Question
What Causes Type 2 Diabetes?
Answer
Type 2 diabetes is caused by a combination of genetic and lifestyle factors. Although there is a strong family link (you are more likely to get type 2 diabetes if a close family member has it), the chance of getting type 2 diabetes is greater if you:
• are overweight
• have high blood pressure
• do little physical activity
• have a high fat, high sugar diet.
Type 2 diabetes progresses slowly and you can have it for many years without knowing it. It differs from Type 1 diabetes, which is thought to occur because the body’s immune system attacks and destroys the insulin-producing cells in the pancreas. Type 2 diabetes is not caused by the body’s immune system.
Other causes of diabetes
Gestational diabetes
During pregnancy, a woman’s body needs two to three times more insulin than usual to keep her blood glucose levels normal. Gestational diabetes develops if your pancreas is unable to produce the extra insulin needed, causing higher than normal blood sugar (glucose) levels. Gestational diabetes can often be controlled with diet and exercise, and will usually improve or disappear after your baby is born, but your doctor may test you for diabetes 3 months after your baby is born, and every 1 or 2 years after that.
Pancreas disease or damage
Pancreatic disease (chronic pancreatitis), or damage to the pancreas, in particular to the cells in the pancreas that produce insulin, can also cause diabetes. This means that the pancreas makes less insulin, resulting in higher than normal blood glucose levels.
Medication-induced diabetes
Some medicines such as corticosteroids (e.g. prednisolone or dexamethasone) can cause weight gain, and increase the amount of glucose and lipids (cholesterol and fats) in the blood. This increases the risk of getting type 2 diabetes. Other medicines for serious mental illnesses such as schizophrenia and bipolar disorder (e.g. olanzapine and clozapine) can also cause weight gain and increase blood glucose levels, causing type 2 diabetes.
If you have gestational diabetes, medication-induced diabetes, or diabetes due to pancreatic disease or damage, you will be monitored, managed and treated as if you have type 2 diabetes. This will involve making diet and lifestyle changes and may mean that you have to take diabetes medicines to control your blood glucose levels.
If you have medication-induced diabetes, you will need ongoing blood glucose monitoring after you have stopped taking your medicines, as you will still be at risk of developing type 2 diabetes (due to insulin resistance) and the complications of diabetes, including heart and circulation (cardiovascular) problems, in the future.
Question
What is pre-diabetes?
Answer
If you have pre-diabetes, you are at high risk of developing type 2 diabetes and also are at increased risk of developing heart disease. Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be classified as full-blown diabetes. Those with pre-diabetes are at increased risk of developing type 2 diabetes within a decade unless they adopt a healthier lifestyle that includes weight loss and more physical activity.
First, let’s define what “pre-diabetes” is and is not. Diabetes is defined as having a fasting plasma blood glucose level of 7mmol/L or greater on two separate occasions. If diabetes symptoms exist and you have a casual blood glucose taken at any time that is equal to or greater than 11.1 mmol/L and a second test shows the same high blood glucose level, then you have diabetes.
In general, people who have a fasting plasma blood glucose in the 5.6-6.9mmol/L range are defined as having impaired fasting glucose. If your doctor gives you an oral glucose tolerance test, and at two-hours your blood glucose is 8-11mmol/L you have “impaired glucose tolerance”. Either of these is medical terminology for what your doctor is probably referring to when he says you have “pre-diabetes.” Be sure to ask your doctor what your exact blood sugar test results are when he tells you that you have “pre-diabetes.” Some physicians are not as familiar as they should be with the new national guidelines for diagnosing diabetes. They may be telling you that you have pre-diabetes, when in fact you have actual diabetes.
Among those who should be screened for pre-diabetes include overweight adults age 45 and older and those under age 45 who are overweight and who have one or more of the following risk factors:
are habitually physically inactive
have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
have a family history of diabetes
are members of certain ethnic groups have had gestational diabetes or have given birth to a child weighing more than 4 kg
have elevated blood pressure
have an high cholesterol or high triglycerides
have polycystic ovary syndrome
have a history of vascular disease
That all said, if you have pre-diabetes diabetes, what should you do? If you are at risk for developing type 2 diabetes, you can reduce your risk by 58% through sustained modest weight loss and increased moderate-intensity physical activity, such as walking 60 minutes a day.
What Should You Eat?
It’s not so much “what” you should eat, but how much. If you are overweight, your first and foremost goal should be to lose weight. This means working with an Accredited Practising Dietitian to determine the quantity and type of food you should eat at each meal. One of the key issues in losing weight is controlling portion size. Your dietitian will also direct you how to make food choices that cut down on the amount of fat you eat because each gram of fat has significantly more calories in it than a gram of carbohydrate or protein. This means:
eating more foods that are broiled and fewer foods that are fried.
cutting back on the amount of butter you use in cooking.
eating fish and chicken more, and only lean cuts of beef.
eating meals so that your dinner plate has more vegetables, , salads, lean protein, fruit and wholegrains
Your dietitian will show you how you can continue to eat all the foods you love — just probably not in the same proportions as you have in the past. Having diabetes or having “pre-diabetes” does not mean that you can’t eat certain foods. The solution isn’t “avoid foods with sugar in them.” Rather, you need to lose weight if you are overweight, cut back on portion sizes, and plan for those occasions when you eat a small piece of cake or chocolate.
Physical Activity
Along with weight loss, your goal will be to begin program of physical activity, if you aren’t getting regular exercise now. Why? Because physical activity will help you use the insulin you produce to convert the food you eat into energy. This will help keep your blood glucose lower. If you have a small piece of cake with a meal, follow it up with a brisk walk.
Question
I have been on a ‘weight loss plan’ for 7 weeks and can’t loose weight .
My mum and I have completely changed our lifestyle over the past 7 weeks. We exercise every day and have been eating very “clean” foods. Every night we do a minimum of 1 hour workout but this is mostly cardio, and I have been reading that strength training is very important for weight loss, however my mum is 54 and finds weights etc very difficult, I am 17 and I will endeavour to incorporate this into my workouts if that’s what I should be doing. It’s very disheartening for the both of us to not loose a huge amount of weight when we are both working so hard. Is there anything that we can change to help us loose weight? Note: my mums BMI is 26.5 (the majority of her weight is around the abdominal area which we believe is from menopause) and my BMI 28 so we both don’t have a huge amount of weight to loose we would like 5-10 kgs each. Please help! 🙂
Answer
You should be so proud that you and your mom have made such positive changes to both your diet and exercise. It appears that your exercise regime is very good. Including weights would definitely be beneficial. If your mom cannot do weights she can do pilates which is also strengthening. Post menopausal weight always sits abdominally but she will lose it in that area when her weight drops.
I think you need to look at the portions of food you and your mom are consuming. Consider what is on your plate; not just the type of food, but also the quantity of it. You might be surprised to learn how much you are eating in a ‘normal’ meal – it could be a great deal more than you realise. Overweight people consistently underestimate how much they eat at a sitting, while underweight people overestimate the amount. The bottom line is portions. If you are not sure of the quantities you should be eating you should consult an Accredited practising Dietitian. In Australia portions tend to be large, and getting larger, which is why portion control is so crucial to reaching and maintaining a healthy weight. We have been brought up to ‘finish what is on our plate’ which unfortunately destroys the natural instinct of the body indicating how much we should eat and when we are comfortably full. Only eat when you are physically hungry and stop when you are comfortable – never full! Enjoy your food and eat slowly. It takes 20 minutes for the message to get from your stomach to your heat that you have had something to eat. Everything you eat goes on a plate and you are sitting down to eat it – this does away with picking and snacking!
You have done so well – you just have to put in an extra effort to achieve your goal.
Question
Why do I need a low fat diet before my gall bladder is taken out? Do I need a low fat diet afterwards too?
Answer
The story of gallbladder removal (or cholecystectomy) is just one example of how adaptable bodies can be. The gallbladder, an organ near your liver, acts like a reservoir for bile to be stored and used to digest fats later when you need it. But, even once it’s removed, your body can still produce the bile just like before. In fact, your body can even adjust to store bile in the duct between the liver and small intestine, creating a kind of makeshift gallbladder for itself. Pretty impressive, eh? And, more to your line of questioning, some people may notice changes in digestion and need to alter their diets after a cholecystectomy either temporarily or permanently (no two patients are the same!). However, most people are able to return to business as usual with their diet within a few days or weeks. Even though fats sometimes get a bad rap, they are a key part of your body’s dietary needs, and fortunately, the gallbladder-less can still reap the benefits.
There are no universally recommended diets for those who’ve recently parted with their gallbladder. However, there are some general suggestions that dieticians have thought up to help get your digestive tract running as smoothly as possible after surgery:
• Eat smaller, frequent meals, so that your digestive tract can work with smaller amounts of food at a time without its reservoir of bile.
• Avoid high-fat foods right after surgery, to give your body has time to compensate and adjust to the decreased amount of bile.
• Slowly increase fiber intake, which can help with diarrhoea.
• Avoid caffeinated beverages, spicy foods, and dairy right after surgery, which might upset or irritate your digestive tract until it has a chance to bounce back.
The newly gallbladder-less might also want to consider how other side effects from surgery can impact their lives. About 90 percent of gallbladder removals are done as laparoscopic surgeries, which involve a few small incisions to insert a small camera and instruments and remove it as noninvasively as possible. This is the “gold standard”: the risk of complications, such as infection, are low and pain usually decreases significantly after three days. For patients with abdominal scarring or other conditions, an open surgery might be done instead. This carries a slightly higher risk of complications (infection, bruising at the site, or urine retention), but is also a low-risk procedure. Gallbladder removals are very safe, but it’s probably good to be prepared for some pain and discomfort in the days following either type of surgery.
Gallbladder removal may leave you an organ lighter, but chances are you’ll hardly miss it. Maintaining a balanced diet with lots of fruits, veggies, and whole grains, listening to your body’s signals, and keeping in touch with your health care provider about any concerns can help you carry on just as you did before, fats and all!
Question
Will I lose weight after puberty?
Answer
You’ll probably gain weight in puberty — most girls do. You may notice more body fat along the upper arms, thighs, and upper back. Your hips will grow rounder and wider; your waist will become narrower.
Your doctor will check your height and weight each year to make sure you are growing properly. If you are gaining weight too fast, you may need to increase your exercise and substitute fruits and vegetables for junk foods. You should have a regular exercise regime and be aware of the portions you are eating.
Puberty typically begins between ages eight and 13, and lasts about two to four years. During this time, the amount of fat, muscle and bone changes quickly as girls make the transition into womanhood. Failure to gain weight during adolescence is actually unhealthy (gaining too much can also be unhealthy).
Major bodily changes take place in girls during puberty; the final major growth spurt in life occurs during this period. Puberty actually begins when the brain instructs the ovaries to make the female hormone oestrogen. This hormone and others cause a girl’s body to grow in size and change in shape as it prepares for procreation — or having a baby. Gaining 7kg. or more during puberty is considered normal and necessary for proper growth and development. As a girl develops, her body will make more fat to allow for fuller thighs, stomach and breasts, and wider hips. Lean body mass in girls diminishes from approximately 80 percent to 75 percent by the end of puberty, while the amount of body fat increases. In comparison, the percentage of lean muscle mass in boys increases from about 80 percent to 90 percent by the time they reach adulthood.
To reduce your percentage body fat increase your exercise both aerobic and weights.
If you are unhappy with your weight I suggest you consult an accredited dietitian to advise you on healthy eating lifestyle.