Living With A Diabetic Hubby

Last week was a week of major upheaval of lifestyle for us, for on Monday, hubby was confirmed as a Type 2 diabetic, with a reading of 14 mmoL/L. Which means, to a layman, a very high level of plasma glucose.


For the rest of the week, we were kept busy trying to figure out what he should eat and should not eat. A dietary plan has to be worked out, with the intake of carbohydrates, sugar, fat, protein, and even sodium calculated. Everything I put into the pot or wok, had to have its calories calculated, and broken down into the carbo/fat/protein/sodium/sugar levels. 


Eating out is worse. We were suddenly stumped for ideas on where to go or what to eat, as most food outside are not healthy. Of course, healthy foods are sashimi (not sushi as it contains white rice and sake, alcohol), or Korean grilled stuff or steamboat. But then, we had to take into consideration the sodium levels in the Korean grilled stuff and the soup in the steamboat. 


So, that left us only sashimi, which we already had a week earlier. So we decided on Chinese food on Sunday evening. Imagine our order to the cook of a Chinese restaurant: "Spinach soup with no salt, and no century eggs, please....fried beehoon with no salt, or soy sauce please." And on Saturday, we had to turn down an invitation to pancakes cooked by a "top English chef", in his own words. What a bummer! 


When I mentioned this, some friends of mum said, "Oh, I have diabetes, too. There's no upheaval. Just take less sugary food, and if possible, don't take any white sugar." 


Well, I'm sorry, it's not as simple as that. And this is the reason why I have chosen to write this post, to hopefully educate those who hold to the myth that if you have diabetes, you only need to stop taking white sugar and take less sugary food.


My father-in-law died within two years of injecting insulin. No, not from insulin injection, but from the complications caused by diabetes, which I think some people are not aware of.


First, the complications caused by diabetes:

• Vascular disease - The large blood vessels are narrowed, resulting in nutrients not being carried to your body's organs which might result in heart failure or stroke.
• Small blood vessel disease - Blood vessels in the eyes and kidney may be damaged, which might result in vision loss and kidney failure.
• Nerve damage - The nerves in the feet and hands might be damaged, and cuts or blisters might be infected, which might result in having to amputate the limb.
• Skin disorder - Skin disorder such as bacterial infections, fungal infections, itching, Diabetic Dermopathy, Necrobiosis Lipiodica Diabeticorum, Atherosclerosis, Eruptive Xanthomatosis and Acanthosis Nigricans (see: http://tiny.cc/41z01 and  http://tiny.cc/wzeeq)

Two in three diabetic patient will suffer from the complications above. A good diet management will only manage to delay the complications, but if the patient lives long enough, the complications will come as surely as it will rain after a long dry spell.


Second, the list of food to avoid:

• Refined and simple carbohydrates - Sucrose, glucose or fructose (sugar derived from fruits), white rice, white bread, white flour, table sugar (whether white or brown does not matter), sweets, honey and corn-syrup are to be avoided as they convert to glucose very quickly. 
• High fat food - The list is endless and self-explanatory, too, I think, so I'll leave it as it is.
• High sodium food - Canned food, preserved food, processed food, snacks like potato crisps, sauces and gravy are to be avoided as those food contain salt. 
• Alcohol - this can cause liver damage and heart failure in a diabetic patient.

List of recommended food that hubby should take to prevent rapid peaks in the blood glucose levels:

• Complex high-fiber carbohydrates - Oats, cereals, legumes, wholegrain products, dried beans, peas, lentils, fruits like oranges, strawberries, and dark green vegetables, or yellow peppers.
• Omega 3 - Salmon, tuna, mackerel (but NOT king mackerel) and herring. These fish contain omega 3 and protect against the hardening of arteries.
• Omega 6 fatty acid - Blackcurrant oil, primrose oil, borage oil. These protect against nerve damage.

Have I considered the Atkins Diet? Well, I have researched that as well, and found that the Atkins Diet is an over-hyped commercial diet, which might in the long term do more harm than good. Why? Because the Atkins Diet opt for a high protein and low-carbohydrate program, which causes a person to lose the water in their body rather than the fat cells. That is why anyone on Atkins Diet loses weight rapidly. (see the claims and reality of the Atkins Diet - http://tiny.cc/5dbya )

So, I had to resort to planning our own menu. After calculating hubby's calorie needs, I have to calculate each and every ingredient I use. For those who may not know how to work out your own calorie needs, below is the Harris-Benedict formula I used:

Men: BMR = 66 + (13.7 x W) + (5 x H) - (6.8 x Age) = Daily calories required

Women: BMR = 665 + (9.6 x W) + (1.8 x H) - (4.7 x Age) = Daily calories needs

W = weight in kg   

H = height in cm

Age = years

After I got the daily calories need for BMR, I multiply it by an activity factor for our lifestyle. 
Activity factor guideline table:

• Sedentary - none or very little exercise = BMR X 1.2
• Light activity for average of 2 days/week = BMR X 1.375
• Moderate activity level exercising  4 days/week = BMR X 1.5
• High activity levels exercise & sports more than 6 days/week = BMR X 1.7
• Higher activity levels = up to 2 x BMR

And now, I have to go cook. I do believe I will become an expert dietitian by the end of two months!!  

Effects of Caffeine On Diabetics

Most of us need caffeine, be it tea or coffee, to jump start our battery in the morning. Hubby is no exception. In fact, he takes caffeine throughout the day, most of it in the form of coffee. Ever since he discovered that he is diabetic last Monday, he has been taking his coffee plain: black, no sugar. 


Let me sidetrack for a moment here. When I was in Penang, I visited my uncle on my mum's side, and was shocked to see what Parkinson's Disease (PD) did to him. Coming back to KL, I read up on PD, and found that caffeine and green tea contain properties that reduces the risk of PD. Nicotine, too, ironically. But that's another story, which will be in another post. For this post, we'll concern ourselves with caffeine.


While reading up tons of material on diabetes, I stumbled upon a single sentence: "Those with diabetes type 2 should avoid caffeine." I sat up. What?? And so embarked upon a research on caffeine and diabetes.


After having sifted through tons of material, I'm conflicted. There are reports that caffeine and green tea are health food, and reduces diabetes risk. It is claimed that the quinines found in caffeine increases the sensitivity to insulin, hence less insulin is needed to regulate the glucose in the blood (see http://tiny.cc/xdcv2 and http://tiny.cc/ma2aa and http://tiny.cc/ocnl9). Diabetes Type 2 is caused by decreased sensitivity to insulin, and the pancreas has to produce more insulin, which will one day wear itself out and fail. That is why hubby was prescribed medication to increase his sensitivity to insulin.


But there are lots more reports that contradict those findings. There were studies that showed that when Diabetic Type 2 patients were given caffeine, their blood glucose level spiked 8% (see http://tiny.cc/8kvbz and http://tiny.cc/s03c8 and http://tiny.cc/nnvp8). 


So, which group is right? And the samples taken are rather small, to provide an accurate result. When hubby first heard that he might have to give up coffee, too, his reaction was not unexpected: he'd rather die from diabetes than give up coffee.


If I have to venture my personal opinion, I would say on the surface, it looks like coffee should be avoided. BUT on closer look at the composition of coffee, I think (warning: I may be wrong here, so don't rely on my opinion if you have diabetes) coffee on its own has its beneficial properties. It is the caffeine in it that decreases the sensitivity to insulin. So, the solution may be to drink decaf coffee, and in moderation. (See http://tiny.cc/f9n74 for the composition of coffee)