In this episode, I interview Sally Marchini who is a dietitian and active member of the Australian Diabetes Council and Coeliac Australia. She shares her personal experience as a Coeliac and type 1diabetic, mixed in with her professional recommendations on how to mange type 1 diabetes.
Type 1 diabetes is a genetic condition that can only be treated with the use of insulin and taking care of carbohydrate intake. Sally myth busts low carb diets and warns that low carb diets can lead Type 1 diabetics into ketoacidosis resulting in death. She also explains that exercise is good for overall health for everyone including Type 1 diabetics. The key though, is understanding your medications and your body to avoid blood sugar roller coasters.
Sally gives some awesome advice on how to get help for diabetic fatigue and provides some really useful links to websites where you can get help, which include Diabetes Counselling. I also mention an exercise physiologist Allan Bolton’s who’s into adventure sport see more about him by visiting his website. Want more detailed information? Listen to the podcast, and don’t forget to hit me up on Twitter or Facebook.
Managing Type 1 Diabetes
With Sally Marchini
- Type 1= autoimmune condition; body’s immune system kills off the cells that make insulin. People with Type 1 diabetes= bodies stop making insulin altogether- they need to replace this insulin either by multiple daily injections or an insulin pump. Type 2= also genetic but comes on more slowly. People can manage via diet and lifestyle and certain aspects of T2D can make it harder to control such as abdominal weight gain- encouraged to minimise that. Metabolic syndrome which progresses to Type 2 diabetes- harder for body to use insulin and pancreas wears out and cant produce enough insulin to keep body going. Diet and lifestyle can make a difference but t’s progressive and pancreas eventually wears out and they’ll need to top insulin up.
- Honeymoon period in Type 1 diabetes.
- Type 1 diabetes can occur at any stage of life. Diagnosed more and more in adults. Diagnosed through blood test that shows antibodies. When first diagnosed may be mistaken for Type 2 and when management for Type 2 doesn’t work that they’re tested for type 1. Comes on more slowly when diagnosed later in life.
- Type 1 diabetes- before insulin was invented they had to cut out all CHO from diet and they did not live very long. It’s not a good management technique! Diabetic ketoacidosis= blood turns to acid- terrible health consequences including death if insulin not managed properly.
- 24/7 job. Some people find hard to deal with. Diabetes distress= people cant cope with and give up and this has terrible consequences.
- People need quality CHO’s for nutrition we need but also for energy (CHO’s break down to glucose- body’s preferred fuel). Understanding what quality nutritious CHO’s are- choose moderate amounts of foods from Australian Dietary Guidelines. Low glycaemic index- won’t cause spikes in blood sugar levels.
- Diabetes control: understand how insulin works, what profile of insulin is and try to match that to food you’re eating. Can keep blood glucose level at a more even level.
- Diabetes isn’t a game of perfect for blood glucose. Try to keep it as close as you can to range of what your target is. Target’s are individual.
- The more you can learn about it the better you can deal with it and minimise the highs and lows and enjoy life and food and manage weigh.
- On an average be ok over time. HbA1c test- 3 monthly average of blood glucose levels- more important than day-to-day tests.
- Type 1 diabetics need to test regularly to know if you need to correct or if you know CHO for a hypo.
- Pump makes exercise easier. Can still exercise on injections. Self-experimentation and finding out what works for you. On pump can set basal rate- if she eats something she only needs 1/3 of insulin while exercising of what she normally needs.
- How is insulin sensitivity calculated: they are formulas endocrinologists’ use. Dietitian’s don’t prescribe insulin. Look at blood glucose readings based on what they’re eating to work out how much insulin they need per carb. Work out if they’re having enough insulin for that carbohydrate that they’ve had.
- Diabetes educator can also advise on insulin dosage.
- Common for people end up gaining weight with Type 1- encouraged to eat anything they like. Told how much insulin they need per carb serve but can have as many carb serves as they like. Not educated on quality of CHO’s. Happens without realising it. People with Type 1 diabetes- can eat what they like because they can adjust insulin for it, should still think about health and wellbeing- involves healthy eating, following dietary guidelines, eating in moderation and eating quality CHO’s.
- Just because you can eat a lot and eat whatever doesn’t mean you should!
- People with Type 1 diabetes who put on a lot of weight are at risk of metabolic syndrome which is what people with Type 2 have before they’re diagnosed with diabetes. Insulin resistance, have to increase amount of insulin they’re having, abdominal adiposity- putting on weight around their middle- so much insulin and glucose in bloodstream and liver cant process it so gain weight around middle.
- Understand quality CHO’s and the glycaemic index of CHO’s. Body needs quality CHO’s to burn fat. Understanding quality and quantity of CHO’s. Important to see dietitian to get balance right.
- All people with diabetes are at increased risk of heart problems- both inflammatory conditions. Should be mindful of heart health. Look at saturated fat and sodium- look at per 100g column. <10g per 100g (<10%) of total fat. 2% of saturated fat and in savoury products less than 400mg per 100g of sodium. Less if it’s not a savour product. As much as fibre as possible to keep everything flowing through.
- ‘Sugar’ on label confuses people.
- Low glycaemic index sugars aren’t a problem- naturally occurring in fruit and dairy.
- Don’t follow low carb diets! It’s a fad diet. For people with diabetes it is severely dangerous- can lead to death (ketoacidosis- these diets promote this).
- Type 2 diabetes: be realistic about food choices and don’t cut out carbs.
- Diet and exercise to keep Type 2 diabetes in remission doesn’t mean you’re cured- it’s sitting in background until you make poor choices- it will come back. All about good management.
- See a health professional regularly (3-6 months to see if you’re still doing the right thing)- it’s complicated!
- Don’t be afraid of exercise. Again see a health professional to make sure you don’t get hypos from exercise and exercise can be a regular part of regime.
‘Good’ and ‘Bad’ foods
With Katrina Mills & Gabby
-A. food isn’t good or bad- it’s just food for specific occasions. A negative association with food- food is not a moral judgement. Occasions when we need to eat these foods e.g. sports drink- endurance athlete’s use during marathon. Take labels off- be mindful if having something more rich in calories or sugar or fat be mindful of frequency of when you eat and how much you eat. Don’t want feelings of deprivation so have a little bit e.g. chocolate. Sometimes foods you have on occasion when you can enjoy them. Can eat sometimes foods without gaining weight or have bad health if it’s all in moderation- don’t let food make you feel guilty! Leads to binge and restrictive eating.
- What do you think of vegemite, coconut oil and quinoa4
-A. Coconut oil: huge food trend. None of these claims have been proven to improve health more than olive oil. Only use as any other oil especially if worried about weight gain. Research doesn’t support its use. Olive oil is so much better and there’s concrete data on it. Go with what you know. Wouldn’t recommend people adding fat to a shake anyway. Coconut oil is a saturated fat. Use it sparingly as you would any other oil
-Vegemite: High in salt but contains iron and B vitamins. Use it as you normally would you don’t need to change it. Only if you have high blood pressure and you’re eating a lot of it.
-Quinoa: Marginally more nutritious than rice but much more expensive. Don’t have to substitute rice for it. Both low GI, basmati rice is low GI. Much of a muchness, choose whatever one you want.