What You Should Know: Diabetes
We sat down with one of Naluri’s clinical dietitians, Michelle Low, to answer some of the most pressing questions regarding diabetes, and resolve a misconception surrounding the chronic health condition that is estimated will affect up to 153 million adults in the SEA region by 2045. Here’s what she had to say.
What is diabetes?
Diabetes mellitus – more commonly known as diabetes - is a chronic disease that is characterized by hyperglycaemia, or high blood glucose, due to a disorder in the regulation of blood glucose in the body.
There are several types of diabetes. The commonly known ones include Type 1, Type 2, and gestational diabetes. Type 1 diabetes is an autoimmune disorder whereby insulin-producing cells of the pancreas are attacked and destroyed by the body’s immune cells. Its exact cause isn’t known, although it can be hereditary. Type 2 diabetes on the other hand occurs due to insulin resistance, where the body becomes resistant to insulin and no longer uses the hormone efficiently. Inactivity and excessive weight are risk factors of Type 2 diabetes. Gestational diabetes is similar to Type 2 diabetes, and occurs in a segment of pregnant women whose blood sugar levels rise during pregnancy. It is temporary and goes away after birth, but it does increase the woman’s risk factors for Type 2 diabetes.
While the causes for all three types of diabetes differ, what they have in common are that they all affect the metabolism of glucose and make it difficult for the body to transport glucose from food throughout the bloodstream into the cells. As a result, blood glucose levels within the blood rise.
What is the best way to manage Type 2 diabetes?
Diabetes management focuses on achieving and maintaining a normal (or near normal) blood glucose profile, preventing diabetes-related complications, and managing comorbidities. Diet is an important component in diabetes management as the consumption of carbohydrates directly affects blood glucose. Type 2 diabetes in particular is best managed through lifestyle modifications and managing one’s weight through diet and exercise. Although diet and exercise is also important for those with Type 1 diabetes, their management of diabetes relies more on their regularly scheduled insulin treatment plans.
Courtesy of Pexels
Why do people with diabetes have to manage their diet so much?
People with diabetes have to take care of what they eat because their food intake affects their blood sugar levels. A person with diabetes should be mindful to regulate their carbohydrate intake so as to avoid any major spikes in blood sugar levels. Not only does this help minimise some of the symptoms of diabetes, it also maximises the efficacy of drug therapies.
Consuming too many carbohydrates in a meal would cause a surge in blood glucose, putting stress on the already-compromised insulin-producing cells. On the other hand, consuming too few carbohydrates may cause hypoglycaemia (or low blood sugar) especially for those on insulin treatments.
For those on insulin treatment plans, they need to learn to adjust the amount of insulin and schedule their doses to accommodate their meals.
What does the diet of a person with diabetes look like?
A diet that promotes slow absorption of glucose and a modest rise in blood glucose is ideal for blood glucose management. A diabetes-friendly diet should also consider the fibre, protein and fat content in lowering the glycaemic response of the diet. Dietary fibre prolongs gastric emptying and slows down the absorption of glucose into the blood while promoting longer satiety.
That’s why choosing foods that contain complex carbohydrates which take longer to digest, are high in fibre, low in fat and are low on the glycaemic index*, coupled with having a balanced meal, can be useful in improving blood glucose control.
Courtesy of Pexels
Besides that, a person with diabetes should limit food with high saturated fat and sodium to maintain a normal blood lipid profile and blood pressure as diabetes is associated with a higher risk of developing cardiovascular disease too. For those with diabetes and a BMI beyond the healthy range, a calorie-restricted diet to promote weight management can improve insulin sensitivity, blood lipid levels and blood pressure.
*Glycaemic index (GI) is a relative ranking of carbohydrates in foods according to how they affect blood glucose levels. The lower the GI score, the less effect the food has on blood glucose levels.
Does sugar/carbohydrate intake directly affect diabetes?
A common misconception is that people with diabetes should avoid sugar in any kind of food completely. The truth is, sugar consumed in moderation will not adversely affect diabetes management.
Although it’s not necessary to avoid any one food, it would be beneficial to consume a balanced diet and sustain a healthy lifestyle to maintain one’s body weight within the optimal range to reduce the risk of diabetes. This usually means eating healthy, nutritious food, energy (calorie) control, limiting saturated fat with moderate total fat intake, limiting food with added sugar, and limiting alcohol intake.
It is important to acknowledge that while carbohydrates and sugar influence blood glucose, they do not cause diabetes. Diabetes is a result of the body’s inability to regulate blood glucose because of insufficient and/or ineffective insulin.
How can a dietitian help someone with diabetes?
Dietitians play a vital role as part of the multidisciplinary approach in diabetes management, as they provide evidence-based medical nutrition therapy to support a person with diabetes in managing the disease.
A consultation with a dietitian consists of dietary education on the types of carbohydrate food sources, carbohydrate counting via an exchange system, information about the amount or serving sizes that should be consumed, and the glycaemic index of various foods.
Courtesy of Pexels
It also includes assisting those with diabetes with meal planning and making adjustments to their existing diet and lifestyle choices. Dietitians also utilize motivational interviewing methods as well as coaching, to support people with diabetes on their journey.
What are resources that people with diabetes can access?
Due to constant advancements in health and technology, receiving advice from health professionals no longer equates to a visit to the doctor’s office. With a marked increase of online health services now available to the public, people are able to receive professional advice and take charge of their health even from the comforts of their home.
Someone with Type 2 diabetes can benefit greatly from a digital health app like Naluri, through which they have easy access to a multi-disciplinary team of coaches – including clinical dietitians – and health monitoring tools that will aid them in managing their diabetes.
A digital health program for diabetes care at Naluri includes access to a sophisticated AI-supported food journal for easy meal tracking, coupled with personalised food and nutrition advice from professional clinical dietitians to build healthier habits over time. These features, in addition to continuous diabetes-related educational materials, are available to best equip people with diabetes with the tools and resources to manage their blood glucose levels throughout the day.
There are also various diabetes-related non-profit NGOs in Malaysia such as the National Diabetes Institute (NADI) and Diabetes Malaysia that provide people with diabetes with the support they need to manage the disease. They organize diabetes-related activities to promote diabetes care and provide resources and assistance to benefit those with diabetes.
People with diabetes can also look up the carbohydrate exchange* list to be more aware of the amount of various foods that equate to 1 exchange. This can be helpful in ensuring meals are within the recommended carbohydrate exchanges and allows those on insulin treatments to tailor their insulin dosage accordingly.
*Carbohydrate exchange is a system where foods with a similar amount of carbohydrates per serving are grouped together. One exchange is equivalent to 15g of carbohydrates.
