SCOPE AND IMPACT OF DIABETES IN THE U.S.: UNDIAGNOSED TYPE 2 DIABETES
DIABETES & PREGNANCY
Pregnancy in diabetic women carries higher risk than in normal women. During pre-insulin era the out come in pregnancy of a diabetic women were disastrous both for mother and foetus. With the introduction of insulin in 1921, there has been tremendous improvement in the outcome of such pregnancies.
Diabetes is encountered in 2-3% of all pregnancies, of which almost 90% are detected during pregnancies and known as gestational diabetes mellitus while the rest are established diabetes either Type 1 or Type 2.
There is no reason for the diabetes women to avoid pregnancy. With the emergence of modern concept of care of such high risk pregnancies, development of newer insulin, human insulin, insulin delivery systems, and advent of home glucose monitoring systems by meters have totally revolutionised the outcome of such diabetic pregnancies. However, management of diabetes in a diabetic woman is a team work of a diabetologist, obstetricians, neonatologist, and diabetic nurse educator, dietician etc.
Patient’s co-operation for regular follow-up, good home monitoring and strict self discipline through out the pregnancy makes the normal outcome of such high risk pregnancies possible.
Pregnant diabetes women can be grouped into two classes. (1) Gestational Diabetics (2) Known diabetics with pregnancy.
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THE TREATMENT OF DIABETES
Diabetes is largely treated by diet. Some of the principles are well established: diabetics have to avoid sugar, and to lose weight if they are obese. Another traditional feature of diabetic diets used to be severe restriction of all carbohydrates, such as bread, potatoes and the like. Diabetics, carefully counting their carbohydrate units, naturally turned to other foods, and a typical diabetic diet was very low in carbohydrates and consequently high in fat. Because many fats have a high proportion of saturated fatty acids, diabetics in western countries thus tended to eat even more saturated fat than non-diabetics.
Today many specialists have stopped prescribing a very low-carbohydrate, high-saturated-fat diet. Carbohydrates (except sugar) are permitted in rather greater amount, so that total fat intake is not increased. And instead of merely telling their patients what to avoid, positive advice is also given: the fats should be chosen to include a proportion of the unsaturated and polyunsaturated ones which effectively reduce blood-cholesterol and triglyceride levels. Diabetics given such a diet have lower cholesterol levels; another bonus is more effective reduction of blood glucose. In these ways, it is hoped that the heart-disease risk of diabetics living in western countries may be reduced towards that of Japanese diabetics.
If we accept that a reduction in risk factors is generally worth while, this must apply with increased force to diabetics. They should certainly stop smoking. If they have high blood pressure this must be dealt with carefully. Control of the blood-glucose level is clearly important but it is also important that cholesterol and triglyceride levels are controlled; the diabetic will be advised to lose excess weight, and this helps reduce the blood cholesterol. As we saw above, some diabetic complications in experimental animals have been largely prevented by insulin treatment. Recent evidence suggests that the same results are possible in man. Dr Job in Paris has reported that very careful control of blood-glucose levels is followed by a lower frequency of eye complications. And Dr Lowy, working in London, finds that the risks to the diabetic mother and her newborn baby are reduced if an extremely careful control of glucose levels is kept.
Lastly, it should be noted that many diabetics – perhaps 50 per cent – do not know that they have diabetes; a report from Ireland showed that no less than one quarter of newly diagnosed diabetic women already had signs of coronary disease. The implication is that we should try much harder to detect diabetes; this will permit its earlier control and correction of the associated risk factors.
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THE G.I. FACTOR AND WEIGHT REDUCTION: THE NEED FOR EXERCISE
A ‘fast metabolism’ is not necessarily a matter of luck. Exercise, or any physical activity, speeds up our metabolic rate. By increasing our kilo-joule expenditure, exercise helps to balance our sometimes excessive kilojoule intake from food.
Exercise also makes our muscles better at using fat as a source of fuel. By improving the way insulin works, exercise increases the amount of fat we burn. A low G.I. diet has the same effect. Low G.L foods reduce the amount of insulin we need which makes fat easier to burn and harder to store. Since body fat is what you want to get rid of when you lose weight, exercise in combination with a low G.L diet makes a lot of sense!
Why exercise keeps you moving. The effect of exercise doesn’t stop when you stop moving. People who exercise have higher metabolic rates and their bodies bum more kilojoules per minute even when they are asleep!
The body loves to store fat. It is a way of protecting us in case of famine. In the midst of plenty we are building up our fat stores.
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Diabetes
ALCOHOL IN DIABETES
The Australian dietary guidelines suggest that alcohol intake should be limited. In diabetes there are additional reasons why intake should be limited.
1. Alcohol may affect blood glucose levels.
2. The effects of too much alcohol may be similar to the symptoms of hypoglycemia. (It may be important for friends to be aware of this.)
3. Many alcoholic beverages contain significant amounts of carbohydrate.
4. All alcoholic beverages are high in energy. This is important where weight control is a problem.
5. Alcohol may induce high blood fat levels and would need to be avoided if this were a problem.
A moderate intake of alcohol should not affect your diabetes. The following points should be kept in mind.
1. Don’t drink on an empty stomach. Food in the stomach will help slow the rate of absorption of alcohol from the stomach.
2. Choose beverages with a low carbohydrate content – Spirits, Dry Wines, Dry Sherries, Dry Vermouth.
3. For a longer drink mix with low carbohydrate drinks: Diet Coke, LoCal Lemonade, water, Soda Water, Natural Mineral Water, artificially sweetened Tonic Water, LoCal Dry Ginger, Diet Pepsi.
4. Avoid using alcoholic beverages with high carbohydrate content – Sweet Wines, Sweet Sherries, Sweet Vermouth, Liqueurs, Port and Stout.
5. Beers – all varieties contain carbohydrates (including diabetic beer). A low alcohol variety however contains less alcohol, is lower in energy and would be better.
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Diabetes
