Being diagnosed with type 2 diabetes can be overwhelming at first – but it needn’t be. HFG dietitian Zoe Wilson spent some time with an enthusiastic reader to demonstrate how just a few simple steps can drastically improve your health.
The growing number of people with type 2 diabetes in Australia is staggering. Nearly 1 million Australians have been diagnosed with type 2 diabetes and another 700,000 are estimated to be living with the disease, but don’t know it. So what should you do if you’re diagnosed? To show you that it isn’t as hard to manage as you may think, HFG dietitian Zoe Wilson is helping HFG reader, Ann Smith, to control her diabetes and to lose the extra weight that Ann has battled with over the past 15 years.
What is type 2 diabetes?
Type 2 diabetes accounts for about 85–90% of diabetes cases in Australia. Type 2 diabetes occurs when the insulin made by your pancreas doesn’t work as well as it should, resulting in more glucose (sugar) in the blood than normal. Over time, a high blood glucose level (BGL) can lead to complications such as heart and kidney disease and blindness, so it is essential to get things under control.
Type 2 diabetes is usually a result of both genetic and lifestyle factors and usually affects older adults, although an increasing number of younger people, even children, are being diagnosed. In fact, type 2 diabetes is Australia’s most rapidly growing chronic disease, with up to 275 Australians developing it every day.
The good news is that in many cases, type 2 diabetes can be prevented, delayed or improved with a healthy diet, active lifestyle and weight loss (if you are overweight). While diagnosis can seem overwhelming and frightening, with good information, careful management and the know-how we’re about to share, you can make living with diabetes easier and even enjoy foods you thought were off the menu!
Symptoms to look out for
Excessive thirst and urination
Tiredness and lethargy
Increased appetite and gradually putting on weight
Slow-healing cuts, itching and skin infections
Blurred vision, headaches, dizziness and mood swings
What puts you at risk of pre-diabetes or type 2 diabetes?
Being overweight or obese (aim for a waist measurement less than 80cm for women and less than 94cm for men)
Being physically inactive
High blood pressure
A family history of type 2 diabetes and/or heart disease
Ann Smith is a 62-year-old, recently retired grandmother of two who was diagnosed with type 2 diabetes eight years ago but “hasn’t taken it seriously” until recently, when she was prescribed insulin to control her blood sugar levels. Ann also suffers from high cholesterol, arthritis and obstructive sleep apnoea. Her weight is currently 103kg (BMI 37.8) – the healthy weight range for most people is a BMI of between 18.5 and 24.9).
Ann’s weight has increased gradually over the past 15 years (about 2kg per year) due to a combination of lifestyle, diet and medication that increased her appetite. Six months ago, Ann hit her highest weight of 113kg and then decided to do something about it. She was motivated by the fear that she might not be able to help look after her grandkids or be around to watch them grow up.
Ann’s husband John is very supportive of her improving her health – he too has type 2 diabetes so is also keen to learn. Ann and John shop together and John has become quite the budding chef since his retirement! Although Ann is retired she is still very busy throughout the week looking after her grandkids and volunteering at her local community centre. She is active most days and always on the go! For the past five years, Ann has been doing an hour of cardio and weights at her local gym three days a week, but no other planned exercise.
“I guess I haven’t really taken it seriously before and know that I have to take drastic action.” “My husband was very concerned. If some catastrophe was to occur – how would we pay for my healthcare?”
HFG dietitian Zoe Wilson
Zoe runs nutrition clinics in the Sydney area and works with people with type 2 diabetes on a regular basis. She aligns herself with the HFG philosophy that “everything is okay in moderation, but it is important to be mindful of what you are eating.” From her personal experience, “the two major problems that people with type 2 diabetes face are an incomplete understanding of the effect that food has on your blood sugar levels and – if you are also overweight – the importance of making small, sustainable changes to help you lose weight and control your diabetes long-term. If you can get these two things right then you give yourself the best chance of preventing the progression of the disease.”
Step 1: Analyse your current diet
Ann’s day on a plate
Zoe asked Ann to explain what her typical daily diet is currently like, so Zoe could see where they could make some small changes.
Cup of tea with skim milk and a bowl of Special K Advantage with Ski D’Lite yoghurt or
1-2 slices of café-style raisin toast or
2-3 days a week Ann skips breakfast and grabs a chocolate bar when out running errands
A cup of coffee with skim milk or
A large flat white (full cream)
A cup of tea and a sandwich made with 2 slices of Helgas or Abbotts multigrain bread, 2 slices of cheese or ham and pickle or
Nothing, or a chocolate bar when on the go (2–3 a week)
A cup of tea and something sweet that John has made eg. a scone with jam and light cream or
A lemon tart
Homemade steak and mushroom or mince and kidney meat pie with steamed vegetables or
Baked chicken breast stuffed with ricotta and tomato with steamed vegetables or
A meat and vegetable casserole or
Spaghetti bolognaise (no extra vegetables) or
‘Masterchef’ pizzas: homemade and judged by her grand-daughter
3–4 glasses diet soft drink
2–3 glasses of water
2 cups of tea
4–5 cups of coffee (up to 2–3 from a café)
Ann generally chooses great products to stock her pantry and eats relatively balanced meals when at home, although she could increase the proportion of vegies on her plate. The major problems I see for Ann are:
An irregular eating pattern which leads to poor decision-making when she is on the run, and irregular patterns in her blood sugar levels Large portion sizes at main meals (particularly dinner) High-energy snacks that are contributing significantly to her daily energy intake ‘Drinking energy’ – a high intake of kilojoules from coffee and tea (and minimal water) An exercise routine that hasn’t changed for five years and needs a shake-up to keep her body guessing.
Step 2: Set goals
The next step was to set some clear goals to help Ann take the first steps towards better health. “Together we worked out some specific goals for Ann to focus on so that she had an action plan when she went home,” says Zoe. “This breaks the task down into bite-sized pieces that will help to keep her motivated. We also worked out a sample day for Ann, with examples of better choices at main meals and snacks including appropriate portion sizes.” Ann and Zoe developed the following goals:
Try not to skip meals. Plan your day so you know when and what you will eat, and don’t get caught out.
Before you eat, ask “am I really hungry?” If the answer is yes, then ask yourself “what do I really feel like?” Choose a small portion of the best quality if it is a treat food you feel like, and savour it. If the answer is no, then ask yourself “why do I want to eat?” and “what else can I do instead?”
Slow down! Take at least 20 minutes to eat your meal, putting your knife and fork down in between bites. Chew chew chew, taste and enjoy it!
Balanced plate at lunch and dinner (see step 4)
Try to walk twice a week (in addition to current gym sessions)
Try to drink less kilojoules – choose water first!
Step 3: Make healthier choices
The shopping trolley makeover
Ann was generally making reasonably healthy choices, but there was room to improve. So, Zoe and Ann went to the supermarket to see what easy swaps could improve Ann’s diet.
Original trolley analysis
Ann has some great basics in her trolley, with lots of fresh fruit and vegies (bananas and asparagus to name a couple), low-fat yoghurt and reduced-salt beans. She does, however, tend to pick products that will satisfy her sweet tooth (Aero, Cadbury Brunch Bars and Vogels Oven Crisp Muesli) leading to extra energy that will be contributing to her weight.
What we chose instead
To reduce the amount of energy (but keep the satisfaction) in Ann’s trolley we left the basics but made a few easy swaps that still suited her. We swapped:
The Abbott’s bread for Burgen, a smaller slice – saving 168kJ per serve (2 slices).
The Vogels Oven Crisp Muesli for the Uncle Toby’s Natural Style Muesli, saving 100kJ, 3.8g fat, 0.9g saturated fat and gaining 1.3g fibre per 45g serve.
The Cadbury Brunch Bar for Uncle Toby’s Bodywise Bars – a sweet snack but with 8.2g fibre and only 510kJ (saving 122kJ, 3.5g fat and 2.2g sat fat) per bar.
Ayam Light Coconut Cream for Carnation Light and Creamy Coconut Flavoured Evaporated Skim Milk. Although light coconut cream is better than regular coconut cream, the Carnation option saves you 167kJ, 11.8g fat and 10.9g sat fat per 100ml.
Country Cheese for Vita-Weat 9-grain crackers to go with some cheese before dinner occasionally, or with lunch instead of bread. For 2 crackers you’ll save 0.7g saturated fat and 80mg sodium and gain 1.1g fibre, due to the wholegrains.
Aero for a Mint Pattie – the same minty chocolate hit but a 548kJ, 10.5g fat and 6.1g sat fat saving per bar.
Step 4: How you can do this at home
Seven golden rules for eating with type 2 diabetes
The good news is that the diet recommendations for those with type 2 diabetes are the same as for the general population – a healthy, balanced and varied diet. Generally, you need to:
Eat regular meals and snacks throughout the day.
Go for 2 servings of fruit and 5 servings of vegies every day.
Follow the 1/4–1/4–1/2 plate model: a meal should be 1/4 higher-fibre, lower-GI carbohydrates (breads, cereals, rice, pasta and legumes), 1/4 lean protein (lean meat, fish, legumes or eggs) and 1/2 vegetables or salad.
Include 3 serves of low-fat dairy per day.
Try to reduce the amount of high-fat, (particularly saturated fat), and high-sugar foods such as takeaway foods, biscuits, cakes and pastries. Also try to limit the amount of salt in your diet.
Drink plenty of water – aim for 1.5–2L per day.
Have no more than 1–2 standard alcoholic drinks a day (for women and men respectively) if you choose to drink at all, and at least 2 alcohol-free days a week.
Zoe’s five tips for successful change and making it stick
Pick something small and focus on that until you’ve turned it into a habit. For example, “I will try to eat breakfast every morning”. Once you are doing it regularly, you can work on the next one.
Swap something you are doing already for something a little healthier. For example, “I will choose a small skim flat white instead of a large full-fat flat white.”
Try to make every meal healthier rather than change the food you eat entirely – reduce the amount of fat, sugar and salt added into your food by choosing lean meat, reduced-fat dairy, no-added-salt ingredients and cooking with non-stick pots and pans so you don’t need to add lots of oil.
Make sure you choose goals that are achievable. If you don’t happen to reach your goal you will make yourself feel guilty and be less likely to keep going – this is a life-long process so you need to be kind to yourself.
When setting goals, use words such as “I will try to” or “at least” – then if you do more you’ll feel great for going above and beyond!
“I guess I haven’t really taken [my diabetes] seriously before and know that I have to take drastic action.”
Did you know? ‘Diabesity’ is the term used to explain the strong link between diabetes and obesity. The AusDiab Follow-up study (2005) found that participants who were obese were four times more likely to develop type 2 diabetes than those of a normal BMI of between 19 and 24.