A 1999 National Opinion Poll survey that showed that one third of us believe that margarine is a high fat food, so proving that the misconception still persists that margarines and soft spreads are lower in fat than butter. The survey also showed that the British public is still confused about healthy eating. Overweight people tend to regard carbohydrates as fattening (bread, potatoes and rice) and only half of those questioned understood that diets high in carbohydrates are not normally linked to weight gain. An integral part of the treatment of diabetes is diet and therefore it is necessary to understand what we are eating.
The 1997 World Health Organisation Report declared that obesity and diabetes has reached epidemic levels. It says that obesity is now overtaking smoking as the most important avoidable cause of ill health. It is associated with high blood pressure, diabetes and many other problems such as arthritis, breathing difficulties and depression. Almost 80% of people with Type 2 diabetes are overweight or obese at diagnosis although the majority of people are unaware that obesity is a risk factor for diabetes.
In 1994 almost 13% of British men and 16% of women were obese, a doubling since 1980 and one in three of the British adult population is overweight.
Obesity is Caused by Inactivity
Populations are generally eating less but exercise levels are lower than they have ever been and so it is thought that obesity is really caused by inactivity – we are eat more food than we use up in energy.
What is the difference between obesity and being overweight?
- Obesity is having a body mass index (BMI) greater than 30
- Over weight is having a BMI of between 25 and 30.
BMI is your weight in kilograms divided your height in metres squared. (7kg = 14pounds) A much simpler definition of obesity is a waistline over 40 inches in men and over 35 inches in women!
Fats are a very important part of healthy eating in reducing the risks of heart disease and keeping blood cholesterol levels down. As people with diabetes have an increased risk of heart disease, it is particularly important to understand about the fats in our diet.
Fats provide some of the energy our bodies need but the healthy eating guidelines recommend that we should eat less fat, especially saturated fat in order to reduce this risk of heart disease. This can best be achieved by eating a varied diet with plenty of fruit, vegetables, whole grain cereals, pasta, rice and potatoes.
Perhaps we need to question if cholesterol is a bandwagon on which the food and drugs industries are jumping. A recent study comparing pravastatin, a cholesterol lowering drug, and a placebo [pretend pill] has shown that for every heart attack that the drug prevents 316 people would have to be treated with it. The authors of the study criticised heart specialists for their unwillingness to use cholesterol-lowering therapy such as pravastatin when it was ‘so clearly beneficial’.
But in the New England Journal of Medicine Dr Frank Meyer, from Germany, pointed out that to achieve one success, 315 people would have to be burdened with a medication, the dangers of which cannot be foreseen and for a period of 20 to 30 years. He again recommended a healthy lifestyle, a varied diet, physical activity avoidance of smoking and adequate social integration. This seems much the preferable option and demonstrates, yet again, that we need to know just this sort of information before we decide to embark on drug treatment which has dubious rates of success. Why should we go through drug treatment when a healthy lifestyle will probably produce better results with no yet to be discovered drug side effects? Treatment with a healthy lifestyle will not, of course, make big money for anybody!
Alcohol and Diabetes
Did you know that alcohol lowers the blood sugars?
Well, it does and naturally this can result in a hypo. The tendency to hypo after alcohol can last up to 4-6 hours and after a real ‘binge’ blood sugars can remain low for a couple of days. The carbohydrates that the drink may contain does not offset the blood sugar lowering effect of the alcohol, so do not count these as part of your carbohydrate consumption and assume you will be OK.
In addition to the risk of hypos, alcohol impairs your judgement and so if you have diabetes, this means that you may not realise that you are having a hypo and so you will not treat it with sugary food. Furthermore, your friends may not realise that you are hypo and may simply assume that your ‘odd’ behaviour is because you are drunk. This is a dangerous situation and can result in a severe hypoglycaemic attack, unconsciousness, seizure and hospitalisation.
Having diabetes does not mean that you cannot or should not drink alcohol because this can seriously affect your social life. However, it does mean that you should:
- Only drink in moderation, sensible advice whether you have diabetes or not.
- Learn by experience how alcohol affects you – everyone is different.
- Take the appropriate steps to prevent a hypo and if necessary lower your insulin dose at the meal prior to going out for a drink.
- The best time to drink is with a meal.
- If you are not having a meal with your alcohol, then it is a good idea to nibble carbohydrate [eg crisps] throughout the evening.
- Never drink alcohol before a meal.
- Have an extra bedtime snack before going to bed. Remember the alcohol could lower your blood glucose during the night while you are asleep, resulting in a night hypo. The alcohol may also make you sleep more soundly and so the hypo warnings may not wake you.