Dealing with Diabetes

In the past 30 years, the rates of those diagnosed with diabetes, in both the young and old, have increased at such an alarming pace that it is now considered a healthcare epidemic. The World Health Organization says the situation is serious worldwide, with more than 177 million people currently diagnosed with diabetes.

In Canada alone, the number of people with diabetes is projected to increase from approximately 1.4 million in 2000 to 2.4 million in 2016. The cost to the healthcare system of this surge in diagnoses is estimated to grow from $4.7 billion in 2000 to $8.4 billion in 2016–an increase of 75 percent!

For what is largely a preventable and treatable disease, the physical and financial cost of diabetes is far too high. Unlike many other disease processes that send researchers searching for a “cure,” the causes of and methods to prevent and reverse type 2 diabetes are already known. By following specific nutritional and lifestyle approaches, the ever-climbing rates of those diagnosed with type 2 diabetes can be reversed, ending this unnecessary epidemic.

A person with diabetes incurs medical costs that are two to three times higher than that of a person without diabetes, including direct costs for medication and supplies ranging from $1,000 to $15,000 a year.

Based on a US study, diabetes and its complications cost the Canadian healthcare system an estimated $13.2 billion every year. By 2010, it’s estimated these costs will rise to $15.6 billion a year and by 2020, $19.2 billion a year.

Understanding Insulin

In order to understand the two main types of diabetes, type 1 and type 2, the role of insulin in the body must be understood. Insulin is a hormone secreted by the pancreas in response to elevated blood sugar. Of insulin’s many roles, one of its most important is to transport blood sugar (glucose) from the blood into the cells. Simply put, the process works in the following manner.

1. Blood glucose levels are elevated by eating a carbohydrate (e.g. piece of bread).
2. The pancreas responds to the elevation of blood glucose by secreting insulin.
3. Insulin opens up the gates of cells to allow glucose to “enter.”
4. The gates of the cells open and glucose gets absorbed into the cells.
5. Blood glucose levels are normalized.

The development of diabetes occurs when insulin secretion is either extremely low, or the cell receptors become insensitive to insulin causing the body to secrete more and more.

Type 1 Diabetes

Type 1 diabetes is the least common of the two main types of diabetes and occurs in 5 to 10 percent of all those diagnosed. Type 1 diabetes is primarily diagnosed in children and adolescents and occurs when an individual is unable to secrete insulin and must rely on insulin injections to properly absorb blood sugar.

In an attempt to find a cure, several researchers have come up with possible theories as to why type 1 diabetes develops in the first place. Potential causes may include autoimmune disorder, milk allergy, or genetics. Unlike type 2 diabetes, type 1 diabetes does not respond significantly to nutritional and lifestyle changes. In most cases, type 1 diabetics need to be on insulin therapy for life.

Type 2 Diabetes

Type 2 diabetes is the most common type of diabetes and is diagnosed in 90 to 95 percent of all cases. Although type 2 diabetes is now affecting our youth due to the increasing number of obese children, the majority of those diagnosed are over age 30 and are overweight or obese.

Type 2 diabetes is very different from type 1 diabetes in that cell receptors become insensitive to insulin, causing more and more insulin to be secreted. In his book Diabetes and Hypoglycemia, Dr. Michael Murray clearly identifies the difference between type 1 and type 2 diabetes when he states, “Healthy individuals secrete approximately 31 units of insulin daily; the obese type 2 individual secretes an average of 114 units daily. Individuals with type 1 diabetes secrete only 4 units of insulin daily.”

What Triggers Type 2 Diabetes?

In order to appreciate how type 2 diabetes develops, consider the following example. A person eats a piece of white bread, which is made from refined flour. Due to the lack of fibre, protein, and essential fat, the piece of white bread breaks down into blood sugar (glucose) and enters the bloodstream at a rushing speed (the piece of bread has a high glycemic index rating). In order to deal with the blood sugar, the pancreas responds by secreting an appropriate amount of insulin.

If this person continues to eat a diet filled with refined carbohydrates and does not take in sufficient fibre, protein, and essential fat, and does not exercise, the body will try to adapt by secreting more and more insulin to deal with the excess sugar.

Unfortunately, excess insulin creates two serious problems: 1) it causes excess glucose to be stored as fat, contributing to weight gain, and 2) it causes blood sugar to drop too low into a state known as hypoglycemia. Hypoglycemic symptoms include fatigue, moodiness, mental fogginess, and cravings. In order to satisfy a powerful craving and get an energy boost again, most individuals grab the closest sugary or starchy treat, causing this vicious cycle to begin all over again. This continual bouncing around of blood sugar and over-secretion of insulin is the first stage in the development of type 2 diabetes.

Incurring the Cost of a Preventable Disease

As mentioned, type 2 diabetes is a largely preventable disease if proper information and nutritional changes are applied. Unfortunately, change and education is not occurring at a fast enough rate to make a dent in the number of those diagnosed.

In fact, diabetes, with its associated health complications, is now one of the most financially burdensome diseases on the Canadian healthcare system. Secondary diseases and complications caused by type 2 diabetes, such as atherosclerosis, kidney problems, nerve disorders, blindness, erectile dysfunction, amputation, and foot ulcers are draining the well of healthcare dollars and decreasing people’s quality of life. Consider the following statistics for Canadians diagnosed with diabetes.

• Approximately 80 percent of people with diabetes will die as a result of heart disease or stroke.
• Diabetes is a contributing factor in the deaths of approximately 41,500 Canadians each year.
• Canadian adults with diabetes are twice as likely to die prematurely, compared to persons without diabetes.
• Life expectancy for people with type 1 diabetes may be shortened by as much as 15 years. Life expectancy for people with type 2 diabetes may be shortened by 5 to 10 years.

Instead of healthcare dollars being directed toward prevention and education, a large percentage is allotted toward the treatment of diabetes and its complications, which includes costly medications, hospital stays, and diagnostics. According to the Canadian Diabetic Association (CDA), the estimated cost of diabetes has skyrocketed.

Tools for Change

If you are diagnosed with type 2 diabetes, it is important to undergo a complete workup from your family doctor in order to determine baseline levels of your sugar levels, body weight, blood pressure, and cholesterol. Knowing these amounts will be an important platform to monitor change. As well, have your doctor perform a HbA1c (hemoglobin A1c) test every three to four months to ensure you are properly maintaining blood sugar levels.

In addition to a complete physical, there are three tools that should be incorporated into every diabetic’s life to help monitor and control glucose levels and lose weight. These tools are 1) a glucometer; 2) a copy of the glycemic index; and 3) a copy of the glycemic load.

A glucometer is a small home glucose monitoring device to help patients manage their blood sugar levels. This small machine draws blood by pricking the top of the finger with a small, simple, disposable lancet. The individual checks his or her glucose readings by placing a small amount of blood on a reagent strip and then placing the strip into the glucometer. The glucometer then gives a glucose (blood sugar) reading. After a short training session, diabetics become quite proficient at monitoring their blood sugar levels.

The glycemic index is a scale that measures the specific rate at which food enters into the bloodstream. The faster the speed of entry, the more insulin the pancreas will secrete. Food is categorized on the glycemic index scale from a scale of 0 to 100, depending on its effect on blood sugar levels. For ranking purposes, the glycemic index is divided into three categories: low (up to 55), medium (56 to 70), and high (over 70). For the most part, foods that are lowest on the glycemic index have the slowest rate of entry into the bloodstream and therefore have the lowest insulin response.

To gain all the benefits of eating carbohydrates while avoiding excess insulin secretion, it is important for diabetics to stick to carbohydrates ranked low to medium on the glycemic index. For the most part, all vegetables (with the exception of white potatoes), most fruits (with the exception of dates, raisins, and lychee fruit), whole grains, and beans are ranked fairly low on the glycemic index. Processed foods such as white bread, white flour, cereals, pretzels, muffins, candy, soft drinks, and breakfast bars are ranked higher.

The glycemic load shows how much sugar is in the food, rather than just how high it raises blood sugar levels. In other words, it considers a food’s glycemic index as well as the amount of carbohydrates per serving. The calculation of the glycemic load (GL) is the glycemic index divided by 100 and multiplied by its available carbohydrate content. In summary, the values are:

• High: 20
• Medium: 11 to 19
• Low: 10 and under

Let’s take the example of carrots–a highly nutritional food choice. Unfortunately, carrots have received some undeserved bad press due to their high glycemic index rating of 71. Yet, a carrot has only has 4 grams of carbohydrates in total. To determine the glycemic load, the calculation is 71 x 0.04 = 2.84 GL.

Carrots, therefore, have a low glycemic load rating and will not over-secrete the hormone insulin. Now let’s take the example of one cup of cooked, white pasta that also has a glycemic index rating of 71, but contains 40 grams of carbohydrate. The calculation is 71 x 0.40 = 28.7 GL. As you can see, pasta has a high glycemic load because it is so dense in carbohydrates.

Take Charge of Your Health!

Of all the steps necessary to achieve proper blood sugar control, achieving a healthy body weight is the most important. Instead of following a fad or “crash” diet to lose weight quickly, healthy and gradual weight loss (two to four pounds per week in the first three weeks and one to two pounds per week after that) is the best way to lose and maintain your ideal weight.

In addition to weight loss, the following nutritional and lifestyle approaches are key steps for diabetics to take back control of their health.

Eat a sufficient amount of lean protein, essential fat, and fibre. Protein, fat, and fibre act as “brakes” slowing down the entry of glucose derived from carbohydrates into the bloodstream. Remember, the slower the entry of a carbohydrate into the bloodstream, the smaller the amount of insulin that is secreted in response.

Incorporate proteins such as yogourt, egg whites, fish, chicken, protein powder, and tofu and healthy fats such as flaxseed oil, fish oils, nuts, seeds, and avocados into the diet. Healthy fibre options include psyllium, ground flaxseeds, beans, vegetables, fruits with skins, and whole grain breads.

Avoid processed and packaged foods that are loaded with sugars and refined flours. These foods likely have a higher glycemic index and load rating, causing blood sugar levels to bounce around and weight gain to occur.

Consider supplements that can help monitor blood sugar control, such as chromium, fish oils, vitamin C, and magnesium. Speak to your primary healthcare practitioner about which ones are right for you.

Avoid foods that are high in saturated fat, such as red meat, full fat dairy products, and deep fried foods. These foods can worsen glucose tolerance and increase the risk of type 2 diabetes. In fact, diabetics have been shown to do extremely well on a vegetarian diet.

Start exercising as a part of your daily routine, and you will lose weight, feel great, and maintain proper blood sugar control. Choose exercise activities that you think are fun, rather than those you think are good for you. Be sure to consult your healthcare provider before embarking on any new physical activities.

Wield Your Power

In terms of health care, knowledge is power. This statement is especially true when it comes to type 2 diabetes. If you or someone you love has type 2 diabetes, do not consider it a life-long sentence. By becoming educated on how to use the proper tools, making smart nutritional choices, and exercising regularly, you can regain control of your blood sugar levels, your weight, and your health!

PDF Chart of High and Low Glycemic Index Foods

Type 2 Diabetes is Caused by a Number of Lifestyle Factors Which Include:

• An increase in high glycemic index foods in the diet, such as refined flours and sugars (i.e. white pasta, rice, cookies, crackers, white bread, soft drinks, etc.)
• An increase in portion size
• An increase in obesity
• A decrease in physical activity.

Fasting Sugar Readings are as Follows:

• 3.9 - 6 millimoles per litre of blood (mmol/L) is within normal range
• 6.1 - 6.9 mmol/L is impaired glucose
• 7 mmol/L or greater is abnormal.