Bishop's Stortford dietician Alex Ballard debunks diabetes myths as part of Diabetes Awareness Week

Alex Ballard, who lives in Bishop's Stortford and works as a specialist dietician in West Essex, writes about how to take small steps towards a healthier lifestyle...

Despite 3.9 million individuals living with a diagnosis of diabetes in the UK there is a whole lot of confusion and misconception about what it is, why it happens and what to do.

This figure is estimated to rise to 5.3 million by 2025 and, with June hosting Diabetes Awareness Week, I thought it would be a good time to start ironing out these uncertainties.

As a dietitian, I have heard numerous, ludicrous comparisons between type 1 and type 2. Do phrases such as 'sugar diabetes' or 'skinny diabetes' ring a bell? However, the reality is that they are entirely separate conditions and individual circumstances cannot be pigeon-holed.

So what is the difference? Let's get back to basics. When we eat or drink, the body's digestive system breaks down the nutrients present into smaller, more manageable pieces. For carbohydrates this results in glucose being produced and moving into the blood.

Therefore, as we consume carbohydrate-containing foods and fluids our blood glucose levels naturally increase. This rise will send signals to the pancreas, an organ sitting snuggly behind the stomach, triggering a hormone called insulin to be released.

Insulin essentially acts as a key floating around unlocking cells. Once these cells' doors are opened wide the glucose is able to move inside, naturally reducing the amount in our blood.

In type 1 diabetes, the pancreas does not release any insulin, which is why individuals will need to start lifelong insulin injections and learn the art of carbohydrate counting (matching insulin doses to the amount of carbohydrates consumed).

Whilst in type 2 diabetes, the pancreas still releases insulin, but that lock and key system has gone a little bit rusty. If the cell doors are jammed shut, both the glucose and the insulin have nowhere to move and therefore they build up in the blood. This can also be referred to as insulin resistance.

Individuals with type 2 diabetes may be able to control their blood glucose levels via diet, lifestyle modifications, medications or insulin. If someone with type 2 diabetes starts insulin injections this does not mean that they now have developed type 1 diabetes.

So, can this all be resolved by a zero-carb diet? Absolutely not! Carbohydrates are present in so many foods that it would be next to impossible to cut them out entirely whilst still maintaining a healthy balanced diet.

Carbohydrates can be divided into three main subgroups: starchy carbohydrates (for example bread, rice, pasta, cereals and potato), natural sugars (such as milk products, like milk and yogurt, and fruits) and added sugars (for instance table sugar, processed foods and sugary drinks).

Clearly the added sugars provide more taste appeal than nutritional value, whilst starchy carbohydrates and natural sugars can contribute fibre, calcium, vitamins and protein. Therefore, table sugar and processed products should be limited rather than making daily dietary appearances.

For starchy carbohydrates, it is beneficial to opt for granary, wholegrain, whole wheat and wholemeal varieties. These are mostly lower glycaemic index (GI) options, meaning they release the glucose much slower into the blood steam. Other low-GI ingredients include oats, sweet potato, bulgur wheat, basmati rice, beans, pulses, nuts, seeds and vegetables

Natural milk sugars (lactose) and fruit sugars (fructose) are still important aspects within a healthy balanced diet. However, if you find yourself drinking gallons of milk, bunches of grapes or cartons of orange juice, you may have identified a contributing culprit for higher blood glucose levels. Aim to have two to three portions of milk, dairy or milk alternatives per day, no more than 150ml of pure fruit juice or smoothie daily and opt for more vegetables and salad over fruit.

Whilst someone with diabetes does not need to cut out carbohydrates entirely, sensibly decreasing intake may help to reduce blood glucose levels or the amount of insulin injected. For example, dishing up a smaller amount of starchy carbohydrates alongside meals and swapping to lower carbohydrate snacks. In type 2 diabetes, a lower carbohydrate diet has been shown to help with remission, especially when implemented close to diagnosis.

If you wish to calculate your carbohydrate intake you can use food labels, apps and books (such as Carbs & Cals). Additionally, many chain restaurants now have the nutritional value of their menus available online.

Just to clarify, sugar does not cause diabetes. However, carbohydrate awareness is one part of the treatment process in both type 1 and type 2 diabetes. Other controllable factors involved in management may include eating patterns, weight, stress, sleep, exercise, alcohol and illness. All to be continued in part two…

You can follow Alex on Instagram @alextalksdiet.