Managing risk factors: type 2 diabetes

Health and Fitness
Heart disease and type 2 diabetes often go hand in hand, as they are both chronic diseases resulting from metabolic syndrome. Metabolic syndrome is defined as metabolic dysfunction, and individuals have a cluster of risk factors including all or some of the following: high cholesterol, insulin resistance, high visceral fat and high blood pressure resulting from long term excessive energy intake, overweight and obesity, inactivity and poor diet quality.

People with diabetes are up to four times as likely to develop heart disease as those without. If you have a family history of type 2 diabetes or have recently been diagnosed, the steps you take to either prevent or manage this disease are the same steps you’d take to decrease your risk of heart disease.

Type 2 diabetes has long been considered a progressive disease. Once you have it, it will gradually become worse and worse. The best you could previously hope for was to prevent the progress and avoid insulin injections for as long as possible.

However, there is growing evidence that type 2 diabetes can not only be stopped in its tracks, but also pushed into remission. Here’s how you can do it and decrease your risk of heart disease while you’re at it.

Reversing diabetes = Increasing insulin sensitivity

It all comes down to insulin. Insulin is a hormone made in the pancreas whose job is to stop the body's blood sugar levels from getting too high. It does this by telling the liver and muscles to hold on to some of the sugar from the blood.

Insulin resistance, or reduced insulin sensitivity, is when the liver and muscles stop listening to insulin. Insulin is telling them to store the sugars, but they ignore it. In response, the pancreas produces increasing amounts of insulin to get the liver and the muscles to listen, but this leads to the insulin producing cells in the pancreas wearing themselves out. At a certain point, the pancreas can’t produce enough insulin to match the resistance and blood sugar levels start to rise. This is when type 2 diabetes is diagnosed.

Therefore, one goal for someone with type 2 diabetes is to improve the liver and muscle’s sensitivity to insulin. This can be done by stopping insulin from bombarding the liver and muscles, and reducing the workload of the pancreas.

In the initial stages, type 2 diabetes can often be managed with regular physical activity and healthy eating. From a dietary perspective, the best way to do this is to moderate the volume, type and timing of carbohydrate eaten.

Moderating the volume of carbohydrate

There is good evidence that a lower carbohydrate diet can improve insulin sensitivity. Note that a low carbohydrate diet does not mean a NO carbohydrate diet. There is actually no single definition of what a low carbohydrate diet is. Much of the research into improving insulin sensitivity focuses on an intake of between 20–40% of daily energy from carbohydrates. For most people, this range can include a reasonable portion of carbohydrate-rich foods at main meals.

If you think you need to moderate the volume of carbohydrate, try:

  • Keeping the carbohydrate-rich food to about ¼ of your plate at mealtimes.
  • Roasting carrot or pumpkin, instead of only potato or sweet potato.
  • Ensuring that you measure out only ½ – 1 cup of rice for meals.
  • Snacking on fruit and veg rather than muesli bars and baked goods.

Choosing the right type

The type of carbohydrate comes down to the glycaemic index, or GI. Low GI foods take longer to break down in the digestive tract and are more slowly absorbed into the bloodstream, which makes for an easier workload on the pancreas and insulin. The most effective way to lower the GI of a carbohydrate food is to increase the fibre content. Fibre is the indigestible part of the plant which helps to slow digestion.

If you’re trying to choose the best type of carbohydrate, try:

  • Swapping to wholemeal or multigrain options for bread and similar foods.
  • Adding psyllium husk or bran to your cereal.
  • Keeping the skin on your potatoes and sweet potatoes.
  • Using high fibre white pasta.
  • Reducing the regularity of lollies, chocolates and soft drinks.

Balancing the timing

Timing when you eat carbohydrate is all about how much work you are asking your pancreas to do at one time. If you go all day without any carbohydrate or sugar and then become so hungry that you have an extra serve of pasta and indulge in chocolate, you are asking your pancreas and insulin to do a lot of work all at once. However, if you have some carbohydrate earlier in the day to avoid becoming overly hungry, you will be better able to manage your portions.

If you need to adjust the distribution of carbohydrate throughout the day, try the below.

Having some high fibre carbohydrate with your lunch, such as:

  • 2 slices of rye bread with soup
  • ½ – 1 cup of brown rice with a stir-fry
  • 1 cup chickpeas with salad.

 

Including a wholegrain snack in the afternoon like:

  • ¼ cup muesli and yoghurt
  • 4 wholegrain crackers and cheese.
  • Reducing your portion of pasta, rice or potato at dinner.
  • Mindfully choosing after-dinner snacks. Put it on a plate instead of eating from the packet, to prevent overeating in the evening.
Clare Wolski

Clare Wolski is a passionate Accredited Practicing Dietitian (APD) and the Head of Clinic Operations at The Healthy Eating Hub in Canberra. She loves empowering people with good nutrition information so they can make the best decisions for their long term health.

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