Wednesday, 7 July 2021

How to Follow a Diabetes-Friendly Diet

From health.clevelandclinic.org

Plus a list of the best foods to eat if you have diabetes

If you want to take control of your health, a diabetes diet can be a great way to do it. And while the word “diet” might seem intimidating, registered dietitian Tegan Bissell says following one may be easier than you think. “A diabetes diet should include the foods you like and fit your lifestyle,” she says.

Bissell teams up with diabetes educator and registered nurse Megan Asterino-McGeean, PA-C, to explain what you need to know to follow a meal plan if you have diabetes.

What is a diabetes diet?

Asterino-McGeean says that the best diet if you have diabetes isn’t a diet at all. Instead, think of a diabetes diet as a lifestyle.

“This diet plan helps those with diabetes live a healthier lifestyle that improves blood sugar management and reduces the risk of diabetes complications,” she says. “The best diet for those with diabetes should focus on meal planning and eating balanced, correctly portioned snacks and meals.”

Some factors that mean a diabetes diet may be right for you include:

  • Blood sugar levels: You have high blood sugar levels or have been diagnosed with diabetes or prediabetes (or told you have “borderline diabetes”).
  • Diagnosis of gestational diabetes: You’ve been diagnosed with a type of diabetes that occurs during pregnancy. People diagnosed with gestational diabetes are at an increased risk of developing Type 2 diabetes later in life — but you may be able to prevent it by following a diet plan for diabetes.
  • Weight: You have been diagnosed with metabolic syndrome or obesity.

The best foods if you have diabetes— and why they’re beneficial

Bissell says the best foods to eat if you have diabetes are:

Lean proteins

Proteins help you feel full and satisfied. Examples of lean proteins include:

  • Chicken.
  • Eggs.
  • Fish.
  • Low-fat dairy.
  • Turkey.

Try these diabetes-friendly recipes to get your fill of lean protein:

Non-starchy vegetables

Non-starchy vegetables provide important vitamins, minerals and fibre. “You can consider them ‘freebie’ foods, as they contain minimal calories and carbohydrates,” Bissell says.

They include:

  • Broccoli.
  • Cucumbers.
  • Green beans.
  • Onions.
  • Peppers.
  • Salad greens.

Check out these seven vegetable recipes that are anything but boring, plus other delicious recipes to help you get more non-starchy vegetables into your daily routine:

Healthy fats

Healthy fats help you feel full and are beneficial for heart health. They include:

  • Avocado.
  • Natural peanut butter.
  • Nuts.
  • Olive oil.
  • Seeds.

Try these recipes to get more healthy fats in your diet:

Complex carbohydrates

Carbohydrates are necessary for energy, fiber and certain nutrients. Complex carbs tend to digest more slowly, which prevents erratic blood sugar levels. Complex carbohydrates include foods such as:

  • Beans.
  • Berries.
  • Brown rice.
  • Greek yogurt.
  • Sweet potatoes.
  • Whole-wheat bread.

These recipes are good if you have diabetes, and they can help keep your engines running all day:

Avoid these foods if you have diabetes

Bissell recommends avoiding foods that tend to spike blood sugars suddenly and can promote sugar cravings. Foods to avoid if you have diabetes include processed items, such as cereals, candy and packaged snack foods, and sugary beverages, such as juices and sodas.

How to follow a diabetes diet

Bissell emphasizes that “one size fits all” doesn’t exist with diabetes diets.

“Many people incorrectly believe they need to cut out all carbs or ‘white foods,’” she says, “but you don’t have to eliminate — just limit carbohydrate portions to amounts that work for you. And try to choose more complex carbs in the right portion sizes.”

To make the most of your diabetes diet, try the following tips, too:

  • Eat fewer processed foods.
  • Cook at home more often than you dine out.
  • Drink more water.
  • Cut out sugary drinks.
  • Include vegetables at most meals.
  • Be mindful of portion sizes.

While you may have to do some trial and error, Bissell says these strategies can help increase your chance for success:

  1. Read food labels: Knowing what’s in your food can help you make better decisions about portion sizes and what to buy.
  2. Enlist help: Get a referral to your local outpatient diabetes clinic or a registered dietitian. These experts can help you get started with better eating habits and teach you how to manage diabetes in realistic ways.
  3. Follow the Diabetes Plate Method: The American Diabetes Association’s Plate Method involves filling your plate with these food ratios at each meal:
    • Half non-starchy veggies.
    • A quarter lean protein.
    • A quarter complex carbs.
    • Wash it down with water or a low-calorie beverage such as tea.
  4. Go tech: Use a phone app to make it easier and more convenient for you to count carbs.
  5. Try problem-solving: Bissell describes problem-solving as seeing how your food affects your blood sugars about one to two hours after eating. Then, adjust foods and portion sizes based on that.
  6. Plan ahead: “You can find many recipes online that are good if you have diabetes,” says Bissell. “We recommend making a meal plan each week, using healthy recipe websites or cookbooks.”
  7. Time meals: Because going too long without eating can cause a drop in blood sugar, Bissell recommends eating a balanced meal every four to five hours for more stable blood sugar levels. “The old advice to eat six small meals a day is not necessary and can elevate blood sugars,” she adds. “That’s another reason why planning the next day’s meals can be helpful — you can ensure you have nutritious foods on hand or packed and ready to eat on the go.”

Are there risks involved with eating this type of meal plan?

Following a diabetes diet plan is safe, says Bissell, if you don’t take it to the extreme.

“Some people eat a diet that’s too restrictive or low in carbohydrates. This causes them to lack important nutrients or have frequent low blood sugar levels,” she says. “Balance is key, along with being realistic about what habits you can maintain for the long term.”

https://health.clevelandclinic.org/diabetic-diet/

Tuesday, 6 July 2021

100 Years of Insulin: What Patients With Diabetes Need to Know

From uknow.uky.edu

The University of Kentucky Public Relations and Strategic Communications Office provides a weekly health column available for use and reprint by news media. This week's column is by Laura Hieronymus, a doctor of nursing practice, master licensed diabetes educator, and the associate director of education and quality services at the Barnstable Brown Diabetes Centre.

LEXINGTON, Ky. (July 6, 2021) This year marks a century since the discovery of insulin. Drs. Fredrick Banting and Charles Best discovered the lifesaving medicine in 1921, changing the diabetes diagnosis from a death sentence to a manageable lifestyle. Insulin is credited with saving millions of people and is considered one of the greatest medical achievements of all time. Today, scientists continue to make great strides in diabetes research. There are ongoing efforts to make advancements in diagnosing and treating diabetes, as well as finding a cure for the disease.

People with Type 1 diabetes rely on insulin to keep their blood glucose at a healthy level. Those with Type 2 diabetes may eventually require insulin due to declining insulin production. There are a number of different types of insulin, so it is important to stay “in the know.”

insulin

Bernard Chantal, iStock / Getty Images Plus

Five Things to Know About Your insulin

  1. Name of your insulin:
    • Always check the label to be sure you are using the insulin that your provider prescribed for you.
    • Know both the generic names and brand names of your insulin (sometimes a generic name may have more than one trade name).This will help you make sure that you are using the correct insulin.
  1. Insulin concentration:
    • Know the concentration, or the strength, of your insulin; if the concentration is incorrect, you may not receive the right dose.
    • The most common concentration is U-100. However, other higher than U-100 concentrations such as U-200, U-300, and U-500 are also available.
    • If you are prescribed a lower concentration of insulin and use a higher concentration, you may get 2-5 times the insulin you need, which would seriously increase your risk for hypoglycaemia (low blood glucose). On the other hand, if you are prescribed a higher concentration of insulin and use a lower concentration, your risk for hyperglycaemia (high blood glucose) will increase.
  1. Colour and appearance:
    • Most insulins will look clear and colourless. If your clear insulin is NOT clear, throw it away.
    • Some insulins, such as premixed insulins, will look cloudy. These insulins contain added substances called buffers that make them work over a longer time. When these types of insulin sit for even just a few minutes, the buffers settle to the bottom of the vial. Gently roll the insulin pen between your hands to mix the insulin before injecting. If your cloudy insulin will not mix, throw it away.  
  2. Insulin dose:
    • Know your dose. Taking too much insulin can increase your risk for hypoglycaemia, and too little insulin can increase your risk for hyperglycaemia.
    • Monitoring your glucose levels will help you and your health care provider determine which dose is best for you.  
  3. Timing of injections:
    • You should be aware of when you are supposed to use your insulin. Be sure you know how often and at what time of day you should use your insulin.

Finally, be sure to ALWAYS review the details and instructions in the medication guide that comes with your insulin prescription. Starting insulin can be overwhelming. Reach out to your provider, pharmacist and/or diabetes care and education specialist for guidance.

Diabetes education is considered such an important part of your diabetes care that medical treatment without it is considered inadequate. To learn more about diabetes education and healthy behaviours such as proper use of insulin, contact Barnstable Brown Diabetes Education Services at 859-323-7391 or diabeteseducationservices@uky.edu.

http://uknow.uky.edu/uk-healthcare/100-years-insulin-what-patients-diabetes-need-know

Monday, 5 July 2021

Type 2 diabetes symptoms: Four sensations indicative of high blood sugar

From express.co.uk

DIABETES is a condition that can gradually creep up on you; even though the symptoms can be brushed off as inconsequential, the internal damage being done is dangerous

Early indications of high blood sugar (the hallmark of type 2 diabetes) include frequent urination, increased hunger, and tiredness. As the condition progresses, sensations might appear. According to the Mayo Clinic, excess sugar in the blood can injure the walls of the tiny blood vessel (i.e. capillaries) that nourish your nerves. This can prevent adequate blood supply and nutrients from reaching the nerves.

Consequently, four sensations might arise in the tips of the toes and fingers. The four sensations in the body's extremities are: tingling, numbness, burning and/or pain.

Do not ignore these warning signs, especially if it's recurrent, because it could result in an absolute loss of feeling in the affected limbs.

Type 2 diabetes: Four sensations indicative of high blood sugar

Type 2 diabetes: Four sensations indicative of high blood sugar (Image: Getty)

In severe cases, serious infections can lead to the toe, foot, or leg being amputated (i.e. surgically removed).

Other indications of nerve damage include nausea, vomiting, diarrhoea, or constipation.

For men, nerve damage can even lead to erectile dysfunction.

Nerve damage (known as neuropathy) is only one long-term health complication that can arise from high blood sugar.

Type 2 diabetes can also "dramatically" increase the risk of cardiovascular issues, such as:

  • Coronary heart disease
  • Heart attack
  • Stroke.

The best way to manage your diabetes is to receive medical support as soon as possible.

If you identify with any of these early warning signs of type 2 diabetes, request a blood test to check for your blood sugar levels.

The NHS listed symptoms of type 2 diabetes:

  • Peeing more than usual, particularly at night
  • Feeling thirsty all the time
  • Feeling very tired
  • Losing weight without trying to
  • Itching around your penis or vagina, or repeatedly getting thrush
  • Cuts or wounds taking longer to heal
  • Blurred vision.

Am I at risk of type 2 diabetes?

People over the age of 25 are more at risk of developing type 2 diabetes, especially if they're from south Asian descent.

Your risk for this condition also increases if you have a close relative who has type 2 diabetes, such as a parent or sibling.

You're also more likely to develop type 2 diabetes if you're overweight. However, it must be noted that some people aren't overweight when they're diagnosed with the condition.

A GP can diagnose type 2 diabetes, which means treatment can begin.

While there is no cure available for the condition, it can be put into remission. This will involve exercising more often, eating a healthy diet, and being a non-smoker. Medication may be prescribed to you in order to help lower blood sugar levels.

https://www.express.co.uk/life-style/health/1458152/type-2-diabetes-symptoms-bodily-sensations-high-blood-sugar-nerve-damage

Friday, 2 July 2021

This One Thing Could Predict if You'll Get Diabetes, Says Study

From eatthis.com

This childhood condition has been linked to type 2 diabetes

According to the Centres for Disease Control and Prevention, about ten percent of Americans, or 34 million, suffer from diabetes. 90 to 95 percent of them have type 2 diabetes, meaning your body doesn't use insulin properly. There are multiple risk factors for diabetes, some of them preventable and others not. Researchers are continually studying diabetes, hoping to gain more understanding about what causes it and how to prevent it. Recently new findings have identified a significant risk factor for type 2 diabetes, that could help prevent many people from developing the condition. Read on to find out the risk factor.


Your Childhood BMI Could Predict Diabetes

The research letter, published in the Journal of American College of Cardiology found that childhood obesity—a high body mass index (BMI)—could be a significant risk factor for type 2 diabetes and early myocardial infarction, and ultimately lead to overall worse health in young adulthood regardless of BMI.

Researchers used BMI z-scores of 12,300 children between the ages of 11 and 18 with 24 years of follow-up self-reported data via the National Longitudinal Study of Adolescent to Adult Health. They found that a higher BMI in adolescence was responsible for a 2.6 percent increase in overall poor health, a 8.8 percent greater risk for type 2 diabetes and 0.8 percent increased risk for early myocardial infarction for adults in their 30s and 40s—regardless of their adult BMI.

"The finding that adolescent BMI is a risk factor for poor health outcomes in adulthood, regardless of adult BMI, has significant implications for our understanding of cardiovascular disease onset," study lead Jason M. Nagata, MD, MSc, stated in a press release. "Considering these findings, health care providers should consider BMI history when assessing for cardiovascular and chronic disease risk."

"Our study suggests that adolescence is an important time period to optimize health and prevent early heart attacks," Nagata continued. "Paediatricians should encourage teens to develop healthy behaviours including physical activity and balanced meals."

https://www.eatthis.com/news-childhood-bmi-diabetes-risk-study/

Thursday, 1 July 2021

How Do Heat and Humidity Affect Diabetes?

From healthline.com

Summertime can bring extra challenges for people with diabetes. Research suggests that hot weather can lead to health issues for people with diabetes, making you more sensitive to high temperatures and humidity.

You may find it harder to keep your blood sugar levels under control, and you may be at increased risk for developing heat exhaustion.

So, when the weather heats up, it’s important to closely monitor your blood sugar levels and watch for possible symptoms that your body is not handling the heat very well. That way, you can take action before the situation becomes serious.

It’s not just that the hot weather can make you feel tired and sluggish. It can have some negative effects on how your diabetes affects your body. For example, people with diabetes tend to get dehydrated more quickly than people without diabetes. Signs of mild to moderate dehydration can include:

  • fatigue
  • decreased urination
  • increased thirst
  • dizziness or light-headedness
  • headache
  • dry mouth and dry eyes

When dehydration becomes more severe, you may develop:

  • excessive thirst
  • dark-coloured urine
  • low blood pressure
  • rapid heart rate

Some people even notice their sweat production drops off.

Dehydration can make your blood glucose levels rise. Then, you may develop a more frequent need to urinate, which compounds the problem.

You’re also more vulnerable to heat exhaustion because diabetes can damage your blood vessels and nerves, including the nerves in your sweat glands, so you may not be able to cool your body as efficiently as it needs.

Additionally, high temps can alter how your body uses insulin. Typically, if you’re exercising, it reduces your need for insulin. But hot weather can throw a wrench into that, and you may be at risk for both high and low blood glucose levels.

That’s a good incentive for discussing with a medical professional how to adjust your insulin, if need be, to account for your activity level and the weather.

In some places, it’s not just hot. It’s hot and humid at the same time. The extra moisture in the air can make the heat feel worse.

And here’s the challenge for people with diabetes: When it’s humid, your sweat doesn’t evaporate as well as it would under drier conditions. That makes it harder to stay cool, and that can make it harder for you to keep your blood glucose levels under control.

The Centres for Disease Control and Prevention suggests monitoring the heat index in your area, since that takes both temperature and humidity into account.

Managing your diabetes carefully is the best way to stay on top of the situation. Here are a few tips to help you do that and stay safe in the heat this summer:

  • Drink plenty of water. Avoiding dehydration is critical, so you’ll want to make sure you’re keeping up your fluid intake. But skip the sugar-sweetened beverages.
  • Dress for the weather. That means lightweight, loose-fitting clothes to help keep yourself cool, especially if you plan to spend time outside.
  • Avoid alcoholic beverages. Alcohol has a diuretic effect, so drinking alcoholic beverages will make you need to urinate more frequently, and you’ll wind up losing fluids.
  • Check your blood sugar levels frequently. This includes before and after activities like exercise, which affects your blood sugar levels regardless of the weather. Hot weather can make your blood glucose levels fluctuate even more than you might realize.
  • If you’re going to be outside, stay in the shade as much as possible. The heat index can be quite a bit higher in direct sunlight, so opt for the shade where it’s a little cooler.
  • Exercise indoors in air-conditioned spaces. You’ll be less vulnerable to heat and humidity. Or if you really love to exercise outside, fit in a workout in the early morning hours when it’s a little cooler.
  • Know your medications. Carefully read all the instructions for your medications so you’ll be aware of any warnings about heat.
  • Be prepared. Keep urine ketone tests on hand if you have type 1 diabetes and use insulin, since you may be at risk for developing a complication known as diabetic ketoacidosis.

If you have diabetes, you’ll want to monitor yourself for the possible development of symptoms of heat exhaustion, as well as hypoglycaemia and hyperglycaemia. Sometimes the symptoms can be similar, so you may want to keep an eye out for a range of symptoms, and when in doubt, seek medical care.

Heat exhaustion

Your body can overheat in response to hot weather and develop a condition known as heat exhaustion. Symptoms tend to include:

  • drop in blood pressure
  • feeling faint
  • profuse sweating
  • dizziness
  • nausea
  • headache
  • weak and rapid pulse rate
  • muscle cramping
  • moist or cool skin even in high temperatures

While not as serious as heat stroke, heat exhaustion can pave the way for it, so don’t ignore these symptoms.

Hypoglycaemia

Hypoglycaemia occurs when your blood sugar drops to abnormally low levels. Officially, it occurs when your blood glucose levels fall below 70 milligrams per decilitre (mg/dL).

Your risk for hypoglycaemia increases in the summer because your metabolism tends to run higher in hot, humid weather, and you’re more likely to absorb more insulin.

When hypoglycaemia develops, you may start feeling confused or develop blurred vision. Other symptoms include:

  • anxiousness
  • sweating
  • tremors
  • heart palpitations

In extreme cases, you may lose consciousness. Be sure to keep glucose tablets or another source of fast-acting carbohydrates on hand so you can take them right away if your blood sugar levels start to drop.

Hyperglycaemia

Hyperglycaemia ccurs when your blood glucose levels are too high. Your body either doesn’t have enough insulin or it can’t use the insulin it has effectively.

You have hyperglycaemia if your blood sugar levels exceed 180 mg/dL after meals or hover above 130 mg/dL before you eat.

Feeling really thirsty or fatigued? Do you need to pee frequently? Those are common signs of hyperglycaemia. Of course, excessive thirst and fatigue can also develop as a result of dehydration. But either way, you don’t want to brush them off. Check your blood sugar levels and make sure you’re also drinking enough fluids.

If you start developing signs that you are becoming dehydrated or having heat exhaustion, stop what you’re doing. Head indoors to a cool spot, drink some fluids to help you rehydrate, and check your blood sugar levels.

If your blood sugar levels have dropped below 70 mg/dL, remember the “15-15 rule,” suggests the American Diabetes Association. That is, consume 15 grams of carbs to raise your blood sugar levels and wait 15 minutes to test your levels again.

If your blood sugar levels are too high, quick-acting insulin can help counteract high blood sugar levels in many cases.

However, if your blood sugar levels are dangerously high, don’t wait. Have someone take you to the hospital. If you have low insulin levels, and very high blood sugar levels, you could go into diabetic ketoacidosis, which is a medical emergency.

Summer can be a marvellous time, but the heat and humidity can take their toll on people with diabetes.

It’s important to watch out for signs of dehydration and heat exhaustion, and keep close tabs on your blood glucose levels. Keep an ample supply of fluids, medications, and other supplies close by. That way you can reach for your medication, fast-acting carbohydrates, or other supplies as soon you need them.

https://www.healthline.com/health/diabetes/diabetes-and-heat

Monday, 28 June 2021

Six simple rules diabetics need to follow

From indianexpress.com

For a diabetic patient, it is the blood sugar levels which reveal whether they have either high amounts of blood sugar (hyperglycaemia) or low blood sugar levels (hypoglycaemia)

Worried about your fluctuating levels of blood sugar? Well, don’t be. Here are six pointers from Dr Ganesh Kadhe, associate director, nutrition medical and scientific affairs, Abbott, on how you can gain control over your sugar levels and stay healthy even with a diabetic condition.

Eat right and exercise regularly

Your food choices matter a lot when you’ve got diabetes. Some are better than others. Eat something every 2½ to 3 hours and main meals no longer than four-five hours apart. Eating meals and snacks at consistent times help keep your blood glucose levels within target range. Include low Glycemic index (GI) foods like whole wheat, brown rice, oats, etc. in every meal. Avoid refined cereal products like white bread, noodles, white rice, etc. as they can raise blood sugar levels. Getting regular physical exercise is equally important to maintain normal blood sugar levels. But check your blood sugar levels before and after exercise and avoid exercising if your blood sugar levels are too high or too low.

Control your cholesterol levels

Diabetes tends to lower “good” cholesterol levels and raise triglyceride and “bad” cholesterol levels, which increases the risk for heart disease and stroke. High cholesterol also leads to a common complication of diabetes known as diabetic dyslipidemia which may result in clogged arteries and coronary complications. Ideally, stay away from a diet high in saturated and trans fats such as fast food – burgers, pizza, fried snacks as these raise your LDL cholesterol.

Check your blood sugar levels regularly

For a diabetic patient, it is the blood sugar levels which reveal whether he/she has either high amounts of blood sugar (hyperglycaemia) or low blood sugar levels (hypoglycaemia) in the blood. Both are extremely dangerous. The best way to check your blood sugar levels at regular intervals is to have a glucometer at hand. Get your HbA1C checked twice a year. HbA1C (Haemoglobin A1C) is a simple blood test that measures how well your diabetes is managed over time. It is aimed at measuring your average blood sugar levels and to see if it has stayed within the required range. It is important to get this test done either twice a year or once in three months depending on how well your diabetes is controlled.

diabetes, what should people with diabetes know about health, diabetes and healthy lifestyle, health rules for diabetics, diabetics and health, indian express news

Check your blood sugar levels before and after exercise and avoid exercising if your blood sugar levels are too high or too low. (Representational image/Pixabay)


Be regular with your medication

Adherence to the prescribed medication at the recommended amount and schedule is important for having a good diabetic control. Missing medication can increase your risk of suffering from several diabetes-related health complications.

Add a diabetes-specific formula

Along with lifestyle modifications and regular exercise, it is advised to add a diabetes-specific formula to your diet plan. Look for a formula that is designed with special ingredients like complex carbohydrates, vitamins and anti-oxidants, to help manage steady release of glucose. Ideally, the formula must be included in your breakfast, lunch or dinner as partial meal replacement in one of your modified meals. It helps to keep blood glucose and weight under control.

Shed those extra pounds

Obesity is one of the most crucial mitigating factors of diabetes. Obesity also causes your cholesterol levels to skyrocket, increasing the chances of heart disease.

https://indianexpress.com/article/lifestyle/health/six-simple-rules-diabetics-must-follow-blood-sugar-tips-7370300/

Sunday, 27 June 2021

From starvation diets to personalized plans: Diabetes nutrition therapy through the years

From healio.com

So-called “diabetes diets” have come a long way since the discovery of insulin in 1921, yet common themes underlying many eating plans today were first developed by registered dietitians more than a century ago, according to two speakers.
Melinda D. Maryniuk

“Nutrition is not something new that we are just beginning to pay attention to,” Melinda D. Maryniuk, MEd, RDN, CDCES, FADA, senior consultant with Melinda Maryniuk & Associates in Boston, told Healio. “Back in the 1920s, people were already focusing on cultural foods and individualized diets in diabetes. As dietitians, we act like we are doing this for the first time. It is helpful to look back in history and realize that there was great work that was laid before us, and there are some things we should learn from.”

Diets before, after insulin

Prior to the discovery of insulin in 1921, regulating food intake — typically severely limiting carbohydrate and calories — was the only treatment for type 1 diabetes, Maryniuk said during a virtual presentation at the American Diabetes Association Scientific Sessions.

In 1915, Frederick M. Allen, MD, first wrote about “total dietary regulation” in the treatment of diabetes, noting that a very low-carbohydrate/low calorie diet was the best way to “clear glucose from the urine and extend life.”

The approach included three steps:

  • Strict calorie reduction for 1 to 4 days, with a diet alternating coffee and whiskey (1 oz every 2 hours) until the urine was “free of sugar;”
  • Preparing “thrice boiled vegetables” for 1 to 3 days; and
  • A gradual addition of protein and fat to avoid a fast rise in glucose.

“Whiskey is not essential — it merely furnishes calories and keeps the patient comfortable,” the text states.

Insulin was heralded as a “miracle” cure, allowing children to consume enough calories to return to a healthy weight. Yet even in insulin’s early days, Elliott Joslin stressed the important of the “treatment triad” for diabetes management: insulin, exercise and diet, and the challenge to “get all three to work together,” Maryniuk said. Joslin was a proponent of the weighted diet in the post-insulin era.

“It was very restricted in terms of the kinds of foods allowed — how much grapefruit, how much orange, potato, oatmeal and cream one could have,” Maryniuk said. “In one of the Joslin books, grapefruit and oranges were the only recommended fruits in the early years. It said, ‘What should a diabetic do if given an apple?’ The answer was, ‘Throw it away.’”

Joslin diets included lists for food values every clinician was expected to memorize, Maryniuk said. Early plans were tightly structured, though diets became progressively more adapted and individualized, allowing for variation in quantity and food type. Still, other clinicians recommended very different diabetes eating plans, and there was debate on the optimal eating plan for diabetes.

“I visited Camp Joslin several times in the late 1970s as a new dietitian,” Maryniuk said. “I remember the boys taking their peaches from lunch, carving off the flesh, and weighing them on the gram scale until they had the precise amount they were prescribed, usually about 150 g. And then I moved to Florida, and their approach to meal planning at a diabetes camp there was so different. Healthy foods were served family style, kids selected what their appetite dictated. I realized then that there was no one approach to meal planning.”

Diabetes diet 2019

Source: Adobe Stock

Edward Tolstoi, MD, best known for advocating “the free diet,” recommended a diet that did not include a gram scale. People with diabetes could choose foods that do not differ from the diet consumed by other family members, as long as choices were healthy. Many other clinicians also pushed for an increase in carbohydrates to allow for a more normal life as early as 1933, Maryniuk said.

The Exchange Lists for Diabetes Meal Planning booklet was first published in 1950 by the Academy of Nutrition and Dietetics, the ADA and the U.S. Public Health Service Diabetes Branch to address a need for standardization in food values and terminology and to simplify nutrition messages. Even in 1950, individualized plans that “suit the special needs” of the person with diabetes were highlighted, Maryniuk said.

Individualized plans key

Today, the message of individualized nutrition therapy has become central, Hope Warshaw, MMSc, RD, CDE, BC-ADM, FADCES, said during the presentation, where she shared nutrition history from the 1980s into the future. Knowledge gained from the U.K. Prospective Diabetes Study (UKPDS), U.S. government food and nutrition polices, and the role of registered dietitians and registered dietitian nutritionists pushing the field forward have kept a focus on a critical need for person-centred care, Warshaw said.

Hope Warshaw

“While over the years since the 1980s there have been tweaks made in the macronutrient recommendations — particularly carbohydrate and fat — and the addition of recommendations regarding the types of fats to consume and not consume, a consistent message has been to consider all elements of the person’s lifestyle, life schedule and eating habits,” Warshaw, owner of Hope Warshaw Associates, LLC, a nutrition and diabetes-focused consultancy based in Asheville, North Carolina, told Healio.

That message is even stronger in the ADA’s 2019 nutrition therapy consensus report, which states individual nutrition needs should be based on personal and cultural needs, literacy, numeracy, access to healthy foods, willingness and ability to make behaviour changes and understanding a person’s barriers.

“Another important statement to guide our recommendations was added to the ADA nutrition recommendations in 2013,” Warshaw said. “That is, in clinician guidance, strive to maintain the pleasure of eating, limiting food choices only when indicated by scientific evidence.”

Eating habits are a challenge to change, Warshaw said; clinicians should strive to work with people from where they are and how they eat. She outlined four “common denominators” of healthy eating patterns, highlighted in the 2019 consensus report:

  • Emphasize consumption of non-starchy vegetables;
  • Minimize consumption of added sugars and refined grains;
  • Choose whole foods over highly processed foods; and
  • Replace sugar-sweetened beverages with water as often as possible. 

“There is great interest in food, nutrition and eating patterns today,” Warshaw told Healio. “I expect that with continued interest and exploding research in this area, new findings for the general public as well as for people with different types of diabetes will impact future guidance. Areas to watch are the role of the gut microbiome in glycaemic dysfunction and potential management, precision nutrition for diabetes care, optimizing artificial intelligence and machine learning to ease management burdens, and optimized strategies and programs, like online coaching platforms, to support necessary behaviour changes to achieve positive outcomes.”

https://www.healio.com/news/endocrinology/20210626/from-starvation-diets-to-personalized-plans-diabetes-nutrition-therapy-through-the-years