Did you know November is Diabetes Awareness Month? As you will read, it has never been more important to learn about diabetes! At the tender age of 4, I was diagnosed with Type 1 diabetes (T1D), which ultimately led to my passion for medicine and my career choice as a nurse practitioner. Living with T1D, I want to educate both adults and adolescents about the differences between T1D and Type 2 diabetes (T2D) and the preventative measures they can take. I love empowering diabetic individuals with information they can use to live the healthiest lives possible.
Both Types of Diabetes are on the Rise
Diabetes has gained media attention because diagnoses of the disease have increased significantly in recent history. Statistics cite that approximately 9.4% of adults over the age of 18 in the United States have Type 2 diabetes (T2D). An estimated 23.8% of adults with T2D remain undiagnosed. The World Health Organization (WHO) reports that the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. WHO has found that the global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. It appears the United States is taking a lead in this epidemic.
Type 1 diabetes was once called “juvenile onset diabetes”; however, this is no longer a medically-accurate title. More and more adults are being diagnosed with T1D. T1D is an autoimmune disease where the pancreas ceases to produce insulin, a hormone that enables the cells of the body to utilize the glucose in food for energy. In an individual with T1D, the immune system starts to attack the beta cells, which are the insulin-producing cells in the pancreas. Both genetic predisposition and environmental factors increase the likelihood of T1D.
Signs and symptoms of T1D include increased thirst, increased urination, increased hunger, fatigue and weakness, visional changes, weight loss, a fruity odor on the breath, or labored breathing. If your child or someone you love is experiencing these symptoms, please see your healthcare provider as soon as possible.
T2D develops when the body becomes less sensitive and more resistant to the insulin the pancreas is producing. When this occurs, the blood glucose level rises in the body because insulin is less effective in controlling blood sugar. Type 2 diabetes is more commonly seen in adults; sadly, more children and adolescents with T2D are being diagnosed. According to the SEARCH for Diabetes in Youth Study that was founded by the CDC, from 2002-2012 the rate of T2D had risen by 4.8% in children under the age of 20. In comparison, the rate for T1D had risen by 1.2% in children.
Genetics can place you at a higher risk for developing T2D, but lifestyle factors influence your risk more than genetics. Lifestyle factors include: inactivity, being obese or overweight, and smoking.
The signs and symptoms of T2D are similar to T1D; however, the symptoms may occur more slowly or go unnoticed for a while. Type 2 diabetes typically develops over time. You may have heard of the pre-diabetic states of “insulin resistance” or “metabolic syndrome”. These are warning signs and can be reversed through better dietary and lifestyle habits.
The Diabetic Diet Myth
Once diagnosed with T1D or T2D, a person they will likely meet with a nutritionist to assist in re-evaluating his or her current diet and make appropriate changes. The typical “diabetic diet”, found during a quick online search is not always the most nutritious or advantageous for long-term health. The most common and recommended diabetic diet is rich in low-fat protein and non-starchy vegetables. Healthcare providers recommend this because these foods do not have a high carbohydrate content. The belief is that these food sources will keep the blood glucose stable and not cause sudden spikes or rises. Eating only low carbohydrate sources of proteins and vegetables may provide some short-term weight loss, but these dietary choices are not conducive to long-term health.
High-quality, complex carbohydrates are often ignored but provide benefits to the body. It is a common myth that diabetics should not eat carbohydrates—a myth that should be busted! Complex carbohydrates provide a rich, slow-burning energy source and the fiber they contain prevents quick blood sugar spikes. The best sources of complex carbohydrates include: brown rice, quinoa, whole grain bread, oatmeal, whole rye, wild rice, buckwheat, squashes, and sweet potatoes. If you have Celiac disease or are gluten intolerant, it’s important to talk to your healthcare provider about healthy gluten-free sources of carbohydrates.
Protein sources are also essential for individuals with diabetes. Protein provides a feeling of fullness and stabilizes blood glucose levels. Good sources of protein include: organic chicken, organic turkey, salmon, eggs, and plant-based sources of protein (lentils, beans, non-GMO tofu).
Fresh, non-starchy vegetables are very important in any diet, but are especially important in a diabetic’s diet. Vegetable sources provide powerful antioxidants and rich sources of vitamins. They are also high in fiber, which helps to stabilize blood glucose levels. The best sources of vegetables include: spinach, kale, asparagus, broccoli, carrots, red onions, red peppers, and tomatoes. You should consume about 7-13 servings of equal amounts of fruits and vegetables each day. A serving is equal to about half a cup, or an apple the size of a tennis ball.
Fruits provide carbohydrates and quick energy. They are rich in antioxidants and vitamins as well. The best sources of fruits for diabetics are lower in sugar. Low-sugar fruits include: strawberries, raspberries, blueberries, blackberries, apples, melons (watermelon, cantaloupe, and honeydew), and red grapefruit.
Type 2 diabetics may consider following a ketogenic diet, which consists of consuming a higher percentage of healthy fats and fewer carbohydrates (between 20 to 50 grams) per day. The benefits of the ketogenic diet for T2D is that it can increase insulin sensitivity and provide better blood glucose control. Some individuals with T2D may benefit from a ketogenic diet; however, please consult with your healthcare provider to determine if it’s the best option for your personal health. Seeing a nutritionist familiar with the ketogenic diet is essential, because if not executed properly, it may cause more harm than good. Children with T1D should not eat a ketogenic diet because they are still developing and require more carbohydrates.
Overall, both T1 and T2 diabetics should be conscious about their food choices and eat in moderation. (This is usually good advice for anyone.) Emphasis should be placed on fiber-rich grains and carbohydrate sources, lean sources of protein, and a rich variety of fresh fruits and vegetables.
The Surprising Link Between Diabetes and Depression
Mental disorders unfortunately carry a stigma in our society. Individuals are reluctant to discuss their concerns over anxiety, depression, trauma, and obsessive-compulsive disorders out of fear for being misunderstood and labeled. The stigma causes inaction in people who should reach out for help. Concern for mental health is greater in those who deal with the added stress of chronic illness. Diabetes, of course, causes additional life stressors.
About 20% of children with T1D deal with depression, which is significantly higher than the general population’s rate of 7-9%. Twenty-four percent of adult patients with T2D are clinically depressed. Depression and anxiety exponentially affect diabetic patients because it makes them less likely to engage in self-care behaviors. This places these patients at a greater risk for poor blood glucose control, increased hospitalization, and earlier onset of complications.
The prevalence of depression and anxiety is higher in diabetic patients because of what is known as “burnout”. Both T1D and T2D require frequent and diligent management. Diabetics are required to monitor blood glucose levels, take medication, be conscious of food choices, calculate carbohydrates, and treat hypoglycemia and hyperglycemia in the daily routine of life. These increased responsibilities may be too much for one individual to tolerate. Diabetic patients with depression may avoid checking blood glucose levels, skip doses of medications, neglect to take insulin, or make poor dietary choices. This downward spiral can cause diabetic patients to become very sick—even deathly ill.
General symptoms of depression include: sleeping more or less, eating more or less, weight loss or gain, agitation, irritability, and seclusion from social activities. Symptoms of depression in diabetic patients include: frequently skipping or forgetting medications, not checking blood glucose levels as recommended by a healthcare provider, and frequent hospitalizations or ER visits.
If you are diabetic or know someone who is diabetic and dealing with depression or anxiety caused from burnout, please know that you are not alone. Many individuals experience similar struggles. There are support groups provided through Florida Hospital in the local Orlando area. The Juvenile Diabetes Research Foundation and the American Diabetes Association also provide wonderful online resources and assistance.
Studies have shown that those who attend support groups have greater success with disease management than those who do not. There are specific counselors and therapists who specialize in dealing with mental health in individuals with diabetes. Do not be afraid to bring this to the attention of your healthcare provider.
Individuals with T1D and T2D face unique health challenges. These include the need for dietary and lifestyle changes and an increased risk for mental health issues. That is why awareness is so important. Awareness of diabetes and its treatment, prevention, and additional health risks is vital to providing diabetics with empowering information. Lastly, and most importantly, know that you are not alone; there is help and assistance that can make all the difference in successfully living with diabetes.
Sarah Sercombe, ARNP has earned a Doctorate of Nursing Practice and is a Certified Pediatric Nurse Practitioner. She has recently joined Cannizzaro Integrative Pediatric Center in Longwood. With open and compassionate communication, Sarah works collaboratively with families on specific health concerns, nutrition, supplements and illness prevention. She believes in caring for patients and families in the unique way they deserve. Call Cannizzaro Integrative Pediatric Center at 321-280-5867 for a free meet & greet with Sarah.
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