Diabetes Health Advice

Type 1 Diabetes

What causes type 1 diabetes?

Type 1 diabetes is an auto-immune condition in which the bodies immune system is triggered to attack and destroy the cells in the pancreas that produce insulin. To this day, there has been no further information as to why this occurs. It cannot be linked to any modifiable health factors (diet, exercise etc.) and unfortunately has no cure. Once a diagnosis has been made, management and medication becomes the only way to control this condition.

Going back to our example and relating it to type 1 diabetes

We have people (glucose) waiting to cross the road. The sensor (brain) detects that there are quite a few people waiting to get across. It sends a signal (insulin) for the light to turn green to allow these people to cross, however, the system put in place to stop the lights failing (immune system) has detected an issue in the signal function (insulin) and completely destroyed it. The light will unfortunately never turn green, without help from some outside source.

Signs and Symptoms

As mentioned above, symptoms can come about abruptly and for some, no symptoms will be present when a diagnosis is made. You’ll find the signs and symptoms of type 1, type 2 and gestational diabetes fairly similar, and this is because they all affect the same process in the body, but in different ways.

• Being excessively thirsty
• Passing more urine
• Feeling tired and lethargic
• Always feeling hungry
• Having cuts that heal slowly
• Itching, skin infections
• Blurred vision
• Unexplained weight loss
• Mood swings
• Headaches
• Feeling dizzy
• Leg cramps

Type 2 Diabetes

What causes type 2 diabetes?

Type 2 Diabetes is a progressive condition and can occur two ways.

Insulin Deficiency

It occurs when the cells of the pancreas can still make insulin, but cannot produce enough to get enough glucose to crossover into the cells. Eventually, the pancreas can stop making insulin altogether.

Remember our crossing the road example?
So, imagine that over time, as most things do, the signal response (insulin) starts to become weaker and weaker. For years the sensor (brain) has been sending this signal (insulin) to the light (cell responding to insulin)telling the light to go from red to green (insulin) and now the signal from the sensor to the light is not as strong as it once was. Sometimes the light won’t turn green until enough signals are sent to make it change, causing lots and lots and lots of people (glucose) to be standing on the side of the road, waiting to cross. Eventually, without maintenance, the light cannot detect any signal at all, meaning the red light cannot change to green without some help. This causes a lot of people to be waiting, and they really want to get across.

Insulin Resistance

This occurs when the cells ignore the signal sent out by insulin to transport glucose from the blood into the cell to be used as energy. You are more at risk of insulin resistance if you are overweight, smoke or have poor sleep patterns and habits.

Back to the example!

So we have people (glucose) waiting to cross the road. The sensor (brain) detects this and sends a signal to the light to turn green. The light understands that it needs to turn green and tries it’s hardest, but some reason, the light doesn’t want to turn red. The sensor keeps sensing more and more signals (insulin).

Signs and Symptoms

Many people with type 2 diabetes won’t have symptoms. As type 2 diabetes is often diagnosed later in life, symptoms are misinterpreted as “a normal part of ageing”. That is why it is so important to get tested regularly, even if you think you are in good health. Once you hit 45 years of age, it is important to have a blood test every 2 years to check.

• Excessive thirst
• Increased frequency of urination
• Lethargy
• Cuts and wounds that heal slowly
• Blurred vision
• Mood swings
• Dizziness
• Previous gestational diabetes

Gestational Diabetes

Gestational diabetes is a type of diabetes that occurs during pregnancy. It is important to know that in most cases, gestational diabetes goes away after the baby is born. However, it does increase the risk of developing type 2 diabetes later in life.

What causes gestational diabetes?

During pregnancy, the placenta produces hormones to help the baby develop and grow. These hormones block the action of the mothers’ insulin causing insulin resistance. As the pregnancy progresses and the baby grows bigger, the mother has to produce more insulin to regulate the amount of sugar in her blood stream.

It’s been shown that later on in the pregnancy, the amount of insulin required to keep blood glucose at a normal level is 2-3 times higher than usual. Now that’s a lot of insulin to be producing! And if the mother isn’t able to produce enough, then the amount of glucose (sugar) in the blood stream will increase, leading to the diagnosis.

Signs and Symptoms

It is common not to have symptoms. If symptoms do occur, it may include

• Excessive thirst
• Increased frequency of urination
• Thrush
• Tiredness

Type 1 Diabetes Mellitus

For those diagnosed with Type 1 Diabetes, it is usually straight onto talking about insulin. As those with Type 1 Diabetes can’t produce their own, they need to inject, or have an insulin pump inserted, to manage their glucose levels. Not having the appropriate amount of insulin in the body can have very large health complications, and these can occur very quickly.

There are a few types of insulin (which I will talk about later in this section), that are administered one of two ways.

Injections

Injecting insulin can be administered into the;

• Abdomen
• The top and outer part of the thigh [10cm from the fold in the hip and 10cm from the knee]
• Into the fatty part at the back of your arm
• Your buttock

This needs to be done multiple times throughout the day (usually before or after a meal). It is quite important to monitor your BGL’s when using insulin, as the amount of insulin injected can have large effects on your BGL’s.

People living with Type 1 Diabetes may also be eligible to have an insulin pump inserted (ask your GP, as this is not the case for everyone). The insulin pump is a small, battery operated device, approximately the size of a small phone. It is worn on the outside of the body 24hrs/day, and connects into a tube that has a fine needle attached to it. This needle sits just underneath the skin, and can stay there for 2-3 days before being replaced. The insulin pump holds a small amount of insulin that is programmed to pump into the body after a meal is ingested. This mirrors the function of the pancreas, and then throughout the day, slowly releases a small amount of insulin steadily into the body. It is important to know that a pump is just another way of getting insulin into the body, and provides a bit more freedom than having to inject throughout the day.

A person living with Type 1 Diabetes will have to use insulin for the rest of their life, and so a clear management plan is needed with regular updates with health professionals. This is true for both types of management.

Type 2 Diabetes Mellitus

For those diagnosed with Type 2 Diabetes, the management plan will differ greatly from person to person. The results from your blood tests will determine quite a bit of your management plan.

One certainty for management however, no matter the stage of Type 2 Diabetes, is a diet and exercise plan.

Pre-Diabetes

You’ve had a blood test, and the GP says you have “pre-diabetes” This is just a term used for those who test results aren’t high enough for a diagnosis of Type 2 Diabetes to take place, but high enough that they are no longer in the “normal” range.

What does this mean for me?

Simple, you need to change something in your life. Your Dr will usually give you 3-6 months of trying to reduce the levels of your blood test before seeking further help. They may send you to a dietician or an exercise physiologist to talk about what you are eating, or your physical activity levels. Changing one of these factors may be enough to get your levels down so you are no longer pre-diabetic. But know that a diagnosis of “pre-diabetes” is the pre-cursor for Type 2 Diabetes. Any change you make to your lifestyle and health must stay in place. Eating healthy and exercising for 3-6 months to get the levels down, then reverting back to old ways, will only prolong what may be coming.

I like to view a diagnosis of pre-diabetes similarly to “Who Wants to be a Millionaire”. This is your phone a friend lifeline. You have an idea that you should do something about your health, and the GP has now given you the reason to start. You can do one of two things. Listen to your lifeline, or stay the course. Staying the course means a possibility that you will have Type 2 Diabetes within a year, whereas listening to your lifeline could mean you don’t have a diagnosis at all.

The choice is clear, listen to your lifeline and win the million dollars.

Diagnosis of Type 2 Diabetes

Some people don’t get the opportunity to change before a diagnosis is made. Unfortunately, this is the case for a lot of Type 2 Diabetics, as the estimate is that 30% of people with Type 2 Diabetes don’t even know they have it yet.

So the question still remains, what can I do?

Diet

Most people already know what things they might need to start cutting back on or changing in their diet’s to improve it. The real test is gaining to motivation to do this over a long period of time. One quote that I tend to stick with is this;

‘One healthy meal won’t make you skinny, just like one unhealthy meal won’t make you fat.’

Consistency is the key, and the easiest place to start is by reducing the sizes of your meals, or changing a few ‘unhealthy’ food choices a week into ‘healthier’ food choices.

There are barriers that can make changing your eating habits quite tough to do. A dietician can talk to you about what these are, and give you more ideas on how to get around them. However the best piece of advice is this;

Keep it simple.

If you are looking to change your food choices, start small, then get bigger. Cut out the things you know you won’t miss that much, and replace them with healthier, but safe options. If you know you like carrots, but hate cucumber, then have carrot in your sandwich but not cucumber! Start with enjoyable, healthier options, and the rest will follow.

Exercise

Exercise is the most inexpensive, easily accessible option for improving your lifestyle that there is. It costs you nothing to get outside and go for a walk, or even jog if you are able. Putting some household items into a non-perishable shopping bag instantly transforms into a weight you can lift for different types of exercise. Fill some old 2L milk bottles up with dirt from your garden, and you have 2 x 4kg weights.

Exercise has an insulin type effect on your body. Exercise can make your cells more permeable, meaning it is easier for glucose to pass from the blood stream into the cell in order to be used as energy. This actively lowers your BGL’s, and can keep them lower, even after finishing exercising.

Now in the following section, “The best type of exercise to complete for your diabetes”, I will explain more to do with what type of exercise to complete for diabetes. But, it is important to just get started. Below are some simple tips to get you going;

• If you sit for 8 hours of the day, try to only sit for 6 hours.
• If you can’t change what you do at work then actively get out of the house when you get home.
• Go for a walk, potter around in the garden, go play with the dog outside if you don’t want to walk them.
• Just being on your feet makes your body have to work harder, increasing metabolism and promoting weight loss.
• Lots of short walks add up to big walks.
• Moving arms and legs helps to promote increased metabolism.
• Everyone can have a few aches and pains. If pain is stopping you from exercising, see an Exercise Physiologist who can tailor a program to suit your needs.

Let’s get started together.

Medication

There are medications that your GP may start you on to help manage your diabetes. I am no pharmacist or chemist, so find below a table summary sheet of some types of diabetes medication you may be on.

If you want more information on what these do specifically, ask your GP, diabetes educator or pharmacist.

Insulin Medication

For those that need to start taking insulin, you are required to talk with a diabetes educator to discuss how to administer, the levels and types of insulin you need to administer, and other things, such as storage and times to take this.

There are essentially two types of insulin, short-acting and long-acting. Usually a combination of these two types of insulin are needed for diabetes management. It is essential that you talk with your health professional to discuss this further.

Cardiovascular Training (walking, jogging, cycling, swimming, rowing, dancing etc.)

Cardiovascular training is a type of exercise that encourages people to complete an open ended, continuous movement. This movement requires a lot of oxygen to continually complete, and so it affects and changes the cardiovascular system (heart and lungs), more so than other systems in the body (muscular system). Completing this type of exercise will improve your bodies ability to utilise oxygen within the body, improve the amount of blood you can pump around your body with a single pump, and over the course of a minute (also called ‘stroke volume’).

Cardiovascular training is important for people living with diabetes to complete, as the research shows that those with diabetes have a four times greater risk of suffering from a cardiovascular event such as heart attack or stroke. By improving the fitness (efficiency) of your heart and lungs, you will also decrease your risk of having a cardiovascular event.

Now some people might not be able to complete a 30 min walk due to breathlessness or pain. But breaking this up into 10 mins walks is quite acceptable to do. Try to remember though that any improvement from what you are currently doing will have an impact.

For example, if you are walking the dog 1 x per week for 20 mins, then by increasing this to 3 x per week for 20 mins it will have a significant affect on your health. What is important to account for though, is that the body adapts to exercise very well, and after a few weeks, you may need to increase this walk to 3 x 30 mins walks to see anymore change.

Now with cardiovascular training, the best thing you can do is something that you will enjoy, because you’re more likely to do it. All of the above types of cardiovascular exercise are good for you, but if you don’t enjoy swimming, guess what, you don’t have to swim! Even getting out into the garden can be a cardioavscular exercise. So if you are feeling a bit stuck, find a type of activity that you enoy (golf, fishing, sailing, cycling etc.) and try to do that as much as possible. When you start feeling fitter. Then you can start increasing or changing what other types of activity you complete.

The benefits of cardiovascular exercise on health are well documented. Getting started is the hard part! So set yourself a realistic plan throughout the week. Write down a schedule that is realistic, and stick to it. The feeling of accomplishment is almost as good as the health benefits you’ll receive.

Resistance Training

It can be a scary sounding type of exercise, but really, resistance training refers to any type of movement or activity that is completed with an external load. Did you just shovel a whole pile of dirt into the wheelbarrow and shift it 20m? That is a form of resistance training. What is important to know with resistance training is the type of exercises you should be completing, how much exercise you should be doing and why you are doing this specifically.

Type of Resistance Training

If you haven’t completed any resistance training before, it’s good to start off with completing large muscle group exercises. Your legs have got some of the biggest muscle groups in our body, so it is important to complete exercises such as squats, lunges, sit to stands, calf raises and functional lifting. Other large muscle groups to work include the chest and back.

The reason it is so important to strengthen these muscles is because the more muscle mass and muscle density you have, it has been shown that the greater BGL control you can have.

Now if we turn back to earlier in the blog where we talk about the process of glucose entering the cells, it is important to also know that excess glucose becomes stored in liver and in the muscles. Now, storing glucose in the muscle is beneficial, as you don’t have to use the blood to transport the glucose to those working muscles. It is already there, waiting to be used. This means that once the storage of glucose in the muscles has been used up, then the body must turn to the blood stream to gain more glucose to enter the cell to then be used.

It is well known that resistance training, in combination with good nutrition, increases muscle mass, and an increase in muscle mass can have a positive effect on our metabolic rate, both at rest and during exercise. A higher metabolism means that you will burn more calories, both while completing exercise and also while completing your normal day to day tasks. The more calories you burn, the higher chance you have of maintaining or losing some body fat, and as we know from earlier in the blog, being overweight or obese can have a large risk for further health complications for those people with diabetes. That means hat not having as much body fat will improve your diabetes, reduce your health complications risk AND improve your blood glucose levels!

It’s almost as good as taking medication, except it is better, because exercise can be free!

How much resistance training do I need to do?

The recommendation for adequate changes in your muscular system is to complete 2-3 workouts per week of 30-45 mins of strict resistance training, focusing on large muscle group movements.

Each exercise should be completed for between 8-12 repetitions and repeated three times.

It is important to find a weight that feels comfortable to lift in the early stages of starting a resistance training program. Once you feel that the weight you have chosen is too light, or you can easily get through your sets and reps, it is time to increase the weight.

Now some people get a little worried about how much weight they should be lifting, and other medical conditions can affect this. However if you are able, it’s important to lift a weight that makes you feel like you are working.

For our bodies to adapt, it needs to be placed under stress. If we don’t place an adequate stress on the body, then it doesn’t need to change in order to complete what we are asking it to do. That’s why if you have walked for 20 mins, 5 x per week for the last 5 years, you might not feel at the end of your walk like you’ve had to do any work. The body is used to what you are doing, and can adeqautely complete the task without any stress. This will maintain a level of fitness, but won’t make you improve your fitness.

Essentially, but the end of your 8-12 repetitions, you should feel like you could push out another 2 or 3 repetitions if you really had to, but that would be it.

But what if I don’t feel strong enough to complete resistance training?

That’s what we are here for! Our jobs are specifically designed to find an exercise program that anyone with any medical conditions can safely complete and feel comfortable completing at the same time. We will never ask you to complete something you don’t wish to, and we will never ask you to do something that we didn’t think you could do.

Our job is to guide, supervise, encourage and push you to improve your fitness in a fun and safe manner.

It’s time to chat about the reality of living with diabetes, and some of the challenges you might face from the first diagnosis and then as you age with this condition.

First Diagnosis

Always comes with a bit of shock, and a huge influx of information. My advice is this, take some time, talk to some health professionals who can give you information, but make it clear about what you would like to know. Some people like knowing the absolute intricacies of everything, while others just want the footnotes. Health professionals are a well of information, and can give you as much or as little information as you like.

Start implementing some changes straight away, and make sure to start off small. Increased walks throughout the week, cutting down the size of your meals etc.

Finding out what type of management you need

As stated above, some people may be able to control the management of their diabetes with exercise and diet, while others may need to inject insulin. Whatever the management style, listen to your health professional about the potential risks, and find out what works best for you.

Expectations

Whatever the management style, you need to have an expectation that some components of your lifestyle need to change. If you don’t embrace this fully, you’ll be on the back foot from the get go. Now not everyone likes exercise, and some people find changing their diet very hard to do, but whatever barriers to have, the more stubborn you are to changing these, the quicker your condition will progress. The quicker you implement changes, the easier they will be to uphold.

You need to realise as well that as you grow older, your diabetes will continue to progress. The longer you have type 2 diabetes, the higher chance you have that you will need to take insulin as a medication.

It is important to realise that your management of diabetes will continue to change. What works for you now may not be what works for you in 5 years time. That is why it is important to continue to stay in touch with your GP and have regular checks via blood tests on your diabetes.

You don’t have to stop the things you enjoy

If you enjoy having a coffee and a piece of cake with your friends as a social outing, you don’t have to stop this. People believe that once a diagnosis is made, you have to stop eating all sugar and carbohydrates to avoid your BGL’s going up.

Now the reality is that the coffee and cake you have will most likely increase your BGL’s, however, if you have a diet that manages your diabetes well and exercise the recommended amount, the chances are that you can have a one outing of coffee and cake with your friends a week. But don’t make it a regular habit everyday. Moderation is key, and making sure that you put things in place so that if you want to enjoy a few beers with mates or a glass of wine, make sure you exercise beforehand and the next day, and maybe you choose to either have beer with a salad, or water with a burger. Make choices that have some upside from a health perspective, and it will make you feel a lot less guilty about it.

Surrounding yourself with support and be confident in your management

Now you don’t want to have friends who encourage you to make poor heath choices all the time, but you also don’t want to surround yourself with friends or family who judge everything you put in your mouth. The thing I hear most from people living with diabetes is how frustrated they get when someone asks;

“Should you really be eating that with your diabetes?”

The answer can be a strict, yes, yes I can, if you have proper management. But moving away from the stigma’s of diabetes is just as important as the management of it. So educate your friends about your diabetes if they don’t know a lot about it.

Try not to hide that you have diabetes. Would you hide that your knee is sore? Or that you’ve had a heart attack? Most likely not, so why should diabetes be any different?

If you are making the correct choices for your health, there is no shame in admitting to having this condition, and certainly no shame in enjoying that coffee and cake with friends.