World Diabetes Day: The importance of nutrition |17 November 2017

Diabetes is a condition in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose (sugar) in the blood. What you eat determines the amount of sugar in your blood and so the right food choices will help you control your blood sugar level.

To commemorate World Diabetes Day on November 14, the Nutrition Unit at the Ministry of Health shares its knowledge and advice to educate the public about the important role of nutrition in preventing and managing diabetes.

Main contributing factors to diabetes

In Seychelles one of the major contributing factors leading to diabetes is obesity which can be caused by high consumption of sugary and fatty foods, and lack of exercise. Sugary foods and drinks include for example, chocolates, fruit juices, fizzy drinks, confectionary, cakes and biscuits. High fat foods include for example, fried chicken and chips, fried samoosas, banana fritters, processed meats like ham, sausages, bacon, corned beef, burger and nuggets.

As obesity is on the rise in Seychelles in both children and adults, so is the prevalence of non-communicable diseases, including diabetes. Most people who have been diagnosed and referred to the Nutrition Unit (NU) with type 2 diabetes are generally overweight or obese.

Recommended nutritional intake for pre-diabetic and diabetic patients

Both pre-diabetic and diabetic patients have the same nutritional requirements as the general population. It is important to eat a healthy and balanced diet with fresh, whole foods containing carbohydrate, protein, small amount of healthy (unsaturated) fats, fibre, vitamins and minerals.

At the same time, the diet must be low in salt, saturated fats and added sugar. Eating too much salty foods increases your risk of developing high blood pressure whereas high intake of saturated fats increases your risk of having high blood cholesterol levels. These in turn increase your risk of developing cardiovascular diseases.

Reducing sugar and increasing fibre

• Have at least 2 portions of fruits and 3 portions of vegetables every day and include a variety. Avoid large amounts of fruits at one time as they are high in natural sugars and can increase blood sugar level in large amounts. It is best to have ½ portion to 1 portion of fruit at a time.
• Choose fresh whole fruits instead of juice because juices are higher in sugar content. Only use juice and other sugary foods if you are experiencing a low blood sugar level.
• Include high-fibre cereals e.g. bran flakes, weetabix and oatmeal.
• Have more beans e.g. kidney beans, chickpeas, haricot beans, lentils and peas.
• Replace rice with tubers on more than three days a week e.g. sweet potatoes, potatoes, cassava and yam as these are higher in fibre and will help control your blood sugar.

Reducing saturated fats and salt

• Oil should be limited to 1 teaspoon per person in meal preparations.
• Frying of food should be limited to once per week.
• Instead of frying, try to grill, steam, poach or bake foods. 
• If margarine or butter is used on bread or crackers, spread very thinly.
• Remove visible fat on meat or remove skin of chicken before cooking.
• Avoid processed meats e.g. ham, poloni, salami, sausages, corned beef, bacon and luncheon meat as these are high in fat and salt.
• Avoid commercial sauces e.g. soya, ‘HP’, oyster as well as stock cubes (Maggi), instant noodles, soups and ‘Aromat’ as these are high in salt.
• You can use a small amount of salt in cooking but include more herbs, spices, chili, garlic, ginger, lemon and lime. Avoid placing salt at the dinner table.

What should your plate look like?

A meal can be a plate of tubers (breadfruit, cassava, yam) with fish and salad or it could be a lighter meal like a sandwich with meat, fish or egg plus vegetables (as shown below). It is best to focus on three meals per day (breakfast, lunch, dinner). If on insulin, also include snacks (mid-morning, mid-afternoon and before bed) in between your main meals. A snack can be yoghurt, fruit, crackers or a glass of milk. It is also important to try and keep meals consistent and to avoid skipping meals as this can lead to uncontrolled blood sugar.

Fluid and alcohol recommendations

• It is important to drink at least 2 litres of water every day.
• Women should have no more than 1 unit of alcohol and men no more than 2 units per day. One unit is e.g. 1 bottle of beer or Guinness/1 shot (25ml) spirit/1 glass (50ml) wine. Those with uncontrolled blood sugar should avoid alcohol. Never have alcohol on an empty stomach as it can lead to low blood sugar.

Nutritional recommendations for different groups

The basic nutritional recommendations also apply for children, pregnant women and the elderly but there are also other considerations for each group:

Children:

• The primary goal for children and adolescents with type 1 diabetes is achieving blood glucose levels that maintain normal growth and development without excessive hypoglycemia (low blood sugar level).
• Excessive amounts of bulky, fibre-rich foods should be discouraged.
• Healthy dietary (unsaturated) fats should be included to help prevent obesity and cardiovascular disease in later life.
• Fat restriction measures should not be over-vigorous in young children especially if they have a small appetite or are faddy eaters.
• The growth of children with diabetes must be constantly monitored using growth charts.

Pregnant women:

• The food intake should be sufficient to sustain the growth and development of the baby and for maternal weight gain.
• Carbohydrate should be distributed throughout the day in three small to moderate-sized meals and 2 to 3 snacks.
• An evening snack may be needed to prevent a drop in blood sugar overnight.
• Regular physical activity can help to improve maternal glycaemia (at least 30 minutes/day) and include walking as the best option.

Elderly:

• Emphasis should be on a regular meal pattern and better food choices so that they can enjoy their food and avoid extreme restrictions.
• Older adults are more likely to experience low blood sugar and in such a condition, intake of 15-20 grammes of glucose or other sources of simple sugar like juice, fizzy drinks and honey will help.
• Those who are underweight are at a higher risk of under nutrition so it is not always appropriate to restrict their intake of fats, salt and sugar.
• Fluid intake is often lower, especially during illness which can lead to dehydration so inclusion of all kinds of fluids in their diet is important, including sufficient water intake.

Recommended lifestyle changes to prevent type 2 diabetes

While there is yet no conclusive evidence to suggest that type 1 diabetes can be prevented, primary prevention of type 2 diabetes is potentially possible.

The components of lifestyle modification and their aims should include, but not be limited to, the following list:

• Weight loss of 5%-10% of actual weight if overweight or obese.
• Increase in physical activity levels e.g. brisk walking for at least 30 minutes, at least 3 times a week.
• Choosing healthier foods that are lower in sugar, salt and saturated fat.

Secondary prevention involves early detection and prevention of complications, therefore reducing the need for treatment. Good control of blood glucose levels can substantially reduce the risk of developing complications as does the management of high blood pressure and raised blood lipids (fats).

Procedure for diabetics to receive nutritional advice

Usually the Nutrition Unit receives referrals from doctors, nurses and midwives from different health centres or the patients themselves can call to book for an appointment.