There are in fact two forms of diabetes mellitus. The least common, comprising approximately 10% of all diabetes is Type 1 diabetes, which occurs mostly in younger individuals and is created by failure of the pancreas to produce sufficient insulin to control levels of blood sugar in the body. The most common form is Type 2 diabetes , comprising 90% of all diabetes worldwide, which occurs mostly in older individuals.
This form of diabetes is characterised by increasing resistance of body tissues to the effects of insulin resulting in elevated blood sugar levels and significantly increased risks of associated heart & arterial disease, strokes, kidney problems, eye disease, neurological disorders, cancer and dementia.
Essentially diabetes is a horrible disease and we should try our best not to get it! The condition is definitely in the genes, type 2 diabetes has strong genetic links to other family members, in essence if a close relative has the disease then you have a much higher risk of getting it. The modern concept though, is that this form of diabetes (along with obesity, coronary heart disease & hypertension)is a ‘disease of lifestyle’ and that adverse eating practices especially the consumption of large amounts of sugar and refined carbohydrates in the diet for a prolonged period of time are the principal reason why people develop the disease.
The corollary to this is that aspects of lifestyle notably nutrition and exercise are important role players in the prevention and treatment of diabetes.
Some interesting statistics:
- 80% of type 2 diabetics are obese
- An epidemic of diabetes is occurring worldwide correlated with rising obesity rates
- In sub-Saharan Africa the number of diabetics is projected to double by 2035
- The WHO estimates that 80% of diseases of lifestyle including diabetes are preventable.
Two thousand years ago, long before the current knowledge regarding the human pancreas and it’s secretion of the hormone insulin to control blood sugar, Hindu physicians had suggested that diabetes was a disease of the rich, caused by indulgence in sugar, which had only recently arrived from New Guinea.
Observations in the 19th and 20th Centuries showed diabetes to be virtually non- existent in populations eating their traditional diets but increasingly found in sectors of populations who ate increasing amounts of sugar and white flour. The dramatic increase in consumption of these foodstuffs in Europe and America during the late 19th Century coincided with dramatic increases in the incidence and deaths from diabetes. Prior to the discovery of insulin in the 1920’s it was commonplace for diabetics to be advised to control their condition by restricting the amount of carbohydrates in their diet.
The discovery and use of insulin for the treatment of diabetes combined with the medical profession preaching a “fat is bad for your heart” mantra from the 1970’s led to a shift of the dietary advice for diabetics towards higher levels of carbohydrate whilst restricting fats. This challenges the” metabolic logic” of the disease given that the very essence is the inability of the diabetic to control blood sugar as a consequence of increasing insulin resistance of their tissues especially the muscles and liver.
Blood sugar is directly derived from the digestion of the carbohydrate (eg sugar, bread, pasta) content of the diet. Furthermore, despite the fact that diabetics suffer a 2 – 3x increased risk of heart disease their cholesterol levels are seldom higher than non-diabetic heart disease sufferers, which indicates that it is unlikely that fat or cholesterol in the diet is the reason behind their increased heart attack risk.
Modern nutrition research has defined a clear role for low carbohydrate higher fat diets for the management of type 2 diabetes. Many of the studies show that by severely restricting carbohydrates to less than 30g per day and eradicating all sugar and refined carbs, diabetics experience significant healthy weight loss with marked reductions in blood sugar, blood pressure and also they require much less insulin or oral drugs to maintain blood sugar stability.
A low carbohydrate diet improves other health markers associated with heart disease such as HbA1c, blood cholesterol profiles, HDL and triglyceride levels. Nonetheless all type 2 diabetics, whether they be treated by diet alone or with oral drugs or insulin should be managed by physicians and dietitians experienced in the management of diabetes. Physical activity also plays a major role in diabetes. Low levels of exercise are associated with increased risks of obesity and type 2 diabetes. Exercise increases the sensitivity of muscle tissue to insulin thus combating the risks of the disease and reducing the effects of established diabetes.
Cardiovascular fitness training like running and resistance training such pushing weights have been shown to improve blood sugar control and overall functional capacity in diabetics. Where possible it is advisable to seek the advice of exercise professionals for guidance as to the correct exercise program. There are important considerations when contemplating exercise with diabetes such as having stable blood sugar levels, eating before exercise, not injecting insulin into exercising limbs and taking care of the feet.
In summary, type 2 diabetes is increasing alarmingly worldwide including Zimbabwe. It is closely tied to rates of obesity and to the increasing consumption of sugar and other refined carbohydrates in our diet. Diabetes is largely preventable by healthy eating habits especially reduced sugar intake and by participating in regular exercise. As the old adage goes “Prevention is better than Cure”! Low carbohydrate nutrition and exercise also play the key roles in the modern medical management of diabetes. Bottom line, if you have a family history of diabetes, best you eat well (no sugar!!), exercise lots and keep your weight down.