Food and diabetes

Food provides you with the energy to live life, and is vital for your wellbeing – affecting both your body and mind. Enjoying food with friends and family is an important part of your social life and emotional health, and it’s no surprise that almost every celebration of life and achievements in our society – like christenings, birthdays and weddings - are celebrated with a gathering to enjoy food together.

The healthy eating and the diabetes food guidelines seem to change as often as you change your underwear! And for those of us with diabetes this can be very confusing to say the least. The ideas we used to have, of filling you day with carbohydrates, particularly for people with type 1 diabetes, where we used to "feed" the insulin we injected, have changed. There are now more flexible approaches to eating and diabetes, an understanding of the quality and quantity of food being important, and more openness to lower carb eating plans, food flexibility and a more relaxed approach.

We think the basic premise of Michael Pollan of "Eat food is the way to go.

“Eat food. Not too much. Mostly plants.”

In his books, such as The Omnivore’s Dilemma and Food Rules: An Eater’s Manual, Pollan promotes other simple messages such as:

• “If it came from a plant, eat it. If it was made in a plant, don’t.”
• “Cook. Cooking for yourself takes back control of your diet.”
• “No snacks, no seconds, no sweets – except on days that start with S.”
• “Don’t get your fuel from the same place your car does. Don’t shop for your food at a petrol station.”
• “Don't eat anything your great grandmother wouldn't recognise as food.”
• “Don’t eat anything with more than five ingredients, or ingredients you can't pronounce.”
• "Always leave the table a little hungry."
  

Finding balance

Finding a balance between healthy everyday foods and occasional foods is the key to a sustainable eating plan that promotes both good health and enjoyment of food. The everyday foods which make up a balanced diet give you energy, protein, antioxidants, fibre, vitamins and minerals and carbohydrate for fuel.

These are the essentials that help keep you healthy, and contribute to a strong immune system and healthy bones, teeth and skin. Making these foods a part of everyday eating is the way to achieve a healthy diet.

Food, diet, weight management and body image are very important parts of diabetes management for all types of diabetes. These things also cause most people a lot of stress, anxiety and can lead to problems with your wellbeing and mental health. Likewise when you live with depression or anxiety, this can impact on your food choices and ability and motivation to remain active.

A healthy diet and regular physical activity are core parts of diabetes management and ensuring you have the best wellbeing.

Choosing healthy foods and being active will help manage your blood glucose levels and your body weight. Healthy eating for people with diabetes is similar to recommendations for everyone so there is no need to prepare separate meals or buy special foods.

Food and type 2 diabetes

Healthy eating should be enjoyed by the whole family. If you have type 2 diabetes then it is very important for your children and grandchildren to adopt a healthy lifestyle to give them the best chance of reducing their risks of type 2 diabetes.

All people with diabetes are advised to have a healthy eating plan and in fact all PEOPLE need this, diabetes or not. People with type 2 diabetes are often trying to lose or maintain their weight so it is important to work with a health care team to set out a healthy eating and activity plan that will help you to reach your goals.

Sticking with a healthy eating plan is not an easy thing to do and support is very important.  Often people have told us that they have to deal with “emotional eating” and other habits that make it hard to make changes in eating and lifestyle.

If you have type 2 diabetes you may be told at diagnosis just to “lose some weight” and your diabetes will “settle down” but you are left wondering how to do this and often too embarrassed to ask for help.

Some people who are overweight or obese feel very self conscious about exercising and find it very hard to get started on an activity programme. Support and counselling can help you to overcome some of these worries and help you take the first steps 

Type 1 diabetes, blood glucose and food

Management of  blood glucose levels for people with type 1 diabetes can be particularly complex and the types and amounts of foods, as well as the timing of meals and snacks, form a central part of daily management.

Managing blood glucose levels for a person with type 1 diabetes is centred around trying to match the insulin dose to the carbohydrate in the food you are eating. There are different types of insulin and various regimes and ways of delivering insulin.

With the use of insulin pumps and new types of insulin that gives you the ability to eat more freely and take the required insulin dose, you can be more flexible in the time of meals and the amount of carbohydrate in meals and snacks. If you have type 1 diabetes you/your family will need to learn how to plan food, insulin and activity to best manage your blood glucose levels.

It is recommended that all people with type 1 diabetes see a dietitian at least once when diagnosed, who has experience in working with people with type 1 diabetes. This will help you develop the best way of managing for you as an individual. You can also touch base with a dietitian when you are having issues with your management or want to make some changes.

Most importantly find a way of eating that suits your lifesetyle and your diabetes. Do not be pressured by other people or worry about what other people with type 1 diabetes are doing. Social media is a wonderful place for support but can also be damaging if you are criticised for your way of eating or managing. Be informed about your choices, see how it works for you and then go with it. There is no wrong or right way to do diabetes!

Healthy Eating for all ages

There is no longer a real "diabetic diet". Instead, a healthy balanced diet is recommended – just as it is for the rest of the population. Yet there are some challenges to achieving a healthy diet for particular populations, such as young children who may be fussy eaters, and older adults who may have lost interest in food. Likewise if you have a complication or other health condition such as gastroparesis or coeliac disease, then food and diabetes becomes particularly challenging.

Diets and Weight Loss - managing the maze!

There are well-known, scientifically-proven benefits to maintaining a healthy body weight, and this is particularly important for people with diabetes. Having an awareness of the benefits of weight loss however, can make some people think that the best thing they could possibly do for their health is to lose as much weight as possible, as quickly as possible... but is this really best for your health?

Although there is no "diabetic diet", there are sometimes a few extra challenges that people with diabetes may need to keep in mind when deciding what to eat – for example, when exercising, or in social situations – particularly where there may be alcohol.

There are lots of options out there now and our ideas about food are changing. However we are all different and you should not change your eating plan without advice from your usual health care team. 

Type 1 Weight Matters

The period of diagnosis of type 1 diabetes can mark a difficult time in the lives of people with type 1 diabetes and the impact can extend to the loved ones, work colleagues and peers of those newly diagnosed.

Adjusting to living with type 1 diabetes can often lead to a struggle with insulin intake, particularly as changes take place in diet and exercise.

Issues of control over blood glucose and diet can lead to concerns about body image and management of diabetes. The sudden and extreme weight loss in the period prior to diagnosis, followed by weight gain as the body becomes healthy again following insulin commencement, can be hard to manage for some people.

Type 1 diabetes can be particularly hard to manage as it is usually diagnosed in childhood or young adulthood (although it can occur at any age), impacting on one of the most exciting and dynamic points of a person’s life. It is at this time that other areas of life are key focuses; including work, education, relationships and travel. Therefore, learning to manage a newly diagnosed medical condition can often seem like a daunting task.

Some weighty issues facing Australians with type 1 diabetes

Living with type 1 diabetes and its impact on lifestyle, can often be difficult to accept for many people newly diagnosed with diabetes. With the current focus on the growing number of Australians who are overweight or obese, and with body image stereotypes portrayed with increased frequency in the media, people are suffering complexities and pressures around body image.

Just like anyone else, particularly in the teenage years, people with type 1 diabetes have complexities and concerns around self-esteem, image and body weight. Along with this they have diabetes to deal with.

While we’ve all heard of fad diets and nightmare exercise regimes, the key point of difference for people with type 1 diabetes is that there is a powerful but risky weight loss tool – the omission of insulin.

The relationship between insulin and weight gain

Insulin is a hormone that affects metabolism and other body systems. It enables most of the body's cells to take up glucose – the body’s energy source - from the blood, storing it as glycogen in the liver and muscle.

Managing blood glucose levels requires a balance in the amount of food consumed, the level of physical activity undertaken and the amount of insulin absorbed. Blood glucose levels can also be affected by stress, infection, illness, medications and alcohol.

Exercise can be difficult for people with type 1 diabetes. Often people exercise to stay fit and to help lose the weight they gain through insulin intake. However, exercise - especially when excessive - can lead to hypoglycaemia and the need to eat more food.  It is a cycle with which many people with type 1 diabetes struggle.

Skipping insulin to lose weight – survey results

In September 2008, an online survey conducted by Diabetes Australia – Vic and the Centre for Adolescent Health revealed that one in three respondents with type 1 diabetes who were specifically asked about whether they were living with eating disorders and diabetes, were regularly skipping or manipulating their insulin dose to gain control over their weight.

A total of 243 Australian people participated in the survey, including 201 with type 1 diabetes, revealing information about eating patterns and weight concerns in the resulting Insulin Misuse for Weight Loss research report.

Skipping and abusing insulin – the facts

• One in three (32.9 per cent) of the respondents to this survey about eating disorders and type 1 diabetes said they have skipped insulin as a way to help them lose weight;
• Almost half (48.5 per cent) of those respondents with type 1 diabetes who skip their insulin say they do so on a daily basis;
• Almost two in five (37.7 per cent) of those respondents with type 1 diabetes surveyed say they have taken less insulin than they required as a way to help them lose weight.

The wider implications and what this means

These statistics reveal an alarming trend for some people with type 1 diabetes who have problems with their weight and body image to use insulin to manage their weight - and highlights the need for an increased awareness among people with type 1 diabetes of the important role of insulin and how to manage this effectively to maintain healthy diabetes control and weight management.

While it is disturbing to think about, skipping or abusing insulin can lead to an earlier than expected onset of diabetes complications and an increased risk of death.

Complications of diabetes can include:

• Feet and eye problems, including amputation;
• Heart and blood problems;
• Erectile dysfunction;
• Nerve damage;
• Kidney complications.

The research also highlights the need for people with diabetes to talk with their General Practitioner (GP) or healthcare professional about their current therapy and how they can best manage their diabetes.

Diabetes and the potential for eating disorders

If a person with type 1 diabetes has an issue with insulin misuse, it can be a symptom of an underlying psychological problem or concern.  Insulin misuse is sometimes carried out as a means of controlling deeper psychological issues, including depression.

Eating disorders are a very real danger for many people, particularly for teenage girls and young women, without even factoring in the increased risk of skipping or taking less insulin.  The Insulin Misuse for Weight Loss research report revealed that one in four girls with type 1 diabetes who responded to the survey, had developed some sort of eating disturbance in their teenage years. We know from other research as well that eating disorders are twice as likely to occur in teenage girls with type 1 diabetes than in girls who do not have diabetes.

If you think that you or a loved one may be dealing with an eating disorder, you need to speak to someone in your health care team about seeking help. This can include both an eating disorder specialist and a diabetes management team working together with you.

I have type 1 diabetes - what does this mean for me? 

Developing a healthy relationship with food and insulin can help prevent dangerous behaviors such as insulin misuse and restriction. It is important for people to embrace a balanced, flexible approach to eating. Whereas type 1 diabetes used to be about what you couldn't eat, it is now more about learning that food is not the enemy and that it is possible to eat a wide variety of foods, maintain a healthy weight and balance this with appropriate insulin use.

If your diabetes, insulin use and/or weight, are areas of concern or confusion, there are people you can talk to, including family, friends and healthcare professionals.

It is important not to feel ashamed and to ask for help if you need it.

Healthcare professionals and GPs are equipped to help with these issues and are able to offer advice on the best way to lead a happy life, whilst effectively managing your diabetes. It is also important that you communicate openly with your healthcare team and inform them of any changes or concerns you experience in your management of type 1 diabetes.

Stay informed and understand the different options that are available. Most of all, it is important to have the courage to face up to, and completely understand, the risks and health implications associated with skipping or manipulating insulin.

 I know someone with type 1 diabetes who may manipulate insulin intake – what can I do?

If you know someone who might be at risk of insulin manipulation, it is important to appreciate that it is a sensitive and difficult topic. It may well be frustrating and difficult for you to fully understand the issues; however offering support to a friend or family member can often make all the difference.

It is important to recognise the signs of insulin misuse and to understand that if it’s something you are concerned about, you are not alone. While insulin manipulation may be difficult to come to terms with, it is a common cause of concern for people with type 1 diabetes, their loved ones, work colleagues and peers.

Warning signs of ongoing problems with insulin misuse can include:

• changes in eating habits (eating more but still losing weight)
• unexplained weight loss
• unexplained hyperglycemia (high blood sugar)
• low energy levels
• frequent urination

While insulin abuse can be an uncomfortable and disturbing topic for many, misusing insulin for weight control is a very real health concern that requires further media awareness and public education.

 Further support and information

See your local doctors or counsellor

Visit the Butterfly Foundation and Eating Disorders Australia

Go to the Type 1 diabetes pages, for more information and stories about these topics