Tuesday 27 September 2016

15 myths about diabetes debunked

Áilín Quinlan

Published 26/07/2016 | 02:30

People with diabetes are advised to follow normal healthy eating guidelines which apply to the general population.
People with diabetes are advised to follow normal healthy eating guidelines which apply to the general population.

Diabetes affects more than 225,000 people in Ireland and the World Health Organisation predicts the disease will be the seventh leading cause of death in 2030. Yet there is much ignorance around it. In conversation with our reporter, Dr Conor Woods busts some common untruths surrounding the condition

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1 You only get diabetes if you're overweight - False

Being overweight or obese increases the risk of developing type 2 diabetes, but is not associated with type 1 diabetes, which results when the immune system attacks the insulin-making beta cells in the pancreas. However, family history, genetics and age also play a role in type 2 diabetes.

2 People with diabetes cannot have sugar - False

Tom Hanks said a poor diet in his younger days has led to him developing diabetes
Tom Hanks said a poor diet in his younger days has led to him developing diabetes

People with diabetes are advised to follow normal healthy eating guidelines which apply to the general population. "Apply a healthy dose of common sense and eat a balanced diet with plenty of vegetables and some fruit," says Dr Conor Woods.

Regular meals should contain high-fibre carbohydrates, plenty of fruit and vegetables, and foods that are low in salt, saturated fat and refined sugar.

However, it's wise to check food labels, as sugar is often added to products such as baked beans, cereals and sauces, to enable informed food choices, resulting in choosing less processed foods to reduce your intake of hidden sugars.

3 People with diabetes should eat brown, rather than white bread - False

It's actually the amount of carbohydrate we eat which will affect our blood glucose levels most. People with diabetes are encouraged to choose wholegrain breads and cereal to increase the fibre content of their diet because fibre has beneficial effects in the body - it reduces cholesterol and the risk of colon cancer and helps with bowel function, as well as keeping a person feeling full for longer so may reduce total food intake.

However, says Dr Woods: "I get less hung up on the issue of white versus brown - to me it's the quantity of carbohydrates you consume that matters. There are benefits to brown and wholegrain foods such as fibre, but the important message is don't eat excess amounts of carbohydrate."

4 Fruit is a healthy food and can be eaten as much as desired - False

Fruit is a healthy food that contains fibre, vitamins and minerals - but it also contains carbohydrates that are broken down in the body to glucose. As a result, fruit must be included in your total calorie or carbohydrate intake.

A diabetes kit
A diabetes kit

"Remember, fruit is sugar, which is why it tastes nice," explains Dr Woods, who says while he recommends that everyone eat five portions of fruit and vegetables a day, people with diabetes should place the emphasis on eating more vegetables than fruit - "though it is important that some fruit be included in the diet".

All types of fruit can be taken by the person with diabetes - it is the portion size that matters.

Examples of a portion of fruit include a small handful of berries, a small apple, small banana or an orange, or two small fruit such as mandarins or kiwis.

5 Special 'diabetic foods' can be taken freely by people with diabetes - False

Foods labelled as "diabetic foods" or "suitable for people with diabetes" are not generally encouraged says Dr Woods.

"In general, we say that if you like something, have a small amount of it as a treat.

"Avoid 'diabetic foods' as there is a concern that the sugar may be replaced by something else, such as fat. Keep the treats but have them less frequently and in smaller portions," he recommends.

Health officials say the increased level of type 2 diabetes is due to increasing level of obesity
Health officials say the increased level of type 2 diabetes is due to increasing level of obesity

6 Sweeteners are bad for you - False

Questions about using artificial sweeteners and increasing the risk of cancer arose when early studies showed a link with bladder cancer in laboratory animals.

However, many subsequent studies into links to cancers and sweeteners have not found clear evidence of this. Dr Woods recommends only using sweeteners "when you absolutely need to". Although small amounts are fine, and better for someone with diabetes than added sugar, he says, it's worth re-considering the necessity for sweetening your food at all. "Think about why you want to add sugar or sweeteners to your food in the first place."

7 Diabetes can be prevented - False

Type 1 diabetes cannot be prevented or its onset delayed at present, as the cause of the auto-immune reaction which underlies it is not yet fully understood. However you can certainly delay, or reduce your risk of developing the onset of type 2 diabetes by eating a healthy diet, staying active, watching your waistline and maintaining a weight that is appropriate for your height.

See diabetes.ie for a test that can help define your own risk and what actions to take to protect your future health based on your current risk.

A blood glucose monitor as used by diabetics
A blood glucose monitor as used by diabetics

8 Type 2 diabetes is the 'milder' form of diabetes - False

There's no such thing as 'mild' diabetes, says Dr Woods, who warns that "this is the wrong language". "All diabetes is serious and especially if it's not properly controlled," he says.

Common complications of diabetes are heart attacks, strokes, blindness and amputations - these are all caused by blood vessels being exposed to too much glucose for extended periods of time.

To prevent developing such complications, early diagnosis and daily management to control glucose, cholesterol levels and blood pressure are essential.

9 A person with diabetes cannot have a career in the Gardaí or Emergency Services - False

People who are diagnosed with diabetes while in employment in the Gardaí or emergency services can continue their career.

People with diabetes who wish to pursue a career in these services will need to pass a medical, which is based on individual assessment. It is the use of insulin, not the diabetes, that may influence the outcome of the medical or impose restrictions on working conditions. "People with type 1 diabetes will always need insulin from the beginning, but people with type 2 diabetes may be well controlled in terms of diet and/or tablet medication for many years," Dr Woods explains. "Type 2 diabetes is a progressive disease, so after many years you may require insulin."

10 Diabetes is curable - False

People with type 2 diabetes, especially those who carry a lot of excess weight, may discover that if they lose weight and begin regular physical activity, their blood glucose returns to normal.

However, this does not mean their diabetes has disappeared. The development of type 2 diabetes is a gradual process in which the body becomes unable to produce enough insulin for its needs. Losing weight reduces the body's need for insulin (less insulin resistance) but as the person ages or if they regain some weight, that imbalance of insulin need/production recurs and blood glucose levels rise. Any person who considers themselves to be in diabetes remission should have an annual blood glucose level check. "Bariatric surgery can also lead to remission from type 2 diabetes and we would hope in the future to have better access to this," says Dr Woods. "Currently in this country, services are very limited."

11 Type 2 diabetes can become Type 1 diabetes - False

People with type 2 diabetes may require insulin injections, but this does not mean they have developed type 1 diabetes. Requiring insulin in type 2 diabetes is not a failure - it's part of the natural progression of type 2 diabetes.

Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one. In type 2 diabetes, insulin is used to help diabetes management, whereas in type 1 diabetes, insulin is essential to sustain life.

12 People with diabetes shouldn't play sports - False

All people with diabetes are encouraged to exercise as part of a healthy lifestyle and a core element of diabetes management. Keeping active can help reduce the risk of complications associated with diabetes by reducing glucose and cholesterol levels.

However, there may be some considerations to take into account before taking up a new exercise regime, so talking to your diabetes team is important.

13 Very low calorie diets can cure diabetes - False

Very low calorie diets are used to promote weight loss and that weight loss, especially in people recently diagnosed or/and of a younger age, can reduce blood glucose levels to non-diabetes levels.

"There are studies which show that if you put people on very low calorie diets, their diabetes may go into remission, but the problem is that these very low-calorie diets cannot be sustained in the long term," warns Dr Woods.

14 You get diabetes from eating too much sugar - False

"There is no direct link between sugar and diabetes," says Dr Woods, but he adds - there are indirect links. Type 2 diabetes is caused by genetics and lifestyle factors. Being overweight increases your risk for developing type 2 diabetes and a diet high in calories from any source contributes to weight gain. "If you eat lots of sugar, you will probably gain weight and when you gain more weight and fat tissue, this will increase your risk of developing type 2 diabetes," Dr Woods explains. Frequent consumption of sugary drinks has been independently linked to the development of type 2 diabetes.

15 Diabetes is not a serious condition - False

"I recommend getting an annual check-up and having your diabetes controlled for other risk factors such as blood pressure and cholesterol. This might mean taking medication such as statins or blood pressure tablets for these risk factors," says Dr Woods.

"Controlling diabetes, blood pressure and cholesterol all reduces the risk of heart attack, stroke and death." Having poorly controlled diabetes doubles your chance of having a heart attack.

* Dr Conor Woods is a consultant physician specialising in endocrinology and diabetes at Naas General Hospital and Tallaght Hospital. For additional information, see the Diabetes Ireland website diabetes.ie, phone the Diabetes Ireland lo-call helpline 1850 909 909 or email: info@diabetes.ie.

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