Diabetes mellitus is a syndrome characterised by a raised glucose concentration in the blood, due to the deficiency or diminished effectiveness of insulin. (Insulin is produced in our body by a gland known as the pancreas.) The condition shows itself by symptoms like excessive thirst, excessive urination, excessive hunger, unexplained weightloss, failing eyesight and repeated infections.

There are two basic types of diabetes: insulin dependent and non-insulin-dependent. Insulin dependent, also known as juvenile diabetes, usually starts in younger people; their pancreas secrete little or no insulin and they must receive one or more injections of insulin each day to control their blood glucose.

Non-insulin-dependent diabetes, also known as maturity-onset diabetes, is the more common type, usually starting in middle age; the patient’s pancreas secrete normal amounts of insulin, but it is ineffective and the response of blood glucose to insulin is subnormal. This type of diabetes is closely linked to obesity. It has also been found that a diet high in fat is likely to lead to diabetes. When people with a family history of diabetes are obese, the incidence of their becoming diabetic (in later life) is over 50 per cent. In females, the risk of diabetes depends on whether they have put on weight on the upper part of the body or the lower. There is an increased risk of diabetes for women who have put on weight in the neck, shoulders and abdominal regions. Women who have put on weight on the thighs and hips are relatively safer.

In a study conducted on 3,000 significantly overweight participants having pronounced impaired glucose tolerance’ (meaning a high but not yet diabetic blood sugar level), a low-fat diet combined with moderate exercise dramatically reduced maturity-onset diabetes risk. It was found that the diet-exercise programme cut diabetes risk by 58%, especially among people of age 60 and older. The average age of people in the study was 51, although ages ranged from 25 to 85. They were put on a low-fat diet and told to engage in moderate physical exercise, such as walking for 30 minutes. The diet was centred on lowering the fat intake to less than 25% of overall calories. Not only did making the lifestyle changes reduce their risk of getting diabetes, but these individuals also lost 5%-7% of their body weight. Scientists believe that weightloss lowers diabetes risk by helping muscle cells to handle blood sugar more efficiently.

Eating the right diet helps avoid having to live with diabetes in the future. In a landmark study, over 42,000 men, 40 to 75 years of age, were studied to see which men developed diabetes over the next 12 years. More than 1,300 men developed diabetes. But this was most commonly seen in men who ate a ‘western’ diet, which is, higher amounts of red meat, processed meat, french fries, high-fat dairy products, refined cereals and pulses, and sweets and desserts. Men Who ate a diet of more vegetables, fruit, fish, poultry, and whole grains were less likely to get diabetes. In men who ate a predominantly western diet, the risk of diabetes went up even more if they didn’t exercise or were overweight.

The rising frequency of obesity was thought to be one of the main reasons for the problem. But this study showed that it might be only one factor. Even men who were not overweight and ate a western diet were more likely to get diabetes.

Diet

Diet appears to be an essential part of diabetic treatment, since a large proportion of patients with maturity-onset diabetes are obese.

The most important dietary measure for the obese diabetics is the restriction of caloric intake to reduce their body weight to that of normal adults of the same sex and height. The caloric requirement of an elderly, obese, diabetic patient lies between 1,000 and 1,600 calories. Weight reduction should be gradual, usually not more than 2 kg per month, which corresponds to a deficit of 500 calories perday. Achievement of the desirable weight is almost always associated with better control of blood glucose level. Sometimes weight control through dietary restriction can control diabetes too, without any help from pills or insulin. Regular exercise is important, as it is effective in controlling weight.

Ideally, an elderly diabetic patient of normal body weight should consume 1,400 to 1,800 calories perday.

In the case of young, active diabetics, under-nutrition is undesirable. It should be avoided, as it would affect the growth pattern of the person. The caloric requirement in this case would lie between 1,800 and 3,000 calories. However, care should be taken to avoid obesity.

Large individual loads of carbohydrates or starch are discouraged, especially when they include concentrated and refined carbohydrates, sugar in particular. For example, a bowl of kheer, a pastry, or a plate of a 100 banda in one serving would be considered as a concentrated source of carbohydrate. The quantities of such items per serving should be reduced, not because they are harmful to diabetics (they are not) - these items tend to increase the total caloric intake of the person.

A diabetic has to keep a check on his weight through his caloric intake. The best way to cut down on calories is to cut down on sugars (sweets and aerated drinks are high sources of calories) and fats (fried foods, nuts, dried fruits, pickles-in-oil are high sources of calories).

Levels of cholesterol tend to be higher in diabetics (after the age of 40 years) than in non-diabetics of the same age. This is associated with a high incidence of coronary heart disease. So the use of saturated fat is discouraged. The proportion of fat may be manipulated by limiting eggs (especially egg yolks) to no more than 3 per week, by replacing, as much as possible, whole milk and processed cheese with skimmed milk and cottage cheese (paneer) respectively, mutton and other red meats with fish and chicken (white meats), and by replacing butter, cream, ghee and vanaspati with polyunsaturated oils, like til oil, mustard oil, groundnut oil and so on.

The fibre content of the diet should be increased as much as possible, as it lowers the absorption of glucose and cholesterol from the diet. Whole grain flour and whole pulses should be preferred in the diet instead of refined flour and washed pulses. (Do not throw a way the ahokar from the atta.) Wherever possible, fruits and vegetables should not be peeled.

In diabetes, there is no medical objection to taking alcoholic drinks in moderation, provided the patient realises that he must take account of their caloric values (whisky, gin, etc. contain about 70 calories per 30ml.). Diabetics are particularly prone to having fatty liver. Even the slightest sign of impaired liver function is a strict contra-indication for alcohol.

In general, a diabetic patient needs a normal, balanced, high-fibre diet, strict weight control (by controlling the calories), exercise and extremely moderate use of alcoholic beverages, together with medication (if required).

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