Should I eat sugar free products if I am a DIABETIC.

Diabetic food is actually an obsolete term. But that is not stopping the emotional attachment diabetic patients have to them nor the feel good factor that the companies are able to generate and the patients happily get trapped into.

There are an nth number of manufacturers selling diabetic food products and building a mulit-dollar business. Diabetic foods are more expensive than standard products, with "sugar-free" term often misleading. Mostly, ‘diabetic’ food labeling is applied to sweet food such as biscuits and chocolate. Because of the confusion that is created by this erroneous labeling, there is an urgent need to increase the awareness about the recent shift in dietary policies, which recommends that any food is suitable for people with diabetes in sensible moderation.

According to recent guidelines - people can eat sugary food but in low amounts and in a balanced way. 

Effectively, healthy eating advice provided by the authorities is the same for people with diabetes as it is for those without.

Endocrinologists and nutrition experts advice a healthy, balanced diet with no need to seek out specially labeled food. Because a manufacturer labels a food as ‘suitable for diabetics’ doesn’t mean that other food is necessarily unsuitable for diabetics.

Because there are no official regulations over usage of the term, foods bearing the label ‘diabetic’ may not have any advantages over alternative options. Sweet products, such as marmalades, sweets and chocolate, listed as diabetic options, may use sugar alcohols instead of sweeteners. Sugar alcohol sweeteners usually end in ‘ol’ and include sorbitol, maltitol and xylitol. Sugar alcohols are lower in carbohydrate than table sugar but may cause an upset stomach or have a laxative effect if taken in larger quantities.

Further more, items labeled, as ‘diabetic’ tend to be less healthy options, which could undermine efforts to promote healthy eating.

Diabetic Neuropathy (weakness of nerves)

Diabetes brings with it myriad of problems. The complications associated with diabetes affect various organs ranging from eyes, kidneys to nervous system disorders like neuropathy. Neuropathy literally means pathological involvement of the nerves or in a layman's language weakness of the nerves. There are basically two types of nerves in our body viz. motor that brings out the signal from the brain to the muscles in the periphery to bring out the movements. The other type of nerves are sensory nerves that take care of taking the peripheral sensation to the brain. There are another type of nerve fibers that involve controlling the body internal homeostasis or maintaining the internal organ balance like maintaining the heart rate, blood pressure, bowel movements, urinary control, pupillary responses and sweating response to changes occurring inside the body. Diabetes can affect all the types of nerves in the body.  So in short, diabetes can cause : 

•                 Sensory Neuropathy affecting sensation perception like touch and temperature.

•                 Motor Neuropathy affecting muscle movement.

•                 Autonomic Neuropathy affecting digestive system or heart rate.

Who is at risk?

Those diabetics, not strictly controlling their glucose control, are at a higher risk for developing the neuropathic changes. Incidence of neuropathy are more common in patients with poor control, obese, have higher levels of blood fat and blood pressure, and are over the age of 40. Apart form these factors duration of diabetes remains another non modifiable risk factor in diabetics and it is independent of the other risk factors.  Overall prevalence of neuropathy may be up to 50% in people with diabetes.

Symptoms of neuropathy will often first manifest as numbness or pain in the hands, feet, arms or legs (distal symmetric neuropathy). Apart from above symptoms, they may also affect the organs like blood vessel, heart, sex organs and also gastrointestinal system. 

What causes neuropathy in diabetes?

Prolonged exposure to high glucose levels is the most important factor. But there other factors that also contribute, like....

•                 Lifestyle: like exercise, smoking and alcohol use

•                 Metabolic: high BP, Low insulin levels, abnormal blood fat concentration

•                 Neurovascular: Damage of the blood vessels carrying oxygen and nutrients to the nerves

•                 Inherited: Preconditions that increase possibility of developing the neuropathy

Symptoms of diabetic neuropathy?

The symptoms depend on the form of neuropathy present, and type of nerves being affected. There might be some people who develop no symptoms leading to subclinical neuropathy. 

Common symptoms might include:

•                 Numbness

•                 Tingling

•                 Pain

•                 Wasting of muscles in feet or hands

•                 Indigestion, nausea and vomiting,

•                 Diarrhoea/constipation

•                 Urinary problems

•                 Impotence or vaginal dryness

•                 Faintness or dizziness

•                 Weakness of the limbs

How is neuropathy diagnosed?

Diagnosis will occur on the basis of person's individual symptoms and a detailed physical examination. The doctor may test blood pressure, heart rate, strength, reflexes and sensitivity. Foot examinations are recommended for all diabetics. Few other tests may be required.

•                 Nerve conduction studies

•                 EMG (electromyography) and

•                 QSART (quantitative sensory testing)

How frequently should a doctor evaluate diabetics for neuropathy?

Foot examination should be done regularly during the clinic visits.

Detailed nerve examination should be done at least once a year. 

THE DIABETIC FOOD GUIDE

Diabetes is a life long problem. Before choosing a complex diabetic diet we should keep practicality of its use in the long term in our mind. It is our belief that success of the diabetic diet lies in its simplification. 

Tips for a successful diabetic diet plan are:

1.     Avoid high calorie dense diet like fried meals, sweets, juices.

2.     Avoid low fiber diet like buiscuits, rusks , namkeens etc.

3.     Half a plate salad with atleast 2 meals a day.

4.     Home cooked food in moderate quantities oil.

5.     100-150gm of whole fruit can be taken e.g apple, guava, pear, orange etc.

6.     Dairy products are safe. And each diabetic should take ½ L/kg of dairy products excluding tea and coffee.

7.     Dry fruits only in low amount.

DIABETES & NUTRITION

Diabetes is a disease in which levels of glucose (sugar) in the blood are higher than normal. Glucose is produced by the body from the foods you eat, mainly carbohydrates. When you consume carbohydrates, your glucose levels go up. Keeping track of how many carbohydrates you eat can help you keep your blood glucose levels in your target range.

What are carbohydrates?

Carbohydrates (carbs) are the starches, sugars, and fiber in your diet. Starch is in breads, pasta, cereals, potatoes, beans, peas, and lentils. Natural sugars are in fruits, milk, and vegetables. Desserts, sweetened beverages, and candy contain added sugars. Fiber is in all plant foods—vegetables, fruits, grains, and beans.

Whole grains contain more fiber, vitamins, and minerals than refined grains like white flour. Brown rice, wild rice, oats, corn, barley, whole wheat breads, whole wheat pasta, millet, and quinoa are some examples of whole grains.

While the amount of carbohydrate is important, so is the quality. Whole grains, beans, vegetables, and fruits are best.

Managing your diabetes depends on controlling the amount of glucose in your bloodstream. eating the same amount of carbs each day can help blood glucose levels stay on target. The goal is to keep glucose levels as close to normal as possible. For people who take insulin, sometimes the amount of insulin needed is based on the amount of carbs in a meal.

How can I make sure I have the right carbs at meals?

To start, ask your doctor or a registered dietitian or certified diabetes educator to help you plan the amount of carbohydrates to include in your meals and snacks.

Learn to read food labels for carbohydrate content. Check the serving size and look at the amount of total carbohydrate. Decide how many servings you are going to eat and calculate the amount of carbohydrate. For example, if the label shows that one slice of bread has 15 grams of carbohydrates and you choose to eat two slices, then your total carbohydrate intake will be 30 grams or 2 carbohydrate choices.

People with diabetes need to pay particular attention to their carbohydrate intake. But don’t forget to include foods containing lean protein and healthy fats to round out your meal plan.

Exercise in Diabetes management.

Exercise is important for people with diabetes because it

·       Helps insulin work better to lower blood sugar

·       Helps keep weight down

·       Is good for the heart, blood vessels, and lungs

·       Gives you more energy

Before you begin an exercise routine, your health care team will check your heart, eyes, kidneys, feet, and nervous system to make sure you are healthy enough for physical activity.

Choose a type of exercise that you enjoy so that you are more likely to stick with it. Ask your doctor whether your choice of exercise is a good one for you.

How do I get started with an exercise routine?

As you begin to exercise, start slowly so that your body can get used to it.

Start with a 5 to 10 minute walk outdoors or on a treadmill several days a week, and then gradually add a few more minutes of walking each week.

Exercises like cycling and swimming are good for diabetics.

Experts recommend building up to at least 2 1/2 hours a week of aerobic exercise, such as brisk walking, swimming, cycling, or dancing.

Tips for being active throughout the day? 

1.      Walk instead of drive or public transport whenever possible

2.      Take the stairs instead of the elevator

3.      Work in the garden, rake leaves, or do some housecleaning every day

Monitoring Glucose before exercise is vital !

You should check your blood glucose level before and after exercise, especially if you take insulin or oral medications to lower blood glucose. 

Exercise changes the way your body reacts to insulin and this can make blood glucose levels too low or too high. 

These are serious conditions but with the right monitoring, you can be avoid them. Fear of these conditions should not keep you from exercising.

Because exercise can lower blood glucose, some diabetes medication doses may need to be adjusted when you exercise.

• If your blood glucose is 300 mg/dL or higher before exercising, you should not exercise because your glucose level could go higher.

• If your blood glucose is less than 100 mg/dL before exercising, you should eat a snack to keep you blood glucose from going too low.

Diabetes Overview

Why should we care about Diabetes?

Diabetes is a very common disorder to an extent that upto 12% of population in Delhi is diabetic and another 15-20 % is pre-diabetic. Diabetes is a disorder with very serious consequences if not treated well. And it is very costly to treat diabetic complications than to prevent them. The problem with diabetes is that it affects quality of life much more than quantity of life.

What causes Diabetes?

Diabetes occurs when the pancreas, a gland behind the stomach, does not produce enough of the hormone insulin, or the body can’t use insulin properly due resistance to its action.

What is prediabtes?

In Pre-diabetes, person's blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Pre-diabetes is also know as Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG)

What are different type of Diabetes Mellitus?

Type 1

Diabetes occurs when the pancreas makes very little or no insulin. This form of the disease is most often seen in children. 

Type 2

Body is resistant to the action of insulin, meaning it cannot use insulin properly, so it cannot carry sugar into the cells.

Other types include Gestational Diabetes (occurring in pregnant females) and secondary forms of diabetes like pancreatic DM.

What are the Risk factors for developing Diabetes Mellitus?

Main risk factors for developing diabetes are:

·       Being overweight

·       Sedentary lifestyle

·       Family history of diabetes

·       History of gestational diabetes

·       Age

·       Ethnic/racial background:

·       African

·       Asian

·       Hispanic/Latino

·       Native American

What are the symptoms that should alert you to see your doctor?

·       Increased thirst

·       Increased urination

·       Constant hunger

·       Weight loss

·       Blurred vision

·       Fatigue, or a feeling of being tired

·       Frequent fungal infections

·       Very slow healing of wounds or sores

What are my medication options?

Treatment of Diabetes depend on the type of your Diabetes Mellitus

·       For Type 2 DM: Most people can be managed with oral tablets for long time.

·       For Type 1 DM: Insulin is must right from diagnosis

·       For DM in Pregnancy, Insulin is recommended

From the editor's desk...

Dear Reader

Globally, as of 2010, an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases. Its incidence is increasing rapidly, and by 2030, this number is estimated to almost double.Globally, as of 2010, an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases. Its incidence is increasing rapidly, and by 2030, this number is estimated to almost double. India will be country with more than 1 billion of Diabetic patients by 2030. The disease affects more than 50 million Indians - 9% of the nation's adults - and kills about 1 million Indians a year. The average age on onset is 42.5 years. The high incidence is attributed to a combination of genetic susceptibility plus adoption of a high-calorie, low-activity lifestyle by India's growing middle class. With this is kind of burden on our national economy, it makes sense to uptodate ourselves on the basics of Diabetes and its management.                                                      

– Editorial board.

Healthwise

HEALTHWISE

THE KALPAVRIKSH CLINIC is a superspeciality polyclinic that has been envisaged to bring superspeciality care to the people of Dwarka, Delhi. It aims to bring a comprehensive superspeciality care to the community. Beginning with Neurology, Endocrinology and Spinal cord disorder clinic, there is dream that is to make available for people the best medical advice in all the medical superspecialities and to practice evidence based medicine. As a community health education initiative, we are starting a newsletter that will be distributed free of cost. And all the health related information on various topics covered in the newsletter would also be available on this blog.

We hope you find this information useful.