Question

I don't always keep to the diet I am meant to because of my diabetes, which is mild. Do I really have to keep to it?

Answer

The mildest diabetes can be controlled by diet alone. It was formerly assumed that diabetics should have a low carbohydrate regime, but it has been clearly shown that a high carbohydrate diet which avoids excesses of quickly absorbed forms achieves at least as good a level of glycaemic control in diabetics. What really matters is the effect of the food on the blood glucose of the individual, and this is greatly influenced by the speed of its passage through and digestion within the gut. Thus there is a smaller rise in blood glucose if the glucose is taken together with lipids and a protein meal than when taken alone. Furthermore, dietary fibre can also slow blood glucose rises and lower insulin concentrations in both normal and diabetic subjects, owing to a delay but not an overall decrease in absorption. The fibres that are particularly effective are those from fruits and vegetables rather than bran.

The aims of treatment for diabetes are to relieve acute symptoms which follow too high or too low a blood sugar, and to prevent the long term complications of diabetes, which can be severe and can result in death. At present the consensus view is that tight control of the blood sugar will prevent or delay the onset of tissue damage.

It is important to control for other risk factors too, such as blood pressure, smoking, lipids and obesity. Obesity is such a relevant factor in diabetics, and especially those who do not require insulin, that it is essential to reduce the weight by dietary means. However, one must live in the real world and it is impossible to achieve the ideal all the time. The number and degree of your dietary indiscretions are presumably related to the level of willingness in putting up with the inconvenience of controlling blood sugar and other risk factors. As your diabetes progresses, you will realise that it will gradually become more important to try to keep to your diet to avoid acute symptoms.

Exercise will lower the blood sugar and the aim should be to walk for at least 30 minutes 4 days per week. Unless one is not taking any diabetic medication, the idea is to balance the exercise with increased carbohydrate intake. As a general rule, walking for 1 hour would be expected to increase carbohydrate requirements by about 20g, or more active exercise such as playing tennis or football may require at least 40g of carbohydrate per hour. This extra food is best taken at a preceding meal, but small amounts may be taken, as quickly absorbed carbohydrate, just before the exercise or halfway through it.