produces insufficient insulin
- Insulin resistance- our body cells do not respond to the insulin produced.
- Hyperglycemia- excessive sugar build up in the blood due to inadequate insulin production or cells being unable to respond to the insulin produced.
Types of Diabetes Mellitus:
1. Type 1 or IDDM (Insulin-dependent diabetes mellitus): Type 1 diabetes generally occurs suddenly at a young age. It occurs when the body produces little insulin or does not produce insulin at all. The only treatment for Type 1 DM is Insulin therapy. Patients with type 1 usually have a lean body.
2. Type 2 or NIDDM (Non-insulin-dependent diabetes mellitus): Type 2 diabetes generally develops gradually and occurs in middle age. The most common reasons could be high BMI (body mass index), sedentary lifestyle, unmanaged stress, and family history of the disease. Type 2 diabetes can be controlled with a healthy lifestyle, proper diet, weight reduction, or insulin in some cases.
3. Gestational Diabetes Mellitus (GDM): It occurs in pregnant women who did not have a history of diabetes before pregnancy. Gestational Diabetes usually shows up in the middle of pregnancy, during the 2nd or 3rd trimester. In most cases Gestational Diabetes goes away soon after the delivery. However, a majority of the women with GDM are more likely to develop type 2 diabetes at a later stage if they don’t take care of their lifestyle and eating pattern.
Diagnostic tests:
1. Random blood sugar test (RBS): In this procedure a person’s blood sample is drawn at any point of the day irrespective of when he/she had the last meal. Reference values of RBS test:
Normal: 80 - 160 mg/dl
Pre - diabetic: 160 -200 mg/dl
Diabetic: more than 200 mg/dl
2. Fasting blood sugar test (FBS): In this, a person fasts for 8-10 hours before drawing his/her blood sample to test for sugar levels. Reference values of FBS test:
Normal: less than 100 mg/dl
Pre - diabetic: 100 - 125 mg/dl
Diabetic: more than 125 mg/dl
3. Glycated Haemoglobin test (HbA1c): HbA1c test measures the amount of glucose attached to the haemoglobin. The results of this test give the average blood sugar values for the past 3 months. Reference values for HbA1c test:
- Normal: less than 5.7%
- Prediabetic: between 5.7% and 6.4%
- Diabetic: more than 6.5%
Dietary and lifestyle changes to treat/prevent diabetes:
1. Carbohydrates: 50%-55% of the total calories taken in a day should come from carbohydrates. Focus more on complex carbohydrates like whole grains, legumes, vegetables, fruits, oats, and millets. A minimum of 100 grams/day of carbohydrates is recommended as the person may go in ketosis and should be restricted upto 300 grams/day to avoid hyperglycemia.
2. Proteins: 15%-20% of the day’s total calories should come from proteins, mainly from high biological value (HBV) protein sources like eggs, chicken, fish, soya products and quinoa. However, if the patient has diabetic nephropathy, protein intake should alter as per the condition.
3. Fats: 25%-30% of the total calories should be from fat sources. Focus more on unsaturated fats like almonds, walnuts, oily fishes, avocados, and flax seeds. Avoid saturated fats and trans fats which are generally found in red meats, high-fat dairy products, and packaged and preserved foods, as they may increase the risk of hypertension and cardiovascular diseases.
4. Dietary fibre: The recommended dietary allowance (RDA) of dietary fibre for diabetics is 30-40 grams per day. Emphasize more on soluble fibre as it can slow down the digestion process, thereby helping to control diabetes. Foods rich in fibre include wheat bran, oat bran, barley, beans, legumes, apples, and many more.
5. Foods and drinks to be limited/restricted:
- Fried foods and other foods high in saturated fats and trans fats
- Foods high in refined salt/sodium like chutneys, dips, pickles, sauces, and packaged soups/snacks.
- Refined flour/maida products like white bread, pasta, bagels, puffs, and other bakery goods.
- High-sugars foods such such as sweets, bakery products, candies, jams, jellies, and ice cream
- Aerated drinks, fruit juices, sodas and the regular energy drinks (with refined sugar).
- Alcohol to be taken only in moderation- not more than one drink a day for women and two drinks a day for men.
6. Exercise: It is advisable to include atleast 30 minutes of physical activity in daily routine like weight training, yoga, brisk walk with running on & off in between, aerobics and others to keep the metabolism high, as diabetes tends to slow down the metabolic rate.
7. Meal-time and portion size: Food quantity and timing can vary for different people with diabetes. Some may need to eat at the same time each day, while others can be more flexible with their meal timings, depending on their diabetes medicines or the type of insulin taken. If you have been advised mealtime insulin, the eating schedule can be comparatively flexible. If you are on diabetes medicines or insulin and skip or delay a meal, your blood sugar level can drop too low. Therefore, it becomes crucial to get in touch with your healthcare professional for a proper treatment.
Conclusion:
Diabetes is incurable, However, it can be easily controlled with a proper diet and a healthy lifestyle. The nutrition goals for diabetics generally aim at achieving and maintaining optimal metabolic health, improving blood glucose levels and blood lipid levels, and managing blood pressure. With a positive and stress-free mindset and healthy lifestyle practices, diabetes can be eradicated, thereby reducing the number of deaths associated with this ailment.
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