Exercise for your Diabetes!

What is diabetes?

Type 2 diabetes is the most common form of diabetes. It is also called late onset diabetes. People with Type 2 diabetes are more than twice as likely to suffer from heart disease than those without it.

Diabetes is a chronic disease characterised by high blood glucose levels resulting from the body not producing insulin or not using it properly. Genetic predisposition and lifestyle factors contribute to the development of Type 2 diabetes. If blood sugar is not controlled, complications develop over time.

Why should I be concerned about my blood sugar?

Complications of poor blood sugar control include blindness, kidney disease, nerve disease heart disease and stroke.  Many people don’t realise how harmful diabetes can be.  The extra blood glucose (sugar) floating around our bodies can be likened to shards of glass.  It causes cuts in the vessel walls.  When our bodies use platelets to clot the bleeding, it can block the vessel.

· A blocked vessel (coronary artery) in the heart leads to a heart attack.

· A blocked vessel in the eye can lead to glaucoma and even blindness (See photo below—Normal vision on left, affected vision on right).

How can exercise help?

it is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay type II diabetes.  If you look at the diagram on the reverse, it shows how exercise opens up the gate to the cell, allowing the glucose to enter.  This reduces the amount of glucose in the blood, and mitigates the risk of vessel damage.

How much should I expect my blood glucose level to reduce by?

The below diagram shows the direct effect exercise has on blood glucose.  The top line, indicated with diamonds, represent a type II diabetic. The bottom line indicated with the square, represents a non diabetic.

As you can see, during exercise the blood glucose reduces to a similar level to the non diabetic.  The blood glucose levels stay depressed for approximately 24 hours.

As Shown Below , blood sugar (glucose) reduces during exercise

What type of exercise?

A mixture between aerobic exercise (running, walking, riding, swimming) and resistance exercise (weight training can involve attending a fitness centre, participating in a home program, outdoor fitness training) is optimal.

How Exercise Reduces Blood Glucose

How much exercise do I need to do to lower my blood Sugar?

Aerobic exercise should be performed at least 3 days per week with no more than two consecutive days between bouts of activity.  Whereas resistance exercise can be beneficial with 2-3 days per week.  Aim to accumulate a minimum of 150 minutes of moderate intensity exercise per week. 

Does the intensity matter?

Yes! Although a moderate intensity (brisk walk) of exercise has shown to improve blood glucose, a more vigorous intensity for the longest duration possible will lead to the greatest results.

For More Information

Wesley Corporate Health

Level 2 / 46 Edward Street

Brisbane  Qld  4000

Phone:  07 3234 2600

Email: info@weshealth.com.au

Contact Diabetes Australia 1300 136 588
Website: www.diabetesaustralia.com.au

Disclaimer

This Fact Sheet is provided for your information only and does not replace qualified medical advice. The information provided may not apply to every person or all situations. A medical practitioner should be consulted for all treatment and medication.

Healthy Eating and Type 2 Diabetes

What is diabetes?

Type 2 diabetes is the most common form of diabetes. It is also called late onset or non-insulin dependent diabetes. Type 2 Diabetes is the 6th leading cause of death in Australia.

Diabetes is a chronic disease characterised by high blood glucose levels resulting from the body not producing insulin or not using it properly. Genetic predisposition and lifestyle factors contribute to the development of Type 2 diabetes. If blood sugar is not controlled, complications develop over time. Complications of poor blood sugar control include blindness, kidney disease, nerve disease in lower limbs, heart disease and stroke.

Why are Carbohydrates so Important?

Carbohydrates are starches and sugars which are broken down to glucose in the body. The glucose then enters the bloodstream and the blood glucose level gradually rises. The body then sends insulin (a hormone required to transport glucose) to the blood. This allows the glucose to leave the bloodstream and enter the cells in muscle tissue and the brain. It is then used for energy, much like a car uses petrol.

Having diabetes means that your body is not able to uptake glucose from the blood and into the cells. Your body either does not produce enough insulin, or the receptors on your cells are not working and cannot take the glucose in.  Either way, you need to monitor the amount of carbohydrate that you take into your body in food, so that your blood sugar levels do not rise too high or fall too low. 

By having regular meals and ensuring that they contain some carbohydrate, your blood sugar levels should remain relatively stable. By testing your own blood glucose levels you can see how effective this is, and alter your intake accordingly.

Where is Carbohydrate Found?

· Breads and cereals

· Fruit

· Starchy vegetables (potatoes, sweet potato and corn)

· Legumes (dried peas and beans)

· Milk and yoghurt

· Confectionery and other sweets

· Sweet beverages

· There are no carbohydrates found in meat and fats.

Healthy lifestyle

Type 2 Diabetes can be prevented or delayed by following a healthy lifestyle. This includes regular physical activity, making healthy food choices, and not putting on weight. The eating habits recommended for a person with diabetes are the same as those recommended for the general population.  To help manage your diabetes, your meals need to be:

· Spaced regularly and evenly throughout the day.

· Low in fat, especially saturated fat.

· Based on high fibre carbohydrate foods such as whole grain breads and cereals, beans, lentils, vegetables and fruits.

If you are overweight it is important that you try to lose some weight.  This will help to control your diabetes and it will also decrease your risk of developing heart disease and high blood pressure.

Glycemic index (GI)

Glycemic index refers to the effect carbohydrates have on blood sugar levels after being consumed. Historically, carbohydrates were referred to as ‘simple’ and ‘complex’ and it was believed that simple sugars affect the blood sugar levels more quickly than the complex. New research has found that all carbohydrates enter the blood stream at differing rates and that it is the type of carbohydrate that determines how quickly the blood levels change. Other factors affect the GI of a food, including the physical form of the food, how processed/cooked the food is, and the fat and fibre content.

The rate at which carbohydrate is broken down to glucose affects the blood sugar response.  Carbohydrate foods which are broken down more quickly will enter the bloodstream more quickly and therefore increase the blood sugar levels more dramatically. Conversely, carbohydrate foods which are broken down slowly enter the blood stream more slowly. Therefore the blood sugar level rises gradually, and this rise is sustained for longer.  A more gradual release of sugar into the bloodstream means that sugar does not build up in the blood. Your body is able to remove the sugar from the blood as quickly as it enters it, hence preventing high blood sugar levels.

To highlight which foods raise the blood glucose levels quickly and which raise them slowly, foods have been given a number or a Glycemic Index (GI).  This takes into consideration the rate at which carbohydrate is broken down into glucose. 

· Low GI foods enter the blood stream slowly

· High GI foods enter the blood stream more quickly

To control blood glucose levels it is beneficial to choose from the group of foods which have a low GI (ie. slowly digested).

Which carbohydrates have a low GI?

Generally the more highly processed a carbohydrate food is, the higher the GI value. Therefore, foods which have not been processed to a great extent will typically have a low GI.

The following list shows those carbohydrate foods which have a low GI. It is important to note that other carbohydrate foods are still acceptable, but these are your best choices.  You should aim to include one of these at every meal.

· Particular breads such as Burgen breads, Performax, Ploughman’s Wholegrain, Multigrain/wholegrain/mixed grain, heavy fruit loaf, pumpernickel, oat bran and honey.

· Particular crispbreads, crackers, biscuits such as Ryvita, Rye Cruskitts, Salada, Snack Right Fruit Slice.

· Particular breakfast cereals such as rolled oats, All Bran, Kelloggs Guardian, untoasted muesli, mini-wheats (plain), Special K.

· Temperate fruits such as apples, oranges, firm bananas, apricots, peaches, plums, pears, grapes, dried fruits. Whole fruit is better than juice.

· Starchy vegetables such as sweet potato and sweet corn,

· Pasta and other grains such as Basmati or Mahatma Premium Classic white rice, barley, bulgar and cous cous.

· Legumes (dried peas and beans)

· Milk products and alternatives - low fat varieties of milk, soy drink (calcium fortified), custard, yoghurt.

· Other non starchy vegetables (such as salad vegetables, green vegetables and orange vegetables) and are generally low in carbohydrate and therefore have little effect on your blood glucose levels. Include five or more serves of vegetables per day.

How much carbohydrate should I have?

You should have at least 2-3 serves at meals.  If you are on insulin you may need to have some carbohydrate at mid-meal snacks.  You may also need extra carbohydrate if your activity level is higher.

1 serve = 1 slice bread

   = 1/2 cup breakfast cereal

   = 1/2 cup cooked rice or pasta

   = 1 piece fruit

   = 1 medium potato / 1/2 cup starchy vegetables

   = 1 cup milk (250 ml)

   = 200 g tub of yoghurt

   = 1 cup cooked legumes

At least one serve at each meal should be a low GI food.

 

Most importantly, remember to:

· Have regular meals

· Have carbohydrate at each meal

· Participate in regular activity

· Lose weight if overweight

For More Information

Wesley Corporate Health

Level 2 / 46 Edward Street

Brisbane  Qld  4000

Phone:  07 3234 2600

Email: info@weshealth.com.au

Contact Diabetes Australia 1300 136 588
Website: www.diabetesaustralia.com.au

Disclaimer

This Fact Sheet is provided for your information only and does not replace qualified medical advice. The information provided may not apply to every person or all situations. A medical practitioner should be consulted for all treatment and medication.

Metabolic Syndrome (or "Syndrome X")

What is Metabolic Syndrome?

The metabolic syndrome is a cluster of risk factors that increases the risk of coronary heart disease and type two diabetes. It is characterised by raised fasting plasma glucose, low HDL (protective/good) cholesterol, high LDL (poor) cholesterol, raised triglycerides, abdominal obesity and high blood pressure.

Current estimates suggest around 20-25% of the worlds population have the metabolic syndrome (1). Those who have the metabolic syndrome are twice as likely to die from and three times as likely to have a heart attack or stroke compared to non metabolic syndrome sufferers(1). Additionally those with metabolic syndrome are five times more likely to develop type two diabetes at some point in their life (1,3). Current Australian estimates produced by the 2005 AusDiab study state that 1.7 million Australians have diabetes, but nearly half of all cases of type two diabetes remain undiagnosed (2). Approximately 275 Australians develop diabetes every day (2). Diabetes is the fastest growing chronic disease in Australia and one of the most common world wide and is the fourth leading cause of death in the developed world 1,4).

This cluster of cardiovascular disease (CVD) risk factors that represents metabolic syndrome is expected to create a tsunami of heart disease and stroke cases creating a CVD epidemic of biblical proportions.

The Link: Diabetes and Metabolic Syndrome

Globally 3.2 million people die from complications associated with diabetes (1). Type two diabetes accounts for 90% of all cases of diabetes and has total financial cost of 10.3 billion dollars (2). Type two diabetes is a leading cause of premature death and illness due to it’s association with CVD, and is now responsible for up to 80% of all CVD deaths (1,2,3). 

The metabolic syndrome and its cluster of risk factors is most commonly experienced is those who are suffering from glucose intolerance or type two diabetes. This factor leads to substantial disease burden due to the additional cardiovascular disease risk of the metabolic syndrome, which has been suggested to be beyond the risk of each abnormality (1,3,4).

The metabolic syndrome is not however just limited to those suffering form diabetes and impaired glucose  tolerance. In fact many individuals experiencing the first signs of metabolic syndrome do so well before any formal diagnosis of type two diabetes has been made. These initial signs are represented by a elevated blood glucose (hyperglycemia) and triglyceride level and a decreased HDL (protective/good) cholesterol. These factors in there own right significantly increase an individuals risk of CVD. In fact those individuals with either or both type two diabetes or metabolic syndrome have the same CVD risk as a current cigarette smoker.

What Causes Metabolic Syndrome

What causes metabolic syndrome is a hotly debated topic amongst experts however most would agree that central obesity and insulin resistance are significant factors (1,3,4). Additional factors that may also have a casual effect include genetics, physical inactivity, poor nutritional status, ageing, a pro inflammatory state and hormonal changes (1). The role of these aspects do however appear to be greatly influenced by the ethnic origin of the individual (1).

1. Insulin Resistance

The pancreas's beta cells are responsible for the bodies production of the vital hormone insulin. Insulin is the key hormone responsible for driving glucose into the bodies cells to be utilised as a source of fuel. Insulin resistance occurs when cells in the liver, skeletal muscle and adipose/fat tissue become less sensitive and eventually resistant to insulin (1,3,4).  As a consequence glucose remains in the blood stream as it is no longer being taken up by the cells. This leads to further production of insulin (hyperinsulinlaemia)  in order to remove the high levels of blood glucose, which over time weakens the beta cells of the pancreas and eventually leads to beta cell failure (1). If the pancreas can no longer produce insulin then a person’s ability to control their blood sugar is lost which subsequently leads to a diagnosis of type two diabetes. Prior to this occurring the body is already in a pro inflammatory state and an accumulation of triglycerides has begun to occur. This leads to cellular damage and is characterized in it’s early stages by low HDL (good) cholesterol, high triglycerides,  high alanine transaminase (liver function test) , increased waist circumference and potentially raised serum uric acid levels.

2. Central Obesity

Many experts believe that central obesity is the catalyst to metabolic syndrome and insulin resistance (1,3,4,5). Obesity is an important independent CVD risk factor that is routinely associated with high cholesterol levels, high blood pressure, raised blood sugar and low HDL (good) cholesterol. Research indicates that obesity is associated not only with an increased risk CVD but also type two diabetes, some forms of cancer and osteoarthritis. Obesity is internationally recognized as a body mass index of equal to or greater than 30kg/m2. However, more indicative of metabolic syndrome is an individuals waist circumference or the accumulation of fat around the abdomen (1).  

Criteria of Metabolic Syndrome in Adults

The International Diabetes Federation Definition

International Diabetes Federation”: Worldwide Definition of the Metabolic Syndrome. www.idf.org/idf-worldwide-definition-metabolic-syndrome

Ethnic specific values for waist circumference

How is it diagnosed?

General investigation should include blood tests of cholesterol and lipids, blood sugar, liver function and kidney function (these tests require you have to have been fasting overnight). Analysis of the urine and a urine albumin to creatinine ratio (looking for protein in the urine as a sign of kidney damage).

Ways to reduce your risk.

Incorporate as many lifestyle changes as you can. Eating a healthy diet, exercising regularly, and losing weight will all dramatically reduce your risk of diseases associated with Metabolic syndrome.

Make dietary changes. Eat plenty of natural wholegrain foods, vegetables and fruit,  reduce portion sizes and limit foods high in sugar and fat. Reduce saturated foods such as meat, full cream dairy and many processed foods. This will help improve your cholesterol levels. Reducing alcohol consumption to less than 2 standards drinks a day may help lower triglyceride levels.

Increase your physical activity level- regular exercise raises the level of HDL (‘good’) cholesterol in the blood, which helps remove excess cholesterol from your body and protects against heart disease. Exercised muscle cells are also more sensitive to insulin.

Manage your weight– increasing physical activity and improving eating habits will help you lose excess body fat. As a result, your blood pressure will drop and your cells will be more sensitive to insulin.

Quit smoking– smoking increases your risk of heart disease, stroke, cancer and lung disease. Quitting will have many health benefits, especially if you have Metabolic syndrome.

Medication may be required– Lifestyle changes are extremely important but sometimes medication may be required to manage the condition. The most     important thing is to reduce your risk of heart disease, stroke and Type 2 diabetes.

How will it affect me?

Metabolic syndrome can present with a variety of symptoms depending on the associated medical  conditions. Some people with Metabolic Syndrome may not have any symptoms initially. You may experience the following symptoms:

· Tiredness and fatigue.

· Sleep apnoea (transient periods of breathing sensation and snoring during sleep) associated with obesity.

· Headache (due to high blood pressure)

· Frequent urination, thirst, weight loss or gain due to high blood sugars.

· Chest pain or shortness of breath on exertion  (i.e. poor blood supply to the heart).

· Collapse or other neurological symptoms due to blockage of the vessels that supply the brain with blood.

Where do I get help?

· Your doctor.

· An accredited practicing dietician (contact the dieticians Association of Australia: http://www.daa.asn.au)

· International Diabetes Institute. (03) 9258 5000.

· Diabetes Australia (www.diabetesqld.org.au) 1300 136 588

· Quitline (137 848) www.quit.org.au

References

1.)“International Diabetes Federation”: Worldwide Definition of the Metabolic Syndrome. www.idf.org/metabolic-syndrome

2)”Diabetes Australia”. www.diabetesaustralia.com.au.

3)“National Heart, Lung and Blood Institute”. www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html

4)“Mainstreaming the Metabolic Syndrome: a definitive definition”.www.mja.com.au/public/issues/183_04_150805/zim10442_fm.html

5)“Metabolic Syndrome”. www.heart.org/HEARTORG

For More Information

Wesley Corporate Health

Level 2 / 46 Edward Street

Brisbane  Qld  4000

Phone:  07 3234 2600

Email: wellness@weshealth.com.au

Disclaimer

This Fact Sheet is provided for your information only and does not replace qualified medical advice. The information provided may not apply to every person or all situations. A medical practitioner should be consulted for all treatment and medication.