Diabetes: A Not So Sweet Scenario!
Diabetes: yes, you have probably heard about it before – whether that be on the news, at your doctor’s clinic or maybe you or someone you know has it. Becoming one of the world’s most prevalent chronic health conditions, diabetes has been labelled as the epidemic of the 21st century.
But what is diabetes? Can it effect you? How does it impact the lives of everyday Australians? What about our elderly populations? With prevalence at an all-time high, the time to act is now - here is all you need to know about the disease and how it can affect you, your family, friends and the people you care for.
What is diabetes?
Diabetes mellitus (diabetes more commonly known) is a chronic (long term) health condition associated with the endocrine system. Diabetes is characterised by unstable or high blood glucose levels (glucose is a type of sugar which our bodies use for energy). The endocrine system is a collection of glands that make hormones which control growth, mood, metabolism and organ function. In diabetes, the pancreas (gland that sits behind the stomach) does not produce the hormone insulin effectively, which is needed to convert sugar into energy. As a result, the sugar in our body remains in the bloodstream which leads to high blood glucose levels.
There are different types of diabetes that can impact men, women and children of any age, including:
Type 1 diabetes
Type 2 diabetes
An auto-immune condition in which the body’s own immune system has attacked and destroyed the cells in the pancreas that produce insulin. As a result, no insulin is released and sugar remains in the blood stream which cannot be used for energy. This type of diabetes is commonly diagnosed in childhood.
This form of diabetes accounts for approximately 85% of all diabetes cases in Australia. It usually occurs in adults; however, more and more children, adolescents and young adults are developing it sooner due to poor diet and lifestyle choices. In type 2 diabetes, the pancreas does not produce enough insulin OR the body develops a resistance to the effect of insulin.
Diagnosed for the first time in pregnancy and increasing the chances of developing type 2 diabetes later in life, gestational diabetes usually occurs at 24-28 weeks gestation. During pregnancy, the placenta produces hormones which can impair the action of insulin, leading to increased blood sugar levels.
It is estimated that 1 in 20 Australians have diabetes (not including gestational); however, it is projected that an additional 500,000 are living with the condition undiagnosed. Quickly becoming a silent killer, diabetes does not discriminate based on age or gender and can impact people of all races and indigenous groups and residents of both inner and outer regional cities.
With that in mind, let us look at tips for nutritional management and the impact on the elderly.
What About Nutrition?
Diabetes and diet go hand in hand and food choices are both a help and a hindrance to diabetes management. The dietary factor of diabetes management is vital – in some cases, dietary modification is all you will need to manage your diabetes and prevent progression to medication or insulin. It is important to note that when it comes to dietary management of diabetes, there is no standardised approach for everyone, and it is highly recommended that you seek out advice and directives from an Accredited Practicing Dietitian (APD) and/or diabetes nurse educator for a tailored dietary plan that best suits you and your condition.
In saying that, making good dietary and lifestyle choices is a standardised recommendation for all, with many governing health institutions pushing for greater intakes of fresh food (fruit, vegetables and wholegrains) and cutting back on discretionary foods (e.g. packaged/ processed foods, salty snacks and sweetened beverages).
Here are some helpful tips and tricks to better manage your dietary choices and improve your diabetes management.
1. Eat For Health!
The Australian Dietary Guidelines are evidence-based recommendations which are derived to improve health and well-being. The Australian Guide to Healthy Eating (AGHE) is a fantastic starting point for anyone who wishes to improve their dietary choices. The guide focuses on enjoying a wide variety of fresh foods from the 5 core food groups, encourages the use of small amounts of healthy fats (unsaturated fats and oils including olive oil, nuts, avocado, seeds and seed oils etc.), restricting discretionary foods to an occasional basis (e.g. chips, chocolates, alcohol, takeaway and fast food) and promoting water intake.
The 5 food groups include:
Vegetables and legumes/beans
Milk, yoghurt, cheese and /or alternatives
Lean meats and/or alternatives
2. Be wary of carbohydrates
Carbohydrates are one of the 3 main types of nutrients we get from food and the most important in diabetes management. Carbohydrates are sugars, naturally found in many of our foods including fruits, starchy vegetables, milk, grains, legumes, sugar and anything sweetened with sugar (e.g. lollies, sugary beverages, chocolate, jam etc.). When we eat a food containing carbohydrate, the body breaks this down into glucose and uses insulin to convert this into energy and therefore, it is important to have regular amounts of carbohydrate to maintain energy levels and stabilise blood glucose levels.
All carbohydrate foods are digested to produce glucose; however, they do so at different rates – some slow, some fast. The glycaemic index (GI) is a tool to illustrate how quickly a carbohydrate food is digested and enters the blood stream.
Low GI carbohydrate foods are broken down and absorbed slowly and have a gradual impact on blood glucose levels. High-GI foods are rapidly broken down and absorbed by the body and will result in high peaks in blood glucose levels followed by steep crashes. These peaks and falls indicate unstable blood glucose control and result in poorer management of your diabetes.
Overall, carbohydrates do not have to be avoided on a diabetes diet, however, be wary of the type of carbohydrate you are eating. The best combination is to eat moderate amounts of high-fibre low-GI carbohydrates, focusing on at least 1 low-GI carbohydrate option at each main meal.
Rolled oats Muesli Multigrain Bread Traditional Sourdough Pasta Hokkien Noodles Fresh Rice Noodles Basmati Rice Quinoa
Instant oats Cornflakes Rice Bubbles White/wholemeal bread Crumpets Instant noodles Dried rice noodles Jasmine/white rice Brown rice
Corn Sweet potato (orange) Carisma potato Lentils
Legumes (e.g. chickpeas, kidney beans)
Sweet potato (purple)
Most fresh fruit
Melon (eg. watermelon, rockmelon)
Milk (cow and soy)
For more information on glycaemic index and for simple low-GI swaps, visit https://www.gisymbol.com/swap-it/
3. Regular mealtimes
Eating regular meals and snacks is important for diabetes management, particularly for those on insulin or medications as hypoglycaemia (low blood sugar) can occur. Spreading meals across the day and enjoying a variety of foods from the 5 food groups at each meal is a great starting point. Ensure ½ your plate is filled with vegetables (e.g. cooked or salad), ¼ of your plate contains a lean protein (e.g. grilled chicken or fish) and ¼ filled with a wholegrain/starch (preferably lower-GI such as pasta, corn, wholegrain breads, basmati/brown rice, muesli or sweet potato).
If you are on an insulin regime, mid meal snacks containing carbohydrate may be required – speak with your dietitian or diabetes nurse educator to see if this is the right fit for you. Options for healthy, low-GI and protein packed snacks include:
Fresh fruit & yoghurt
1x slice of fruit toast OR multigrain toast with peanut butter
Smoothie made with 1 cup (250mL) milk, yoghurt and fruit
Air popped, plain popcorn (approx. 1 cup) with a small handful (30g) mixed nuts
Vita-weat crackers topped with ricotta/cottage cheese, tomato and cucumber
Vegetable sticks (e.g. carrot, cucumber, capsicum) with hummus or tzatziki dip
Milk & milo
Diabetes and the Elderly?
As we age, maintaining good nutrition can become difficult. Ageing can affect what you eat and how your body works—for example, you may have a smaller appetite, need less energy or be managing other health conditions. In aged care, best practice guidelines recommend a “normal diet” for residents with diabetes – meaning there is no special diet or restrictions in place. Why? For residents with diabetes, it is vital to avoid the impacts of low blood glucose, however using dietary strategies to avoid high blood glucose can impact adequate nutrition and hydration. Poor oral intake from suppressed appetite, reduced thirst, medical, cognitive and physical impairments (e.g., may require assistance with eating and drinking or texture modified diets/fluids) can quickly lead to malnutrition and/or dehydration, resulting in reduced mobility and function, increased risk of illness, falls and infection, delayed wound healing and poor quality of life.
Our OSCAR Care Group Accredited Practising Dietitians work closely with aged care homes and their residents to provide individual assessments and tailor a nutrition care plan to best suit their needs, with the focus of diabetes management to avoid dietary restriction and tight control practices due to the higher risk of malnutrition.
Our goal: making every mouthful of food as nutritious as possible to get the essential nutrients our residents need to stay healthy and happy.
Lauren Goffredo, Accredited Practising Dietitian for OSCAR Care Group