Living with Type 2 diabetes

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In this episode, I interview psychologist Dr Jessica Browne. Jessica is currently a research fellow at The Australian Centre for Behavioural Research in Diabetes. At this year’s annual scientific meeting, she will be presenting on a case-controlled analysis of young adults with diabetes, in relation to mental health and self care. Through her research, she has found that young adults, with diabetes, have unique challenges to face when dealing with diabetes throughout their life.

 

I also cover how to manage Type 2 diabetes with nutrition and exercise. In particular, I discuss the glycemic index and what types of food to look out for when managing your blood sugars, and how exercise is beneficial to diabetic blood sugar control. Don’t forget to rate the show on iTunes or leave me a comment below 🙂

Check out this episode!

Transcript 

Living with Type 2 Diabetes 

00:02:30- Gabby explaining carbohydrates

  • There is a stigma that people who have Type 2 diabetes eat a lot of sugar.
  • Type 1 Diabetes covered in previous podcast with Sally Marchini.
  • Type 2 Diabetes use to be called adult-onset diabetes as it showed later in adult life, however now it is appearing in teenagers. Developed over time and people have elevated blood sugar (glucose, which is broken down carbohydrate in the blood). Blood sugar normally sits around 5.6mmol/litre.
  • Pre-diabetes: blood sugar levels stay elevated after a meal for more than two hours or getting past the 5.6mmol/litre mark.
  • Insulin resistance is when insulin levels are higher than what they’re supposed to be.
  • A Glucose tolerance test (GTT) is when you go into the clinic fasted, drink a glucose solution and your blood sugars are measured to see how your blood sugar is reacting in that time. If your blood sugar remains elevated then you may be diagnosed with diabetes or pre-diabetes.
  • Family history of diabetes- good to get a standard blood test first, and if blood sugars are elevated they may send you for a GTT.
  • Diabetes affects 65% of population. Can be prevented or can reduce the risk of diabetes by changing lifestyle such as exercise and healthy eating.
  • People with diabetes have to keep an eye on carbohydrates and food in general, not just sugar. Carbohydrates and protein elevate blood sugar and eating too much fat can contribute to insulin resistance.
  • Previous podcast on saturated fat and insulin resistance.
  • Carbohydrates found throughout whole diet (breads, cereal, rice pasta, grains, legumes, starchy vegetables (such as potatoes), fruit, fruit juice, milk, honey, sugar, soft drink, jelly; carbohydrates are everywhere!
  • Once diagnosed with Type 2 diabetes, you have to watch more than just the sweet things; you have to watch the total diet. Carbohydrate intake first and foremost which encompasses sugars (carbohydrate is an umbrella term for sugars and starches e.g. lollies and bread)- don’t have to cut them out of the diet because our bodies need carbohydrates; just need to think about what ones we have and how much we have at each time.
  • Also have to make sure we’re not over-eating in general because protein (meat, poultry, eggs etc.) also raises blood sugar levels and eating too much saturated fat will lead to weight gain and being heavier increases risk of diabetes.
  • Insulin is a naturally occurring hormone in the body that increases when we eat carbohydrate foods and has a response when we eat protein foods as well. When we eat these foods insulin is released to help mop up the glucose out of the blood and transfer it to muscles and other cells. Insulin resistance is when this system doesn’t work properly. More insulin is produced to do the same job but it doesn’t clear the glucose as well as it can because the cells are resistant to the insulin. That’s when people need to exercise (exercise increases insulin sensitivity) or take medications to bring blood sugar levels down.
  • The types of carbohydrates we eat affect insulin so it’s best to choose low glycaemic index (GI) carbohydrates. The amount of carbohydrates also affects insulin along with the type and this is called glycaemic load.
  • Low glycaemic foods and a low glycaemic load decrease the amount of insulin released; get a steady rise of sugars over time but it doesn’t peak; this is what we want!
  • Everybody’s tolerance to carbohydrates is different and people’s blood sugar responds to a different level of carbohydrates as well. Everyone’s diet has to be assessed (especially if diagnosed with diabetes) with what medications they’re on, how much exercise they’re doing and what else is happening in their life. E.g. labourers burn more energy and need more carbohydrates than people with an office job.
  • People should be able to have some carbohydrates; body uses it for energy and brain uses as a primary fuel source.
  • The dietary guidelines are a population-based, not individual tool. We manipulate the guide for the individual.
  • Be aware of generic plans or those that completely cut out carbohydrates because it’s not necessary. If you’re going to make changes with your diet (and you have diabetes), inform your doctor because it may affect insulin/medication dose, as your blood sugar levels will change and you don’t want them too low.
  • Low GI foods: foods that aid the body in releasing glucose slowly into the system. Typically high in fibre and harder to breakdown e.g. multigrain and seeded bread, sourdough or wholemeal bread.
  • Fibre content, acidity level (more acidic, lower the GI), fat and protein influence GI and slow down digestion of the carbohydrate food.
  • Basmati rice, cous cous, barley, sweet potato, quinoa and legumes are all low GI foods.
  • If you’ve been diagnosed with diabetes or blood sugar levels have been abnormal then see your doctor for a referral for a dietitian who can help you to bring blood sugar levels down.
  • Type 2 diabetes is not reversible, but can be put in remission. Pre-diabetes is reversible!

Psychological perspective young adults with Type 2 diabetes

00:15:30- Jessica Browne

  • Young adults with Type 2 Diabetes are an emerging group, traditionally Type 2 Diabetes been thought of as a condition of older age but now it’s being diagnosed earlier.
  • Young adults (18-39 years) are a unique group; at a life stage of developing careers, relationships etc. and adding Type 2 Diabetes to this challenging stage of life makes it more challenging!
  • Scare tailored health care currently available for young people with Type 2 Diabetes.
  • Huge burden on young people for a long time.
  • Conducted a study with young adults with Type 1 diabetes, young adults with Type 2 diabetes and older people with Type 2 diabetes. Found young adults with Type 2 diabetes are more similar to the young adults with Type 1 diabetes than to the older adults with Type 2 diabetes in terms of psychological health, particularly in regards to depression.
  • Young adults with Type 2 diabetes and young adults with Type 1 diabetes found to have higher rates of clinically depressive symptoms than the older group with Type 2 diabetes. Suggests that having Type 2 diabetes as a young person is just as challenging as having Type 1 diabetes as a young person.
  • Two young adults groups were both found to be struggling to maintain a healthy diet and the older group was found to follow dietary recommendations more frequently. Suggests burden of constant dietary management is playing out similarly for the two young groups.
  • Out of all the groups the young adults with Type 2 diabetes were least likely to be taking their insulin as recommended.
  • Managing dietary requirements, regular physical activity, self-monitoring of blood sugar levels via finger prick, taking regular medication and insulin, attending health care appointments and screenings are all part of self-care for people with diabetes.
  • All types of diabetes are serious despite the belief that Type 1 is more dangerous than Type 2.
  • Young people have a more isolated experience with diabetes.
  • The lives experience is similar between young adults with Type 1 and young adults with Type 2 diabetes.
  • Research found that young people feel very stigmatised due to their diabetes whereas older people do not feel as stigmatised.
  • Services are in place for young adults with Type 1 diabetes such as clinics in hospitals; some of these clinics are now becoming available to young people with Type 2 diabetes but need more tailored care for this group. Connecting young people with others who have diabetes is important to reduce the social isolation and to share the journey with. State and Territory Diabetes Foundations e.g. Diabetes NSW have some services available for young people so contact them to see what’s available. Generation T2: program for young adults with Type 2 diabetes run by Diabetes Victoria.
  • Facebook group ‘young adults with T2D’ for support.
  • OzDoc Tweet Chats: Australian diabetes online community. Can post questions or read responses. A good start in the diabetes community to reduce isolation and to communicate with other young adults who have diabetes.

Should I exercise when I have Type 2 diabetes?

00:32:30- with Gabby

  • If you have Type 2 diabetes and you plan on making changes to your exercise or dietary habits let your doctor know first and get some advice because it can affect medication and insulin and could lead to low blood sugar episodes (hypo’s).
  • Exercise is beneficial for Type 2 diabetes as it helps with insulin sensitivity, helps muscles increase the amount of transporters in the muscle cells that absorb glucose and bring blood sugar levels down.
  • Exercise helps you lose weight or maintain a healthy weight; the heavier someone is the higher their blood sugar levels will be and when you lose weight blood sugar levels decrease.
  • It helps to keep blood cholesterol and blood pressure in check. This is important because having diabetes increases the chances of heart disease or an atherosclerotic condition such as hardening of the arteries and blockages.
  • Recommended that people who have Type 2 diabetes have lower blood pressure and cholesterol (which are risk factors for heart disease) than what is normally recommended for people without diabetes.
  • Exercise helps lower stress (which affects blood sugar and blood pressure). High stress= high blood sugar.
  • Exercise increases muscle strength and bone mass to lower osteoporosis risk which is a huge problem in the population and can lead to death (if someone has a fall and breaks a hip they are more likely to get sick especially if they’re elderly).
  • Exercise improves circulation and wound healing; huge problem for people with Type 2 diabetes, especially in the lower limbs. Poor circulation caused by hardened arteries, blood cant get to the area to heal the site, ulcers stay open, get infected, become gangrenous and need amputation.
  • Exercise improves mood, self-esteem and self-confidence in general and is beneficial for everyone.
  • Individual approach to exercise, some people have poor mobility (difficulty walking or standing) so if this is the case see an exercise physiologist to help with exercises you can do seated.
  • If you are able to walk it is recommended to exercise for at least 30 minutes each day. Can break it down into blocks but it’s not as effective as in one go.
  • Need at least an hour of exercise every day to lose weight.
  • Strength training boosts metabolism and helps with blood glucose management.
  • Walking also helps but probably not as effective.
  • Do a combination of cardio and weights every day! 30 minutes is not too much to ask considering how much Type 2 diabetes impacts your health.
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