STUDENT CONTRIBUTOR: Adam Brooks | School of Nutrition, Ryerson University
October 13, 2020
Diabetes is a pain in the butt! There are a hundred things you have to think about at any given moment. This article is meant to make life with diabetes a little bit easier by providing a snapshot into the top management strategies that you can incorporate into your daily routine along your journey to becoming a dia-bad-a**.
Food & Nutrition:
A healthy diet and physical exercise are key components in successfully self-managing diabetes. Unfortunately monitoring and keeping track of your diet can be challenging -and in the age of misinformation and fad diets- downright overwhelming. Research from the American Diabetes Association shows that for most people, the hardest part of a diabetes treatment plan, is determining what to eat. There is no one-size-fits-all diet for everyone, so what do you do? Where do you start? And how do you ensure you are taking the right steps to protect your health?
Managing Diabetes with Nutrition:
There has been plenty of evidence showing that a healthful eating pattern - Mediterranean, vegetarian, vegan, keto, Portfolio and DASH eating patterns, to name a few. - and regular physical activity are key components in diabetes management. Health Canada recommends at least 150 minutes of low-moderate daily aerobic activity in 10-minute bouts for adults, with 2-3 days of muscle-building activities per week.
Ideally, an individual diagnosed with diabetes should be referred to a registered dietitian once diagnosed. To help you understand how food can become your front-line of defence in your self-management strategy of diabetes, it is recommended that newly diagnosed patients meet regularly with a dietitian - within the first 3-6 months, especially.
Canada’s Food Guide:
The new edition of Canada's Food Guide released in early 2019 states that "healthy eating is more than the foods you eat. It is also about where, when, why and how you eat.". This is incredibly important to remember when creating a lifestyle plan to help manage your diabetes diagnosis. Recommendations urge Canadians to cook from home more often, share meals with family and focus on slowly making changes to your diet - as opposed to changing your eating habits over night.
Other recommendations from Canada’s Food Guide include:
Have plenty of fruits and vegetables
Choose whole grain foods
Make water your drink of choice
Counting Carbohydrates:
Carb counting involves keeping track of the amount of carbohydrates you eat every day. Because carbs have the greatest effect on blood sugar, being able to monitor your daily carbohydrate intake is one of the most important steps you can take to better self managing diabetes.
Be aware though that all carbs are not created equal! Studies have shown that whole grains can affect blood sugar differently than processed grain products. This is due to whole grain foods having a lower glycemic index. Click HERE to read more about counting carbohydrates.
The Glycemic Index:
The glycemic index is a scale that ranks carbohydrate-containing foods by how much they raise blood glucose after they are eaten. Foods with a high glycemic index increase blood glucose faster and higher than foods with a low glycemic index.
Think of the 3 categories of glycemic index foods like a traffic light:
Green light = low glycemic index foods that you can choose most often
Yellow light = medium glycemic index foods that you can choose less often
Red light = high glycemic index foods that you should choose least often
You can read more about the Glycemic Index here.
Prediabetes:
Prediabetes occurs when there are high levels of glucose detected in the blood, but not high enough to be considered a person will full-blown diabetes. People with prediabetes have a high risk of developing type 2 diabetes if they do not properly manage their health through diet and exercise.
There has been some promising research in the benefits of the DASH eating plan in improving blood pressure, insulin resistance and managing obesity. The DASH plan is a practical strategy because it does not require special foods or supplements and is an approach that is easy for the entire family to follow.
As with any diet it is important to speak to your doctor or a registered dietitian before making any changes to your diet or embarking on a weight loss plan.
DASH Eating Plan (Dietary Approaches to Stop Hypertension):
While there is no 'one-size-fits-all' diet for diabetes, the DASH eating plan is flexible, balanced, addresses many health aspects related to diabetes management and is relatively easy for the whole family to follow.
Research indicates that the DASH plan has been shown to reduce blood pressure, insulin resistance and help manage weight loss. Basic recommendations include:
Eating a balanced plate of vegetables, fruits, and whole grains
Fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
Limiting foods that are high in saturated fats
Limiting sugar-sweetened beverages and sweets
More information on the DASH eating plan can be found here.
So, what's the scoop with all the different types of Diabetes?
The three most common types we hear about are Type 2, Type 1 and Gestational.
Type 1 Diabetes (T1D):
Type 1 diabetes occurs when the body is unable to produce insulin. Without insulin, the body is unable to use glucose (sugar) for energy. This leads to a dangerous - sometimes life-threatening - buildup of excess glucose in our blood and can lead to diabetic ketoacidosis (DKA), and contribute to poor eye, nerve, and kidney health down the line.
Unlike pre-diabetes and type 2 diabetes, you cannot prevent, cause, catch or cure T1D. However you can successfully manage it by taking insulin injections along with proper diet, exercise, and lifestyle planning.
Research recommends that individuals with type 1 use the carb counting approach to improve glycemic control, along with choosing low glycemic index foods, such as:
Whole-grain pasta & breads
Dried beans, lentils, and chickpeas which can be used as “grain alternatives”
Fruits and milk which can be part of a healthy dessert
See a full list of low glycemic index foods here.
Type 2 Diabetes (T2D):
Type 2 diabetes is the most common form of diabetes and accounts for almost 90% of all diabetes cases throughout the world. In T2D, the body can still produce insulin, it is just unable to effectively use insulin to break down glucose for energy - known as insulin resistance.
While there isn’t a single specific cause for this type of diabetes, there are various risk factors associated with it including obesity, genetics, and smoking. There is no cure for T2D, however it can be managed with diet, exercise, and medication.
Just like managing T1D, type 2 diabetes can be effectively managed through carb counting and choosing low glycemic index foods. Again, quality of carbs is the most important part here, you should always try to:
Choose whole grains wherever possible
Avoid overly processed foods
Choose medium and high glycemic index foods less often
Make water your drink of choice
Recently, there have been many studies conducted, concerning the benefits of very low carb diets such as the Keto, and Mediterranean diets.
It is important to speak to your doctor or dietitian before fully committing to any diet, but the keto and Mediterranean diet in conjunction with Canada’s Food Guide can be great starting points when determining the quality, and quantity of whole grains that should be included in your daily eating routine.
Gestational Diabetes (GDM):
Gestational diabetes is a common condition that occurs during pregnancy and is usually diagnosed during the third trimester. It is similar to type 2 diabetes because your body is unable to use insulin efficiently. Planning ahead and kicking off a pregnancy with a healthy lifestyle, including diet and exercise is extremely important for overall health during pregnancy.
During pregnancy, the placenta releases hormones that interfere with the body’s ability to use insulin, causing an increase in blood glucose levels. While there are no evidence-based recommendations for preventing GDM, women who are pre-diabetic, overweight, or who have a history of polycystic ovarian syndrome (PCOS), or hypertension, have an increased risk of developing GDM.
Research indicates that a diet consisting of low glycemic index foods in women with GDM, is safe, easily sustainable and can significantly reduce the need for the use of insulin during pregnancy. It is important that you include foods in your diet that are:
Whole grains, such as bread and pastas
Cereals which are unprocessed and have a high fibre content
Avoiding high glycemic index foods, such as white bread, processed foods and potatoes will help to stabilize blood sugars, too. Canada’s Food Guide is your best friend when it comes to determining if a food is whole grain or not.
When planning to get pregnant or working toward making sure you enjoy a healthy pregnancy, speak with a dietitian for individualized nutrition and lifestyle support.
The last two types of diabetes that are not very well known are LADA and MODY.
LADA (Latent Autoimmune Diabetes in Adults), a.k.a. 'Type 1.5' Diabetes:
LADA (sometimes referred to as diabetes type 1.5) is a rare form of diabetes that only occurs in adults. It is like type 1 diabetes in that the body will eventually stop producing insulin (although this can take up to several years after a diagnosis is made).
A patient diagnosed with LADA will have to take insulin injections to avoid a dangerous buildup of glucose in the blood. Although there is no specific treatment for LADA, patients are mostly treated in the same way as individuals with T1 and T2 diabetes.
Self-managing a LADA diagnosis follows many of the same rules as a T1 or T2 diagnosis:
Stick to low glycemic index foods
Make sure to include whole grains in your diet
Avoid overly processed foods
While there hasn’t been much evidence on the benefits of very low carb diets (VLCD), such as the Keto or Mediterranean diet in managing LADA, it is important to speak to your doctor or dietitian and see if these diets could be beneficial for you.
MODY (Maturity Onset Diabetes of the Young):
MODY is a type of diabetes caused by a single gene mutation, known as monogenic diabetes. It accounts for 1-2% of all diabetes cases and has characteristics of both type 1 and type 2 diabetes.
MODY is usually diagnosed at a young age, from late childhood to early adulthood and treatment can vary between diet and exercise and use of insulin and/or medication. Patients with MODY usually have a long family history of diabetes.
Managing a MODY diagnosis can be difficult if your child or teen happens to be a picky eater. Management of MODY includes many of the same rules as managing a type 1 or type 2 diagnosis such as eating low-glycemic index foods as well as avoiding processed carbs. Some things you can do to help your child eat these foods include:
Eat meals together
Get your kids cooking – they usually like to eat the foods they have made
Drink water instead of sugary drinks
Focus on small, gradual changes such as introducing a new vegetable once a week
Canada’s Food Guide has some excellent resources on meal planning and cooking for children and teens. Contact a registered dietitian, today, for extra support!