Diabetes

mistah,

You obviously have a healthy lifestyle from the point of view of exercise and at 13 stone at 6' you aren't overweight (same height and weight as me ) but it's important to take the advise of your nurse. The most important factor is your diet and knowing what and what not to eat. The link that Bruce gave will give the best advise. It's sometimes surprising which foods are OK and which aren't. For example, grapes are extremely high in sugar and should be avoided and DrMark mentioned corn syrup above which is still prevalent in a lot of processed foods in this country. If you're in doubt ask your diabetic nurse or GP to put you in touch with a dietician.

The most important thing though is not to ignore it. I don't often agree with Mick but sometimes a good kick up the rear can be a good thing.

Good luck

Steve

Anyone diabetic should have access to a specialist dietician for advice, definitely ask for a referralif you want to go. Often worth bringing along the chief cook/shopper of the house if that is not you. If it is not in the cupboard it will not get eaten.....

bruce

Hello Steve

Perhaps you could clarify something for me and other Diabetics. Please correct me if i am wrong but i always thought fruit was good for us and that  the sugar in fruit was OK. I thought its refined sugar which is the one to avoid. Hope you can enlighten us all regarding eating fruit,as grapes and also Bannanas is something we always have in the house.

Thanks

mista h

No - sugar is sugar.  Did they give you your Hemoglobin A1C reading?  That is a very important reading to know.

You can buy fruit sugar and it is naturally sweeter, so you use less of it.

Excellent on cereal!!

Jason (Type 1 for 28ish years)

Refined sugars (as opposed to starches) are hard for a diabetic to handle, they cause a rapid spike of sugar that a normal person can physiologically 'smooth' out. However not only refined sugars do this but some natural sugars-essentially foods with a high glycaemic index are rapidly absorbed or metabolised to sugar. GI is often written on packaging now.

There is no such things as a 'diabetic diet' specifically, the diet you should have is a healthy one with appropriate balance of all foods-indeed the diet we should all eat. That means low fat, high fibre, low salt, lots of grains and pulses and oily fish and (crucially) the appropriate calories for your energy output etc.

Fruit and veg are 'healthy' but they also contain calories, they should be considered amongst your overall energy balance. Watch for fruit juice drinks, many are sweetened but some pure fruits also naturally high in fruit sugars such as apple, grape and mango. Bananas contain more long-chain sugars-less of an instant energy spike but they are quite calorific so need to be consumed in moderation.

Get a dietician's advice, or check out the numerous good resources online such as the link I posted.

Bruce

Bruce has very elegantly given the answer above. You just have to be aware of what you can eat without worrying and which foods you have to be careful with. A chat with a dietition will put your mind at rest.

Steve

Mista H

Whatever you do, please make sure you take care of yourself. As I'm sure Jason can attest, being a diabetic means you have to be careful, but it doesn't mean the end of an enjoyable life.

My poor old Dad developed Type 2 quite late on, but failed to follow his doctor's advice and created enormous problems for himself in the last four years of his life, on top of everything else that went wrong.  I also had a Type 1 aunt who failed to look after herself and lost her right leg below the knee and her left foot, and her quality of life in her last decade was not good.

As someone else said, regular contact with a qualified dietician and your doctor are important.

Quite!  Living with diabetes isn't complicated once you understand the issues.  I am Type 2, and my advice is simple:

A sensible diet, low in carbohydrate and low GI Carbs where possible;

Take your medication;

Go for a walk (I walk to work)

Get a blood glucose meter and eat to your meter readings, following the NICE guidelines;

No cakes

No biscuits

No bread

Limit your spuds.

As a result, I've lost weight, the peripheral neuropathy symptoms have disappeared and my skin is in better condition.

Just be sensible, and you'll live to a ripe old age!

Dave

Well you won your first game in a while so hopefully things are looking up for you, and Berbatov looks like he's just getting going. Sadly I'm travelling back to the Smoke from North Yorks so I'll miss our game (featuring the debut of our new old boy Joey Cole) but hoping I can catch it on the radio. Hopefully we'll mash the Mancs 4 - 0 like we did in the Cup back in 2010.

Maybe we'll get a repeat of the '75 Cup Final?

Just to add to Dave's good advice:

Pasta, bread, corn, potato are all not good choices.  In fact, eating potato is the next thing to eating a mouthful of sugar, because that's what your body turns it into in a very short amount of time.  Limit these foods as far as is possible.  Also, and I hate to say this, because you alluded to it earlier, fruit juice is but a hair breadth's better than soda...loads of sugar.  As Dave mentioned, you want low glycemic index carbs when you eat carbs.

Take daily blood sugar readings; fasting you should be below 110 or so, and after eating you shouldn't get much over 180.  And you don't want to be below 70 either.  You can get a meter for free...it's the bloody test strips where they break it off inside you.  Maybe in the UK it's different.

Also, find out your hemoglobin A1c reading; this gives you a picture of your blood sugar over time; over the past 3 months, with the last month weighted at about 50%.  Sugar attaches to the hemoglobin on your red blood cells, and is a very "sharp" molecule.  (Think of each sugar molecule as a little tiny steel wool pad attached to the blood cell.) 

When the blood cells are in the larger arteries and veins, not much problem.  But as they get further into the peripheral vasculature, and the vessel diameter is so small that the red blood cells have to "squeeze" through "single file"; then the steel wool rubs on the lining of the blood vessel and destroys these cells in the vessel, and damages the vessel so it is no longer patent.  This disrupts the blood supply (and of course nutrient supply) to the body functional ("parenchymal") cells in that area that need it (which are supplied by the now damaged blood vessel.) 

That is why body parts (e.g., toes, eyes, kidneys) are affected because the functional cells are being starved and suffocated. (In essence.)  High blood sugar means lots of steel wool pads attached to the blood cells, as opposed to normal BS where there are not so many.

You want your A1c to be below 6.5, better even to get it below 6.0 if you can.  I have seen them at over 13 with one guy (who was a relatively young (early 40's), decently in shape, African American) whose A1c was over 13, and he ended up in the hospital at the insistence of his wife because he was "acting strangely" - his blood glucose was over 900.

Another one that really ticked me off was on one of my hospital rotations; I show up in a guy's room to review his medications.  The nurse is in the room giving him his insulin injection.  It was lunch time.  What was he having for lunch?  (Supplied by the hospital, mind you.)  Macaroni & cheese, and mashed potatoes.  No nutritive value, and feeding into the worst aspects of his condition.  I didn't know whether to b*tch-slap him, or the hospital dietary staff.

There are lots of web sites that can give you info on which carbs are not so bad, and which ones are evil.  Here's one from the University of Sydney:

http://www.glycemicindex.com/

You already seem to have the exercise thing in tow.  Take control of it, before it takes control of you. End of life as a raging diabetic sucks; I've seen it in person.  We all have to die some day, but QOL up to that time can be maximized.

The bad money is on the "I'll just take medication and I can eat whatever I want."  That's a fool's play, and one I see WAY too often; probably 75% of the time.  In fact, the pharmacist with whom I most recently worked is a 68 year old type-II diabetic, and despite knowing better, will eat an entire bag of candy in a day, while quaffing regular Cokes.  I don't know why he doesn't just shoot himself; same end game and the latter is quicker and less painful than the former.

Rant/50 pence worth of free advice over - soap box now available.

Yep went to that game,in the days when i was younger and better looking.

Mista h

Mista

Be aware that European scales are different for measuring blood sugar and Hba1c than those shown above for the USA.

We measure blood sugar in mmol/l and normal levels would vary between 3-7 approx (in the fasted state). Hba1c is now measured in different units too, most UK labs use scales where 25-45 is normal, levels below 50 generally indicating decent control. Hba1c is a clever way of assessing average sugar levels over the previous 3 months.

Home blood sugar testing is a bit complicated, wether it is useful to you depends on how you are able to interpret the tests and modify factors accordingly. It is generally most useful for patients with medication, especially ones that can be tweaked to respond to daily variation (such as insulin). Blood sugar testing is not recommneded for all and is unnecessary for many. Incidentally testing strips are free in the NHS, and if you are a diabetic on medication so are all your prescriptions.

I would reiterate that personal treatment choices and management plans are precisely that-personal. They are therefore based on your individual case and are best discussed with your doctors and diabetes nurse rather than from well-meaning web contributors! I would suggest if you are getting more involved with your diabetes care asking them for an Hba1c to be repeated at a minimum of 3 months to indicate if things are improving is very reasonable. Bear in mind also that the risk factors for future complications include cholesterol and blood pressure. Both are often elevated in diabetic patients. Optimising those is actually of greater importance than perfect sugar control in long term studies. Ensure they are at the correct levels, and if not they may well need medication (diet has a modest effect on cholesterol only, and even less on BP). Don't just manage your sugar-manage your overall risk profile.

Make sure you also get a thorough regular assessment of the areas potentially damaged by diabetes too, this mean regular checks of your eyes (usually with retinal photographs), circulation and sensation in your feet and also kidney function. I'd expect these to form part of your annual assessment.

Hope this is helpful.

Bruce

Hello Bruce

My blood count last week was 14.....not good. But i am a strong willed person and i have already cut back big time,pudds/sweets/biscuits/chocolate are all out and my diet has already changed and i know i have the wilpower to stick to a better diet. my nurse has already given me the form for another blood test in 3 months time. I am due back in the Marsden for another op in a few weeks and they will almost certainly want blood tests. I also have my eyes checked every year at my local hospital.....they are fine.

Thanks for the link to the Diabetes website which i am going thru. Its good to have so many Docs using this forum,i dont think i will ever need to go to my GP ever again.

Mista h

Mista

Sounds good. However the advice of staff who know you and know your case is far better than my (or indeed other docs) giving broad-brush tips on a Forum like this.

Bruce

I must confess to not being the best a my diet. After looking at the no-nos mentioned in these posts, what is actually left to eat?

Is it just salad and pasta? 

Hi Bruce,

You made a very simple statement regarding diet:

If you dont buy it and put it in the cupboard YOU CANT EAT IT.

Amamzing how many people with Diabetes do not follow this simple advice.

As an NHS Specialist Podiatrist running the Diabetic/Wound Care Clinic in my local Community Hospital for several years i was always amazed at what it was that made the Pt change their lifestyle. A pain in the butt ulcer on the foot that required regular dressings anti biotics etc etc and then the eventual visit to the Vascular Surgeon for bits to be chopped off. or was it the loss of sight in one eye and loss of driving licence. The old man no longer responding to her indoors. or the fact you live in the boys room making yourself comfortable every 30 minutes or so. The habitual tiredness. The regular mild confusion.

Then the real tragedy when the writing is on the wall and they ask What Can i Do Now?  Erm should have asked the question 10 years ago.

The pre 2nd world war generation had rationing. Today the kids seem to eat from morning till night and drink so much fizzy pop i am surprised they do not pop. So i wonder what will be the reality in 30 years time as the current 15 year olds get to middle age

Bankruptcy of the NHS is forecast to result just from Obesity.

Sadly people, which is you and me , do not seem to take responsibility for their general well being today. They believe that regardless of what happens they can be fixed.

David

Salad fine...pasta, not so much.  (Again, none of this means you can never eat it, but the frequency & portion need to be monitored.)

You can eat all sorts of lean meat (non-processed) & fish, vegetables (corn is NOT a vegetable), higher fiber (or should I say, fibre) foods, and check the website link I gave from the University of Sydney for the low GI carbohydrates.  It takes a little more imagination and effort, but it is not a sentence to eating cardboard and styrofoam.

And nothing I wrote was intended to replace working with your physician/nurse.  But rather to give some dietary basics (since eating the wrong stuff is largely the genesis of the condition) and a physiological analogy that we used on my diabetes educator rotation.

And apologies for using USA measures.

No exactly Mark I'm not here for a diagnosis , but it is always useful to get another point of view.

It is about balance and moderation  not long lists of things that you must or must not have. Choose healthier options, and enjoy unhealthier ones less often. Balance food with regular exercise; the ingle biggest step anyone can take to preserve not just years, but quality of life in later age.

Bruce

Thanks to all of the healthcare professionals whom have contributed their wisdom on this thread.

Having moved from the UK to Canada in the late 90's, I was shocked to see how there were no healthy choices in the fast food world.  Then realised how engrained 'big food' is in the culture here.

Also, Corn Syrup, it's in everything !!  I used to love a glass of Ginger Ale years ago, but now it just tastes like syrup (yuk).

After a high BP alert a few weeks ago, I have been refered to a Nutritionist, I'm taking the wife who has a Gluten free diet, but is nevertheless a 'carb-lover'.

I'm gonna try harder to eat better, it's a shame that our culture is working against us.  And don't get me started about our massively increased Gluten intake.