Diabetes & Nutrition 101
by Shefali Raja, BSc., RD
Community Nutritionist

When it comes to diabetes, what you don’t know can indeed hurt you, so it’s critical to be informed and to be vigilant about preventing future complications.

The number of people who are developing diabetes is rising at epidemic proportions. Not only is the incidence of diabetes growing among adults, but it’s rising at an alarming rate in children and youth. According to the Canadian Diabetes Association, 2.4 million Canadians are currently diagnosed with diabetes and up to six million people in Canada are prediabetic (they have elevated blood sugars but not high enough to be diagnosed as diabetic). Twenty five per cent of these prediabetics will be diagnosed with diabetes over the next three to five years.

Why such an epidemic?
A sedentary lifestyle, eating foods that are high in fat, low in fibre and highly processed in larger portions than our bodies need leads to unhealthy weight gain, especially around the abdomen. This is a major risk factor for diabetes.
Why should you be concerned?
Diabetes-related complications are very serious and impact the heart, nerves, eyes and kidneys. For example, having high blood sugars on a regular basis causes blood vessels to become thicker and less elastic, making it more difficult for blood to pass through. High blood sugars can also cause high fat levels in the blood. These fats can narrow or clog the blood vessels and lead to heart attack, angina (heart pain), stroke, etc. Those with diabetes are at serious risk for heart disease — and if heart disease is something that already runs in the family, this issue is of even greater concern.
When it comes to diabetes, what you don’t know can indeed hurt you, so it’s critical to be informed and to be vigilant about preventing future complications.

What is diabetes?
Simply put, diabetes is a chronic condition that develops when the pancreas either doesn’t produce enough insulin (a hormone that helps convert food to energy) or can’t effectively use the insulin it produces.
Two main types of diabetes:
Type 1 is an unpreventable disease resulting from failure to produce insulin and requiring insulin injections; most common in children and young adults and usually diagnosed at a young age.
Type 2 is a potentially preventable disease resulting from insulin resistance in the body; it affects both children and adults.

Who is most at risk?
• Simply being South Asian is a risk factor. South Asians are up to four times more at risk
• Those with an immediate family member with diabetes
• Those who are over 40 years of age
• Those who follow a poor lifestyle
• Individuals with unhealthy weight gain, especially around the abdominal area
• Women who had gestational diabetes when pregnant or delivered a baby whose birth weight was more than nine pounds
• Those with high blood pressure
• Anyone experiencing warning signs such as blurred vision, thirstiness, fatigue or frequent urination

What should you do?
Speak to your health care provider about getting screened for diabetes if you fit into one of the above categories.

Accept and understand the diagnosis
Unfortunately, there is some stigma attached to illnesses in the South Asian community. People don’t want to talk about health conditions and are often in denial and try to hide them. It’s important to start accepting the diagnosis and supporting one another in dealing with making appropriate changes to avoid future complications.
Break things down into small steps. Small, sustainable goals lead to long-term success.

Protect against abdominal weight gain:
• Exercise more regularly and make it part of your daily routine.
• Follow an eating plan that supports sustainable, healthy weight loss or weight maintenance depending on your current weight status. (See the suggestions in the section on ways to keep blood glucose levels in acceptable range.)

Control your Blood Sugars
Carbohydrate-containing foods include grain products, some vegetables, fruits and dairy products; they break down into glucose in our body and then travel through the bloodstream to various places, including the brain, muscles, fat tissue and liver. Once reaching its destination, glucose serves as the main source of fuel for each of these cells; in effect, it acts like gas in your car. This entire process is regulated by the hormone insulin that is produced in your pancreas. Insulin’s job is to open the door to each cell, allowing the glucose to enter.

While the body can manage the fluctuations in blood sugar that come with both eating too much and eating too little, too much feasting (combined with too big a waistline and not enough exercise) can make the body less willing to respond to the insulin, a condition more formally known as insulin resistance. As we become more resistant to the effects of insulin, our blood sugar levels continue drifting higher and higher, and our ability to bring our sugar levels down after eating is impaired. This condition of impaired blood-sugar control is known as pre-diabetes. If left uncontrolled, it leads to Type 2 diabetes and its complications.
Medications or insulin needs to be taken in order to facilitate this process and keep the blood sugar levels in acceptable ranges in order to avoid complications. A little weight loss or healthy eating can also keep blood sugar levels in acceptable ranges.
Acceptable targets of blood glucose levels for those with diabetes are:
4 - 7 mmol/L first thing in the morning after an overnight fast
5 -10 mmol/L two hours after eating.

Ways to keep blood glucose levels in acceptable range:
Eat well: There is no one food that is bad and needs to be avoided. The food we eat is made up of different nutrients such as carbohydrates, proteins, fats, vitamins, minerals and water. Foods that are high in fiber and also protein foods will slow down the breakdown of the meal and help to keep the blood sugar levels from rising and falling too quickly.

Eat three balanced meals per day, four to six hours apart. It is important to eat on time especially if you take diabetes medication. Diabetes medications are meant to boost the insulin in your blood at meal times, so by not eating on time your blood sugars can become very low and lead to something called hypoglycemia or low blood sugar reaction. Your blood sugars become very low and you might start to feel dizzy, shaky, nauseous etc. Quickly drinking about ¼ to ½ glass of juice or having a candy can help immediately. Test your sugars and have a small snack right after.

Vegetables that are high in nutrients and low in calories like spinach, leafy greens, lettuce, eggplant, peppers, zucchini, cucumbers, radish, broccoli, cabbage, cauliflower, and celery can be eaten in larger portions as they have very little carbohydrate or sugar content and should take up half of your plate.
Foods containing starch should take up one quarter of your plate. Choose whole grain breads, whole wheat roti, high fibre cereals, rice, whole grain pasta or potatoes. Your body needs these foods for energy. Look for at least four grams of fibre per serving.

Protein foods should take up one quarter of your plate. These include fish, lean meats or poultry, eggs, or vegetarian protein choices, such as tofu, dahl, lentils or beans and low-fat cheese.
Have low-fat milk or yogurt and a small piece of fruit to complete your meal.

Limit:
• Sweets such as sugar, regular pop, desserts, candies, jam, honey, chocolate, Indian sweets like barfi, jalebi, ladoo, etc.
• High-fat choices such as fried foods, chips, Indian fried snacks, pastries and foods that contain trans fats or hydrogenated fats. Healthy sources of fats include canola oil, olive oil, flax-seed oil and soft non-hydrogenated margarines.
• Between-meal snacks (if needed) can include one glass of 1% milk and 2 tablespoons of nuts or ¾ cup of low-fat yogurt and a small piece of fruit, one slice of whole wheat bread or four melba toast or one roti with one to two ounces of light cheese or one tablespoon of peanut butter.
• Choose sugar substitutes like Splenda if you can’t give up the sweet taste in your chai or coffee, or if you want to bake. Look for products that have Splenda or sucralose written on them as they would be low in carbohydrates and not affect your blood sugar.

Make these steps part of your lifestyle:
• Test blood glucose levels at different times of the day and understand what affects your blood sugar levels. Make adjustments to your meal plan or exercise routine to keep blood sugars in the recommended ranges.
• Exercise soon after a meal to bring down the blood sugar.

For more help on diabetes management, speak to your doctor and also ask about diabetes education programs at your local hospital. The diabetes-management way of eating and living is very healthy and can be followed by the whole family. All foods can be included in moderation.