Updated 15 February 2017

Diabetes - your questions answered

Many people living with diabetes have similar questions about their diet.

People living with diabetes often ask questions relating to their condition and the dietary treatment of diabetes. Here is a list of some of the most commonly asked questions and answers for readers.

Q: Will exercise help me to control my blood glucose levels?

A: “Yes”. Doing regular exercise such as brisk walking will certainly help to control blood glucose levels and keep weight under control. Studies have shown that regular, moderately strenuous exercise reduces the risk of diabetes in normal and overweight individuals of both sexes. The positive effect of exercise on diabetes is believed to be due to an improvement in the way insulin works in the body and in glucose transport in muscles. Also keep in mind that regular exercise lowers the risk of heart disease which is often associated with diabetes.

Q: How much exercise should I do?

A: Walking briskly for 4 hours a week will use up nearly 8500 kJ per week. It is also easy to stick to this level of activity to improve insulin sensitivity and reduce weight. Always have a medical checkup and an exercise tolerance test before you start doing exercise, especially if you are older. Please take care to check your insulin levels regularly and to have some carbohydrate after you have exercised to prevent hypoglycaemia.

Q: How much weight must I lose?

A: Ideally diabetics should not be overweight, but it is also unrealistic to set your goals too high. Generally speaking a modest loss of 10% of body weight will improve insulin sensitivity and glucose tolerance and reduce blood cholesterol levels and high blood pressure. So be realistic when you attempt to lose weight. Start off by deciding to lose 5 kg and when you succeed, then set your next goal.

Q: Can I use artificial sweeteners?

A: “Yes, but in moderation.” Artificial or non-nutritive sweeteners as they are also called, include saccharin, cyclamate, aspartame, and sucralose. Despite the fact that the safety of some of these products has been questioned, e.g. that cyclamates may cause bladder cancer and that aspartame may cause seizures, hyperactivity in children and mood changes, a series of carefully designed and controlled studies could not substantiate any of these negative claims. The moderate use of artificial sweeteners can help diabetics to make their diets more varied and acceptable. Don’t however, overdo things by drinking litres and litres of artificially sweetened carbonated drinks, which contain caffeine, fill you up and prevent you from eating a balanced diet.

Q: What about sugar?

A: Historically the use of table sugar or sucrose was totally banned in diabetic diets. Nowadays, however, nutrition experts have concluded that it is acceptable to use small amounts of sugar to make the basic diabetic diet palatable. Always remember that you should use sucrose in small quantities together with high-fibre foods, e.g. sprinkling 1 teaspoon of sugar on high-bran breakfast cereal or oats porridge will make the high-fibre food much more palatable, without upsetting your glucose levels. However, you cannot take this bit of advice as carte blanch to start eating sugar and sweets and cakes and chocolate indiscriminately.

Q: What about diabetic foods?

A: Diabetic foods can also be used to increase the variety of the diabetic diet, but don’t kid yourself that they are lower in energy than standard foods. In many cases you will find that diabetic sweets or chocolates or biscuits have a higher energy content and what is worse, a higher fat content than their non-diabetic equivalents. Do a little experiment the next time you visit the supermarket. Look at the energy and fat contents of a diabetic product such as a diabetic chocolate bar and then compare these values with those of a standard chocolate bar. You will be surprised how often the diabetic food contains more fat and therefore also more energy.

Also keep in mind that some diabetic products contain sugar alcohols (mannitol, sorbitol, xylitol, maltitol), which may cause diarrhoea if eaten in large quantities. Most of these products have to state on the label that they should be eaten in small amounts. Sugar alcohols contain just as much energy as sucrose, i.e. 17 kJ per gram, so you won’t be saving on energy intake when you use diabetic foods which contain these sugar substitutes. Finally diabetic products are often very expensive when compared to standard foods.

Q: Where can I get recipes for diabetic meals?

A: Three of my colleagues published a delightful and useful recipe book for diabetics awhile ago. The book is called “Cooking the Diabetic Way” by Lategan, Menssink and Meyer. It is available in both English and Afrikaans (“Groot Kookboek vir Diabete”),and you should be able to buy or order copies from Van Schaik Publishers, who are situated in Hatfield, Pretoria. The cookbook not only lists a wide variety of recipes for all occasions, but also features the energy and nutrient content of servings of each recipe. This recipe book is tailored to South African foods and tastes, so if you are bored with your diabetic diet, give it a try.

- (Dr I V van Heerden, registered dietician/DietDoc)


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Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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