The medical recommendations for managing and avoiding diabetes are constantly being updated. Here, Georgia Rickard and dietitian Kate Marsh present you with the latest findings.
Diabetes is our nation’s fastest growing, chronic disease. By 2013, it’s estimated that 4.2 million of us will have it. Australia already has the sixth-highest incidence of type 1 diabetes in children worldwide, while almost one million of us are estimated to have type 2 – although real figures are unknown, as it’s thought many of us aren’t aware we have it. At least one in every 20 women will develop the gestational type, too.
No one’s yet discovered the answers that will lead to a cure, but the scientific community has made substantial progress. Here, we update you with the latest medical advice.
Try to maintain a healthy weight
Carrying extra weight makes it more difficult for your body’s insulin to do its job. Losing weight will reduce blood glucose levels, blood pressure and blood fats and reduces your risk of heart disease.
Eat a healthy diet
Your diet should be aimed at controlling your weight, glucose levels, blood fats and blood pressure.
Keep your intake of saturated fat low and avoid trans fats by choosing lean meats and low-fat dairy products, and by limiting intake of fast foods and manufactured biscuits, chips, cakes and pastries.
Maintain a regular intake of carbohydrate foods spread over the day, to avoid large fluctuations in blood glucose levels. If you take insulin, the amount of carbohydrate you eat at each meal needs to be matched to your insulin dose. Carbohydrate should come mainly from fibre-rich fruits, vegetables, wholegrains and legumes, as well as low-fat dairy products.
Choose mostly low-GI carbohydrate foods including heavy wholegrain breads, oats, barley, legumes, corn, cracked wheat, quinoa, pasta, noodles, many fruits, and dairy products such as milk and yoghurt.
Avoid a high-protein diet (more than 20 per cent of energy from protein) – they’re not recommended due to possible negative effects on kidney function and a lack of evidence for long-term benefits.
If you drink alcohol, stick to one standard drink per day if you are female and two if you are male.
Do some form of moderate-intensity aerobic exercise (eg. walking, cycling, swimming) for at least 150 minutes each week (ie. 30 minutes on five days of the week).
Include resistance training three times per week. This can help control blood glucose levels, 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.
If you do, and are 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 the Quitline on 131 848 (or visit www.quitnow.info.au).
Monitor your condition
Have regular tests to monitor your diabetes control and to detect any complications.
HbA1c: (a measure of your average glucose levels over the past two to three months) every three to six months. Generally, people with diabetes should aim for an HbA1c below seven per cent, but discuss this with your doctor.
Blood fats: (including cholesterol and triglyceride levels) at least yearly, or more often if you’re outside the target range. If LDL (‘bad’) cholesterol levels are greater than 2.5mmol/L and/or triglyceride levels are greater than 2.0mmol/L following lifestyle changes, medication may be needed.
Blood pressure: every time you visit your doctor. A blood pressure reading of greater than 130/80 (or 125/75 if you have signs of kidney disease) indicates the need for medication.
Kidney function: 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: soon after diagnosis for type 2 diabetes and within 5 years of diagnosis for type 1 diabetes, then every 1–2 years, or more frequently if problems are found. Speak to your ophthalmologist or optometrist.
Feet examination: have this once per year, to check for any nerve or circulation problems that could contribute to ulcers. If problems are detected, regular check-ups with a podiatrist are recommended. It is also important to check your feet daily at home.
What about reports that lowering blood glucose is dangerous?
Long-standing medical knowledge has dictated that aiming for normal blood glucose levels (BGLs) lowers the risk of death from cardiovascular disease. But a recent US study of more than 10,000 people with type 2 diabetes found lowering BGLs (with a HbA1c [see above] target of 6 per cent) may actually increase risk of death. So what’s the truth?
No one’s sure, but experts speculate participants may have lowered their BGLs too quickly – and that these results may only be specific to the US population (indeed, a similar, Australian study of 11,140 people, found that lowering BGLs slowly [to HbA1c levels of around 6.5 per cent] actually lowered risk of death). It’s best to consult your GP about your own, personal needs.
Every year, thousands of research institutions release findings that help shed light on how to better manage, prevent and maybe even cure diabetes. We highlight some of the most exciting results.
1. Just seven minutes of exercise may be enough
Just seven minutes a week of short, intensive exercise may significantly reduce the chances of developing diabetes, says new research published in BMC Endocrine Disorders. Over a two-week period, researchers asked 16 inactive, young men (with an average age of 21 years and BMI of 24) to take part in a total of just 15 minutes of high-intensity exercise, which resulted in a reduction of their glucose and insulin responses by 12 per cent and 37 per cent respectively. Insulin sensitivity was also improved, by 22.5 per cent. Short on time? Make sure you work hard during your exercise sessions.
2. Diet soft drink is linked to increased risk
They might not contain any sugar, but diet soft drinks may increase the risk of type 2 diabetes, according to the findings of a new, five-year-long study. Researchers from the University of Texas and colleagues studied more than 6800 participants between 45–84 years (who were free of cardiovascular disease and diabetes when the study began), looking at their intake of diet soft drinks in relation to their risk of developing type 2 diabetes. The study found drinking diet soft drinks at least daily was associated with a 67 per cent increased risk of type 2 diabetes, compared to those who didn’t drink them. The findings don’t necessarily mean that diet soft drinks cause diabetes, but it’s best to make water your first choice of drink.
3. Tea may have benefits
According to researchers at Scotland’s Dundee University, drinking black tea may help prevent or manage, type 2 diabetes. Their study found that certain constituents of tea, such as theaflavins and thearubigins, may potentially be able to combat type 2 diabetes due to their ability to mimic insulin action, thereby acting as an insulin substitute. Of course, the researchers caution that tea is still no substitute for medication.
4. Coffee helps, too
A study of more than 28,000 post-menopausal women found those who drank more than six cups of any type of coffee per day were 22 per cent less likely to be diagnosed with diabetes than those who drank none. Women drinking six cups of decaf a day had a 33 per cent reduced risk. It’s thought the minerals and high antioxidant levels in coffee beans may have beneficial effects on metabolism and BGLs and potentially provide protection to the pancreas.
5. Control blood pressure
Previous research has found an association between high blood pressure and the incidence of type 2 diabetes, but whether blood pressure control predicts diabetes risk has not been studied – until now. According to new research, uncontrolled high blood pressure can double the risk of developing type 2 diabetes.
The study, which looked at 1700 hypertensive men and women, found those with uncontrolled blood pressure had twice the incidence of diabetes (8 per cent versus 4 per cent), even after controlling for baseline blood pressure, BMI, family history and physical activity.
6. Low-GI diets are effective
Many have questioned the effectiveness and safety of a low-GI diet in managing diabetes. However, a new review, by respected editorial group Cochrane, has confirmed low-GI diets can improve blood glucose control in people with diabetes, without increasing the risk of hypoglycaemia. The researchers found that following a low-GI diet decreased HbA1c levels by 0.5 per cent in both type 1 and 2 diabetes, with two of the studies also finding a significant reduction in episodes of hypoglycaemia (compared to a high-GI diet). Lowering blood glucose levels usually comes with an increased risk of hypoglycaemia, so this is a particularly important finding.
7. Vinegar may play a useful role
Could vinegar one day replace hyperglycaemic medication? It’s early days, but researchers at Arizona State University found that individuals with type 2 diabetes who consumed vinegar with a high-carbohydrate meal had 19 per cent lower BGLs afterwards than the placebo group. A second study found that taking two tablespoons of apple cider vinegar with a piece of cheese before bedtime reduced fasting glucose by 6 per cent. According to lead researcher Dr. Carol Johnson, it’s the acetic acid in vinegar that has an antiglycaemic effect. Try adding some to your next salad dressing.
8. Your cells ‘remember’ your high blood glucose readings
When was the last time you had overly high blood glucose? Even if you don’t remember, new research shows that your cells have the ability to do so. Not only do they remember the effects of high blood glucose, but they continue to replicate them, potentially for weeks afterwards. According to lead researcher Associate Professor Assam El-Osta, cell ‘memories’ of a bad diet can also be embedded into your DNA and passed on to your children’s cells, too, providing another insight into the hereditary nature of conditions such as obesity and diabetes. Yet another reason to keep blood glucose levels stable.
9. Going vego
A new study funded by the US National Institutes of Health has found that following a low-fat vegan diet controlled blood glucose three times more effectively than a diet based on American Diabetes Association (ADA) guidelines. The vegan diet also helped reduce weight and cholesterol and 43 per cent of those following it were able to stop taking medication compared to only 26 per cent of the ADA dieters. Whether you choose to embrace veganism or not, there’s certainly nothing wrong with adding more vegies to your day – no portion control required!
10. Eggs in moderation
A 2008 study by Harvard Medical School, has concluded that eating more than a couple of eggs a week may increase the risk of developing diabetes – and may make the condition worse in those who already have it. The researchers analysed the egg-eating habits of almost 57,000 men and women, concluding that an egg a day may increase the risk of type 2 diabetes (possibly due to the high cholesterol content) by about 60 per cent, or up to 77 per cent in females. But eating just one egg a week was found to carry no extra risk: and as a good source of nutrients, there’s no need to avoid them entirely.
Diabetes-friendly Mars Bars...?
Poor blood vessel function is strongly linked with diabetes. But a 2008 study, funded by Mars Inc., found that drinking their flavanol-rich cocoa beverage may improve blood vessel function. Additional research is needed, but it’s thought cocoa may one day play a role in diabetes management.
Did you know? Earlier this year, scientists discovered a link between a family of viruses and the onset of type 1 and 2 diabetes, after they spotted traces of an infection in more than 60 per cent of sufferers. They’re now predicting that a fully-developed vaccine could be available in about 20 years, preventing onset of the disease.