The Glycemic Index for Dummies – The Wrap Up for the Week

If you’re like me, a T2 with little time to monitor all this stuff … I mean I do drink Diet Coke, what more do you want?… here it is all on one page along with my patented [sort of] go/no-go list.  And, there is nothing to buy!

In my defence, the above is not quite accurate … I was diagnosed a T2 over a dozen years ago, was on the original panel for Avandia in New Zealand and the PRC and with a combo of tablets, limited exercise and diet, have returned an HbA1c under 7.0 for years now. 

However, one person has made the management of my diabetes so much easier…. Professor Jennie Brand-Miller, who holds a Personal
Chair in Human Nutrition in the School of Microbial
Biosciences at the University of Sydney. Her research interests
focus on all aspects of carbohydrates—diet and diabetes, the
glycemic index of foods, insulin resistance, lactose intolerance
and oligosaccharides* in infant nutrition. She holds a special
interest in evolutionary nutrition and the diet of Australian
Aboriginies.

That is the official resume: I know a little of her personal struggle
to get the GI recognised – the dismissal by colleagues overseas.
The academic world is small –even smaller for diabetics.
She defied an army of critics and now the Sydney University
Glycemic Index Research Service [SUGIRS –cute?]  is
respected around the world. Jennie not only persevered, her
books have sold over 2M copies around the world -her nickname around Sydney Uni is ‘GI Jennie’!

The GI Index

The Glycemic Index is actually just a way of saying “this food raises your blood glucose, or blood sugar, a little bit, or a lot or something in between”. So, it’s simply a scale from zero to one hundred, a bit like a thermometer scale, and the foods that have G-I values close to 100 contain carbohydrates that are able to raise your blood glucose really quickly and that affect is not a good affect, you want carbohydrates to come in slowly, from a health point of view.

Classification GI range and examples:
Low GI - 55 or less - examples include: most fruit and vegetables (but not potatoes), basmati rice, oats, All-bran, Aussie Special K …and, go prunes!
Medium GI - 56 - 69 - examples include: sucrose, Mars bar, bananas, most power bars.
High - GI 70 or more - examples include: corn flakes, potato, jasmine rice, white bread, white rice, Rice Chex, forget scones and rice cakes and Gatorade.
GI Load

The glycemic load (GL) is a ranking system for carbohydrate content in food portions based on their glycemic index (GI) and the portion size.

The usefulness of glycemic load is based on the idea that a high glycemic index food consumed in small quantities would give the same effect as larger quantities of a low glycemic index food on blood sugar. For example, white rice is somewhat high GI, so eating 50g of white rice at one sitting would give a particular glucose curve in the blood, while 25g would give the same curve but half the height. Since the peak height is probably the most important parameter, multiplying the amount of carbohydrates in a food serving by the glycemic index gives an idea of how much effect an actual portion of food has on blood sugar level.

The GI Label

Look for it – you will find it on previous no-go foods like: breads, breakfast cereals, yoghurts and chocolate drinks … and, you can believe them!

When you see the GI Symbol  on a food package label, you will find the GI value of that food near the nutrition information panel, along with the words ‘high’, ‘medium’ or ‘low’. The value is a reliable measure based on proper testing in people.

My Personal Go/No-Go Food List

As I said at the start of this – I have kept my HbA1c below 7 for years as a T2 diagnosed over a dozen years ago via a little exercise, tablets and diet.  During that period, I started a Cable TV network in the US, a school in China and a new department at a University in NSW.  I needed a quick and easy to remember guide and the ability to eat out often.

Oooooh, how I wish I had access to this lot in Beijing! 

My go food list – at any time in any place – in sensible portions….

All- Bran [Aussie is lower than US!]              

Muesli

Pasta [just about all types]                          

Sweet Potatoes & Yams

Milk  [just about all types]                           

Yoghurts [look for natural sweeten]

Beans                                                         

Nuts & Raisins

Fruits  [skip dates]                                     

Vegies  [skip pumpkin and potato]

Meat, Poultry & Fish –have no carbohydrates, so no GI – watch the fat &
frying! However, woking is a good way to go! Wait till Monday.

More on my simple, go/no-go approach on Monday!

*oligosaccharides - for those that really want to know – they are natural sugars
occurring in plants, some of which are in the Aborigine diet!

Technorati Tags: classifications of GI foods, G.I, G.I Labels, G.I Load, GI, GI Foods, GI label, GI load, T2 eating, T2 GI food, T2 GI recommendations, what are low GI foods, what is low GI

Geoacaching and Strips

This has to be crazy but anything that gets me exercising has got to be worthwhile!

A friend in the States tipped me off to this blog where I found the following post:-

I want to share an inspiration I had, thanks to my son’s recent diagnosis as having type-1 diabetes . . . those little test-strip containers make outstanding micro-cache canisters!

The canisters are slightly smaller than film canisters and have a water-tight, attached lid. They are also lined with a dust-free, solid desiccant material that dries out any moisture that gets inside, so paper log pages stay dry, or get dried out if they are rained on while being logged.

Leave it to a geocacher to discover a small water-tight container and get all excited.

I tested these canisters by closing a dripping wet piece of paper into one. Over the period of a day and a half the paper was dried completely. So, I soaked the paper again. And again, the paper dried completely. I’m sure there is a limit to the amount of water the desiccant can absorb, but clearly it is enough to keep all but the most abused geocache dry for a very long time through many rainy days/months of logging. And heck, even if you are not concerned about moisture, the size and the attached lid still make these one of the best micro-cache containers I’ve ever seen (I’m not a real fan of “ultra-micros).

I am interested in trying to market these little gems with 100% of the proceeds [sic] going to support diabetes research. I just posted a set of three of these with some custom log pages on eBay. Please let me know what you think and if you have any other ideas on how to promote diabetes support with geocaching. I really appreciate the GC.com travel bug support of diabetes. I think it is exceptionally cool.

My son tests enough to generate another empty canister about every two or three days, so we probably have about 150 of these saved up right now. I expect there are other diabetic geocachers out there that could contribute to this cause as well.

What is Geocaching?

Geocaching is an entertaining adventure game for gps users. Participating in a cache hunt is a good way to take advantage of the wonderful features and capability of a gps unit. The basic idea is to have individuals and organizations set up caches all over the world and share the locations of these caches on the internet.

GPS users can then use the location coordinates to find the caches. Once found, a cache may provide the visitor with a wide variety of rewards. All the visitor is asked to do is if they get something they should try to leave something for the cache.

Now I know what to do with all my strip canisters other than give them to my 8yo daughter who incorporates them with her doll play somehow!

Technorati Tags: Diabetes Blog, Diabetes Test Strips, Geocaching, type 1 diabetes

Diabetes and Travelling - Part 2

A Collection of Tips…Part Two

Continuing an overview of good things to do as a diabetic traveller…. If you would like to read the first five tips, start here….

6.  Check Your BGL Frequently – I know there are plenty of you out there testing 8, 12, 16+ times a day, so to you I give a thumbs up .

But for others I would suggest, especially if travelling more than 3 time zones to test glucose levels more frequently….  And from Australia, we tend to do that all the time. We all get in the habit of keeping a mental note of what effects certain foods have on our blood sugars (at least I do). But being in a different time zone and eating different foods can have a much greater effect on your blood sugar than you think.

For example, I fly between Sydney and the West coast of the U.S. regularly and notice drastic changes once I reach each side. My blood sugars get extremely low even when eating the same foods. It’s almost as if my insulin starts working 50% more within my body for the next few days after arrival and I have to make constant adjustments. This is something that would be good to consider.

The effects of Jet Lag can be worse for diabetics. However, there are things you can do.

7.  Discuss it with the Doc –When you are going on a rather long trip, it is a good idea to get checked out by your doctor a few weeks before going.

Consult with him or her and explain the length and extent of the trip. You could even talk about the cultural and culinary differences between your home and where you’re going and how it might affect your blood sugar. Also make sure you’ve brought more medical supplies than you think you’ll need. This includes extra insulin/pills, syringes, fast acting glucose tablets, fast acting insulin for emergency highs … always carry a copy of your prescriptions … particularly since 9/11.

How you pack your meds is also important. When I first started my trips to China, the only real diabetic drugs available were Glibenclamide… and as a T2; I was using a mix of tablets.

8. Bottled Water, Drink it! – Hydration is very important, but just as important is the quality of your hydration source. Especially if you’re in a foreign country where the water quality is debatable then pick up a few bottles of drinking water. Trust me; even in locations within the U.S. the water quality is far from optimal. Better safe than sorry.

9. Check Out Travel Insurance – Especially when staying on longer trips and even after extensive packing there is still a chance for things to go wrong. What happens when your luggage with your 5 weeks worth of medication gets lost at the airport?  Contact your insurance company and see what they can cover in case you aren’t already covered. It also might not hurt to inquire about international travel insurance if you plan on going abroad.

As part of your travel planning visit Diabetes Australia and download their handy guide.

10.  Watch the Alcohol – Ah yes, temptation again. You may feel like “letting loose” with a few too many martinis at the coconut bar on your island get away but try to resist. People with diabetes can enjoy alcohol just like everyone else but the key is moderation (Just like everyone else). Some tips involve being selective about what you drink, the sugars and calories in those mixers add up very quickly.

Also, eat something before drinking, drinking on an empty stomach is never a good idea whether you have diabetes or not. I’m sure (hopefully) you’re “celebrating” with other people and just not getting drunk by yourself, if so make sure they know your situation in case of emergency and even to support you in not over doing it.

As an insulin dependent Type 1, read a special article on travelling in the young diabetic website Reality Check… a great place to visit even if you’re a certified oldie like me.

Technorati Tags: insulin, living with diabetes, Travel Tips, Travelling with diabetes, Type 1, Type 2

Blood Sugar Targets

It is interesting that different people will give you different BGL targets. I am 65, a Type 2 and my GP is happy if my fasting is around 7.5 while others tell me that’s terrible (particularly my super-healthy brother –another Type 2). However age is a factor for target scores  … I can usually hit the 6’s … but what do the pro’s say?

The American Association of Clinical Endocrinologists (AACE) recommends the following general blood glucose testing goals for adults with type 1 and type 2 diabetes:

Preprandial* (fasting, or before a meal) - 6.1 mmol/l [100 in USA]

Two hours postprandial (after the start of a meal) - 7.8 mmol/l [140 in USA].

Our own NSW branch of Diabetes Australia push a far higher threshold on a whole page on BGL and are supporting an innovative thing called a self-test scratchie… a great gift for those friends who think they may have diabetes and want to use your monitor.

They say….

• If your BGL reading is less than 5.5 Diabetes is unlikely.
It is recommended that you retest your BGL in three years.

• If your BGL is between 5.5 - 6.9
The results require further investigation. An Oral Glucose Tolerance test (OGTT) should be taken …. Who still remembers their first free glass of orange juice?

Down South they are a little tougher ….

From Diabetes Australia – Victoria… the following recommendations…

Targets For Glycaemic Control:

Risk of hypoglycaemia (low blood glucose) - Less than 3.5 mmol/L if insulin or certain types of tablets are used, but this does not apply to other tablets or where glucose is controlled by meal plans alone.

Normal levels 4-6 mmol/L before meals
4-8 mmol/L after meals*

Ideal levels 4-6 mmol/L before meals
Up to 8 mmol/L after meals*

Moderate levels 6-7 mmol/L before meals
Up to 11 mmol/L after meals*

High levels More than 7 mmol/L before meals
More than 11 mmol/L after meals*
* Two hours after starting the meal

While The American Diabetes Association also lowers the bar considerably ….
Time of Test                                         Goal Plasma Glucose

Before meals                               90-130 mg/dL (milligrams per deciliter) [ 5.0 to 7.2]*
Before bedtime snack                   (1-2 hours after a meal/postprandial)
                                                      less than 180mg/dL [10.0]*

                                                  * Official Diabetes Blog conversions.

However, most discussion centres on the lower thresholds for diagnosis … if you are reading American blogs and you want to do the conversions [I like doing them in my head – like metric vs. imperial] there’s a cool converter here.

At what point do you find you get a hypo? I get that dizzy feeling around 3.5 and have taught myself to recognise it – my briefcase is always stocked with muesli bars

Technorati Tags: Blood Glucose Levels, Blood Sugar Converter, Diabetes Management, Hypos

History of Insulin and its Future

Traditionally, clinicians have used oral agents for as long as possible before reverting to insulin. However, we are now moving towards a culture in which insulin is being advocated earlier in the disease process; particulalry in Europe.

This is particularly true in type 2 diabetes where intensive treatment is not associated with the same risk of hypoglycaemia often seen in type 1 diabetes. In addition, recent developments with insulin analogues have made insulin a far more versatile management tool than has been the case in the past.

Looking back at the first-generation insulins in the 1920s, there were problems with supply, impurity and inconsistency of potency. Despite Hagedorn’s discovery of NPH [early 20’s and Novo Nordisk the Danish company was founded on it … the H in the name is actually his!] –the first protracted insulin to be made available–there remained problems of instability combined with injection pain.

Little progress was made until the 1950s and 60s when NPH and Lente insulins provided more tolerable intermediate action. The mid-1960s saw Novo’s first mono-component insulin which was:

• Highly purified
• Had no animal proteins
• Contained no contaminants
• Possessed a specification higher than had previously been achieved.

Following the Nobel prize-winning work of Dorothy Hodgkins on the structure of insulin in the early 1960s, the potential of interfering with the biokinetics of insulin pointed to the potential for designer products in the future. However, the first short-acting analogues did not appear until the 1990s.

The most recent development has been the 2004 introduction of Levemir® (insulin detemir), the long-acting insulin analogue which has a more predictable glucose-lowering effect than both NPH insulin and insulin glargine (the first long-acting insulin analogue, which appeared in 2002) in patients with type 1 diabetes as well as producing fewer nocturnal hypoglycaemic events than NPH.

Last year both Levemir and Lantus [another analaogue from sanofi-aventus, USA] were approved for use in Australia and as part of the PBS – thanks Diabetes Australia for a great lobbying effort! Quick note: it is not yet approved here for Type 2 pateients except on private script.

Technorati Tags: Diabetes Management, Diabetes Treatment, History of Insulin, insulin, insulin injections, type 1 diabetes, Type 2 Diabetes

Staying Well With Diabetes

Over time, high blood glucose levels can damage the body’s organs. However, the good news is that most diabetes-related complications can be prevented.

Today’s post will help you to understand the risks and know what you can do to reduce your risk or even prevent getting complications at all.

WHAT ARE THE MOST COMMON COMPLICATIONS OF DIABETES?

• Damage to the big blood vessels (microvascular/ cardiovascular complications) leading to heart attack and stroke.
• Damage to the small blood vessels (microvascular complications) causing problems in the eyes, kidneys, feet and nerves.
• Other parts of the body can be affected by diabetes including the digestive system, skin, and immune system. Although not considered a complication, people with diabetes may have more thyroid problems than people without diabetes.

Cardiovascular disease (blood vessel disease, heart attack and stroke) is the leading cause of death in all Australians. However, in diabetes the risk is greater. People with diabetes often have increased cholesterol and blood pressure levels. When these are combined with increased blood glucose levels the risk of cardiovascular disease increases.

Smoking, having a family history of cardiovascular disease and being inactive also increase the risk.

WHAT CAN HAPPEN IF BIG BLOOD VESSELS ARE DAMAMGED?

Damage to the big blood vessel can lead to heart attack and stroke.

Heart Attack – Typical Symptoms Can Include:

• Squeezing or crushing chest pain going down the arms.
• Arm or jaw discomfort.
• Feeling anxious, sweaty, breathless or weak.

Heart Attack – People With Diabetes May Have Different Symptoms Such As:

• No signs at all, leading to a ‘silent’ heart attack.
• Indigestion, bloating and nausea.

Women in general, and particularly those with diabetes, are more likely to have these and/or other symptoms.

Stroke – Symptoms Can Include:

• Feeling dizzy.
• Feeling confused.
• Loss of strength or movement of the face, arm and /or leg on one side of the body.
• Loss of feeling of the face, arm and/or leg on one side of the body.
• Double or blurred vision.
• Droopy smile or finding it hard to talk or swallow.

If you think you might be having a heart attack or stroke, dial 000 immediately and if possible, call someone for help.

Blockage Of Blood Vessels Feeding The Legs – Symptoms Include:

• Pain in one or both legs when walking (intermittent claudication).
• Loss of hair growth, shiny skin on legs.
• Cold, discoloured feet.
• Slow-healing skin wounds.

HOW TO REDUCE THE RISK OF DAMAGE TO THE BIG BLOOD VESSELS

There are a number of things which can be done to reduce the risk or even prevent damage to the big blood vessels. This can help you to stay well with diabetes.

What you can do to reduce the risk of damage:
• Test your blood glucose levels as recommended.
Aim to keep your blood glucose levels as normal as possible (ideal range is 3.5 – 8.0 mmol/L). For more information refer to the Blood Glucose Monitoring fact sheet and talk to your doctor or diabetes educator.
• Don’t smoke.
If you smoke – stop! If you feel you can’t give up smoking on your own, ask for help (call Quitline 131 848).
• Be physically active.
Do at least 30 minutes of moderate physical activity on most, if not all, days of the week.
• Follow a healthy eating plan.
Talk to a dietician. Also refer to the Food Choices and Diabetes fact sheet.
• Lose Weight
Losing even a small amount of weight will help reduce your blood pressure, blood glucose and cholesterol levels.
• Look after your feet.
Check your feet every day and if concerned, see a podiatrist. Try to choose footwear which protects your feet.

What you diabetes team can do to reduce the risk of damage:

• Cholesterol - Your diabetes team should arrange to have your cholesterol and triglycerides checked at least once a year*.
• Blood pressure - Every time you visit your doctor, have your blood pressure checked. As a general guide, the ideal is less than 130/80 (less than 140/90 in the elderly).
• HbA1c (glycated-haemoglobin) - This test shows an average of your blood glucose levels over the past 10-12 weeks and should be arranged by your diabetes team every 3-6 months*. Aim to keep HbA1c levels under 7%.
• Ask your doctor if you should be taking low dose aspirin as it can help protect you from heart attack.

*unless otherwise recommended
 

WHAT CHOLESTEROL LEVEL DO I AIM FOR?

While the ideal total cholesterol level is less than 4.0 mmol/L, it’s important to know there is ‘bad’ cholesterol and ‘good’ cholesterol.

• ‘Bad’ Cholesterol
LDL cholesterol is known as ‘bad’ cholesterol. Higher levels of LDL increase your risk of heart and blood vessel diease. LDL should be less than 2.5 mmol/L.

• Triglycerides are another kind of blood fat that increase the risk of heart disease. Triglycerides should be less than 2.0 mmol/L.

• ‘Good’ Cholesterol
HDL is known as ‘good’ cholesterol. A level higher than 1.0 mmol/L helps to protect the heart and blood vessels.

How To Reduce Your Cholesterol

• You can help reduce the ‘bad’ cholesterol and triglycerides by avoiding saturated fats (fats from animal products, palm and coconuts found in processed foods) in the food you eat. If you drink alcohol, do so in moderation.
• Regular physical activity will also help reduce the ‘bad’ cholesterol and at the same time increase your ‘good’ cholesterol.

WHAT CAN HAPPEN IF SMALL BLOOD VESSELS ARE DAMAGED?

Small blood vessel damage in diabetes can affect the eyes, kidneys, nerves and feet.

The Eyes

• Blurred Vision
When blood glucose levels are high (eg: at the time of diagnosis) there may be changes in the shape of the lens of the eye causing blurred vision. This usually goes away when blood glucose levels return to a lower level.

• Cataracts
A cataract is a ‘clouding’ of the eye lens that can also cause blurred vision. Cataracts are more common in people with diabetes and can occur at a younger age than for those without diabetes. They can be repaired with surgery.

• Glaucoma
Glaucoma occurs when pressure in the eye is too high. This can damage the nerves that connect the eye to the brain and lead to blindness. However, early treatment can stop further vision loss.

• Retinopathy
This is a condition where the tiny blood vessels at the back of the eye are damaged by elevated blood glucose levels over a period of time. These damaged blood vessels can cause loss of vision if they leak, bleed or become blocked. Many people don’t notice any problems in their sight until retinopathy is well advanced. So it is very important to have an ophthalmologist or qualified optometrist check your eyes every 1-2 years*. Early detection and laser treatment can prevent further damage and loss of vision.

How To Reduce The Risk Of Eye Damage

• Keep your blood glucose levels, HbA1c and blood pressure at recommended levels.

• If you do not notice any changes in your vision, contact your doctor or eye specialist immediately.

• If you have Type 2 diabetes, your eyes should have been checked at the time you were diagnosed then every 1-2 years* - more often if problems already exist.

• If you have Type 1 diabetes, your eyes should be checked five years after you were diagnosed then every year* - more often if problems already exist.

The Kidneys (renal disease)

Increased blood glucose levels over time and elevated blood pressure can increase the risk of long term damage to the kidneys (nephropathy). People with diabetes are likely to have urinary tract infections more often than people without diabetes which can cause or worsen damage to the kidneys.

How To Reduce The Risk Of Kidney Damage

• Keep your blood glucose levels, HbA1c and blood pressure at recommended levels.

• Your doctor should arrange a urine test for micro albuminuria (tiny pieces of protein in the urine) every year*. You may need other kidney function tests as well.

• Talk to your doctor about blood pressure medications called ACE inhibitors and Angiotensin Receptor Antagonists which also help to protect the kidneys. You can be on these medications without blood pressure problems.

• If you think you have a bladder or kidney infection, contact your doctor immediately. Symptoms can include cloudy or bloody urine, passing water more often and/or feeling the need to pass water more often and/or a ‘burning’ when passing water. Incontinence (bedwetting or loss of bladder control) can be a sign, as can increased blood glucose levels.

• If you have kidney disease, keeping blood pressure under 125/75 can help to slow damage.

*unless otherwise recommended.

The Nerves (neuropathy)

• Nerve damage can be caused by high blood glucose levels, drinking large amounts of alcohol and other disorders.

• Damage an occur to the ‘feeling’ (sensory) nerves affecting the legs, arms, hands, chest and stomach.

• There can also be damage to the nerves that control actions of body organs (automatic nerves). This can cause problems with stomach emptying (gastroparesis), intestines (diabetic diarrhoea or constipation) and the genitals (erectile dysfunction – for more information refer to the Sexual Health and Diabetes fact sheet).

What Are The Symptoms Of Nerve Damage?

These can include the following:

Feet And Hands

• Pins and needles
• Tingling or pain
• Lack of feeling

Stomach Emptying (gastroparesis)

• Changes in the speed of stomach emptying, which can affect blood glucose levels
• Nausea and vomiting
• Bloating
• Heartburn and feeling constantly full

Intestines

• Constipation (the most common digestive problem in diabetes)
• Loose tools, especially at night (diabetic diarrhoea)

Erectile Dysfunction

• Not being able to get or keep an erection long enough for intercourse.

How To Reduce To Risk Of Nerve Damage

• Keep your blood glucose and HbA1c at recommended levels.
• Tell your doctor about any tingling, pain or numbness in your feet or hands.
• Tell your doctor about any digestive complaints and see a dietician who may be able to help with your eating plan.
• Look after your feet and check them every day.
• Have a yearly foot check by your podiatrist, doctor or diabetes educator. For more information refer to the Foot Care and Diabetes fact sheet.
• If you drink alcohol, have no more than 2 standard drinks per day for men and 1 for women. Also have 2 alcohol free days per week. If you are over 65, consider halving this amount.

DOES DIABETES AFFECT THE SKIN?

The most common problem is very dry skin caused by damage to the small blood vessels and nerves.

How To Reduce The Risk Of Skin Problems

• Keep your blood glucose levels and HbA1c as near to normal as possible to reduce the risk of skin infections.
• Don’t let your house get too hot, especially in winter when the heaters are on and, if possible, increase the humidity.
• Protect your skin by wearing gloves if you are using household cleaners and solvents.
• Avoid very hot baths and showers and use non-scented soaps.
• Use a cream or lotion on your skin after bathing, preferably one that is perfume-free.
• Check your feet every day. If you have dry, rough or cracked skin on your feet, soo your podiatrist or doctor and refer to the Foot Care and Diabetes fact sheet.
• See your doctor if your skin is very dry or irritated.

ARE THERE OTHER PARTS OF THE BODY AT RISK OF DAMAGE?

Teeth And Gums

People with diabetes can have a higher risk of tooth decay and gum infections when their blood glucose levels are high. Tooth and hum infections can increase your risk of heart diease.

Signs of dental problems:

• Dry mouth and/or burning tongue
• Red, sore, swollen or bleeding gums
• White film on your gums, inside cheeks or tongue.

How To Reduce The Risk Of Problems

• Regularly visit your dentist, who needs to know that you have diabetes and will show you how to care for your teeth and gums.
• If you have a dry mouth, drink water. Sugarless gum can help increase saliva production.

Immune System

The immune system helps to ward off and fight infection. By slowing the action of white blood cells, high blood glucose levels make it more difficult to prevent and fight infection.

How To Reduce The Risk Of Infection

• Keep your blood glucose levels in target range
• Get plenty of rest
• Wash your hands often
• All people with diabetes should have a yearly influenza (flu) injection. Ask your doctor about a pneumonia injection.

Thyroid

Although diabetes doesn’t directly cause thyroid problems, studies show an increased risk of hypothyroidism (low thyroid levels) in people with Type 1 and Type 2 diabetes, especially in women over 40.

How To Reduce The Risk Of Problems

• Your doctor may recommend a test for thyroid function (TSH) every 5 years.

Remember, most diabetes-related complication can be prevented. By following the advice in this fact sheet, you can stay well with diabetes. If you have any concerns, always discuss them with your doctor or diabetes health professional.

About The Author:
Diabetes Australia Victoria is the peak consumer body representing people with diabetes in Victoria and providing vital support and information to the community about diabetes.  To find out more about Diabetes Australia Victoria please click here

Technorati Tags: Diabetes Complications, Diabetes Diets, Diabetes Education, Diabetes Facts, Diabetes Management, Diabetes Professionals, Diabetes Risk Factors, Diabetes Support, Diabetes Treatment, Lifestyle Modification, living with diabetes, Monitoring Diabetes

Balancing Food, Activity And Insulin

Healthy eating is essential to managing diabetes, whether you take tablets, insulin or no medication.

Finding The Balance

To manage your blood glucose levels, you need to aim for a balance between the amount of food you eat, the physical activity you do and the insulin you take. You will need to consider the timing, amount and type of carbohydrate foods you eat, as well as the timing, amount and type of the insulin you take. Your dietician can provide advice on an eating plan that’s best for you.

It isn’t always easy to find the right balance, but regular blood glucose testing will help. Your diabetes educator or doctor will tell you more about testing (also refer to our post about Glucose Monitoring).

Carbohydrates

Carbohydrates provide energy and good nutrition.

The timing – why is it important?

The aim of good diabetes management is to match your insulin intake with the carbohydrates you eat. There are many different types of insulin with different actions such as the time they start to take effect, reach their peak and run out. It is important to eat a regular and consistent amount of carbohydrate containing foods throughout the day. If your carbohydrate meal plan is regular from day to day, it will be a lot easier to manage your blood glucose levels.

The amount – too little or too much?

If you eat more carbohydrate than usual, without increasing your physical activity or your insulin, your blood glucose level can rise too high (hyperglycemia). If you eat too little carbohydrate or skip a meal, your blood glucose level can drop too low (hypoglycemia or hypo). That’s why you need to find the right balance of carbohydrate containing foods.

There is no ‘one size fits all’ as the amount of carbohydrate that’s right for you will depend on your age, body size and how physically active you are. Some people use carbohydrate ‘exchange’ or ‘serve’ lists to work out the amount of carbohydrate they eat and keep it consistent day to day (one carbohydrate ‘exchange’ contains 15 grams of total carbohydrate). Reading food labels or carbohydrate counters can help you calculate the amount of carbohydrate in various foods.

The type – why does it matter?

The Glycemic Index (GI) is a ranking of the effect a carbohydrate food has on your blood glucose levels. For example, foods with a low GI raise blood glucose levels more slowly than foods with a high GI. Knowing the GI of the foods you eat can help you to manage your blood glucose levels. Including carbohydrate foods that have a low GI may help to prevent hypos between meals, whereas foods with a high GI are useful during prolonged physical activity. But remember, eating too much of any carbohydrate will still raise your blood glucose levels.

Alcohol - Can I Drink It?

Most people using insulin can drink alcohol in moderation. Be aware though that alcohol can increase the risk of a hypo. The common symptoms of a hypo (weakness, shaking, dizziness, sweating and lack of concentration) can be similar to the behavior of someone who is drunk, so there is a risk that your hypo may go unnoticed if no one knows you have diabetes.

A hypo can also be harder to treat after drinking large amounts of alcohol. In General, The Maximum Amount Of Alcohol Recommended For A Person With Diabetes Is:

 • 1 standard drinks a day if you are female

 • 2 standard drinks a day if you are male It is also recommended you have at least 2 alcohol-free days a week. (One standard drink is equal to 285mL regular beer, 425mL low alcohol beer, 100mL wine, 60mL fortified wine or 30mL spirits).

Here Are A Few Tips To Reduce The Risk Of An Alcohol-Related Hypo:

 • Make sure someone with you knows you have diabetes

 • Drink in moderation

 • Always eat some form of carbohydrate when drinking alcohol*

 • Eat a low GI snack before bed

 • Test your blood glucose level before bed

 • Wear some form of diabetes identification (eg: MedicAlert®)

*if there are no carbohydrate foods available, use a standard soft drink or fruit juice when mixing drinks. Otherwise, use a low joule (diet) soft drink as a mixer.

Physical Activity - How Does It Help?

Regular Physical Activity Helps To:

 • Improve insulin sensitivity which makes insulin work better and lowers blood glucose levels

 • Control blood fats (cholesterol and triglycerides), blood pressure and body weight.

 • Increase bone strength and improve your general sense of well being. How Can I Avoid An Exercise-Related Hypo? Physical activity can cause your blood glucose levels to drop low. People taking insulin need to plan ahead before physical activity.

Here Are Some Tips To Reduce The Risk Of Hypos Due To Physical Activity:

 • If your blood glucose level is below 6 mmol/L, you may need an extra carbohydrate snack before starting your activity.

 • If you are being active for a long time, make sure you have some carbohydrate food or drink during your activity.

 • Adjusting insulin may also help to reduce your risk of a hypo. Discuss with your doctor or diabetes educator how to adjust your dose depending on the type and length of your activity.

 • Testing your blood glucose level before, during (if exercising for a long time) and after your physical activity will help you to find the right balance.

 • Physical activity can lower blood glucose levels for up to 24 hours afterwards. Having more carbohydrate at your next meal or snack and a low GI carbohydrate containing food before bed can help. Adjusting your insulin at bedtime may also be an option – discuss this with your doctor or diabetes educator.

Sometimes, physical activity may cause a temporary rise in blood glucose levels, particularly if the activity has been competitive or stressful. Despite this rise, you need to have adequate carbohydrate containing foods afterwards, as a delayed hypo may still occur. People with Type 1 diabetes are generally discouraged from strenuous physical activity when blood glucose levels are above 15 mmol/L as it can cause levels to rise even further.

Other Issues

People with diabetes also need to consider factors relating to their feet, eyes, kidneys and heart, so it is important to talk to your doctor before starting any new physical activity program.

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Blood Glucose Monitoring

9.1 Why Is It So Important To Test My Blood?

Self-blood glucose monitoring (SBGM) is a valuable diabetes management tool, which enables people to check their own blood glucose levels as often as they need to or as recommended.

Regular testing of your blood glucose level (BGL) can reinforce your healthy lifestyle choices as well as inform you of your response to other choices and influences.

Importantly, BGL pattern changes can alert you and your health professionals to a possible need for a change in how your diabetes is being managed.

Testing your BGL’s will help you to:

• Develop confidence in looking after your diabetes.
• Better understand the relationship between your BGLs and the exercise you do, the food you eat and other lifestyle influences such as travel, stress and illness.
• Know how your lifestyle choices and medication, if used, are making a difference.
• Find out immediately if your BGLs are too high (hyperglycaemia) or too low (hypoglycaemia), helping you to make important decisions such as eating before exercise, treating a ‘hypo’ or seeking medical advice if sick. (For more information refer to Diabetes Australia’s individual fact sheets on Physical Activity, Hypoglycaemia and Sick Days about these topics).
• Know when to seek the advice of your diabetes health professional about adjusting your insulin, tablets, meal or snack planning when BGL goals are not being met.

How Do I Test My Blood?

You will need a blood glucose meter, a lancet device with lancets and test strips. The finger in pricked with a lancet to obtain a very small drop of blood which is then applied to a test strip placed in the meter. The results are displayed within seconds.

Blood glucose meters are usually sold as kits giving you all the equipment you need to start. There are many different types, offering different features and at different prices to meet individual needs. Most of these are available from Diabetes Australia, pharmacies and some diabetes centres.

A diabetes health professional such as diabetes educator can help you to choose the meter that’s best for you. Your diabetes educator will also give you all the information you need about how, where and when to test your blood glucose levels (BGLs) and work with you in planning a routine that works for you and the life you lead.

What Do I Aim For?

Successful management of diabetes is all about aiming for a careful balance between the food you eat, how active you are and the medication you take for your diabetes. Because this is a delicate balance, it can be quite difficult to achieve ideal control all the time.

For some people, the ranges will vary depending on the individual and their circumstances. While it is important to keep your BGLs as close to a normal or non-diabetic state as possible to prevent complications, it is equally important to check with your diabetes educator or doctor for the range of blood glucose levels that are right and safe for you. Therefore the following information should be treated only as a general guide.

Targets For Glycaemic Control

Risk of hypoglycaemia
(low blood glucose) Less than 3.5mmol/L*  - if insulin or certain types of tablets are used, but does not apply to other tablets or where blood glucose is controlled by meal plans alone
Normal levels 4-6mmol/L* before meals **
4-8mmol/L* after meals **
Ideal levels 4-6mmol/L* before meals
Up to 8mmol/L* after meals **
Moderate levels 6-7mmol/L before meals
Up to 11mmol/L* after meals **
Above target levels More than 7mmol/L* before meals
More than 11mmol/L* after meals**

*In Australia blood glucose levels are measured in mmol/L (millimoles per litre). In some other countries the unit of measurement if mg/dL (milligrams per decilitre).

**Two hours after starting the meal

Targets for glycaemic control taken from Diabetes and You – the Essential Guide, published by Diabetes Australia 1999, revised 2002.
Who Is At Risk Of Low Blood Glucose (Hypoglycaemia)?

• People who are using insulin or those taking diabetes tablets which increase their own insulin production are at risk as both have the effect of lowering blood glucose. They can therefore cause hypoglycaemia (low blood glucose) when BGLs are less than 3.5mmol/L. (Note: Hypoglycaemia can occur at higher BGL levels in children and people who have had higher BGLs for a long time).
• People whose diabetes is managed by lifestyle alone or with other types of diabetes tablets which do not increase their own insulin production, are not at risk of hypoglycaemia.

Are High Blood Glucose Levels Dangerous?

Sometimes you may get a higher BGL reading than usual and you may not be able to figure out the reason. When you are sick with a virus or flu, your blood glucose levels will nearly always go up and you may need to contact your doctor, especially if ketones are present. However, it is only when BGLs are consistently higher than they ought to be over weeks or month that the damage-causing complications can occur.

What Causes Glucose Levels To Go Up And Down?

There are a number of common causes for glucose levels to increase or decrease. These include:

• Food – time eaten, type and amount of carbohydrate (eg: bread, pasta, cereals, vegetables, fruit and milk)
• Exercise or physical activity
• Illness and pain
• Diabetes medication
• Alcohol
• Emotional stress
• Testing techniques
• Other medications

When Should I Test?

Your diabetes health professional will help you decide how many tests are needed and the levels to aim for.

You will also be advised to record all your tests. Even though your meter may have a memory, it is important to keep a record of your readings in a diary and to take this with you to all appointments with your diabetes health professionals. Most meters on the market have software which will allow you to download your records in different formats such as graphs and charts. Even if you do this, it is still helpful to keep a diary, not only for your tests but also details of your daily activities, the food you eat and other relevant information. This will provide both you and your diabetes team with important information in deciding if and how your treatment may need to be adjusted.

Ask your doctor or diabetes educator about how you can use a diary to help you to better manage your diabetes.

A Guide For People With Type 1 Diabetes

• Testing at least three to four times a day is recommended. However many people with Type 1 diabetes do test more often, such as those using a pump (CSII – continuous subcutaneous insulin infusion).
• Test before breakfast (fasting), before lunch, before dinner and at bedtime.
• Test occasionally between 2am – 3am (overnight levels).
• Test 2 hours after any meal.

Test more often when you are:

• Being more physically active or less physically active
• Sick or stressed
• Experiencing changes in routine or eating habits eg: travelling
• Changing or adjusting insulin
• Experiencing symptoms of hypoglycaemia
• Experiencing symptoms of hyperglycaemia
• Experiencing night sweats or morning headaches

A Guide For People With Type 2 Diabetes

• Test once or twice every day, changing the time of day at which your test is done or as directed by your doctor or diabetes educator.

• Suggested times to choose from are:

o Before breakfast (fasting)
o Two hours after any meal
o Before bed

If your diabetes is stable, this may be reduced to one or two tests a day, two to three times a week.

You may need to test more often when you are:

• Sick or stressed
• Experiencing changes in routine or eating habits eg: travelling
• Changing your medications and/or insulin
• Being more physically active or less physically active
• Experiencing symptoms of hypoglycaemia
• Experiencing symptoms of hyperglycaemia
• Experiencing night sweats or morning headaches

What If The Test Result Doesn’t Seem Right?

If you’re not convinced that a result is correct, here’s a suggested checklist:

• Have the strips expired?
• If the strip the right one for the meter?
• Is there enough blood on the strip?
• Has the strip been put into the meter the right way?
• Have the strips been affected by climate, heat or light?
• Did you wash and thoroughly dry your hands before doing the test?
• Is the meter clean?
• Is the meter too hot or too cold?
• Is the calibration code correct?
• Is the battery low or flat?

All meters will give a different result with a different drop of blood. As long as there is not a big difference (more than 2mmol/L) there is not usually cause for concern.

The accuracy of all meters can be checked with meter-specific liquid drops called control solutions. These are expensive, have a short shelf life and only last a few months once opened. However your diabetes health professional or pharmacy may be able to do this for you at no charge.

What Is Glycosylated Haemoglobin (Hba1c) Test?

The HbA1c test shows an average of your blood glucose level over the past 10-12 weeks and should be arranged by your doctor every 3-6 months. The measurement is expressed as a percentage (%) not as mmol/L like the tests you do on your blood glucose meter.

Is The Hba1c The Same As Testing Your Own Bgl’s?

No, the HbA1c test doesn’t show the highs and lows that your home testing shows. Therefore it does not replace the tests you do yourself but is used as an added tool in giving the overall picture of your blood glucose management.

What Hba1c Do I Aim For?

The goal for most people with diabetes will be in the 6.5% to 7% range however this may need to be higher for children and the old and frail. Your doctor will advise.

How Does It Work?

A glycated haemoglobin test is possible because red blood cells (RBC) are continuously being made by your long bones and released into your circulation. When these cells are released, they pick up a percentage (5) of the glucose in the blood stream at that time.

Each RBC lasts about 120 days. Therefore any blood sample will have a range of cells released over the previous 120 days with different amounts of glucose attached. The HbA1c test if able to work out the average.

About The Author:
Diabetes Australia Victoria is the peak consumer body representing people with diabetes in Victoria and providing vital support and information to the community about diabetes.  To find out more about Diabetes Australia Victoria please click here

Technorati Tags: Blood Glucose Levels, Diabetes Articles, Diabetes Associations, diabetes australia, Diabetes Diets, Diabetes Education, Diabetes Facts, Diabetes Literature, Diabetes Management, Diabetes Symptoms, Diabetes Testing, living with diabetes, Monitoring Diabetes

Person With Diabetes or Diabetic?

We have been having a constant struggle in our office with what is the politically correct term for someone with diabetes.  Is it “a person with diabetes” or is it “a diabetic”?

As I don’t have diabetes, I’ve asked Stephanie to open a poll on our forum to see what YOU prefer.

We’ve had emails from people on both sides of the debate.  Only last week i was going through all my posts on our forum and blog to see how I referred to people with diabetes. 

I do have to admit i have used the word “diabetic” a lot in the past.  After a lot of thought i decided that this was not the best word.  So i went back through all my previous posts and articles and changed it where possible. 

SO you now know where my vote lies what do you think?  What is the preferred way of referring to a person with Diabetes? (there i go again with MY preferred way)

Why dont you go ahead and vote on our online poll here

Technorati Tags: Diabetes Poll, Diabetes Terminology, Diabetic, Person With Diabetes