Living with diabetes

Diabetes is an increasing health problem for New Zealanders and it is likely that you or someone close to you may have diabetes or be in danger of getting it.

We asked the experts your questions about what things you need to know to reduce the risk and how to cope with diabetes if you do get it.

What is diabetes?

Diabetes is not a single entity but a group of conditions characterised by chronically raised blood glucose levels. This glucose abnormality is due to absolute or relative lack of insulin and has many causes.

Type 1 and type 2 are the most common. There is a third type called gestational diabetes that occurs in approximately 4-6% of pregnancies at 24-28 weeks and disappears after delivery, but these mothers are at high risk of developing type 2 diabetes in later life.

What is insulin?

Located behind the stomach, the pancreas is an organ which has two different functions: it produces pancreatic juice used in digestion in the small intestine and it produces a number of hormones, one of which is insulin.

One of insulin’s roles is to reduce blood glucose. After a meal containing carbohydrate, insulin is released into the blood to help the transport of glucose from the bloodstream into other cells where it can be used or stored as energy. Between meals the liver produces glucose with the aim of keeping blood glucose at a desirable level. Insulin is used to signal the liver to stop production when the level is high enough. If the body is unable to produce enough insulin, or it becomes resistant to the insulin produced, blood glucose levels can get out of control.

What is the difference between type 1 and type 2 diabetes?

These are two very different types of diabetes.

Type 1 accounts for less than 10% of diabetes and is where insulin-producing cells in the pancreas are destroyed, so that the pancreas does not produce any (or very little) insulin. It is commonly diagnosed in children but can occur at any age and people with type 1 diabetes will need insulin injections for life.

Type 2 is much more common and accounts for 85-90% of all diabetes. We are presently experiencing a huge increase in cases. In type 2 diabetes insulin production becomes inadequate, or body cells become resistant to insulin, or both. Contributing factors include being overweight, having a family history of type 2 diabetes, having a sedentary lifestyle and increasing age. It is treated initially healthy eating and exercise. Medications may be needed if blood glucose levels cannot be kept within the normal target agreed with your medical practitioner. Nationally, 61 percent of people with diabetes aged 25 years and over regularly received either insulin or metformin to control blood glucose. The highest use was in those aged 65–74 years.

Does eating too much sugar cause diabetes?

Eating sugar is not a direct cause of diabetes. There are a number of factors that can increase your risk of developing type 2 diabetes (see below). The more of these that apply to you, the more likely you are to develop type 2 diabetes.

High-sugar food and drinks are a problem if they result in you consuming more calories than you need and cause you to gain weight.

Am I at risk of diabetes?

If you have two or more of the following risk factors it is recommended you get your blood glucose tested once a year:

• European over 40 years old
• Maori, Asian, Middle Eastern or Pacific Island descent aged 30 years or older
• Have diabetes in your family
• Have high blood pressure
• Are overweight (especially if you carry most of your weight around your waist)
• Have Impaired Glucose Tolerance (IGT)

Or if you have had:

• A large baby weighing more than 4kg/8Ib 11oz, or have had gestational diabetes (diabetes during pregnancy)
• High blood glucose in pregnancy
• High blood glucose in the past

I have recently been diagnosed – will it get worse and will I have to inject myself with insulin?

Type 2 diabetes is a progressive disease. As you get older there is a probability you will eventually have to take medication to control your blood glucose and you may eventually require insulin injections.

The good news is that keeping well, good glucose control and a healthy lifestyle have proved to be effective in delaying this process.

Is diabetes hereditary? My mother and grandmother have it so does this mean I will get it?

With type 1 diabetes, the susceptibility is inherited but not the disease itself.

Type 2 diabetes has a significant genetic predisposition so it does tend to run in families. If there is a family history you should reduce your risk factors such as being overweight or lacking exercise. Have your doctor check your glucose levels on a regular basis.

I have recently lost a lot of weight and someone told me I could be diabetic. Is this possible?

Weight loss is sometimes a symptom of diabetes but it can also be a symptom of many other conditions. Ask your GP to assess you and arrange further investigations.

What’s the link with being overweight?

There are many risk factors for diabetes; being overweight is just one of them. If you are overweight, losing weight will ensure your diabetes is better managed and will have many other beneficial effects on your health such as reducing your risk of heart disease.

I am continuously thirsty, no matter how much water I drink. Does this mean I am diabetic?

Thirst is one of a number of symptoms of diabetes so it would be wise to consider further investigations.

Other symptoms can include: blurred vision, unexplained tiredness, passing urine more frequently, numbness and tingling in the feet and legs, and recurrent infections. If you are worried, the first step is to see your GP and get tested.

Do I have to go on a special diet if I have diabetes?

Instead of a ‘diet’, think of it as everyday healthy eating. Healthy food choices are an essential part of managing diabetes well. Think in terms of making changes to your meal plan that you will be able to carry on with long-term. A positive way to look at it is to focus on healthy, nutritious choices and give priority to these in your meal plan.

Here are some healthy eating tips for diabetics:

• Have regular meals of a similar size each day.
• Replace very sugary foods with alternatives; eg water or diet drinks instead of sweet drinks.
• Keep treat foods for special occasions.
• Choose whole grains instead of more processed grains, eg barley and rolled oats and heavy, dense breads; instead of white or wholemeal breads.
• Choose whole fruit instead of fruit juice.
• Increase the amounts of non-starchy vegetables, eg greens, carrots, tomatoes, mushrooms.
• Choose foods low in saturated fats. Avoid visible fat on meat, chicken skin, foods cooked with butter, lots of cheese and cream.
• Trim fat from meat and use low-fat cooking methods such as grilling and baking, not frying.
• Select healthy fats in amounts appropriate to your needs, eg choose margarine in place of butter, spray oils in place of butter and meat fats.
• Regularly eat low-glycaemic index (GI) carbohydrate foods that produce a slower rise in blood glucose levels.
• Use lower-fat varieties of dairy products and choose lean cuts of meat in moderate amounts.

There is a lot to learn so take advantage of opportunities for education and support from your practice nurse, local diabetes society or diabetes clinic. Many people diagnosed with diabetes would benefit from seeing a dietitian to get specific advice.

Do I need to eat special diabetic foods?

There is no need. All nutrients for healthy eating can be found in normal foods. Artificially sweetened drinks and jellies can occasionally provide variety in your meal plan, but remember to carefully read the label as not all drinks labelled ‘diet’ are truly sugar-free; some are only reduced in sugar and cannot be consumed freely.

Some sugar-free products may have more fat in them than regular varieties. Consider any sweets a treat food to be savoured in small amounts; the sugar-free label is not a license to consume these treats in vast quantities. Similarly, check the labels carefully on ‘low-fat’ products as some can be high in sugar.

What is hypoglycaemia?

This is when blood glucose falls below the normal level. It can occur when people are on medication or insulin to reduce blood glucose. There are several warning signs such as feeling dizzy, faint or sweating.

Treatment is by taking some form of fast acting sugar, eg glucose tablets, which raise the blood glucose levels rapidly. This is followed by a sandwich or meal to ensure the level doesn’t drop. It is important to take note of the cause of each episode, so you can avoid it happening again.

What will happen if I don’t start controlling my diabetes?

Unfortunately, one of the major problems with diabetes is that after a period of time, if blood glucose levels are not well controlled, it causes damage to the body’s blood vessels. In particular, the large blood vessels of the heart, brain and legs and the very tiny blood vessels and capillaries that supply the eyes, kidneys and nerves.

These lead to the classic complications of diabetes including poor blood circulation and numbness of feet, high risk of heart disease and kidney failure, all needing to be carefully managed.

Why is exercise important in managing diabetes?

Exercise has many benefits: it increases circulation, burns up energy, helps to keep blood glucose levels well controlled and keeps weight down, as well as making you feel good! It may also lead to a reduction in the dose of insulin or tablets that you need to take.

I play a lot of competitive sport; will I be able to continue with my exercise programme?

Diabetes is no barrier to playing competitive sport and there have been many successful sportspeople who have continued to perform at a high level and manage their diabetes well.

You will, however, need the support of a diabetes team to help you manage your food plan, testing and medication adjustments around training and playing commitments.

Can I still drink alcohol now that I have diabetes?

Yes, but in moderation. It will have less impact on your blood glucose levels if you drink small amounts of alcohol regularly, than having it all at once.

It is also important to eat carbohydrate food when drinking alcohol to avoid a hypoglycaemic reaction.

My husband has just been diagnosed. Do I have to cook different meals for him?

Think of it as eating healthier rather than differently. The types of meals that are appropriate for your husband are healthy meals for everyone in the family. By adjusting the family meal to accommodate your husband’s needs, you will be encouraging your children to develop healthy eating from an early age and it will become a way of life.

Who can I contact for more information on diabetes?

Contact your local diabetes society. There are 38 diabetes societies in New Zealand, all of which are affiliated to Diabetes New Zealand. Membership of your local society provides you with both local and national publications, and invitations to meetings and support groups. Click here to find the Diabetes Society nearest to you.

Diabetes Auckland is the local diabetes society for the greater Auckland region (Wellsford to Pokeno). They offer a six-part ‘healthy living with diabetes’ course that supports you in making lifestyle changes so you can manage your diabetes well. Phone Diabetes Auckland on 09 623 2508 or 0508 342 238 for information on courses.