Preventative Measures
Avoiding Type 2 Diabetes

Type 2 diabetes * is a chronic, incurable and sometimes insidious disease. It is increasingly prevalent in western societies, and in many developing countries where the adoption of western lifestyle is becoming common. Almost everyone knows of someone, be it relative, friend or neighbour, who has or will develop diabetes.

Diabetes has a special significance in my life, as my mother and four of her eight sisters have diabetes. Not only am I concerned with the development of some serious complications in my mother’s situation, but also that my sisters and I have an increased risk of developing diabetes, as do our children. It is a disease to be avoided and is preventable.

IMPORTANCE OF INSULIN
The pancreas is responsible for manufacturing, storing and releasing insulin. Insulin is essential for our survival, regulating blood glucose levels by facilitating the transportation of blood glucose into almost every cell in the body.

Insulin also tells fat cells to change glucose and fatty acid into fat, and stimulates centres in the brain responsible for feeding behaviour. It is necessary for tissue and organ growth, as well as regulating the balance of other hormones in the body.

In type 2 diabetes, the body becomes resistant to insulin, causing the pancreas to produce higher levels of insulin. However, sugar levels are not effectively controlled because the body is insulin resistant, so more insulin is produced. Surplus insulin then converts glucose into body fat, leading to increased weight and more overproduction of insulin, in a perpetual cycle.

COMPLICATIONS
Numerous problems associated with diabetes include nerve damage, kidney disease, vision disorders such as cataracts, glaucoma, corneal disease and retinopathy, as well as stroke, heart disease, and peripheral vascular disease, which sometimes leads to ulcers, gangrene and even amputation. The chance of developing pancreatic and liver cancer increases significantly.

RISK FACTORS
Risk factors vary. Some, such as ethnic background, family history of diabetes, and giving birth to a child over nine pounds cannot be changed (I have the latter two in my history), but lifestyle factors like diet, exercise and smoking are controllable. High blood pressure and cholesterol levels should also be kept within the normal range.

There is an online test on the American Diabetes Association’s website that determines the likelihood of developing diabetes. To take the test, go to http://www.diabetes.org/risk-test.jsp. Talk to your doctor if your score is ten or above.

MEASURING BODY FAT
Being overweight and underactive are triggers for the onset of diabetes, according to the International Diabetes Institute. Studies show that eighty percent of diabetics are overweight or obese.

There are three methods of measuring body fat to indicate the potential development of diabetes; body mass index, waist circumference, and waist/hip ratio.

Body Mass Index (BMI) measures total body fat. Calculate your BMI online at www.nhlbisupport.com/bmi/.

Waist circumference, the focus for Diabetes Week 2007, is also useful in determining the likelihood of developing diabetes. Excess body fat, particularly abdominal fat, contributes to insulin resistance. Losing weight, especially around the abdomen, improves insulin uptake by the body, thus blood glucose levels are better controlled.

Women should have a waist measurement of less than ninety centimetres, while men’s waistlines should be less than one hundred centimetres.

Some experts believe the waist/hip ratio is a better indicator than BMI for the likelihood of European males developing diabetes. A calculator to measure Waist/Hip ratio is available online at https://www.fitness2live.com.au/waist-hip-ratio.

STRESS
Stress, both acute and chronic, may have a destabilising effect on blood glucose levels. Seeking professional help may be necessary for high levels of stress, especially if ongoing. Reducing stress and adding relaxation techniques, such as yoga and meditation, may assist in keeping blood glucose levels low, when integrated with a balanced diet and exercise program.

GLYCEMIC INDEX
The Glycemic Index (GI) is a helpful tool for controlling blood sugar levels. Complex carbohydrates are an important part of the diet, providing energy. However, carbohydrates with a high GI rating quickly elevate blood glucose. This can be harmful to your health, especially if you already have diabetes or pre-diabetes, or are overweight and sedentary.

Low GI carbohydrates slowly release glucose into your bloodstream, keeping your energy levels balanced with only small fluctuations of insulin levels. An added benefit of low GI foods is that they help control the appetite and delay hunger.

For people with diabetes, a low GI diet helps reduce insulin levels and insulin resistance, while improving glucose and lipid levels.

The International Diabetes Institute recommends eating at least one low GI food, with each meal or snack to help balance blood glucose levels.

The GI rating does have limitations. Foods high in fat and salt, such as potato chips, may have a low to medium on the GI, but no nutritional value. Use common sense and choose low GI foods with high nutritional content.

To find out more about the glycemic index go to http://www.glycemicindex.com

FAT
All fats are high in kilojoules and therefore fattening, so should be limited. Monounsaturated and polyunsaturated fats are preferred over saturated fats because they do not contribute to heart disease. Total dietary fat consumption should be less than thirty percent of kilojoule intake, with saturated fats equalling less than ten percent.

Monounsaturated fats: fish, some margarines, oils such as sunflower and vegetable.

Polyunsaturated fats: some margarines, oils such as peanut, canola and olive, lean meats, avocados, nuts.

Saturated fats: dairy products, such as cheese and milk, non-lean meats, processed meats, most takeaway foods, coconut and palm oils.

FIBRE
Fibre is essential for controlling glucose levels and maintaining a healthy bowel. There are two main types of fibre, soluble and insoluble.

Soluble fibre improves the regulation of blood glucose levels by slowing digestion and food absorption. It increases removal of cholesterol via the bowel, thus aids in lowering blood cholesterol levels. Insoluble fibre keeps the bowel in good working order.

Soluble fibre: oats barley, legumes, some fruit and vegetables, nuts, seeds.

Insoluble fibre: some fruit and vegetables, wholegrain cereals and breads.

PROTEIN
Protein is essential for good health. It is also important for weight management, reducing between meals hunger and increasing metabolic rate for up to three hours. Consume sources low in fat, such as fish, shellfish, legumes, lean meats and tofu.

EXERCISE
Exercise assists in weight management, increases fitness and helps control blood glucose levels. There are two main forms of exercise, aerobic and anaerobic.

Aerobic exercise burns glucose thus lowering blood glucose levels, and improves cardiovascular fitness. Activities include walking, running, cycling, swimming and dancing. Aim to do about 150 minutes of aerobic exercise each week, over four or five sessions.

Anaerobic exercise can help increase muscle mass and reduce body fat. Resistance and strength training exercises, such as weightlifting, are anaerobic. Strength training benefits older people because it helps maintain muscle mass, which declines naturally with age.

Seek medical advice before embarking on a new exercise program, especially if you are overweight and do not exercise regularly. Strength exercises, like weightlifting, require guidance from a qualified professional, especially in the initial stages.

MEDICAL CHECKUPS
Type 2 diabetes often shows no obvious symptoms, so it is important to have regular medical checkups, especially if you have any risk factors. Discuss with your doctor what is best for your individual situation, as well as the latest information on diabetes prevention and control.

CONCLUSION
Type 2 diabetes is avoidable for most people. Many risk factors are controllable through lifestyle changes, mainly diet and exercise. Changing your lifestyle to prevent diabetes is worth the effort when considering the alternative, developing diabetes and its numerous complications.

* Diabetes Type 2 will be referred to as diabetes in the rest of this article.

References Available