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About 2.3 million people in the UK have diabetes ,  about 4 in 100 people.
Diabetes is a common  condition in which the amount of glucose in the blood is too high and so the body cannot use it properly. This is because the pancreas, a gland in the upper rear of the abdomen, produces a hormone called insulin, which itself controls the flow of blood sugar throughout the cells of the body ,does not produce any or not enough insulin or the insulin that is produced doesn’t work properly at its sites of action(known as insulin resistance).Insulin is needed to allow  glucose to enter the body’s cells. Glucose comes from digesting carbohydrate from various kinds of food and drink, including starchy foods such as breads, rice and potatoes, fruit, some dairy products, sugar and other sweet foods. Glucose is also produced by the liver.

The there are three important types of diabetes are:

Type 1 diabetes (previously known as insulin-dependent diabetes) is an auto-immune disease -this is where the  immune system of the body destroys the insulin-producing beta cells in the pancreas. This type of diabetes, also known as juvenile-onset diabetes, accounts for 10-15% of all people with the disease. It can appear at any age, although commonly under 40, and is triggered by environmental factors such as viruses, diet or chemicals in people genetically predisposed. People with type 1 diabetes must inject themselves with insulin several times a day and follow a careful diet and exercise plan.

Type 2 diabetes mellitus (known as type 2 diabetes)is a  disorder in which either the pancreas does not make enough insulin or the cells of the body become resistant to insulin. Your body needs insulin to regulate the levels of glucose in the bloodstream.It often goes hand in hand with obesity, high blood pressure and high cholesterol. It used to be known as adult-onset diabetes or non-insulin-dependent diabetes. These terms aren’t used any more, because type 2 diabetes is increasingly affecting younger people and some people with type 2 diabetes have to use insulin.Usually it appears in people aged over 40, though in South Asian and Black people it can appear from the age of 25.

Gestational diabetes mellitus (GDM)
GDM, or carbohydrate intolerance, is first diagnosed during pregnancy through an oral glucose tolerance test.  Risk factors for GDM include a family history of diabetes, increasing maternal age, obesity and being a member of a community or ethnic group with a high risk of developing type 2 diabetes. While the carbohydrate intolerance usually returns to normal after the birth, the mother has a significant risk of developing permanent diabetes while the baby is more likely to develop obesity and impaired glucose tolerance and/or diabetes later in life. Self-care and dietary changes are essential in treatment.Between 2 and 5 out of 100 pregnant women get a kind of diabetes called gestational diabetes. About 40 in 100 women with gestational diabetes will go on to have diabetes later on.

Diabetes is important because it can over time,lead to blindness, kidney failure, and nerve damage , this is the result of damage to small vessels, referred to as  microvascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases, this is referred to as macrovascular disease. Diabetes affects approximately 17 million people (about 8% of the population) in the United States. In addition, an estimated additional 12 million people in the United States have diabetes and don't even know it.


In type 1 diabetes the insulin making cells in the pancreas are destroyed, causing a severe lack of insulin, It is still a mystery why this happens but suggestions include:

    * infection with a specific virus or bacteria
    * exposure to food-borne chemical toxins
    * exposure as a very young infant to cow's milk, where an as yet unidentified component triggers the autoimmune reaction


However, these are  not proven causes as yet.


In  type 2 of diabetes the receptors on cells are less responsive to the insulin - this is known as insulin resistance.In response to this, more insulin may be produced, and this overproduction exhausts the insulin-manufacturing cells in the pancreas. There is simply insufficient insulin available and the insulin that is available may be abnormal and so doesn't work properly.

The following risk factors increase the chances of someone developing type 2 diabetes:

    * increasing age
    * obesity
    * physical inactivity


Rarer causes of diabetes include:

    * certain medicines
    * pregnancy (gestational diabetes)
    * any illness or disease that damages the pancreas and affects its ability to produce insulin, such as pancreatitis.


The good news is that because type 2 it doesn’t develop overnight, if people at risk of developing type 2 diabetes are identified early enough, they may be able to take measures to avoid it.It is becoming more common in children and young people of all ethnicities.

If you have a slightly raised blood glucose there are things that you may be able to do to try to prevent or delay type 2 diabetes from developing. Doctors have realised that lifestyle changes can often restore blood glucose levels to normal and so avoid type 2 diabetes developing and avoid damage to the heart and circulatory system.

Excess weight (especially  around the waist) and fatty tissue  contribute to insulin resistance. Weight reduction of 5-7 per cent and getting regular exercise (about 30 minutes of moderately intense activity per day) can help prevent the progression to diabetes in overweight people with glucose intolerance (pre-diabetes). Eating a fibre-rich diet in which less than 30 per cent of total energy comes from fat and less than 10 per cent of energy comes from saturated fat, as well as foods that have a low glycaemic index, can also help.

Taking glucose-lowering medications may also slow or prevent progression to diabetes in people with impaired glucose tolerance.

The main symptoms of undiagnosed diabetes include :
.passing urine frequently (especially at night)
.increased thirst,
.extreme tiredness/lethargy
.unexplained weight loss,
.genital itching or regular episodes of thrush,
.slow healing of wounds and
.blurred vision.





Although there are differences in treatment for Type 1 and Type 2 diabetes, the dietary advice for managing both types is the same.Although a carbohydrate-controlled diet used to be suggested, there is now no special diabetes diet.Instead your diet should be based on the same principles of healthy eating that everyone should follow.

Principles of healthy eating for diabetes:

 1. Eat regular meals
Steps to a good diet

    * Eat regular meals.
    * Cut down on high sugar foods.
    * Reduce the amount of fat.
    * Eat five portions of fruit and veg a day.
    * Reduce salt intake.
    * Keep alcohol to moderate levels.

Starchy foods such as potatoes, pasta, bread, rice and cereals release their energy slowly because they need to be digested first.This means they don't cause high surges of sugar in your blood in the same way that sugary foods do.

2. Cut down on high sugar foods

Foods with sugar (sucrose or glucose) require little or no digestion for your body to absorb the sugars.

This means they cause blood glucose to rise quickly after a meal.
Diabetic foods

Be wary of  so called -diabetic foods- because:

    * there is nothing special about them
    * they are more expensive
    * some contain more fat than ordinary brands.

Normally the pancreas produces a boost of insulin to cope with the raised blood sugar, but in diabetes this process fails.

So moderating the amount of high sugar foods in your diet will help control your blood sugar level.

3. Reduce the amount of fat in your diet

Fat has the most amount of calories - 9 calories per gram compared to carbohydrates and protein therefore cutting down the amount of fat  eaten will have the most effect on reducing your total calorie count.Fat can be reduced by grilling steaming  and purchasing lean cuts of meat - for example chicken breast without the skin,use oil that is high in 'good' fat such as olive oil when you need to use oil,but sparingly of course.

4. Eating five portions of fruit and vegetables every day provides the essential vitamins and minerals we all need.

5. Cut down salt intake.Six grams of salt or less a day is the recommended amount for adults. This equates to a slightly heaped teaspoon.if you don't add salt to any of the food you eat, the amount of ‘hidden’ salt in processed and packaged foods means you can easily eat two to four times this daily limit.

 A note about glycaemic index because you will come across this.

The glycaemic index (GI) of a carbohydrate-containing food tells you what effect eating that food will have on your blood glucose  level. Foods with a low GI (e.g. green beans has a GI of 30) tend to break down slowly during digestion and make your blood glucose level rise more slowly and steadily than foods with a high GI (e.g. white bread at about 70). Pure glucose is given a GI of 100. Choosing low-GI foods can benefit people with diabetes and those who are trying to control their weight.






5.Alcohol in moderation.

    *  14 units per week for women
    *  21 units per week for men.

A unit of alcohol is:

    * 250ml (1/2 pint) of ordinary strength beer or lager
    * A 125ml glass of wine
    * A pub measure of sherry or vermouth (25ml)
    * A pub measure of spirits (25ml)

You can always ask to be referred by  your GP to a dietician for advice on your diet.





6.Excercise (do consult with your doctor about this)

Wear an ID which identifies you as having diabetes whenever you are exercising alone (or anytime) so that others may help you appropriately in the event something unexpected happens.f you get injured or suffer sudden hypoglycaemia people who may come to your aid need to know you take insulin or that you are a diabetic.Don't make a secret of your diabetes.

Always have a fast acting carbohydrate food with you during and after exercise (raisins, juice etc) in case hypoglycaemia symptoms occur. Low blood sugar symptoms can occur up to 24 hours after exercising.   If your blood sugar level is less than 100 mg/dl prior to exercise, take a carbohydrate snack prior to beginning the exercise. A good rule of thumb is to add 15 grams of carbohydrates (1 Carbohydrate Exchange) to your usual diet for each 30 minutes of moderate exercise, or for each 15 minutes of intense exercise.
 If your blood sugar level is higher than 100 mg/dl before exercise, it is probably not necessary to take the carbohydrate snack before a light exercise session, but you may need extra carbohydrates 1/2 hour to 2 hours following the exercise. Add 1530 grams of carbohydrate to the next meal or snack if your blood sugar dips below 70 mg/dl within an hour or more following exercise.If you experience hypoglycaemia, you should see your doctor. You may be advised to adjust your medication on days that you exercise. For long duration and/or high intensity exercise sessions, plan extra carbohydrate snacks during the activity. An additional 15 to 30 grams of carbohydrates is suggested each 3060 minutes of exercise (e.g., football, hiking, biking, etc)Try and avoid high intensity exercises such as weight training, running, or tennis.Check feet daily for any signs of pressure sores or friction, blisters, etc.Exercise at the same time and for the same duration each day-if possible. This can help keep your blood sugar levels in the same range. Exercise can affect your blood sugar, so closely monitor your levels before and after you exercise to measure the effect exercising has on your body. Drink extra liquids during and after exercising to prevent dehydration. It also helps prevent erratic blood sugar levels and combats heatstroke.For longer exercise sessions make sure you take extra carbohydrate snacks during the session.  Do not exercise if Your blood sugar is above 300 mg/dl, especially with positive urine test for ketonuria or if you are sick with flu, infection or another illness that is worsening blood sugar control.

Foot Problems can occur when:

    * Shoes fit poorly
    * Socks are not worn or are not absorbent
    * Friction or pressure points develop on feet.

so,

    *   Inspect feet daily for signs of friction or pressure sores.
    * Speak with your physician, podiatrist or diabetes educator about proper foot care procedures.
    * Buy shoes which are well-made for the type of exercise you do and which fit you.
    * Consult a shoe retailer who specializes in exercise foot wear.
    * Buy cotton, absorbent socks.


Whats the difference bettwen mmol/L and mg/dl?

Both are used to measure blood sugar levels. The only difference is the country in which they are most commonly used. mmol/L is the most common measurement used in the UK with mg/dl predominantly used in the USA.

    * mmol/L: Millimoles per litre
    * mg/dl: Milligrams per 100 millilitres

Blood glucose typically varies from 4.5 mmol/L to 6 mmol/L for people without diabetes.




Converting Blood Glucose Levels from mmol/l to mg/dl

There are two measurement sytsems for measuring blood glucose levels, the 'World Standard' of mmol/l and the US system of mg/dl

The US system will eventually be replaced by the World Standard, but until it does we need to be able to understand both.

The simple way to convert is to multiply or divide by 18, the following table makes it a little easier


mmol    mg/dl


2       36          dangerously low  

3       54          low you need to eat something quickly

4       72         slightly low

5       90         normal before eating

6       108         normal before eating


7       126         normal before eating


8       144         maximum before bedtime


9       162

10    180         maximum 1-2 hours after a meal.

11      198

We hope you have found the above useful please have a look at the rest of the site and what it  offers

Please make sure you see your doctor if you have diabetes or indeed if you think you may have diabetes the above information is under no cirumstances a replacement for sound advice from a licensed medical practitioner.The information presented is purely for educational purposes only. 

Please make sure you see your doctor if you have diabetes or indeed if you think you may have diabetes the above information is under no cirumstances a replacement for advice from a licensed medical practitioner.It is purely for educational purposes only.

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