Recently I have received a number of questions from the public, which clearly illustrate that diabetes and its treatment are not well understood by many people who are diagnosed with this condition. It may, thus be useful to diabetics to provide you with the answers to some of these questions in simple language.
What is diabetes?
A typical question posed by many people who have been diagnosed with diabetes, is: "The doctor says I have diabetes, but I don’t understand what this means?"
Human beings have a gland in their bodies called the pancreas, which produces a hormone called insulin. Insulin basically helps to transport glucose (a type of sugar) into body cells so that the cells can use the glucose as a source of energy. Brain cells are particularly sensitive to a lack of glucose. To achieve transport of glucose into body cells, insulin acts like a key that fits into keyholes and open doors. The "keyholes" are called insulin receptors which are found in all body cells. When insulin opens the keyholes, glucose can move into the body cells to be used for their energy requirements.
Patients who are diagnosed with so-called type 1 diabetes (also called insulin-dependent diabetes mellitus or IDDM), don’t produce enough or no insulin in the pancreas for the transport of glucose into body cells. Consequently, type 1 diabetics need to inject themselves with insulin to ensure that their body cells can obtain enough glucose for energy.
Patients who are diagnosed with so-called type 2 diabetes (also called non-insulin dependent diabetes mellitus or NIDDM), may produce enough insulin in the pancreas, but the keyholes or receptors on their body cells don’t work properly so the insulin can’t unlock them and can’t help glucose move into the cells. This is a condition called insulin resistance, because the receptors are resistant to insulin and prevent it from doing its job. Type 2 diabetics can often control their condition by losing weight if they are overweight, eating the correct diet and doing regular exercise. If these treatments are not sufficient, type 2 diabetics have to take oral medications such as metformin (e.g. Glucophage, Metphage, etc) or glibenclamide (e.g. Glycomin, Daonil, etc). In severe cases, the doctor may prescribe a combination of an oral antidiabetic medication and insulin injections.
Can diabetes be cured?
At this stage, there is no permanent cure for either type of diabetes. Medical Science has not yet found a way of making the pancreas produce insulin in type 1 diabetics or to permanently make insulin receptors work properly again in type 2 diabetics. However, by losing weight if they are overweight, eating the correct diet and doing regular exercise, many type 2 diabetics can drastically reduce the dosage of their oral antidiabetic agents and in some cases even be allowed to stop taking their medications, provided they stick strictly to their diet and exercise routine and do not gain weight. Type 1 diabetics can improve their condition dramatically by also losing weight if necessary, sticking to a strict diet and doing exercise. In some cases type 1 diabetics can achieve such good control of their condition that the doctor may reduce their insulin intake.
If you have lost weight, eat the correct diet, and do daily exercise, you need to see your doctor regularly for checkups and blood tests to see if you can reduce your dosage of medications, but never stop taking your medications without your doctor’s permission, because the complications of untreated diabetes are severe and can be fatal.
So although diabetes cannot be cured, you can do a lot to control the condition and improve the quality of your life.
What type of diet helps for diabetes?
Researchers have discovered that a low-fat diet with a low glycaemic index (GI), which is rich in protective nutrients, can go a long way to improve insulin resistance and both types of diabetes.
It is essential that all patients who have been diagnosed with insulin resistance or both type 1 or type 2 diabetes should consult a registered dietician to help them work out what they can and cannot eat. The dietician basically has to calculate an individual diet prescription for each patient. This diet prescription is based on the patient’s type of diabetes, the severity of the diabetes, the patient’s age, gender, present weight, present activity level, medications (insulin or oral medicines) and other conditions he or she may be suffering from (e.g. obesity, high blood pressure, increased blood fat levels). In addition, the dietician will have to explain how to spread your food intake over the course of the day. This is particularly important for patients with type 1 diabetes who have to inject themselves with insulin. Your insulin injections and food intake much be coordinated to obtain the best results.
To consult a registered dietician, visit the Association for Dietetics in SA (ADSA) website and click on "Find a Dietician" to find a dietician in your area. You can also phone the ADSA Head Office at: (011) 789-6621 or 789-1383 and ask which dieticians practise in your town or region.
Health24 also provides information about diabetes and diabetic diets, the Glycaemic Index and Type 2 diabetes.
The question of exercise
Exercise is one of the most useful treatments to help you control your blood sugar and insulin levels. Always first ask your doctor what type of exercise you are allowed to do before you start with a physical activity programme. You can, for example, start going for brisk walks for about 30 minutes every day, but only if your doctor gives permission. For type 1 diabetics, the doctor may have to change the dose of insulin and its timing to fit in with your exercise schedule. Your dietitian will also have to adjust your diabetic diet prescription when you start doing daily exercise to ensure that you don’t develop low blood sugar levels.
It is important that diabetic patients who have not exercised for years should start exercising gently for short periods of time. Don’t start off by trying to run a marathon! As you become fitter and more used to balancing your insulin or oral medications and food intake with your physical performance, you can gradually increase how much and how long you exercise. Listen to your body and when you feel tired, lightheaded or dizzy, stop, rest and eat some food with a higher GI. If necessary, contact your doctor or dietician to discuss such side-effects so that they can help you to adjust your medication or your food intake so that you can obtain the maximum benefit from your exercise.
Communication is vital
Diabetes is a condition where communication and insight into the factors that influence your well-being, are vital. Read as much as possible about your condition and keep in constant touch with your support team (i.e. your doctor and your dietician). Don’t make changes to any of the factors that help you control your blood sugar and insulin levels, without first discussing such changes with your support team. You don’t want to develop hypoglycaemia or hyperglycaemic or a diabetic coma.
With the correct approach and the support of your doctor and dietician, diabetics should be able to lead an active, full and happy life.
- (Dr IV van Heerden, DietDoc, May 2011)