India is the world capital of diabetes with almost 8.7% of diabetics in the age group of 20-70 years according to WHO. This rapid increase cannot just be attributed to genetics alone. Our sedentary life styles, eating habits and weight precipitate the onset. Rapid urbanization, a faster pace of life , easy availability of nutrient free, high fat, salt and sugar,foods(HFSS), addiction to the screen which prevents physical activity , are the main reasons for this boom. Obesity alone is a leading factor of early onset and poor outcomes of treatment because it reflects our lifestyles.

Let’s understand the what, and how of this metabolic disorder.

Diabetes is a medical condition wherein the blood glucose or sugar levels are higher than the normal range. When we consume food , the carbohydrates are converted to glucose and transported to the cells . The glucose enters the cells with the help of insulin and in the cells it is utilized to provide energy. Insulin is produced by the beta cells of the pancreas in response to the sugar levels in the blood, when the pancreas produce less insulin, no insulin or when there is adequate insulin but is not utilized by the body- insulin resistance, the condition of diabetes develops.

 

CAUSES of Type 2 diabetes (T2DM)

Non modifiable risk factors: These are beyond our control but knowing them can help us work positively on our life styles to delay or prevent the onset of diabetes.

• Family history. If a close blood relative is a diabetic, your risk of diabetes increases.

• Race / ethnicity: Asians are more prone to diabetes

• Age: the risk of type 2 diabetes increases with age

• Gestational Diabetes: If you have diabetes during pregnancy tour risk increases

Modifiable risk factors: These are the main triggers that you have control over and are the corner stone for prevention and control of diabetes.

• Weight: Obesity/ overweight, high waist to hip ratio, increases your risk of diabetes. Losing 5-10% of weight has a significant effect on prevention and control of blood sugar levels.

• Physical Activity: Lack of activity increases the risk of insulin resistance and obesity, which in turn increase the risk of diabetes. Just a 30 minute brisk walk for 5 days a week can help improve insulin sensitivity , preventing not just diabetes but also related co morbid conditions

• High blood pressure has a detrimental effect on the health of our arteries. Keeping the blood pressure under control will help with better diabetes management and prevention of onset.

• Cholesterol: Low HDL(good cholesterol) and high triglycerides increase the risk of T2DM .

• Smoking increases the risk of a number of health problems especially diabetes.

• Alcohol: over indulgence in alcohol has a detrimental effect on the pancreas , where it leads to inflammation and on the liver which it can damage. Both these organs are crucial for the regulation of blood sugar.

• Lifestyle: Poor food choices, stress, and lack of sleep are very important contributing factors for early onset and management of blood sugar levels. 

 

Prevention 

If you are at risk of becoming a diabetic then work on the modifiable risk factors.

• Screening and early detection: Get regular check-ups for early signs

• Antenatal care: Checking for diabetes is a normal protocol in antenatal care.

• Overweight children and adolescents at onset of puberty should also be screened

• People with pre diabetes should modify their lifestyle including regular check-ups to prevent further deterioration.

• Lose 5%10% of body weight if overweigh 

• Get at least 6 to 8 hour of sleep daily 

• Healthy lifestyle measures including diet and physical activity 

• Stress management 

• Avoidance of alcohol and tobacco

 

Treatment 

The first line of treatment will be decided by your doctor. Once diagnosed you should not hesitate to consult a medical practitioner for proper care to prevent deterioration and complications. Self-medication should be avoided at all cost.

Whether you need medications or your health care provider advices lifestyle changes, one thing is certain that you need to follow a proper diet and life style to control diabetes.

Medical Nutrition Therapy (MNT) :A healthy diet is the corner stone of diabetes management ,with or without medication. What you eat, how much you eat, what time you eat are all important for keeping the blood sugar in control. Following a good eating pattern will help

• Good sugar control

• Will keep your cholesterol and blood pressure under control

• Help you achieve and maintain a healthy weight

• Prevent / delay onset of diabetes related problems

• Keep you energized and productive.

Diabetic diet is not about deleting foods but about enjoying a normal diet with understanding how to indulge occasionally. The key to eating right is understanding food groups and how to plan a healthy meal or snack.

Carbohydrates: They are the main source of energy for our body. They are a structural component of our DNA and RNA.Carbohydrates break down to glucose and hence affect the blood sugar the most. However eating the right quantity and quality is important to keep the sugar levels stable.

CHOOSE:Whole grains like whole wheat, sela or parboiled rice, brown , red rice, millets , barley , oats. 

AVOID: Refined cereals and products made from them. Maida, sooji, potato (in excess), fruit juices, sugars, dry fruits, processed snacks with hidden sugars, aerated drinks and sodas.

Fibre: Is probably one of the most important nutrient for blood sugar control. It is also protective against cholesterol, LDL cholesterol and triglycerides. It adds satiety and delays the digestive process and keeps the gut in top shape. Both soluble and insoluble fibre are a must for diabetes control.

CHOOSE: Soluble fibre: It forms a gel slowing digestion preventing post meal spikes. Apple, banana, oats, peas, avocado , beans are all good sources. Insoluble fibre is not digestible and passes out, it helps by improving insulin sensitivity and prevents constipation. Whole grains, bran, nuts, seeds, and the skins of many fruits and vegetables are sources .  

HOW MUCH: NIN recommends 40g of dietary fibre daily.Whole grains contain appox 1 gm/ 20gm , Barley, Quinoa,  – 3 gm/ 20gm serving, whole dals- 3- 7gms / 30gm serving, Fruits & vegetables- 3-5gm / 100gm serving

PROTEINS: These are essential for maintain the structure of cells, muscle, for maintain the immunity. There are some 20 basic amino acids which make up Proteins out of which 9 amino acids are essential and cannot be produced by our body. These are called Essential Amino acids – EAA. The quality of protein is determined by their presence. 10,000 different proteins make you what you are.

CHOOSE: Healthy protein packages. Egg, chicken breast, salmon and fishes are good sources of proteins as they contain all EAA, making them sources of complete proteins. Milk and dairy is also a complete protein, choose skimmed milk for health. Plant proteins are healthier as they are cholesterol free, contain healthy fats, fibre, phytonutrients. Nuts and seeds, rajmah, whole dals, Soy, are good sources of plant proteins. 

AVOID: Organ meats, excessive intake of red meats.

HOW MUCH: 15- 20% OF TOTAL CALORIES. Amaranth – 3gm/ 25gm, Bajra 2gm/ 25gm, quinoa – gm/ 25gm, Dals are appox 7gm / 30gm, almonds 6g/ 30gm, Walnut- 5g/ 30gm, Paneer 6gm/ 30gm, Egg- 8gm/ pc, Chicken breast- 21g/ 100gm, salmon 20gm/ 100gm.

FAT: Fats are an essential macro nutrient that are needed forsatiety, taste, palatability of diet, provide essential fatty acids, biosynthesis of membrane lipids & lipid mediators, modulates lipoprotein metabolism, and facilitates transport of fat soluble vitamins

CHOOSE: Unsaturated fats- Liquid at room temperature; found in plant products such as vegetable oils.  Monounsaturated fatty acids -  Foods rich in MUFAs include mustard oil, peanuts and most nuts like almonds, walnuts. Polyunsaturated Fats- Foods high in PUFAs are vegetable oils -safflower, corn, sunflower oil etc. Omega 3 fatty acids- Good sources include fatty cold water fish such as salmon, mackerel, herring, flaxseeds, flax oils and walnuts .All of these protect against heart diseases and support preventing the promotion of health issues in diabetics.

Mix oils:, choose Peanut with mustard oil , rice bran with Cannola, sunflower + mustard or cannola oils.

AVOID: The intake of fats that are found to increase risk of heart diseases by increasing the total and bad cholesterol. Saturated fats- Found in animal foods like meat, butter and whole milk. Other foods include coconut oil, desi ghee and palm oil. Trans fat- In vanaspati ghee and in commercial baked goods such as biscuits, cakes, patties, fans and in reheated oil fried foods such as samosa, kachori, pakora etc.

HOW MUCH: Less than 25 % of total calories. ½ kg / person/ month is a good thumb rule to follow. 

FRUITS & VEGETABLES : They add fibre, vitamins minerals, antioxidants to our meals. They are crucial for our health. Vegetables a low calorie dense and help in filling up with out adding to many calories, which is good for diabetes control and weight control. Fruits make for a good snack choice and help satiate the sweet cravings.

CHOOSE: Seasonal , locally grown produce for maximum health benefits. Green leafy vegetables must be consumed often. Choose colours to get a lot of phytonutrients that protect us. 

Red Fruits and Vegetables: Lycopene, ellagic acid, Quercetin, and Hesperidin. 

Orange and Yellow Fruit and Vegetables: Beta-carotene, zeaxanthin, flavonoids, lycopene, potassium, and vitamin C.

Nutrients in Green Vegetables and Fruit: Chlorophyll, fiber, lutein, zeaxanthin, calcium, folate, vitamin C, iron, calcium, and Beta-carotene.  

Blue and Purple Fruits and Vegetables: Lutein, zeaxanthin, resveratrol, vitamin C, fiber, flavonoids, ellagic acid, and quercetin.

White fruits and Vegetables: Beta-glucans, EGCG, SDG, and lignans that provide powerful immune boosting activity. 

HOW MUCH: Non starchy vegetables can be had in any quantity. 2 -3 fruits/ day are adequate.

 

Putting it together:

 Eat three major meals and two snacks daily

 Stick to the same meal timings.

 Major meals must include a Carb+protein+ vegetable+ dairy

 Fill up ½ your plate with vegetables, both cooked and salad, 1/4th for whole grain , 1/4th for protein, add a serving of dairy.

 Choose fish at least 3 times a week

 Choose and ounce of nut and seed mix  3-4 times a week

 Keep the added salt low and avoid table salt.

 Eat at the dining table in a relaxed atmosphere, do not lie down after eating.

 10-15 minutes of walk post meals helps control blood sugars.

 

Diabetes can be prevented and controlled but it needs discipline and daily investments. Our traditional grains, food combinations , spices are all very supportive of overall health and diabetes control. A diabetic needs to have healthy balanced meals, which means the whole family can eat together and benefit, you do not need to cook a separate meal. Eat healthy and exercise daily.