Diabetes Mellitus is synonymous to sugar to many people. In fact so much so that in Malay it is literally translated as 'Sweet Urine' (Kencing Manis) with the possible explanation that the sugar that you eat in excess gets excreted in your urine. I used to wonder if anyone had actually tasted the urine then fortunately one of my Chemistry teachers told us that back in the days he knew someone with diabetes that when this person urinated, ants crawled towards the urine! Fact or myth? Now let's simplify what actually happens inside our body if we have diabetes.
Diabetes is essentially a health condition where you might have a high sugar level in your bloodstream, inadequate insulin secretion, sluggish insulin action or even both. Note the word 'bloodstream', hence this why for many of us, the primary method of diagnosis is a fasting blood sugar, glucose tolerance test etc. A lot of the time, there is no symptom that we could pick up ourselves but if you notice either of these early symptoms, you should be more alert:
- Increased in thirst
- Increased in production of urine
- Weight loss/weight gain
If this rings any bell and you are concerned about it, especially if you have a long family history of diabetes, make an appointment with your family doctor who will lead you to the right direction.
Generally speaking, there are two broad types of diabetes simply called Type 1 and Type 2 Diabetes. Type 1 is often as a result of inadequate insulin which usually presents early in childhood. Type 2 on the other hand is due to sluggish insulin action or/and partial inefficiency that overweight adults often encounter.
Why do we consume sugar?
We consume sugar mainly to feed our brain. When there is excess sugar, we need our liver to store away the sugar and it will also send signals to the muscle tissues and fat tissues to help with storing away the abundant sugar in our bloodstream. If there is not enough sugar in our blood, the liver and the fat tissues will release its stored glucose to help our brain to function properly (which is why as you might notice, when we do not have enough sugar, we cannot think straight and we get grumpy!) Amazingly, the key to these processes is insulin hormone which is released by the pancreas as it regulates them and makes sure that our blood sugar level remains within the healthy level of 3.5 to 8.0 mmol/L at all times.
In people with diabetes, there is either a lack of the hormone, resistance to the hormone or lack of its action as mentioned above. Therefore there is no control of the blood sugar level and everything goes haywire. The constantly erratic blood sugar level is going to complicate our health by affecting our eyes, nerves system, kidneys, skin, makes us more prone to infections and diabetic emergencies such as hypoglycaemia (very low blood sugar level), diabetic ketoacidosis (often in Type 1) and diabetic non-ketotic hyperosmolar state (often in Type 2), both of which characterized by very high blood glucose level. All of the diabetic emergencies can lead to coma and death.
There are many drugs that have been developed by the pharmaceutical companies to help people with diabetes in combating the problem but one thing that health practitioners still preach to their patients is to have a sensible and healthy diet. What this means is to recognize what makes our blood sugar go sky high and no, it is not just the sugar in your coffee, tea or cakes. On the other extreme, do not lead yourself to hypoglycaemia by avoiding food. Sensibility is the key.
Sugar & Carbohydrates
The words 'sugar' and 'carbohydrates' are used interchangeably all the time. There are 4 types of carbohydrates (or saccharides) in the biochemistry world, but luckily for us these are categorized into 2 broad groups in food science ; simple and complex. Simple carbs are sugars such as ones that you have in drinks and desserts and sources of complex carbs are starchy food such as potatoes, pasta, bread, etc. Both these types of carbohydrates will be metabolized in your body to become glucose. There is also another category of carbohydrate labeled : refined and unrefined. Refined sugar as the name suggests is the type that has been processed for you, such as granulated sugar, pasta, bread etc while unrefined sugar comes from natural sources which have not been processed such as apples, potatoes, sweet potatoes etc.
In people with diabetes it is advisable to take more of unrefined sugar because it will be absorbed slowly therefore it prevents the rapid 'swings' of blood glucose compared to when we take refined sugar. Food from unrefined sugar also has a lower glycaemic index and this indication helps in the metabolic control of diabetes as it means that it will raise your blood glucose slowly relative to the rate at which it will be absorbed.
Food recommended for diabetic patients would be based on the healthy food pyramid. This page is particularly useful in helping you map out your healthy diet plan:
- Starches e.g wholewheat pasta, bread or noodles, yam, potatoes, sweet potatoes, brown rice, etc
- Vegetables e.g lettuce, broccoli, spinach, peppers, carrots, tomatoes, cabbage
- Fruits e.g apples, papaya, berries, guava, fruit juices, etc
- Milk & dairy e.g milk, yogurt, cheese
- Meat and substitutes e.g chicken, beef, fish, other seafood, tofu, eggs etc
- Fat and sugar e.g vegetable oil, spread AND;
If you have diabetes and still find it difficult to understand what kind of food is suitable for you, how much of each to take, counting carbohydrates and need to talk to somebody about it, a dietitian or nutritionist would be the best person for you to talk to.
Other things you could do in aiding your diabetic control would be:
- Maintain a healthy weight by exercising
- Stop smoking
- If you take alcohol, keep it to the minimum
- Ensure you attend your regular diabetic consultation with a good compliance to your medication
If you are looking for recipes on our website that are suitable for people with diabetes, stay on the ones with the initial (D).
By the way, fact or myth that people with diabetes might have sugar in the urine? Fact. When there is too much of glucose in the bloodstream, as it passes through the kidneys, only a limited amount of glucose are able to be reabsorbed into the bloodstream, with the excess being excreted through our urine. Gotta love your chemistry teachers!
- Kumar & Clark, Clinical Medicine, 5th Edition, UK, Saunders (2004)
- Underwood, General & Systematic Pathology, 4th Edition, UK, Churchill Livingstone (2004)
- National Diabetes Information Clearinghouse (NDIC)
- Persatuan Diabetes Malaysia
- Wikipedia, the free encyclopedia