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t_Articles
Diabetes mellitus has been increasing worldwide as populations age
and the incidence of obesity increases. It is a fairly common disorder
in Asian countries, affecting one in ten to one in fifteen adults. The
good news is that with a few lifestyle changes, the risk of diabetes can
be greatly reduced and people that have diabetes can lead normal, active
lives.
WHAT IS DIABETES?
Diabetes is often first diagnosed by the detection of glucose (a type
of sugar) in the urine, leading many to wrongly believe that eating too
much sugar causes diabetes. This is simply not true. Diabetes is a
disorder that affects the body's ability to use glucose properly.
During digestion, carbohydrates (sugars, starches and fibres) in our
food are converted to glucose. Glucose is then carried in the blood to
our cells, where it is used as energy. Insulin, a hormone produced by
the pancreas, helps this blood glucose enter our cells, and keep our
blood sugar at a healthy level.
People with diabetes either produce little or no insulin, or their
cells do not respond to the insulin produced (insulin resistance).
Unable to enter the cells, large amounts of glucose accumulate in the
blood (hyperglycaemia), and spill into the urine.
DIFFERENT TYPES OF DIABETES
There are two main types of diabetes:
Type 1 diabetes or insulin-dependent diabetes mellitus (IDDM)
happens when the pancreas produces little or no insulin. This type of
diabetes accounts for 5 - 10% of all diabetes cases worldwide.
Type 2 diabetes or non-insulin-dependent diabetes mellitus (NIDDM)
is much more common, especially among some Asian populations. This
type of diabetes usually develops after age 40 and is more common in
people who are overweight. Many people can have a mild form of Type 2
diabetes for years with few symptoms.
In Type 2 diabetes, the pancreas produces insulin, but not enough, or
the body's cells are resistant to insulin, making it difficult or
glucose to be used for energy. Research shows that Asian populations are
more prone to insulin resistance.
Another type of diabetes is Gestational diabetes which occurs during
pregnancy when hormonal changes accompanying pregnancy increase the
body's resistance to insulin. Women who are overweight and older are
more susceptible to this type of diabetes. While gestational diabetes
usually disappears when the baby is born, more than half of these women
go on to develop Type 2 diabetes later in life.
CAN DIABETES BE PREVENTED?
While diabetes does have a hereditary component, many of the risk
factors for the condition can be controlled thereby lessening a person's
chance of developing diabetes
Type 1 diabetes
is now known to be an auto-immune disease in which the body's
infection-fighting mechanisms destroy insulin-producing cells. This type
of diabetes is almost always treated by insulin injections. There is no
known cure or prevention.
Type 2 diabetes
is the most
common form of diabetes and in many cases is preventable. While
heredity, race and age can affect a person's risk of getting Type 2
diabetes, the greatest risk factor is being overweight.
Being overweight increases the resistance of cells to insulin while
losing weight helps to decrease insulin resistance. Physical activity is
very important as it has been shown to help improve insulin sensitivity
and aid in weight control, thereby helping to prevent diabetes
developing.
Risk Factors for Type 2 Diabetes
Family history of diabetes
Age over 40
Overweight
Previously had gestational diabetes, or delivered a baby weighing
over nine pounds (greater than 4 kg)
Being physically inactive
Symptoms of Diabetes
Urinating frequently
Increased thirst
Increased hunger
Unexplained weight loss
Extreme tiredness
Infections and cuts that don't heal
Blurred vision
HOW IS DIABETES TREATED?
To treat Type 1 diabetes, daily insulin injections must be balanced
with meals and daily physical activities. Type 2 diabetes is usually
controlled by diet, weight management and exercise. If the blood sugar
level still remains high, then oral medication or insulin is prescribed.
Diet
In the past, people with diabetes followed very restrictive diets
using specific weighed and measured amounts from standard food groups.
Thanks to a better understanding of the effects of different foods on
blood glucose levels, there are now more flexible food choices. The
recommended diet for people with diabetes is similar to the diet
recommended for everyone, being high in carbohydrate and low in fat.
All carbohydrate foods affect blood sugar levels. For this reason,
carbohydrate foods such as rice, noodles, bread and fruits, are spaced
out evenly throughout the day. Studies on the effects of various
carbohydrate foods on blood sugar levels have shown that sugar does not
cause a rapid rise in blood sugar as previously believed. Sugar has a
moderate effect on blood sugar similar to many other carbohydrate foods.
For this reason many medical associations, including the American
Diabetes Association and the Canadian Diabetes Association, allow small
amounts of sugars to be substituted for other carbohydrates in most
diabetic diets, provided the overall energy and nutrient content of the
diet is not compromised.
Recommended diets for people with diabetes are generally low in fat,
especially saturated fat. This is because too much fat provides extra
energy (calories) which can contribute to weight gain. Excess saturated
fat is associated with increased blood cholesterol which is in turn a
risk factor for heart disease - a condition particularly common in
diabetes.
To lower fat intake, choose lean meat, seafood, poultry without skin,
use low-fat or non-fat dairy products, and cut down on the amount of
fats and oils used in cooking.
High intensity sweeteners, such as acesulfame-K, aspartame,
cyclamate, saccharin and sucrolose, can be used by people with diabetes
and may help to control calorie intake. These sweeteners do not affect
blood sugar levels.
Regular meals
Eating meals on a regular time schedule helps to keep blood sugar at
a steady level. Skipping meals can cause blood sugar levels to drop too
much (hypoglycaemia), while overeating can raise blood sugar levels too
high (hyperglycaemia). Any meal plan should also take into account the
timing and the type of medications taken, as well as physical activity
levels.
Exercise
Exercise is very important because physical activity improves the
cells' sensitivity to insulin, which helps transport glucose into cells.
As the muscles use glucose for energy, the blood sugar level falls.
Exercise also helps to reduce or control weight, improve circulation and
help prevent cardiovascular problems. Any exercise must be balanced with
meals and medications to prevent complications, such as hypoglycaemia.
Medication
Insulin is always necessary for people with Type I diabetes, whether
it is injected one or more times per day, or continuously infused via an
insulin pump. In some cases, oral medications for Type 2 diabetes are
given to stimulate the pancreas to produce more insulin or to slow the
release of glucose into the blood stream. In most cases, Type 2 diabetes
can be treated by diet alone. Medications must always be balanced with
exercise and meal schedules to work effectively.
Discuss these matters with your dietitian or doctor.
Staying Healthy with Diabetes
Monitor blood glucose level frequently.
Take your medication as directed.
Follow a suitable eating and exercise plan to maintain a healthy
weight and control blood sugar.
Get regular check-ups.
Take special care of your feet.
Get regular eye examinations.
Good blood glucose control will minimise complications of
diabetes.
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