Diabetes

Diabetes is a chronic condition, meaning that it is a long-term disease. When you eat food, it is broken down into sugar molecules (called glucose), which enter your bloodstream. This is what influences your blood sugar level. Normally, once there is glucose in your blood, an organ in your body called the pancreas starts to release the hormone insulin, which helps to move the glucose from your blood into the cells of your body. This gives your organs the energy they need to function.

In type 1 diabetes, your body does not make insulin. In type 2 diabetes your pancreas still makes insulin but over time your cells do not respond to insulin in the same way. They become insulin resistant. The glucose from your food builds up in your blood instead of going into your cells. This is what makes your blood sugar levels high. The pancreas will keep trying to make more insulin to make the cells respond but eventually the pancreas cannot keep up and blood sugar levels keep rising.

Gestational diabetes is when a woman, who did not have diabetes before, develops diabetes during pregnancy. The chance of developing type 2 diabetes after gestational diabetes varies depending on the follow-up time and ethnicity (Bellamy et al., 2009). Approximately 50% of Indo-Asian women with gestational diabetes will develop type 2 diabetes within five years postpartum (PHAC, 2011). However, the risk can be prevented or delayed with lifestyle changes.

Anyone is at risk of diabetes. However, your risk increases if you are/have:

• Over the age of 45
• Of South Asian origin
• A smoker
• Overweight/obese
• Low levels of physical activity
• A poor diet
• A family history of diabetes

Environmental factors can also increase the risk of diabetes. For example, being of low income, education, or being a refugee or immigrant can increase your risk. For example, these factors influence your access to healthcare resources and health information, which in turn can make you more susceptible to developing insulin resistance.

• Blood Work
• Managing High and Low Blood Sugar Levels
• Exercise
• Diet

Blood Work

Hemoglobin A1C Glucose (i.e. sugar) can attach to your blood cells. A1C is a type of blood test that measures the average percentage of blood cells attached to glucose over the past 3 months. When extra sugar remains in your blood that is not used by your body, it leads to higher A1C levels.

Plasma glucose (self-monitoring)

Another way to check for diabetes is by measuring your current blood sugar levels. You can use a glucose monitor, to measure your plasma (i.e. blood) sugar levels. Your target levels depend on whether you measure your blood sugar before or after eating a meal. Be sure to talk to your doctor about your ideal blood sugar levels:

Low Blood Sugar	High Blood Sugar
Symptoms: -Shaking -Sweating -Nervousness or anxiety -Irritability or confusion -Dizziness -Hunger	Symptoms: -Feeling very tired, thirsty -Having blurry vision -Needing to urinate more often
Management if you blood sugar falls below 4 mmol/L: -Take four glucose tablets -Drink four ounces of fruit juice -Drink four ounces of regular soda, not diet -Eat four pieces of hard candy	Management: -Be physically active unless your blood sugar is above 11 mmol/L -Take medication as instructed -Regularly follow your diabetes meal plan -Check your blood sugar as directed; more often if you are sick or concerned about high or low blood sugar -Talk to your doctor about adjusting your insulin (Type I only)

  *If you frequently notice you are having blood sugar levels that are too high or too low, talk to your doctor about your diabetes management plan/medications*

Exercising safely with diabetes:

• Drink water before, during & after exercising
• Measure your blood sugar before exercising
  • IF 4 mmol/ L or less: eat a snack (2 tablespoons of raisins, 4 glucose tablets); measure glucose after 15 min
  • IF 11 mmol/L or more: do not exercise – check your urine for ketones
• Keep a snack (granola bar, fruit) with you if you are exercising for a long time, as your blood sugar could get too low
• Wear proper fitting shoes and check your feet every day for bruises, swelling, blisters, or injuries

• Your diet is an important part of managing your diabetes. Having a good diet requires understanding how different foods raise your blood sugar levels.
• Glycemic index (GI): a measure of how fast certain foods can raise your blood sugar. You want to stay away from foods with a high glycemic index, and eat foods with a low glycemic index often.
  • Low GI: less than 54
  • Medium GI: 55-69
  • High GI: 70+

*Remember – low GI foods can still have other bad ingredients. Stay away from fried foods, foods with lots of salt, or foods high in trans or saturated fats, even if they have a low GI. Please refer to the resource sheet below for examples of foods to enjoy and avoid*

• South Asian recipes that are diabetes-friendly:
  • 7-day South Asian healthy meal plan from Diabetes Canada
  • South Riverdale Community Health Centre South Asian Diabetes
• Foods to avoid:
  • Snacks: jaggery, jalebi,idli, dosa, dates, rice cakes, oatmeal cookies
  • Meals: chicken cooked with skin, white rice/ naan, bread, raisins, aloo paratha
• Instead try eating:
  • Snacks: a handful of berries, cheese, a small cup of low fat plain yogurt
  • Meals: roti/bread made from besan (gram flour), quinoa or bean salads, roasted low GI vegetables (eggplant, broccoli, carrots)
• Understanding if your food is made up mostly of carbohydrates, fats, or proteins can also help you understand what raises your blood sugar the most:

Carbohydrates rapidly raise your blood sugar levels after you eat them. In comparison, proteins and fats raise your blood sugar levels slowly and by a lesser amount. Try not to eat carbohydrates alone. Eat carbohydrates (for example, grains, cereals, fruits) alongside proteins (tofu) and healthy fats (avocado, walnuts) to help slow down the digestion of carbohydrates.

Remember, not all fats are the same. Use this acronym to remember which fats are unhealthy (saturated), and which are healthy (unsaturated):

• Ketoacidosis strips
• Glucose Monitors
• Pedometers
• Resource Sheet
• How to Read the Nutrition Label Slides