Thursday 23 May 2019

15 ways to control diabetes

Type 2 diabetes is reaching epidemic levels in Ireland, but there's a lot you can do to keep your blood sugar under control. Diabetes expert Dr Val Wilson shares 15 things you should know to self-manage the disease, avoid associated illnesses, and live life to the fullest

A 'finger prick' home blood glucose test
A 'finger prick' home blood glucose test

One in four people worldwide now have diabetes, and numbers are on the rise, but by making some small changes to lifestyle, you can achieve big differences in diabetes control.

Diabetes is a condition where there's too much sugar (glucose) in the blood because the hormone insulin is absent (Type 1 diabetes) or cannot work properly because there's too much fat around body cells (Type 2 diabetes). In Ireland, up to 7.5pc of people may have Type 2 diabetes, caused by obesity and taking little or no exercise. If the condition isn't managed properly with insulin or medication, high blood sugar levels can cause serious complications such as heart disease, nerve damage, blindness and kidney disease. Although people who take insulin to treat their diabetes are at risk of having low blood sugar levels, the long-term effects of having a high amount of sugar in the blood over time is the reason diabetes must be controlled well.

1 You may think that Type 2 diabetes is not as serious as Type 1

This is not the case. Having Type 2 diabetes increases the risk of developing heart disease, so having good control of blood sugar, blood pressure and cholesterol levels is very important. GP surgeries now offer regular health checks where you can have these levels monitored, even if you haven't felt unwell.

Building up your exercise endurance steadily improves your cardiovascular health
Building up your exercise endurance steadily improves your cardiovascular health
A 'finger prick' home blood glucose test

2 Being overweight means insulin can't work properly in the cells of the body

This is called insulin resistance. If you're a woman with a waist measurement of over 35 inches or a man whose waist measures over 40 inches, Type 2 diabetes and heart disease are more likely. A key factor in developing Type 2 diabetes is the excess body fat that sits around the waistline, making the person appear apple-shaped rather than pear-shaped. Excess fat in the mid-section of the body has the greatest effect on the working ability of insulin to reduce blood sugar levels.

3 The occasional high or low sugar level is to be expected so don't let it throw you

There is no such thing as perfect control - if you had it, you wouldn't have diabetes, because your body would be able to keep blood sugar levels within normal limits on its own. Health professionals (your GP, practice nurse, diabetes consultant and diabetes nurse) like you to aim for normal to good control (blood sugar readings on your own monitor of 5-8mmol/L), although this is not always easy if you have repeated infections and/or depression or brittle diabetes (diabetes that is very difficult to control) that increase your blood sugar levels.

4 Moderate exercise means different things to different people

Exercise is moderate if it doesn't get you out of breath, but seek medical advice before beginning an exercise programme. Building up your exercise endurance steadily improves your cardiovascular health. Do exercises regularly that strengthen your muscles and build up muscular endurance so that your body benefits (muscles, ligaments and tendons become shorter over time with diabetes). Aim to increase how flexible you are by setting goals - being able to touch your toes, for example. If you are overweight, chose exercises that burn body fat such as swimming, cycling or using a treadmill.

5 Gaining an understanding of your diabetes gives the condition meaning

This knowledge can motivate you to control your condition as well as you can. It's true that being overweight, taking little or no exercise and smoking all contribute to poorer health, but big improvements in Type 2 diabetes and heart disease can be made by eating healthier foods, taking exercise several times a week and quitting smoking.

6 People with diabetes who are anxious tend to have higher blood sugar results

It's natural to feel anxious when you have to face lots of lifestyle changes because you have diabetes. Identify why you feel anxious and decide on a potential way of dealing with it (for example, if you often eat junk food because you need comfort but 'know you shouldn't'). Contact a health professional who can offer you appropriate support and who you feel won't judge you, like your diabetes nurse or GP practice nurse.

7 The way you feel - mental health - is just as important as physical health

Understanding how your emotions affect your diabetes is the key to managing these ups and downs so that you are in control of your blood sugar levels. The brain needs glucose to function properly, but too much or too little has a marked effect on behaviour and personality. Depression is also very common in people with diabetes. If you suffer from depression, it's important to visit your GP for help with this so that it doesn't have a long-term impact on your blood sugar levels.

8 Intense exercise can increase blood sugar levels rather than lowering them

Intense exercise causes the liver to release stored glucose to fuel the muscles, so there's a seven- to eightfold increase in glucose production in the body, and only half of this is used by the muscles. If you do intense exercise, there must be some insulin available (if you take it) to deal with the stored glucose released by your liver to fuel the muscles.

9 If you are drinking alcohol, always eat some carbohydrate to prevent low blood sugar

If you take insulin or sulphonylurea medication, certain drinks, such as vodka and gin, will lower blood sugar, so you're more likely to have a hypo. Drinking vodka and orange juice, on the other hand, will increase blood sugar because of the fruit sugar in the juice. The key to drinking alcohol is moderation.

10 In a diabetic diet, one serving of carbohydrate is 15 grams

Different foods with the same amount of carbohydrate raise blood sugar in the same way, so a serving of two medium potatoes has the same carbohydrate content as one cup of vanilla ice cream - 60 grammes. It's the amount of carbohydrate that's important, not the type.

11 Some carbohydrates raise blood sugar more quickly than others

Swap white or wholemeal bread for wholegrain bread, which contains slow-release carbohydrate. Eat porridge oats instead of corn- or wheat-based cereals, as oats raise blood sugar slowly and reduce cholesterol. Choose fruit that's raw or under-ripe, as this contains less fruit sugar. Long-grain rice has more carbohydrate than basmati rice, so read the labels and compare values before buying.

12 Smoking and diabetes are a deadly combination

The likelihood of having a heart attack, stroke or blood circulation problems if you smoke and have diabetes goes up by 4 to 9pc. If you don't smoke for three months, your blood circulation increases throughout your whole body, reducing the risk of lower-limb amputation.

13 Diabetic complications are not inevitable

When sugar levels are high, your blood becomes thick like syrup so your heart has to work much harder to pump it around your body. This sugar sticks to the sides of blood vessels, narrowing the amount of space available for your blood to flow through. Sugar can also attach itself to white blood cells, so if sugar levels are higher than normal, this can change the function of cells - red blood cells are unable to hold as much oxygen, and white blood cells are not able to fight infection.

14 Changing what you eat and how you exercise can actually reverse Type 2 diabetes

Lifestyle change CAN reverse Type 2 diabetes if you are very motivated to achieve this goal but YOU MUST talk to your diabetes consultant before cutting down on carbohydrates, as your diabetes medication will need to be altered.

15 Some medications can increase blood sugar levels

'Water tablets' (diuretics) like thiazide have a tendency to increase blood sugar because they stop insulin working as well. This is also the case for some tablets taken for high blood pressure (Atenolol, Bisopropol, Minoxidil, Nifedipine, and Amlodipine) that alter the way sugar is processed by the body. Being aware of this means you can report blood-sugar control problems to your GP.

* Dr Valerie Wilson has a PhD in Diabetes Health Promotion and specialises in diabetes self-management. Her latest book, Diabetes? Keep Calm and Take Control, is out now

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