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Diabetes: six steps to smarter eating

Although there can be serious health consequences with untreated diabetes, managing your diabetes carefully can help you live a full, healthy and active life. Enjoying a healthy diet is the cornerstone to managing your diabetes, whatever type of diabetes you have.

Food, glucose and insulin

Glucose is a form of sugar found in sweet and starchy foods. It's absorbed as a natural part of digestion. One function of your blood is to carry glucose around your body. When glucose reaches body tissues, such as muscle cells, it's absorbed and converted into energy. The glucose concentration in your blood is automatically regulated and insulin is crucial for this.

The hormone insulin is needed to move glucose from the blood into the cells where it is broken down to provide energy. Insulin is secreted into the blood by your pancreas - a gland found behind your stomach which also produces digestive juices. If there's not enough insulin or your cells aren't responding properly to insulin, glucose levels can build up in your blood. This means your pancreas needs to produce more and more insulin to control blood glucose levels. Eventually your body can't produce enough insulin to control blood glucose so your levels rise and diabetes develops.

You may experience symptoms of diabetes such as excessive thirst and passing urine a lot. And over time, uncontrolled blood glucose levels can cause irreversible problems to the delicate blood vessels in the eyes and kidneys which can lead to complications such as loss of eyesight, kidney failure and nerve damage in your hands and feet.

The aim of diabetes management is to reduce the risk of long-term complications and reduce the impact of symptoms on your day-to-day life, by keeping your blood glucose levels to within a certain range that's right for you.

Your credentialled diabetes educator and accredited practising dietitian (APD) can give you full advice on lifestyle changes to help you maintain the right blood glucose level for you. But whatever type of diabetes you have, here are six simple healthy eating changes that can make a big impact on your short-term and your long-term health.

1. Switch to healthier fats

All fats are rich in kilojoules but too much of the saturated kind can not only lead to overweight and obesity, it can also increase cholesterol levels. This can contribute to build-up in your arteries and lead to heart attack and stroke. Being overweight also makes your cells less sensitive to insulin so trying to stay within a healthy weight range for you is important.

Eating less fat overall and switching to healthier mono-unsaturated and poly-unsaturated fats most of the time can help to control your weight and keep your blood vessels healthier. Some simple swaps include:

Eat less Replace with
Full-fat dairy foods Low-fat dairy foods
Fatty, processed meats such as sausages and salami Lean meat and skinless poultry, tofu , pulses (beans and chickpeas), white fish and oily fish (see below)
Ready-made meals and takeaways which can be full of fat and salt Home-cooked meals using fresh low-fat ingredients and flavoured with herbs, spices, citrus juices and balsamic vinegar instead of salt
High-fat snacks which are full of sugar or salt, such as biscuits, cakes, pastries, chocolate and potato chips Avocados, unsalted nuts (such as walnuts, macadamias, almonds and hazelnuts) and seeds such as sunflower and pumpkin

2. Focus on fish

The essential fats found in oily fish, the omega-3 fats, are especially important for good health. These oils can help keep your heart and blood vessels healthy, reduce blood pressure and may even be able to boost your mood. Try to eat two portions of fish a week of which at least one should be oily fish such as mackerel, salmon or pilchards. Australia's National Heart Foundation recommends a daily intake of 500mg of omega-3 which is the equivalent to eating two to three 150g portions of oily fish per week.

3. Go low GI

Glycemic Index (GI) is a system indicating how quickly a particular-carbohydrate food will trigger a rise in blood glucose levels. The lower the GI count, the slower the carbohydrates in the food breaks down during digestion - and the slower the release of glucose into the bloodstream. This means more stable blood glucose levels and it helps keeps you feeling fuller for longer, too. Low-GI foods also increase your body's sensitivity to insulin.

Each food is given a GI ranking number between zero and 100:

  • Low GI = 55 and under
  • Medium GI = 56-69
  • High GI = 70 and above

Choose foods that are low or moderate GI most of the time. such as oats, muesli, dense grainy breads, beans and lentils. Yoghurt and milk also count as low GI foods.

You'll often find the low GI symbol on breads, cereals and other packaged foods to help guide your shopping choices.

Having a high blood glucose level even for short periods increases your risk of complications so it's important not eat too many high-GI foods too often and not to eat a large amount of high-GI food in one go. Low-GI foods help to slow down the absorption of an entire meal. So if you indulge in the occasional sweet treat, have it as part of a healthy meal of mostly low-GI foods.

A simple guide to switching to low-GI foods

Eat less Eat more
White bread and white flour-based foods Wholegrain breads, rye bread, pumpernickel, fruit loaf, stone ground flour, sourdough, wholemeal pita bread, wholemeal chapattis
High sugar breakfast cereals including cornflakes, Rice Bubbles, Weet-Bix, Coco Pops. High fibre breakfast cereals such as All Bran and Sultana Bran, oats
Mashed potato Baked potato with skin, Nicola potatoes, sweet potato
White rice Basmati rice, Doongara rice, pasta, noodles, bulghar wheat, quinoa, barley, cous cous
Fruit juices Whole fruits such as apples, pears, grapefruits, peaches, plums, oranges, cherries, firm bananas, sweet potato, sweet corn. Vegetables – fill half of your plate with veggies and try to go for different colours to benefit from their natural goodness

4. Love those legumes

Make beans and lentils part of your diet by adding them to healthy soups, salads and curries. Pulses such as beans and lentils, kidney beans, haricot beans, black-eye peas, black beans, chick peas, butter beans, and low-salt baked beans contain soluble fibre which helps to lower blood cholesterol by binding to fats in the bloodstream to prevent them from being absorbed.

Recent research also shows that eating more foods that contain soluble fibre can help to reduce abdominal fat, also known as central obesity or fat around your middle, which has been linked to high blood pressure, insulin resistance and type-2 diabetes.

Take note that pulses do contain carbohydrates and not everyone's blood glucose levels respond to carbohydrate foods in the same way. It's important to monitor how your glucose levels respond to different foods. This is especially important if you use insulin or take medicines. Your diabetes specialist or diabetes educator can teach you how to check your blood glucose levels.

5. Limit alcohol intake

Alcohol is high in kilojoules (energy) and the mixers that accompany it can be high in sugars, acids or both. This means drinking may raise your blood glucose levels. However, drinking a lot of alcohol can also lead to hypoglycaemia (where your blood glucose levels dip dangerously low) if you are using insulin or taking diabetes medicines.

Also remember that if you're watching your weight, alcohol could be a diet disaster as it stimulates appetite and weakens your willpower.

It's also a good idea not to drink alcohol soon after exercising. During exercise, glucose is absorbed by cells in the exercising muscles, so drinking alcohol soon after could lower your blood glucose levels further.

The National Alcohol guidelines recommend that Australian adults drink no more than two standard drinks a day, avoid binge drinking (drinking more than four standard drinks in any one occasion) and have one or two alcohol-free days per week.

A standard drink =

  • 375 ml bottle or can of mid-strength beer (3.5% alcohol volume)
  • 100 ml of wine (13.5% alcohol)
  • 30 ml of spirits (40% alcohol).

If you do choose to drink, keep to the recommended limits, avoid sweet wines and beers, and choose sugar-free mixers.

6. Don't skip meals

Don't be tempted to skip meals in order to limit your kilojoules if you're trying to maintain a healthy weight.

Most meal-skippers choose to leave out breakfast thinking that it will help them lose weight but in fact, the opposite is true. There is research that shows breakfast skippers are more likely to end up eating more kilojoules during the day compared with breakfast eaters, often by filling up on unhealthy snacks, and can gain weight as a result.

Most people experience a drop in blood glucose levels at night, so it's important to refuel first thing in the morning. Ideally, your breakfast should include a mix of low-GI carbohydrates, lean protein and fibre. Try a a boiled egg with wholegrain toast and Vegemite, muesli or porridge made with traditional oats with fresh or dried fruits and a handful of almonds or walnuts, or low-salt baked beans with sourdough toast followed by a piece of fresh fruit.

Further information

Diabetes Australia
www.diabetesaustralia.com.au

Dietitians Association of Australia
www.daa.asn.au

Sources

American Diabetes Association. Alcohol. [online] Alexandria, PA: American Diabetes Association [Accessed 6 Jul 2011] Available from: www.diabetes.org/food-and-fitness/food/what-can-i-eat/alcohol.html

American Heart Association. Fish 101. [online] Dallas, TX: American Heart Association, Inc. [Last updated May 2010, accessed 6 Jul 2011] Available from: http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Fish-101_UCM_305986_Article.jsp

Diabetes Australia. Alcohol and diabetes. [Online] Canberra, ACT: Diabetes Australia. c2011 [Accessed 6 Jul 2011] Available from: http://www.diabetesaustralia.com.au/Living-with-Diabetes/Eating-Well/Alcohol/

Dietitians Association of Australia (DAA). Unsaturated fats. [online] Deakin, ACT: DAA. [Accessed 6 Jul 2011] Available from: http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/unsaturated-fats/

Dietitians Association of Australia (DAA). Glycaemic index. [online] Deakin, ACT: DAA. [updated Apr 2011, accessed 7 Jul 2011] Available from: http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/glycaemic-index/

Farshchi HR Taylor MA Macdonald IA. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. Am J Clin Nutr. 2005; 81(2): 388-396.

The Glycemic Index. [online] Sydney, NSW: University of Sydney [Accessed 6 Jul 2011] Available from: http://www.glycemicindex.com/

Hairston KG Vitolins MZ Norris JM et al. Lifestyle Factors and 5-Year Abdominal Fat Accumulation in a Minority Cohort: The IRAS Family Study. Obesity. 2011; 16 Jun [epub ahead of print]

National Health and Medical Research Council. Australian Guidelines: To Reduce Health Risks from Drinking Alcohol. Canberra, ACT: Commonwealth of Australia. 2009 [accessed 6 Jul 2011] Available from: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/ds10-alcohol.pdf (PDF 2.3Mb)

National Heart Foundation of Australia. Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health. [online] Australia: National Heart Foundation of Australia. [last updated Nov 2008, accessed 7 Jul 2011] Available from: http://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-FishOils-position-statement.pdf (PDF 242Kb)

Last published: 30 October 2011

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This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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