Diabetes is the most common condition people approach me with. People often carry with them pre-existing misconceptions and their own beliefs and solutions of those already incorrect delusions. Consulting a client who is living with diabetes is never an easy task, rather I would say prescribing the diet is relatively the simpler part of the job. The real challenge is busting those pre-existing ideas which have developed over the years due to false information and suggestions of the people around them. Most of these ideas given by people come from a place of love and concern, but they do more harm than good.
As a dietician my job is not limited to providing a diet. My job is to ensure my clients achieve best possible health and happiness. Which is why I chose to take a more holistic approach in my practice rather than just sticking with the food and diet routine.
Before we move towards diet and lifestyle changes, I think it is essential that everyone should understand what the condition is and why it happens in our body. People often misunderstand that Diabetes is not a single disease, rather, it is a term used for a group of metabolic diseases in which a person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or perhaps both. It is a chronic condition which affects how the body turns food into energy. To elaborate further, food is broken down into sugar (glucose) and released into the bloodstream. When glucose enters the bloodstream, blood sugar level increases and a signal is sent to the pancreas to release insulin. Insulin acts like a key to let blood sugar into the cells to be utilised for energy. Lack of insulin or no response to insulin leads to high blood sugar levels. Overtime, high blood sugar levels may lead to heart diseases, vision loss and kidney disease. It is not necessary for people to memorise all this information, nor I expect them to, but no harm comes from gathering knowledge of a problem which is present in abundance.
There is no cure for diabetes in allopathy. Doctors often prescribe medicines which the patient would be taking for the rest of their life, in severe cases they even prescribe insulin injections. They do that to prevent symptoms from worsening, but it is far from a cure. Therefore, it is important to educate yourself on diabetes self-management and to schedule regular health care appointments. It is also advised to constantly monitor your blood sugar level.
Even in the absence of a cure, people still manage to live a regular healthy life. Take my word as a certified dietician with over 25 years of experience. Diabetes is the most common issue people approach me with. All these clients have similar preconceptions and ideology about living with diabetes. I usually start these sessions by altering their preconceived notions and busting their existing beliefs regarding their condition. My clients are often shocked by my statements and surprised with the progress they make in a short amount of time.
Myth busting section –
Now that we have a broad understanding of what diabetes is, let’s discuss the 2 major types of diabetes: type 1 and type 2.
Type 1 diabetes is an autoimmune condition. An autoimmune condition is one in which your body’s defence system is unable to differentiate its own cells and foreign cells, which causes it to attack healthy normal cells of the body. Type 1 diabetes is caused by an autoimmune reaction that prevents the body from making insulin by destroying the insulin making cells (called the beta cells) within the pancreas. This condition is usually diagnosed in children and young individuals.
Secondary Diabetes is a condition similar to type 1 diabetes. However, in this situation the beta cells are destroyed by an external stimulus such as illness or disease, or an injury to the pancreas.
Subtle signs of type 1 diabetes include:
· Dry mouth
· Increased hunger (especially after meals)
· Upset stomach and vomiting
· Extreme thirst
· Frequent Urination
· Unexpected weight loss
· Fatigue
· Heavy, laboured breathing
· Blurry vision
· Infection on skin and urinary tract
· Mood swings
· Bedwetting in children
All the above-mentioned symptoms should be looked after, and it is advisable to visit the doctor before any of the issues turn severe.
Signs of emergency include:
· Belly pain
· Shaking and confusion
· Dehydration
· Diabetic ketoacidosis (DKA)
· Fruity smell on your breath
· Rapid breathing
· Loss of consciousness (rare)
Learning about these signs of emergency is extremely vital and should be common knowledge among people. Only 5% of people with diabetes have type 1. It is prevalent in both males and females equally. People who are younger than 20, or people with a parent or sibling with type 1 or Caucasians are more likely to develop type 1.
People with type 1 can live a long and happy life through self-management, regular check-ups, monitoring blood sugar levels and most importantly sticking to a healthy diet plan and exercise routine. People with type 1 must use insulin shots to control their blood sugar levels.
Lifestyle changes section
Type 2 diabetes most commonly develops in individuals over the age of 45. However, the number of children and young adults being diagnosed with type 2 diabetes is increasing rapidly. Previously we learned that insulin is made in the pancreas, and it plays a pivotal role in helping cells absorb blood sugar so that it can be used for energy. In type 2 diabetes, the cells develop what is called insulin resistance, which means that cells do not respond to insulin and the absorption of blood sugar fails to occur. In turn, the pancreas starts producing more insulin, eventually they are unable to keep up and the blood sugar keeps on rising, which may result in type 2 diabetes or prediabetes.
Type 2 diabetes is a life-long condition, and its symptoms are so mild that they are often ignored. It is estimated that there are about 8 million people who suffer from diabetic symptoms but are unaware of it.
Subtle signs of type 2 diabetes include:
· Being very thirsty
· Higher urinating frequency
· Loss of weight
· Blurry vision
· Mood swings
· Tingling or numbness in hands and feet
· Feeling of fatigue
· Dry skin
· Excessive hunger
· Slow healing of wounds
· Prone to infections
This condition develops in the body due to various factors. It may be due to genes, extra weight, metabolic syndrome, over secretion of glucose from the liver or broken beta cells. Combination of any two of these factors may result in type 2 diabetes.
Therefore, we as individuals must be informed on the risk factors which play a role in promoting type 2 diabetes. Below I will mention some of the risk factors, bear in mind the greater the number of factors that apply to you, the higher is the chance of you developing the condition.
Risk factors include:
· Age: 45 or over
· Family member with same condition
· Heart and blood vessel disease
· High blood pressure
· Low HDL (good) cholesterol
· High triglycerides
· Being overweight or obese
· Delivering a baby who weighs over 9 pounds or 4.5kgs
· Gestational diabetes during pregnancy
· PCOS
· Depression
· No exercise routine
· Smoking
· Stress
· Unnatural sleeping pattern
One client interaction which I specifically remember was a 60-year-old gentleman who was suffering with DM (diabetes mllitus) for over 15 years. He had high levels of blood sugar and was adamant to follow his own diet. He had his own personal notions and reasons to have and avoid certain types of food. He was on constant medication but felt no relief for past few years. During our first session I gave him an easy and practical diet which included food of his choice. I also made sure to explain to him the importance of every food item in that diet and the benefit each item brings forth. Slow and steadily, we were able to make progress as he started to accept my prescribed diet bit by bit. I introduced good choices of food one by one and eliminated any food item which was unnecessary or perhaps unsafe. After some time, he felt relief and took a test to measure his sugar levels. Once he noticed that his blood sugar levels has decreased significantly, he finally developed faith in me and demonstrated complete compliance with my diet plans. Gradually he was able to reduce all his medication and was amazed that he could consume small amounts of sweets, mango, and banana without having any negative repercussions. I also saw a huge change in his personality as he became happier, healthier, and more active than he had ever been in the past 10 years.