Diet for Diabetes (1 & 2)
by Sue Kira, Naturopath & Clinical Nutritionist
– What is Type 1 diabetes?
– Symptoms at onset of type 1 diabetes
– What is type 2 Diabetes?
– Development of type 2 diabetes
– Causes of type 2 diabetes
– Symptoms of type 2 diabetes
– Avoiding and managing Type 2 diabetes
– Type 2 Diabetes and Auto-Immunity
– What is pre-diabetes?
– Risk factors for pre-diabetes
– Treatment of pre-diabetes
– What is Gestational Diabetes Mellitus
– Risk factors for gestational diabetes
– How to manage gestational diabetes
– Causes of gestational diabetes
Case study: Type 1 diabetes, insulin pump, diet and headaches
Type 1 Diabetes
What is Type 1 Diabetes?
In type 1 diabetes, the pancreas, a large gland behind the stomach, stops making insulin because the cells that make the insulin have been destroyed by the body’s immune system and without insulin, the cells cannot turn sugar into energy. This then classifies type 1 diabetes as an auto-immune condition.
Currently, science does not know what causes this auto-immune reaction and at this stage there is no cure. Although diet doesn’t appear to cause type 1 diabetes, diet can help support someone who has it (see case study below).
Often called juvenile diabetes, type 1 diabetes usually commences in childhood, and is managed with insulin injections or an insulin pump.
Symptoms at onset of type 1 diabetes
- Always feeling hungry
- Passing more urine
- Being excessively thirsty
- Feeling tired and lethargic
- Headaches
- Having cuts that heal slowly
- Itching, skin infections
- Blurred vision
- Unexplained weight loss
- Mood swings
- Feeling dizzy
- Leg cramps
Type 2 Diabetes
What is type 2 Diabetes
Type 2 diabetes is a progressive condition where the body becomes resistant to the normal effects of insulin or gradually loses the capacity to produce enough insulin, known as insulin resistance.
People with type 2 diabetes often have strong genetic factors, but is also associated with modifiable lifestyle risk factors. For some, the first sign of diabetes may be a complication such as a heart attack, vision problems, or a foot ulcer. Usually type 2 diabetes occurs more in adulthood, but more younger people are getting it, probably due to their diet.
Development of type 2 diabetes
Type 2 diabetes develops over a number of years, during which insulin resistance starts, and insulin becomes increasingly ineffective to manage the blood glucose levels.
Because of this insulin resistance, the pancreas responds by producing more and more insulin to achieve some degree of balance of the blood glucose levels. During this time the cells in the pancreas that produce insulin wear-out, so by the time someone knows they have type 2 diabetes, they have often already lost 50 – 70% of the cells that produce insulin.
This means that type 2 diabetes is a combination of ineffective insulin and not enough insulin. Type 2 diabetes is a progressive condition with ongoing destruction of cells in the pancreas that produce insulin. If not managed well, this will lead to the need to use insulin via injections or other methods.
Even with the best diet and exercise, sometimes the progression of the disease will continue, meaning that tablets or insulin will be needed.
Causes of type 2 diabetes
While there is no apparent single cause of type 2 diabetes, there are certainly plenty of well-established risk factors. Some risk factors can be controlled and others you are born with.
You are at a higher risk of getting type 2 diabetes if you:
- have a family history of diabetes
- are overweight
- have high blood pressure
- are over 55yrs old – the risk increases as we age
- have an Aboriginal or Torres Strait Islander background, Pacific Island, Indian subcontinent or Chinese cultural background
- are a woman who has given birth to a child over 4.5 kgs (9 lbs), or had gestational diabetes when pregnant, or had/have a condition known as Polycystic Ovarian Syndrome (PCOS).
Symptoms of type 2 diabetes
In type 2 diabetes, many people have no symptoms at all and it’s often not picked up until the complications of diabetes have occurred.
Symptoms include:
- Being excessively thirsty
- Headaches
- Passing more urine
- Feeling tired and lethargic
- Always feeling hungry
- Having cuts that heal slowly
- Leg cramps
- Itching, skin infections
- Mood swings
- Blurred vision
- Gradually putting on weight
- Feeling dizzy
Avoiding and managing Type 2 diabetes
Being diagnosed with impaired glucose metabolism doesn’t automatically suggest that you will get type 2 diabetes but it will increase your risk by 10-20 times more than those with normal blood glucose levels. Strong evidence shows that type 2 diabetes can be prevented in about 60% of cases in the pre-diabetes population by eating well and exercising.
To manage Type 2 Diabetes, while there is currently no full cure, the condition can be managed with diet, exercise, weight management, and medication.
However, there is now much anecdotal evidence that the right diet can remove the symptoms of type 2 diabetes with clinical tests showing no diabetes. This is considered remission, which means symptoms can return if healthy diet and lifestyle factors are abandoned.
Type 2 Diabetes and Auto-Immunity
We know that type 1 diabetes is an auto-immune disease. An auto-immune disease results when the body’s immune system turns against a part of the body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them.
At the time of writing (Feb 2017), type 2 diabetes is in the process of being redefined as an autoimmune disease rather than just a metabolic disorder, particularly when insulin is needed as part of the treatment. Diet and exercise will still be helpful for those needing insulin and may reduce the need to increase insulin as time goes on.
Some people can even have a reversal of their need for insulin in type 2 diabetes but this would need to be recommended by your doctor.
If you give the a diet for diabetes support a solid commitment for a few weeks and don’t feel any better, or you are having problems getting a good stable blood sugar level, then have a discussion with your practitioner about transferring to an Auto-Immune Diet.
There can at times be other factors going on with your body such as inflammation, immune challenges and digestive system upsets. In consideration of these issues, the auto-immune diet may be worthwhile.
Pre-diabetes
What is Pre-diabetes?
Pre-diabetes describes a condition in which blood glucose levels are higher than normal, but not high enough to have type 2 diabetes. Pre-diabetics generally have no signs or symptoms, but a higher risk of developing type 2 diabetes and cardiovascular disease.
Without sustained lifestyle changes, including healthy eating, increased activity and losing weight, approximately one in three people with pre-diabetes will go on to develop type 2 diabetes.
People with pre-diabetes have impaired glucose tolerance (IGT) where blood glucose levels are higher than normal but not high enough to be classified as diabetes, or impaired fasting glucose (IFG) where blood glucose levels are escalated in the fasting state but not high enough to be classified as diabetes. It is possible to have both Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT)
Risk factors for pre-diabetes (similar to type 2 diabetes)
- Overweight, especially those who have excess weight around the waistline
- Physically inactive
- High triglycerides and low HDL-C (good cholesterol) levels and/or high total cholesterol
- High blood pressure
- Family history of type 2 diabetes and/or heart disease
- Women with Polycystic Ovarian Syndrome (PCOS)
- Women who have had diabetes in pregnancy (gestational diabetes) or given birth to a big baby (more than 4.5kgs)
- Aboriginal and Torres Strait Islander background
- Ethnic backgrounds such as the Pacific Islands, Asia and the Indian sub-continent
Treatment of pre-diabetes
For most people with pre-diabetes the best treatment is regular physical activity, healthy eating and if necessary, lose weight.
People with pre-diabetes are also at increased risk of heart disease, so controlling blood pressure, blood cholesterol and triglycerides is important, along with any other blood parameters that are not normal.
Regular physical activity helps your body use insulin more effectively and help you to feel fit and healthy. Aim for at least 30 minutes of ‘moderate intensity’ physical activity on most, if not all, days of the week. Include some resistance training 2-3 times per week to improve the way your muscles work, such as body weight exercises or lifting weights (or try a ‘pump’ class).
Talk to your doctor before starting any new physical activity or diet.
Gestational Diabetes
What is Gestational Diabetes Mellitus?
Gestational diabetes mellitus (sometimes referred to as GDM) is a form of diabetes that occurs during pregnancy and in most cases goes away after the baby is born. GDM is diagnosed when higher blood glucose levels first occur during pregnancy. Between 5% and 10% of pregnant women will develop gestational diabetes and this usually happens around the 24th to 28th week of pregnancy.
All women are tested for GDM by their GP as part of the 24-28 week pregnancy routine examination. Women who have one or more of the risk factors are advised to have a diabetes test when pregnancy is confirmed, then again at 24 weeks if diabetes was not detected earlier in the pregnancy.
Risk factors for gestational diabetes
While there is no single reason why women develop gestational diabetes, you are at risk of developing gestational diabetes if you:
- Are over 25 years of age
- Are overweight
- Have a family history of type 2 diabetes
- Have a family history of gestational diabetes
- Had gestational diabetes during previous pregnancies
- Previously had Polycystic Ovary Syndrome
- Previously given birth to a large baby
- Are indigenous Australian or Torres Strait Islander background
- Are Vietnamese, Chinese, middle eastern, Polynesian or Melanesian background
How to manage gestational diabetes
It’s important to know that most women with gestational diabetes have a healthy pregnancy, normal delivery and a healthy baby. The treatment is physical activity, healthy eating and monitoring, and maintaining a normal blood glucose level while you are pregnant.
While maternal blood glucose levels usually return to normal after birth, there is an increased risk for mum and baby to develop type 2 diabetes in the future. Gestational diabetes can often be managed with healthy eating and regular physical activity, but some women need insulin injections for the rest of the pregnancy.
Causes of gestational diabetes
In pregnancy, the placenta produces hormones that help the baby to grow and develop. These same hormones can block the action of the mother’s insulin. This is called insulin resistance. Because of this insulin resistance, the need for insulin in pregnancy is two to three times higher than normal.
If you already have insulin resistance due to diet and lifestyle choices, then your body may not be able to cope with the extra demand for insulin production and the blood glucose (sugar) levels will be higher, resulting in a diagnosis of gestational diabetes. When the pregnancy is over and blood glucose levels return to normal the diabetes disappears, but it can increase the risk of developing type 2 diabetes later in life.
Diet for Diabetes
Controlling or preventing diabetes doesn’t mean being deprived of delicious foods for life, it just means being more selective in what you eat.
With a diet for diabetes there are plenty of choices of yummy satisfying foods to help you manage diabetes and feel your best.
Your nutritional needs are virtually the same as everyone else, so no additional special foods are necessary. You just need to pay attention to some of your food choices, especially the carbohydrates you eat.
Carbohydrates have the biggest impact on your blood sugar levels so be careful about the types of carbohydrates you eat, with the focus on high fibre complex carbohydrates such as sweet potatoes, quinoa and buckwheat, to prevent your body getting a sugar spike and producing too much insulin.
Did you know that insulin is a fat storing hormone? So we don’t want too much of that happening as weight gain also increases the risk of diabetes.
Eat small amounts of healthy fats from raw nuts, seeds, olive oil, fish, coconut and avocados. Enjoy good quality proteins such as eggs, beans, seafood, free range grass fed chicken, turkey and other meats. Have loads of vegetables but limit the starchy ones. There are even some sweet treats that shouldn’t upset your blood sugar balance too much.
But watch out for sugar! Sugar is hidden in so many packaged foods so the first step is to use whole foods made at home. If you are going to eat packaged foods, then there are some hidden sugars to keep an eye out for on the packet label that you might not be aware of.
Apart from the obvious ones (sugar, honey and molasses) added sugar can be in the form of agave nectar, cane crystals, corn sweetener, crystalline fructose, dextrose, evaporated cane juice, fructose, high-fructose corn syrup, invert sugar, lactose, maltose, malt syrup and more. Avoid!
The idea of a diet for diabetes is to eliminate foods considered detrimental, and include foods that are supportive, which helps your body do its natural job of healing. For this reason, apart from sugar I also recommend a diet free of gluten, dairy and additives. And fresh is best!
The diabetes diet is suitable to support all types of diabetes and hey…a diabetes diet does not have to be boring.
Important: Before you commence a new diet, see your medical or health care professional for qualified guidance about what foods and supplements are best for your body. While on the diet do not stop any medications or supplements previously prescribed unless advised otherwise by your medical or health care professional.
Note: During the early stages of a new diet, you may experience symptoms such as fatigue, headaches or body aches, which may occur because your body is detoxifying. However, if you are unsure about a symptom at any time, check immediately with your medical or health care professional.
Case study: Type 1 diabetes, insulin pump, diet and headaches
Client name and identifying information changed
A while ago a young 16 year-old lady visited my clinic (with her mum) to see me about recurrent daily headaches. Her case history showed that she was a Type 1 diabetic and she was also on an insulin pump. The insulin pump gave her the freedom to not worry about how much insulin to inject into herself as it ‘self-regulated’ according to what she ate.
She was normally bright and full of life, but headaches were crippling her. Knowing that a person without diabetes who eats inappropriately can get headaches when blood sugar levels go up and down, I questioned her more about her ‘pump’ and her diet.
It seemed that before she had the pump, she found that she had to be very cautious of her diet and have a good balance of proteins, good quality fats, and carbs from vegetables and fruit (rather than starchy sugary foods). This diet kept her blood sugar level reasonably stable and each time she needed a dose of insulin the level was consistent.
Then she was offered an insulin pump, which is a small electronic device, about the size of a mobile phone that is carried on a belt, inside a pocket, or even attached to a bra allowing a very discreet therapy. The pump helps a diabetic more closely mimic the way a healthy pancreas functions.
The pump, through a Continuous Subcutaneous Insulin Infusion (CSII), replaces the need for frequent injections by delivering precise doses of rapid-acting insulin 24 hours a day to closely match the body’s needs.
With this in place, she was told that she could then eat and do whatever she liked because the pump would automatically adjust the dose of insulin needed, thus giving her more freedom and peace of mind.
Unfortunately, she took this literally and started to eat a carb rich diet, with loads of sweet foods, bread, pastas, chocolate, ice-creams, soft-drinks (soda) and so on.
There was no protein and not much in the way of good fats or healthy vegetables. I asked if her insulin use with the pump was higher than previously and she admitted it was a lot higher. I suggested a trial for the next week of going back to her previous healthy diet.
She returned in 10 days and reported not one headache since the dietary change, along with lots more energy and vitality and a clearer complexion, which she was also very excited about.
I wanted to present this case study, because many people think that type 1 diabetes can’t be treated with diet. Although it cannot be cured by diet, it can help to have better health and more vitality.
There have been many cases of reported ‘cures’ of the other types of diabetes with diet, weight control and exercise. But these really should be called ‘remissions’ because once diabetes has been triggered it is more about balance and maintenance, and if there is a return to the old unhealthy diet then diabetes will surely return hastily.