Lifestyle matters in type 2 diabetes
Diabetes (also known as sugar diabetes or diabetes mellitus) is a
condition in which there is a problem getting glucose (sugar) from the
bloodstream to the cells that need it for energy. Insulin, a hormone made
by beta cells in the pancreas (a small organ behind the stomach), is
required for this process. In diabetes there is either damage to the beta
cells, causing lack of insulin, or insulin-resistance - where increasing
amounts of insulin are needed to be effective, eventually exhausting the
beta cells.
In type 1 diabetes, beta cells are destroyed by the immune system. It
tends to come on suddenly, usually affecting children. Symptoms like
thirst, weight loss and frequent urination are common. Type 1 diabetics
require life-long treatment with insulin injections.
Type 2 diabetes is characterised by a gradual onset of insulin
resistance, occurring mostly in older people (usually over 40). It is
becoming increasingly common and many people remain undiagnosed, as there
are few symptoms in the early stages. Those most at risk include the
obese, those with a family history of diabetes, those with a history of
diabetes in pregnancy or with polycystic ovaries and certain ethnic groups
including indigenous Australians, Asians and Pacific Islanders.
Obesity may increase the demand for insulin. Losing just 5-10% of
initial weight is a proven method of delaying or even preventing type 2
diabetes in obese people. Type 2 diabetes can be initially treated with
careful diet and increased exercise. In general, a diet high in fibre and
low in fat is recommended. Specific advice can be sought from a dietitian
or diabetes educator. It is recommended that all patients also exercise at
least 2.5 hours a week. Increasing exercise may also delay the development
of diabetes.
Ultimately, most with type 2 diabetes will need medications, and
eventually insulin, as the disease progresses.
Without insulin, blood glucose levels increase. High glucose levels over
time cause damage to blood vessels, nerves, the heart and kidney -
potentially causing heart disease, strokes, nerve damage, loss of vision
and kidney failure. Treatment is designed to keep blood glucose levels low
enough to minimise this damage. Studies show that those whose blood glucose
levels are kept low in the early years after diagnosis have a much lower
risk of heart disease in the next 10-20 years.
Diabetic patients are at increased risk of heart disease and need to pay
more attention to other risk factors such as high blood pressure, smoking
and cholesterol levels. Poor circulation to the legs and possible nerve
damage mean extra attention is needed for legs and feet. A regular visit
to the podiatrist can help prevent a variety of foot problems.
Talk to your doctor about a blood test to check for diabetes if you are
over 40 or have a family history or other risk factors. Early diagnosis
and making positive changes to diet and exercise patterns make a big
difference in this disease.
Wholegrain cereals – important in a healthy diet
Wholegrain cereals are well known for their health benefits. These
include reducing the risk of heart disease and some cancers, as well as
preventing and curing constipation.
But the meaning of “wholegrain” is not always understood.
Cereals are types of grass. Their fruits are known as grains or kernels
and have three parts:
• The bran — the outer layer of the grain
• The endosperm — the middle layer
• The germ — the inner layer.
Cereal products that contain all three layers are known as wholegrain.
They include barley, brown rice, rye, oats, corn (also called maize) and
wheat products such as wholegrain bread and some breakfast cereals.
Lesser-known but highly nutritious cereals are triticale (a hybrid of rye
and wheat), millet, sorghum and buckwheat.
Wholegrains are rich sources of many nutrients and phytochemicals -
natural chemicals found in plants that are important for health.
They contain protein, carbohydrates, fibre, vitamins (mainly the B-group
and Vitamin E), trace minerals, such as zinc and magnesium, and lignans (a
type of phytoestrogen or naturally occurring plant oestrogen).
Grains with the bran and germ portions removed are known as refined
cereals. The refining process is applied mainly to wheat and rice
producing “white” flour and “white” rice. Refined cereals lack many of the
nutrients and phytochemicals present in wholegrain cereals. Refined flour
may be enriched with some vitamins and minerals lost during processing.
However, many of the phytochemicals cannot be replaced.
Cakes, biscuits and pastries are not a good way to eat cereals because
they have a high sugar and fat content. These extra ingredients have
little nutritional benefit and
contribute to dental decay and obesity.
Good Health on the Menu
Wholemeal bread and brown rice are useful ingredients in stuffings.
Stuffed Capsicum
(serves 4)
2 large capsicums
1 cup cooked brown rice
1 small onion, chopped
½ cup fresh parsley, chopped
¼ cup Parmesan cheese, grated
Cut capsicums in half across their middle. Remove seeds and trim ends to
allow each half to sit flat. Fry onion in a little oil until soft. Add
remaining ingredients and fill capsicum halves. Place on an oiled baking
tray and bake at 160°C for 20 minutes or until capsicum begins to
soften.
Myth
You need to drink 8 glasses of water a day.
Fact
The amount of water needed to keep the body well hydrated depends on how
much fluid is lost through sweating, breathing and excretion of urine. It
is thought that the “8 glasses” originated from a recommendation that we
consume 1 ml of fluid for every calorie of food. The average person
requiring 2000 calories/day would therefore need 2000ml of fluid or 8x
250ml glasses. However, most of this fluid requirement is contained in
prepared foods. Recent studies indicate that tea and coffee, while they do
increase urine production, do not cause dehydration and can be counted as
fluid intake.
There are several instances in which fluid intake should be increased.
These include situations where fluid loss is increased as in exercise, hot
weather, and gastroenteritis and also when taking fluid tablets. It is wise
to drink more fluids for kidney stones and urinary tract infections.
Elderly people sometimes lose normal thirst responses and may need
reminders to drink regularly. For most though, thirst is a reliable guide
to fluid needs.
If there are kidney problems or heart failure, fluids may need to be
carefully restricted. Sometimes drinking too much water can alter the salt
balance in the body, potentially causing harm. Users of the drug Ecstasy
may be at risk of ‘water intoxication’.
In general, drink when you are thirsty and when you know your need for
fluids is greater. Drinking water is good for your health but don’t stress
if you don’t make 8 glasses a day.
Whooping Cough is still a risk for new babies
While vaccination for whooping cough has for some time been part of the
routine schedule for babies from the age of 2 months, the infection is
still present in the community creating a risk for very young babies.
Whooping cough is a respiratory infection with the bacterium Bordetella
pertussis. It is highly contagious and is spread by coughing or sneezing.
Infection causes an initial runny nose and dry cough for 1-2 weeks, which
then progresses to a worsening cough that comes in bouts and lasts 4-6
weeks. During bouts of coughing, there may be trouble breathing, resulting
in gasping for air that sometimes causes the classical “whoop” sound.
Bouts of coughing may also result in vomiting.
While the disease is often mild in adults, causing at times only a
persistent night time cough, it can be severe and even fatal in young
non-immunised or partially immunised babies. The infection has been
recognised increasingly in teenagers, prompting the addition of a whooping
cough booster vaccine for adolescents in many countries.
Immunisation is also available to prospective parents and grandparents
to reduce the risk to the newborn.
The disease can be treated with antibiotics if diagnosed early enough.
Family contacts may also be treated. Public health authorities require
notification of diagnosis and those diagnosed should stay away from
school/work until no longer infectious.
Did you Know?
Chilli could help diabetes and heart disease
Australian university scientists are currently investigating the effects
of chilli on diabetes and heart disease.
There are two active ingredients in chilli – capsaicin and
dihydrocapsaicin – which may be able to reduce the over-production of
insulin that occurs in early-stage diabetes. Researchers are investigating
whether it may actually delay or prevent the onset of diabetes. Capsaicin
may also have an aspirin-like effect in reducing platelet sticking which
causes blood clots. It appears that it may also reduce the formation of
fatty deposits in artery walls associated with cardiovascular disease.
Side effects of chilli have not been identified at this stage – although
many people cannot tolerate the immediate effect of the spice when eating
it! While we know that the hotter a chilli is the more capsaicin it has,
it is not yet clear how much chilli is needed to have beneficial health
effects.
If you like chilli and it doesn’t upset your stomach, enjoy it knowing
it may be providing health benefits.
Heart attack one of the main killers in Western Society
There are six main risk factors for this disease. They are:
Hereditary Factors
Smoking
High Blood Pressure
Fats in the blood
Obesity
Lack of exercise
Apart from the first, all of these risk factors are in our own control.
Are you giving yourself the best chance of avoiding a heart attack?
Diabetes needs air and weight
There’s been a bit of an argument among the experts about which is
better for people with type 2 diabetes (adult onset) - aerobic exercise,
like fast walking and jogging, or resistance training, like weights, push
ups, dips and sit ups. There’s no doubt that aerobic exercise helps
weight and sugar control and weight loss. There is also evidence that
resistance training in people at risk of diabetes can actually prevent the
disease occurring. Putting on muscle makes the sugar hormone insulin work
better.
In fact it turns out that both forms of exercise are worth doing.
A group of adults with type 2 diabetes who were not involved in any
regular physical activity were divided into four groups: normal sedentary
lifestyle, an aerobic program (45 minutes, three times per week),
resistance training (45 minutes, three times per week) and combined
aerobic and resistance training.
After 6 months, those in the combined exercise program showed the
greatest improvements in blood sugar control. Improvement was such that,
if maintained, it would be associated with an approximate 10% decrease in
the risk of heart attack or stroke and about a 20% decrease in eye and
kidney disease. This reinforces the strong message that you can make a big
difference to diabetes by changing your physical activity level. If you add
to that a healthy eating pattern like the Mediterranean diet, then you can
derive even more benefits.
The National Health and Medical Research Council’s (NHMRC) guidelines
for doctors treating people with diabetes advises that such lifestyle
measures should be tried before jumping into medications.
Common knee and ankle problems in sporty teens
Teenagers who play a lot of sport before their bones have fully grown
may injure the sites where tendons join onto the bones. In the knee, the
place where the patellar tendon inserts into the front of the leg bone
(tibia) is called the tibial tubercle. In adolescents, this is a growth
plate made of cartilage called an apophysis.
Repeated stress from growth and exercise can cause inflammation and pain
in the area that comes on gradually with running and jumping, typically in
the 12-15 year age group. This syndrome is commonly known as “Osgood
Schlatter’s disease”.
A similar process can occur in the heel where the Achille’s tendon
inserts into the heel bone (calcaneum). This is known as “Sever’s
disease”. These are not actually diseases but inflammation of the
apophysis (apophysitis).
Treatment includes modifying sporting activities to reduce stress on the
area, ice and anti-inflammatory gels to the inflamed area and regular
gentle stretching of the muscles involved (quadriceps in the knee and calf
muscles in the ankle). Symptoms may come and go over time but will
eventually get better. Always see your doctor for appropriate diagnosis of
any recurring pain.
