Dr Sk Hammadur Rahaman, Consultant, Medica Superspecialty Hospital, Kolkata, addresses a few important questions on the vital connections between diabetes, diet, exercise and lifestyle for those living with the condition, as also for those who are borderline cases.
How would you advise a person with diabetes interested in dieting to go for the right diet plan? What according to you is a safe diet plan?
There is not a “one-size-fits-all” eating pattern for individuals with diabetes, and meal planning should be individualized. A variety of eating patterns are acceptable for the management of diabetes.
However one should focus on the key factors that are common among the patterns:
1) emphasize non-starchy vegetables,
2) minimize added sugars and refined grains and
3) choose whole food over highly processed food to the extent possible.
An individualized eating pattern also considers the individual’s health status, skills, resources, food preferences and health goals. Referral to a dietician is essential to assess the overall nutrition status of the patient and also to collaborate with him/her to create a personalized meal plan that coordinates and aligns with the overall treatment plan, including physical activity and medication use.
The Mediterranean-style, low-carbohydrate, and vegetarian or plant-based eating patterns (without overcooking) are all examples of healthy eating patterns that have shown positive results in research.
Reducing overall carbohydrate intake for individuals with diabetes has demonstrated best chances for improving glycemia. For individuals with Type 2 diabetes not meeting glycemic targets or for whom reducing glucose-lowering drugs is a priority, reducing overall carbohydrate intake with a low or very-low-carbohydrate eating pattern is a viable option. As research studies on low-carbohydrate eating plans generally indicate challenges with long-term sustainability, it is important to reassess and individualize meal plan guidance regularly for those interested in this approach, recognizing that insulin and other diabetes medications may need to be adjusted to prevent hypoglycemia and blood pressure will need to be monitored.
The diabetes plate method is a commonly used visual approach for providing basic meal planning guidance. This simple graphic (featuring a 9-inch plate) shows how to portion foods (1/2 of the plate for non-starchy vegetables, 1/4 of the plate for protein, and 1/4 of the plate for carbohydrates).
Download the 3 Simple Steps on Diabetes Management e-book by clicking on the image below. The book is free but you will need to register.
What is the Glycemic Index of food and why it is important for diabetics?
The glycemic index is a scale that ranks the level of carbohydrates in food from zero to 100, indicating how quickly a food causes a person’s blood sugar to rise.
Food high on the glycemic index (GI) can cause harmful blood sugar spikes in people with diabetes. High GI food also makes it more challenging for a person to maintain healthy weight. This is why some people with diabetes use GI to plan their meals.
How should one ensure that there are no hypoglycemia episodes when they reduce intake of carbohydrates?
Hypoglycemia can result in increased appetite, dizziness, weakness, tremor, palpitation, sweating, black out,and a more severe form can even causeunconsciousness and even death. So, when a diabetic reduces carbohydrate intake, he may be warned about these symptoms. He/she may also be advised to monitor blood sugar at home using a glucometer.
Does exercise help lower blood sugar levels? How?
Yes, exercise has a definite role in controlling blood sugar levels. Exercise reduces “insulin resistance” which is a key factor for diabetes. Exercise also helps to shed excess body fat and plays an important role for good sugar control.
What types of exercises are good for persons with diabetes?
Everyone, including persons with diabetes should engage in 150 mins or more of moderate to vigorous-intensity aerobic activity per week, spread over at least 3 days/week, with no more than 2 consecutive days without activity. Shorter durations (minimum 75 min/week) of vigorous-intensity or interval training may be sufficient for younger and more physically fit individuals. They should also engage in 2–3 sessions/week of resistance exercise.
What care should persons with diabetes take while exercising?
If a person with diabetes is suffering from heart disease, stroke, recurrent episodes of hypoglycemia, uncontrolled hypertension, foot ulcer, retinopathy etc then physician’s consultation is a must before doing exercises. High-risk patients should be encouraged to start with short periods of low-intensity exercises and slowly increase the intensity and duration as can be tolerated. If there is significant risk of hypoglycemia, then pre-exercise and post-exercise sugar monitoring is essential and a snack may be necessary before start of exercise.
How reliable do you think are the tests? (ABG, Fructasamine Test, Hba1c, Insulin Test, FBG)
Fasting and post prandial tests are definitely reliable. But a single blood sugar may be influenced by many factors like mental status, stress, overnight sleeping, exercise etc. That’s why Hba1c and fructosamine are required which indicates average blood sugar of 90days and 14 days respectively.
Insulin test for diagnosis or monitoring of diabetes mellitus is not advised.
How can persons with diabetes ensure that the tests are reliable? What are the possible dangers when tests go wrong?
When the test reports are not consistent with patients’ symptoms, then these are not reliable. Suppose, a person with diabetes is experiencing low blood sugar symptoms but laboratory results show normal or high blood sugar levels, then it is not reliable. It is the physician’s responsibility to guide the patients about the reliability of a test.
If a test goes wrong, it can be dangerous. Particularly when a patient has very low blood sugar levels and the reports do not indicate that. It can even turn life threatening.
What is the diet and lifestyle you recommend for pre-diabetic people?
Prediabetes is the harbinger of diabetes. If proper precautions are not taken, then prediabetics are going to be diabetic in the next 5-10 years. So, diet and lifestyle modifications same as a person with diabetes are essential for some diagnosed as prediabetic. Prediabetics are also at risk of suffering complications of heart, kidney, brain, eye and nerve problems.
Related Reading: How to prevent diabetes if you are pre-diabetic
People with diabetes often have sugar cravings. How should they deal with it?
This is an important concern. Actually, sweet receptors are present in the gut and these are overexpressed in persons with diabetes. So, sometimes craving for sweets is more in someone with diabetes. They need to control the sugar cravings. Artificial sweetener in restricted amount may be an alternative option. If blood glucose is under control, with physician’s permission, they may take sweets occasionally.
Does diabetes cause weight gain or weight loss? How should one manage it?
Weight is an important concern of diabetes as a condition. Obesity is an important trigger for diabetes. It is imperative for persons with diabetes to shed excess weight. Anti-obesity drugs are important tools for management of diabetes.
Diabetes per se can also cause weight loss if not properly controlled. And in poorly controlled diabetics, when blood sugar control improves, they gain weight.
To understand more about diabetes and its relationship to kidney disease, please see the video below
