How to live successfully with Diabetes

1. 

No matter what the underlying cause of diabetes is, the result is raised sugar levels in the blood. This is because of an inability for cells to take glucose out of the bloodstream into the cell and use it for energy. The glucose remains circulating in the blood causing high levels. This can lead to serious health problems that affect all organs and tissues, causing damage to the heart, kidneys, nerves, eyes and brain. 

Insulin is a hormone made by the pancreas (an organ in the abdomen which helps with digestion and processing of nutrients in the diet). Insulin is necessary to allow cells to take in sugar from the blood stream and use it for energy. It is often compared to being like a key that opens the gate to the cells and lets glucose in. 

If a person’s pancreas does not make sufficient insulin, they will have Type 1 diabetes, this tends to show itself in younger people but can occur at any age. Insulin is always needed in these patients to replace what the body is unable to make (the “key” is lost and so replacement keys have to be used). 

For most people with diabetes, the underlying cause is that their body has become resistant to the insulin that their pancreas makes. This is Type 2 diabetes, and used to be seen mainly in the older adult population but is now also seen in young adults and even children. It has increased in prevalence due to a combination of diets high in fats and sugars alongside sedentary lifestyle (lack of regular physical activity to burn off the calories consumed). 

Poor diet and lack of regular physical activity leads to unhealthy weight gain (especially around the waistline, or central obesity) which then causes the body’s insulin to become ineffective in working as a key to get glucose into the cells (the “key” is present but has lost its teeth and cannot effectively open the locks – it needs “re-shaping” to be effective again). The blood sugar remains high but the person is tired because they cannot get enough energy from the food they eat, creating a vicious cycle where they feel they must eat more to get energy. High sugar in the blood also makes people feel thirsty, most undiagnosed people or those diagnosed with diabetes but with poor control of the condition complain of hunger, thirst, tiredness and excessive urination. 

2.

Diabetes is not a “death sentence,” rather it is a “life-sentence” as it remains with the person for life and if not managed can lead to complications. Knowledge is power and once a person is willing to accept that they have to do the work to help their body (because either their pancreas does not work, or is working but cannot work against the factors present in the body) there are well-established strategies to successfully manage diabetes and live a long and full life, a conversation well worth having with your doctor. 

Every person is unique, so finding what works well for helping to make healthy diet and exercise changes, alongside taking medications as advised by your doctor, are critical for managing any chronic (long term) condition. 

Many celebrities live successfully with diabetes (Tom Hanks, Halle Berry, Nick Jonas, George Lucas, James Earl Jones to name a few; Good Housekeeping, 2019), even some famous athletes are known to be diabetic and accept they have to work harder to manage their blood sugar alongside training. Although people with diabetes have to be more vigilant about diet and exercise, everyone would benefit from the same healthy dietary changes and regular exercise.

3.

Gestational diabetes is the presence of raised blood sugar in pregnancy for a woman not previously known to be diabetic and most commonly occurs in the second or third trimesters. Women should be screened for this with a special test because if it remains undetected or uncontrolled, it will lead to complications during the pregnancy and delivery for both mother and baby. It usually resolves after delivery of the baby but women remain with a life-long increased risk of developing diabetes and should be advised on healthy diet and lifestyle to maintain a healthy weight, and to have diabetes screening annually. 

There are many successful medical treatments for diabetes that work even better alongside healthy, portion-controlled diet and regular physical activity.  The last two factors are usually underestimated and down played because they take personal effort and time to show benefits. It also may be easier to take a pill than to change a lifestyle and habits (which are far more committed changes to make and sustain). But they make a huge impact on lifetime health, fitness and well being, can reduce the number of medications needed to treat the condition, and positively influence others in families or communities to make similar changes. 

People may choose to invest in supplements to manage their diabetes. Although some supplements may be useful to use alongside medical treatment and lifestyle change, they are rarely able to treat diabetes on their own. Serious damage to the body can be caused by replacing medications without discussing it with your doctor (who can explain the risks and benefits of changing your treatment plan). 

Apart from diet and exercise, other important modifiable risk factors for developing diabetes are excess alcohol consumption and smoking. Limiting alcohol consumption and stopping smoking are key actions that can improve health generally for people with or without diabetes and reduce chronic disease risk. Lifestyle factors that can affect blood sugar control include stress and poor quality sleep. Talking to your doctor about strategies to manage these (which may be related) can have a positive impact on health and well being and provide better control for existing diabetes and hypertension. 

There are also risk factors that we cannot alter such as genetics (family history of diabetes and ethnicity) and increasing age. People with a known family history of diabetes should be more vigilant about screening for diabetes, preventing or minimising it by maintaining a healthy diet and keeping regularly physically active, and being aware of the symptoms and signs. People with type 2 diabetes can often have raised blood sugar for years before they are diagnosed, causing “silent” (without symptoms) damage to their heart, eyes, nerves, kidneys and brain. 

Blood sugar, blood pressure and cholesterol are all related and have common risk factors so they are usually screened for and managed together. People with diabetes have at least twice the risk of having a heart attack or stroke than someone without diabetes so it is even more important to screen for and manage blood pressure and cholesterol in a patient diagnosed with diabetes, and in people with a family history of heart attack, stroke, dementia and diabetes. 

4.

A few things can make a big difference: 

• choosing healthy portion sizes, 
• trying to balance meals (ensuring meals contain healthy protein, complex carbohydrates like provisions or whole grains, and fibre - a Mediterranean-styled diet can be altered to accommodate different flavour profiles and is a good example to follow), 
• adding fruit and vegetables to your daily meals and snacks, 
• choosing water over other beverages (including low sugar ones or artificially sweetened ones). 
• A new study has shown that consistently walking a minimum of 7000 steps daily has a positive effect on health (Paluch, 2021). Again starting small and building up to this, changing the intensity some days or adding in different activities in its place are ways to maintain it. 

Over the years portion sizes have increased and we think we are getting something extra for free when in fact, there is “no free lunch” and we are indeed getting something extra that we really do not need. Our bodies are not wasteful so whatever is consumed, if it is not used for fuel, will be converted to fat and stored. We then add more calories into the store without using them and this creates a prime environment for insulin resistance. 

High fat and high sugar foods are probably the things people like the most but which are the worst things for us to eat regularly so cut down on these. 

For any foods bought, check the food label; check serving size and calories per serving, and look out for the “3s’s:”

• sugars (also known as carbohydrates), 
• saturated fats and 
• sodium 

If these are in the first three items listed on the nutrition label, bear in mind that these foods should be enjoyed occasionally as opposed to regularly. 

Perspective is everything; take time to remember each day how precious life is and what a unique and beautiful being you are. Make yourself a priority and no matter what the trends are, or the advice from others or social media, learn about what is best for you and make good choices that benefit your health and well-being. Life is for living and to be enjoyed and in doing so we also owe it to ourselves to learn about how to limit our exposure to harm. We take great effort to keep our homes and belongings safe, secure, clean and in optimum condition – so why not our bodies and minds too?

This coming World Diabetes Day (14^th November, 2021) do something great for yourself; look at your own lifestyle and see if there is even one thing you could do to optimise your health. Spread the word and help others to do the same – in your family, in your workplace, in your community and put the “kind” back into humankind.

Some useful resources:

https://worlddiabetesday.org
Practical advice and easy to follow steps, recommendations and recipes for healthy behaviour change www.nhs.uk/change4life 

What is the Mediterranean Diet? American Heart Association: www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/mediterranean-diet 

Mental health and well-being: www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing  

References 

1. Diabetes in T&T www.paho.org/hq/dmdocuments/2012/14-TrinidadyTobagoMX2011.pps

2. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9^th edition

lPouyaSaeedi^aIngaPetersohn^aParaskeviSalpea^aBelmaMalanda^aSuviKaruranga^aNigelUnwin^bStephenColagiuri^cLeonorGuariguata^dAyesha A.Motala^eKatherineOgurtsova^fJonathan E.Shaw^gDominicBright^hRhysWilliams^hOn behalf of the IDF Diabetes Atlas Committee¹

https://doi.org/10.1016/j.diabres.2019.10784

3. September 3, 2021. Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study

Amanda E. Paluch, PhD1; Kelley Pettee Gabriel, PhD2; Janet E. Fulton, PhD3; et al. JAMA Netw Open. 2021;4(9):e2124516. doi:10.1001/jamanetworkopen.2021.24516

4. Good Housekeeping. Rula Al-Naswari Nov 4^th 2019. 30 Celebrities Who You Didn’t Know Have Diabetes