1 in 2 adults with diabetes is undiagnosed. As World Diabetes Day takes centrestage each 14th November, we cannot help but acknowledge the dramatic increase in the prevalence of diabetes in many parts of the world. In fact, diabetes used to be of higher risk in those who are 40 years old and above, but lately the onset of diabetes has been observed among the younger population - children and teenagers included.
The consumption of too much processed foods and a stressful lifestyle are all to blame. And sadly, diabetes is not a curable disease. It is, however, a disease that can be managed. It is therefore important to understand the misconceptions of diabetes and get reliable information to reduce confusion and get this disease under control.
Myth #1: Diabetes is caused by eating too much sugar.
Fact: It is not that simple. Diabetes is not caused by eating too much sugar. There are two types of diabetes: Type 1 and Type 2. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease.
Type 2 diabetes is caused when the body develops insulin resistance or when the body’s cells no longer absorb and use insulin as they should. Although insulin resistance is much more common in people who are overweight, thin people may also develop it.  In fact, Type 2 diabetes is caused by multiple factors: genetic, dietary and environmental factors. Other factors such as a diet high in calories, processed foods, trans-fat, prolonged stress can also be risk factors in developing diabetes. 
Myth #2: My doctor says I have “pre-diabetes,” which means I don’t need to make any changes.
Fact: Well, it doesn’t mean that there is nothing to worry about, as pre-diabetes can lead to Type 2 diabetes. But the good news is scientific studies show taking precautionary steps, such as taking care of your diet and exercising, can often halt or at least slow down the progression of pre-diabetes so it doesn’t take a turn for the worse.
The prevalence of Type 2 Diabetes has become so high that a new term – Metabolic Syndrome – was developed for people who have early stages of insulin resistance; where the blood glucose is higher than normal but not as high as it would be if you have diabetes. Those who are in the very beginning stages of insulin resistance, or “pre-diabetes,” often reverse insulin resistance by making simple lifestyle changes.
If you have pre-diabetes, early intervention can turn back the clock and return elevated blood glucose levels to the normal range. Losing weight is an important step for most people with pre-diabetes, and the weight-loss doesn’t have to be huge to make a difference. A weight-loss of just 10 to 15 pounds can really stack the odds in your favour.
Studies show that after exercising, muscles become more sensitive to insulin; reversing insulin resistance and lowering blood glucose levels. Exercise also helps muscles absorb more glucose without the need for insulin. The more developed the muscle is, the more glucose it can burn to control blood glucose levels. So with 30 minutes of exercise each day and healthy food choices, you’ll be well on your way.
Myth #3: Taking insulin means you are at “the beginning of the end”.
Fact: If you have Type 1 diabetes, you must take insulin to survive once you’ve been diagnosed—there are no other treatments for the disease. People with Type 2 diabetes may initially be able to manage their diabetes with a combination of healthy eating and physical activity. Many people start on oral diabetes medication when they are first diagnosed, and eventually, most people will need to go on insulin. This is because diabetes is a disease that changes and progresses over time. Eventually, when your pancreas stops producing enough insulin, you will need to start taking insulin injections. But that doesn’t mean you’ve done a bad job. In fact, a lot of patients who are on insulin are able to manage their diabetes better, and lower their risk of developing complications.
Myth #4: If you have diabetes, you can’t do too much exercise as you might get a low blood sugar attack.
Fact: Regular exercise is good for you when you have diabetes; it is good for your cardiovascular system and definitely helps to control blood glucose levels better. But certainly there are times when you need to be careful about exercising if you have diabetes.
- Diabetic peripheral neuropathy – as blood circulation is usually very poor in diabetic patients, some repetitive exercises on insensitive feet may lead to ulceration and cause wounds that are very hard to heal. So be careful, and invest in a good pair of shoes to protect your feet.
- Avoid exercise when you are experiencing low sugar levels as during exercise your muscles take sugar from the bloodstream to convert into energy. This can decrease your blood sugar levels even further. Those with Type 1 diabetes should be particularly careful with this; make sure you check your blood sugar level before you exercise. Avoid exercises that are too strenuous and slowly build up the intensity.
Nearly everyone with diabetes can benefit from an exercise programme, and although you need to approach it cautiously, it is still a good thing to do.
Myth #5: People with diabetes have to be on very restricted diets.
Fact: People with diabetes should have very nutritious diets, not restricted diets. I have seen people who put themselves on very restricted diets and end up malnourished. Not only that, they also get terribly miserable as they are not enjoying what they eat.
People with diabetes can eat complex carbohydrates, but I encourage them to primarily eat low-glycemic (low-GI) carbohydrates that don’t require large amounts of insulin. Insulin is a fat-storage hormone, so weight loss is often dependent upon eating in a fashion that allows the body to produce less insulin.
Diabetic patients should eat wholegrains that are high in fibre and also provide a lot of essential nutrients to the body to function better. Fibre also helps to slow down the absorption of sugar in the colon. Quality protein and good fat are equally important. Protein is important to help balance the blood sugar level and reduce cravings, whereas good fat is one of the key ingredients for our cell membrane, which maintains a healthy cell and indirectly helps the cell respond better to the insulin. Good fat also gives extra energy to the diabetic patient.
Good choices for high fibre food, protein and fat are brown rice, millet, quinoa, tofu, deep-sea fish, beans, nuts and seeds. And the best eating habit is to have small but frequent meals; eating in this manner may decrease insulin resistance, as a lower amount of insulin in the blood stream may help the body’s cells not be “overwhelmed” by it.
Myth #6: If I have diabetes, I should avoid eating fruit.
Fact: It is a myth that those with diabetes should avoid eating fruit, especially mangos and bananas. Although fruits have a high sugar content, they also offer an important source of vitamins, minerals, water and fibre that are needed by the body. The fibre in the whole fruit helps to prevent a spike in blood sugar levels.
Having a small piece of whole fruit (½ medium mango, 10 lychees, 1/3 cup chikoo, 2 small guavas, or ½ large banana) or a ½ cup of fruit salad for dessert is a fantastic complement to a healthy lunch or dinner. It is very important to watch the amount of fruit eaten because too much at any one time can cause increased blood sugars. This is why portion control is recommended rather than eliminating any specific fruit, especially for individuals with diabetes.
It is advisable to include whole fruits rather than fruit juices or sugary drinks in your diet, as juices often lack fibre and other nutrients, and it is a concentrated source of sugar. This recommendation not only holds true for those with diabetes but also for those without.
Intake of fruit juices should be limited to an occasional treat, with a meal, or once a day only. Excessive consumption of fruit juices may cause weight gain, and thus increase the risk of developing Type 2 diabetes or hinder the management of those with diabetes.
With dried fruits, be cautious with the portion size since two tablespoons of dried fruits such as raisins or two dates contain 15 grams of carbohydrate, which is the same amount of sugar in a full cup of cubed papaya. Some excellent options of fruits to consider are temperate fruits such as apples, pears, oranges, peaches, plums, apricots, cherries and berries. These are higher in fibre and water, and lower in sugars.
Myth #7: People with diabetes can't eat sweets or chocolate.
Fact: If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. They are no more "off limits" to people with diabetes than they are to people without diabetes. If eaten in small portions or as a special treat, diabetics can eat whatever they want. The problem is that most of us eat too much of what we like. The key to sweets is to have a very small portion and save them for special occasions so you focus your meal on more healthy and nutritious foods.
Myth #8: I should choose a plate of fried chicken over a bowl of brown rice, because carbohydrate is bad for me.
Fact: Not necessarily. Because carbs affect blood sugar levels quickly and directly, you may be tempted to eat less of them and substitute more protein. But too much protein may also lead to other problems for people with diabetes; the key is ‘balance’. For instance, meat not only contains protein, but it is also high in saturated fat, thus eating too much of these fats further increases your risk of heart disease. And if the meat is deep fried then you also take in a lot of trans-fats and high calories that can cause obesity. Therefore, carbohydrates, eg. rice, may sound evil, but you can select healthy complex carbohydrates as found in whole-grain form, which also contains vitamins, minerals and fibre. Good carbs take longer to digest so they do not cause a drastic spike in blood sugar levels. Complex carbohydrates that have a low glycaemic index (GI) can help to stabilise blood sugars and also offer a host of other health benefits.
Myth #9: Artificial sweetener is the better choice.
Fact: Artificial sweeteners are not considered real sugar, hence the “sugar-free” labels. However, this does not make them the healthier choice. In fact, they are sweeter than real sugar.
Here’s how five FDA-approved artificial sweeteners measure up on the “sweetness scale,” according to the Sugar Association in us:
- Acesulfame K, or ace K, is 200 times sweeter than sugar.
- Aspartame (marketed as Equal and NutraSweet) is 200 times sweeter than sugar.
- Neotame is about 40 times sweeter than aspartame, or 8,000 times sweeter than sugar.
- Saccharine (commonly sold as Sweet ’N Low) can be between 200 and 700 times sweeter than sugar.
- Sucralose (sold as Splenda) is 600 times sweeter than sugar.
So technically speaking, artificial sweeteners are just a bunch of chemicals with a ‘sweet’ taste. The safety issue is that they may cause negative side effects if consumed in the long term. So the best is still natural substitutes for sugar such as agave, wild honey, molasses; these are sugar that contain some nutrients and enzymes that are great for the body; bottom line is, use with caution and do not overindulge.
Myth #10: High blood sugar levels are the result of your diet and nothing else.
Fact: I cannot mention enough how stress can have a huge impact on a diabetic patient. If you have done everything right, and your blood sugar level is still out of control, then you may need to take stress and emotional factors into consideration; especially if you have Type 2 diabetes. Some people with Type 2 diabetes are very sensitive to stress. Simply because when you stress out, the body will produce especially high levels of stress hormones like epinephrine and cortisol, which drive blood sugar levels up to help boost energy when it’s needed most. So best to deal with your stress through exercise and some relaxation methods like deep-breathing and yoga.
To sum it up - a nutritious diet, healthy lifestyle, exercise and medication are effective tools for keeping your blood sugar levels within the normal range. Now that you know the facts about diabetes, you can take the necessary steps and precautions to learn even more about the disease, manage it and keep it under control.
- The National Diabetes Information Clearinghouse (NDIC), Cause of Diabetes, NIH Publication No. 14-5164, June 2014, http://diabetes.niddk.nih.gov/dm/pubs/causes/
- Mayo Clinic, Diabetes, Risk Factor, 31 July 2014, http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091