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 estimated to 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 characterized by hyperglycaemia, or high blood glucose, due to a disorder in regulating 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 the body’s immune cells attack and destroy insulin-producing pancreas 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 for 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 is 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 essential 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 are also important for those with Type 1 diabetes, their management of diabetes relies more on their regularly scheduled insulin treatment plans. 

Why do people with diabetes have to manage their diet so much?

People with diabetes must care about what they eat because their food intake affects their blood sugar levels. A person with diabetes should be mindful to regulate their carbohydrate intake to avoid any significant spikes in blood sugar levels. Not only does this help minimise some of the symptoms of diabetes, but 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.

Those on insulin treatment plans, 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 promoting slow glucose absorption and a modest rise in blood glucose is ideal for managing blood glucose. 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 help improve blood glucose control.

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. 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 the food affects blood glucose levels.

Does sugar/carbohydrate intake directly affect diabetes?

A common misconception is that people with diabetes should avoid sugar in any food altogether. The truth is, sugar consumed in moderation will not adversely affect diabetes management.

Although avoiding any one food is unnecessary, 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, controlling energy (calories), limiting saturated fat with moderate total fat intake, and eating food with added sugar, and alcohol intake.

It is important to acknowledge that while carbohydrates and sugar influence blood glucose, they do not cause diabetes. Diabetes results from 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 in the multidisciplinary approach to 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.