Foods you eat can have a significant effect on your long term health. Choosing healthy foods can promote and protect your long term health and prevent diet related diseases.
The Eat Well Plate or Food Pyramid should help to guide you in choosing the right foods. The main messages are:
Eating healthily and managing your weight is very important when you have Type 1 Diabetes. Being overweight or obese increases your risk of health problems previously mentioned such as heart disease, increases blood pressure and can over time add extra strain to joints and ligaments. Being overweight can also limit fitness capabilities and most importantly it can make your diabetes more difficult to control as carrying excess weight makes it more difficult for your body to use insulin properly.
If weight loss has been advised by your diabetes team then a realistic slow weight loss over time is more advisable than losing weight too quickly on a dangerous very low calorie diet. For younger children not gaining additional weight and maintaining a current weight is an ideal approach.
Body Mass Index (BMI) can be used as an indicator to determine if your weight is within a normal or overweight/obese range.
To calculate BMI
BMI = weight (kg)
height (m) x height (m)
eg if you are 1.60m and 50kg
50kg = 19.5
1.60m x 1.60m
Ask your health professional to plot your weight and height on a BMI chart to see if you are within the normal range. This is routinely carried out by your diabetes team.
REMEMBER BMI RANGES FOR CHILDREN AND ADOLESCENTS (<18 YEARS) ARE VERY DIFFERENT AND SHOULD NOT BE COMPARED WITH ADULT BMI RANGES
If weight loss is required
You need to take in fewer calories than your body uses through activity. A calorie is a measure of energy. When you eat and drink, calories are the energy source for your body, and the energy you use through activity is energy output.
You burn calories simply by breathing and digesting food. Also you burn calories (energy output) through daily activity eg walking to school, carrying school books playing football at break.
If you eat more calories from food and drink than you burn off through daily activity the result is weight gain! But if you burn off more calories than you eat, the result is weight loss.
The energy input from food and drinks, and energy output from activity does not have to be balanced exactly every day, however having the right balance over time helps keep your weight healthy in the long term. Ask your diabetes team dietitian for advice specifically for you. It may mean reducing your fat intake by eating less high calorie/high fat foods or cutting out snacks in-between meals or if blood sugars are within range before going to bed stopping the habit of having a supper. Also additional activity is needed every day.
In younger children any weight loss advice needs to be closely monitored by your diabetes team to ensure growth and development is normal and their diet isn’t lacking in any important vitamins and minerals. This may need to be discussed with your diabetes team especially if insulin doses need to be altered.
Smoking damages your health. It is the main cause of cancer of the lungs, the larynx, the bladder and the mouth and tongue. Lung cancer is the main cause of death for smokers.
If you have Type 1 diabetes the complications might increase your risk of cardiac disease. If you also smoke you increase this risk considerably. Knowing the risks of smoking is not enough to stop many people smoking.
Smoking seriously damages your health
If blood glucose remains high over a prolonged time, complications arise. It takes the form of circulatory problems in the smallest blood vessels. The Doctor can assess the extent of the damage to these blood vessels by examining your eyes with an ophthalmoscope. In this way the tiny blood vessels can be viewed directly. You will be called for retinal screening from the age of 12. This involves taking a picture of the back of your eye to make sure the blood vessels are normal.
Eye damage caused by diabetes is called diabetic retinopathy.
Kidneys may be damaged by high blood glucose over a prolonged time as well. This is called diabetic nephropathy. Diabetic nephropathy may cause high blood pressure.
The nerves may also be damaged, leading to a gradually decreasing sensitivity of the feet to pain and to temperature. This is called neuropathy. These complications may be delayed or even prevented by good diabetes management and good blood glucose control.
In the USA in 1993 a huge evaluation was completed, the Diabetes Control and Complications Trial (DCCT). 1441 patients with Type 1 diabetes were treated conventionally (one to two injections per day) or with intensive insulin therapy (three to four injections per day). The intensified group had over six and a half years of significantly better blood glucose levels. 8.6mmol/l as opposed to 12.8mmol/l in the conventionally treated group
HbA1c is a laboratory test that your Diabetes team can use to determine whether your bold glucose has been properly controlled over the past two to three months.
HbA1c is the quantity of red blood pigment to which glucose binds fast. Even with a normal blood glucose level, some glucose is bound to the red pigment. The higher the blood glucose, the more glucose binds to the red blood pigment. If the HbA1c value is normal, then your blood glucose has been normal for most of the time over the past two to three months.
Please enter the HbA1c value in your diary. Ask your Diabetes Specialist Nurse what the normal range is.
Your Diabetes Specialist Nurse has already discussed your individual therapeutic aims with you. The determination of the HbA1C in the blood may show you if you have already achieved your therapeutic aims.
The retina has many small blood vessels and over a prolonged period high blood glucose levels start to cause the small blood vessels in the retina to become distended. As the retinopathy progresses it may cause blindness.
From age 12 you should have annual retinal screening.
This is kidney damage caused by high blood glucose. The first sign of nephropathy is increased excretion of a protein called albumin in the urine.
In the presence of kidney damage due to diabetes it is also especially important to keep an eye on your blood pressure, since high blood pressure can accelerate kidney damage.
If, as a result of diabetic kidney damage, albumin is excreted into the urine, or, if the renal function is already impaired by diabetes, it is absolutely essential to keep your blood pressure within normal limits.
Your diabetes team will ask you to provide a urine specimen on at least one occasion each year which will be tested for (micro-albumin urea) very small levels of protein. This is to ensure your kidneys are working normally.
High blood pressure (hypertension) is a disorder of the circulation in which the blood vessels are subjected to increased pressure. Often, high blood pressure goes unnoticed for a long time. However, high blood pressure which remains untreated for years causes damage to the heart and blood vessels – possibly leading to heart failure and a stroke. The incidence of heart attacks, blocked blood vessels and kidney failure is also higher when blood pressure is high. These side-effects of high blood pressure can be prevented with proper treatment.
The heart pumps blood through the blood vessels by contracting and relaxing 60 to 80 times a minute. When the heart muscle contracts to force blood through the vessels, the pressure is higher than when the muscle is relaxed. This means that with every heart beat the pressure in the blood vessels alternates between an upper and a lower value. The upper value is known as the systolic blood pressure and the lower value as the diastolic pressure.
Blood pressure is measured in millimetre mercury (mm hg). Hypertension is when the blood pressure readings at rest are raised when measured repeatedly on various days. It is enough for either of the two values to be raised.
File your toenails instead of clipping them. You should inspect your feet every day in order to detect injuries immediately. You may use a mirror for inspecting as is shown on the next page. You should also wash your feet regularly. Test the temperature of the water: it should not be hotter than 30 degrees Celsius. After washing, dry thoroughly, including the spaces between the toes. If you have rough skin, massage a cream into the feet after drying, but not between the toes. Diabetes can affect the sensation in your feet after several years. For this reason it is very important to always look after your feet.
Parallel-measurement of self-monitoring:
You should bring your blood glucose meter into your clinic and measure against the clinics methods. So you can see if your readings are valid.
Haemoglobin A1c (HbA1c):
This should be measured about once every three months.
At every consultation blood pressure should be measured in order to detect hypertension as early as possible.
All results concerning your diabetes should be recorded in your diabetes logbook.
Even if you are symptom-free you should undergo a thorough examination each year to see whether any diabetic complications have arisen.
Once a year the Doctor should check your eyes (with dilated pupils). Because your pupils will be dilated you shouldn’t drive on your own after the examination. If you already have a diabetic eye complication, you should have the examination more often.
A urine sample will be examined, especially for the presence of protein. Slight micro albuminuria can be reversed by good treatment of blood pressure and through good control of your diabetes.
Test on the feet using the devices shown on the right should be carried out once a year.
Checking the pulse in the feet and, if necessary, examination of the circulation via doppler – ultrasound – technique should be performed.
People with diabetes may hold a driving licence providing that their eyesight is satisfactory and they can show that they have their diabetes under proper control (for example with the diabetes logbook). Children with diabetes can, of course, take part in school sports and go on school trips. People with diabetes can work shifts and nights providing they can structure their treatment to suit. There is no reason for them to be at a disadvantage during working hours. After all, people with Type 1 diabetes have achieved notable successes as artists, politicians and sports personalities.
All women with Diabetes should plan their pregnancies and attend Pre-Pregnancy Care Clinics. They should also take a high dose (5mg) of Folic Acid which is only available on prescription before pregnancy and for the first 3 months of pregnancy. There are pre-pregnancy clinics for women with Diabetes throughout Northern Ireland.
The CHOICE diabetes education programme is available in NI and the border counties of Republic of Ireland, ask your Diabetes TeamChoice Programme