Poorly controlled diabetes has serious consequences.
Based on figures from the National Registry of Diseases in 2014, about 1 in 2 heart attack patients and 2 in 5 stroke patients had diabetes. 2 in 3 new kidney failure cases were due to diabetes. There are over 1,500 amputations per year due to complications arising from the disease (that is roughly 4 amputations per day).
There have been many recent steps put in place to encourage Singaporeans to reduce their portions of carbohydrates, switch to wholegrain alternatives and get active. Adopting healthy dietary habits and an active lifestyle is crucial in reversing or preventing the progression of diabetes.
What is diabetes?
The key problem in diabetes is an excessive amount of sugar in the blood. This 'sweetened blood' creates an increased risk of vessel blockage, or atherosclerosis. Depending on which vessel is being affected, the complications can range from stroke or heart attack, to eye or kidney problems and complications due to nerve damage in the leg.
Normally, the amount of glucose, or sugar, present in our blood is controlled tightly by insulin, a hormone produced by our pancreas. The pancreas is an organ located behind our stomach, which produces many digestive hormones in response to chemical signals when our food is digested.
We can think of sugar particles as passengers coming to a bus terminal. The carbohydrates we eat in a meal are converted into sugar particles in our blood. These 'sugar passengers' stream into the blood (bus terminal) and need insulin (buses) to transport them to their correct destinations to be used as energy in our organs, or stored in our liver or fatty tissue. These organs have receptors (bus stops), to allow the insulin to offload the sugar particles.
In Type 1 diabetes, there is destruction of the pancreas cells, which results in less insulin being produced. There are fewer ‘buses’ to transport the sugar to the organs and the sugar remains in the blood.
Type 2 diabetes is more common and comprises 90 – 95% of all diabetes cases. Type 2 diabetes tends to affect individuals who are overweight or obese, or have a family history with the disease. This disease occurs as a result of progressive insulin resistance. There is elevated sugar in the blood because the ‘buses’ are not working properly, or the 'bus stops' at the organs are not working. With fewer working 'bus stops' at the organs, insulin is unable to park its ‘sugar passengers’ at their correct destinations, and the sugar remains in the blood stream.
How can I control my diabetes?
There are 2 important dietary tools to learn for tackling diabetes. The first one is limiting the portions of carbohydrates in your diet. This is known as carbohydrate counting. You have to learn to identify the sources of carbohydrates in your diet and estimate the portion size.
There are many sources of carbohydrates in our foods. Common ones are grains like rice, bread and pasta, and others include tubers such as potatoes and yam. Some patients are unaware that milk and fruit also contain carbohydrates. When starting a carbohydrate count, make use of the nutrition labels on the food packaging to check for its carbohydrate content. The table below provides a simple guide for common foods containing carbohydrates.
Estimating a portion size is important in controlling the amount of carbohydrates you are taking. We count them in carbohydrate exchanges – 1 carbohydrate exchange is a 15g portion of carbohydrate and is equivalent to half a bowl of rice or noodles, a handful of grapes (about 10 grapes) or a medium banana.
|Types of Food||1 carbohydrate exchange (15g carbohydrates)|
|Rice (white/brown)||2 heaped tablespoons|
|Plain crackers||3 pieces|
|Whole fruits||1 small size|
|Cut fruits||1 wedge|
|Small fruits (eg. grapes)||1 fistful (6 – 8 pieces)|
|Unsweetened fruit juice||125ml|
|Potatoes/Yam/Tapioca||1/2 cup, cooked|
|Corn||1/3 corn cob|
|Milk||250ml or 1 cup|
|Plain yoghurt||1 small tub|
To work out the exact carbohydrate portions you should take each day, your doctor or dietitian can determine a meal plan for you based on your energy requirements and activity. As a start, you could take 3 – 4 exchanges for your main meals, with 2 – 3 snacks of 1 carbohydrate exchange each spread out throughout the day.
While controlling your carbohydrate intake, you could fill your plate with alternatives such as vegetables and tofu, which are low in carbohydrates. The Healthy Plate model from Health Promotion Board is a helpful guide.
Not all carbohydrates are the same. Some are digested much faster and result in sugar spikes in the bloodstream, which may contribute to more difficult-to-control blood sugars. The Glycaemic Index (GI) is a number given to foods containing carbohydrates to help us differentiate which ones are digested faster or slower. This helps diabetic patients to adjust their diet with the aim of replacing bad carbohydrates (those with a high glycaemic index) with good carbohydrates (those with a low glycaemic index).
|Glycemic Index||Examples of Foods|
|Low (GI 0 – 55)||Starchy staples: Wholemeal pasta (boiled), rolled oats, oat bran
Vegetables: Green leafy vegetables, broccoli, tomato, onion
Beans and nuts: Legume, chickpea, lentil, kidney bean, soy bean, baked bean, cashew nut
Dairy products: Milk (low fat), yoghurt (low fat), cheese
Whole fruit: Apple, peach, pear, orange, kiwi, grapefruit, prune, berry, mango
|Medium (GI 56 – 59)||Starchy staples: Brown rice, basmati rice, wholemeal bread, rye bread, pita bread, quick oats, couscous, pasta
Dairy products: Ice cream
Whole fruit: Banana, grape, papaya, lychee
Beverage: Fruit juice, table sugar
|High (GI 70 – 100)||Starchy staples: White rice, white bread, noodles, bagel, corn flakes, puffed rice, instant oats
Vegetables: Potato (baked, boiled or mashed), pumpkin, sweet potato
Whole fruit: Melon, pineapple
Snacks: Pretzel, rice cake, cracker, dates
Beverage: Honey, soft drink
There are other factors that affect the GI of the food.
Cooking time – The longer the food is cooked, the more easily digested it is, and thus its GI would be higher. An example would be porridge having a higher GI than al dente pasta.
Processed foods – Food such as white flour and fruit juices would have a higher GI compared to whole grains and whole fruit respectively.
Ripeness of fruit – An overripe fruit would have a higher GI than one that is not so ripe.
The importance of being active
It’s important to participate in regular exercise as this helps to better control your blood sugar levels. Regular physical activity goes beyond better blood sugar control. It also helps you maintain an ideal weight, control cholesterol levels and reduce your overall cardiovascular risk.
It is recommended you do 150 minutes of physical activity per week. This can be done as 30-minute sessions over 5 days. For a start, you could even break it up into 10-minute sessions spaced throughout your day.
The importance of good dietary habits and an active lifestyle cannot be over-emphasised in our battle with diabetes. Although it may be difficult for some to take the first step in changing their diet and lifestyle, the long-term rewards reaped are definitely worth the effort taken to overcome the initial inertia. Empower yourself to control your diabetes, starting from today.
Article contributed by Dr Wong Pei Ying, family physician at Parkway Shenton, International Plaza