Six Little Friends of Food, Diet, and Diabetes

One of the challenges of living with diabetes is often the change that needs to be made with the food and drink that we consume . Your medical advisors will, no doubt, have given you some very specific advice about what kind of foods to eat and what kind of foods to avoid.


Mydiabetes.com is about providing support to patients, family members, friends, and health care professionals who travel on the diabetes journey. In this weeks blog we look at ways in which we might think about the food and the drinks that we consume. Planning in advance may support us in remaining focused on those changes recommended by our medics.


Here is a recipe for thinking about Food and Drink, Diet, and Diabetes (snack on the bits that you feel may be useful and leave the rest alone).


Ingredients: Who, What, Why Where, When, How, and the knowledge about food that you already have.



Method:


1) Think about Who you will be eating with – have you shared your diabetes story with them? Are they aware of the changes that you are making in your eating and lifestyle?



2) Plan in advance What you are going to eat – planning in advance may help you to avoid the temptation to eat foods that are not a part of your recommended intake. And when you are eating pay attention to What exactly you are eating. Take a greater awareness of the ingredients and the preparation of your food.


3) Before you start to eat ask the question Why are you eating this food at this precise moment? Is it because you are hungry or is there another reason?



4) Where are you planning to eat? If you are planning to eat out investigate the menu in advance – call the restaurant and ask them if they will prepare food to match your specific needs.



5) When do you plan to eat? Are you planning regular balanced meals? Maintaining a balance of blood sugar levels may be helped by a regular eating pattern.



6) And finally How are you eating? Are you eating fast like the way fast food outlets quickly serve up their offerings or are you starting to really enjoy the flavour of the foods that you are eating? Are you eating SLOWLY and taking time to rest and enjoy you new diet?



Expected Results:


More control and more learning about our food and drink, diet, and diabetes.

For more information please come and join us at http://www.mydiabetes.com/

Blood Glucose target ranges - new information for self testers

Diabetes UK has updated its blood glucose target ranges for people with diabetes, following recommendations from the National Institute for Clinical Excellence (NICE).
In November 2007, the International Diabetes Federation (IDF) suggested changes to the post-meal target ranges.

In 2008, NICE published their guidelines for Type 2 diabetes, again with changes to the target ranges.
As part of Diabetes UK’s policy to continually review and update advice for people with diabetes, we have now reviewed our recommendations in line with NICE.

Here are the new ranges

Self monitoring of blood glucose levels UK

Self-monitoring of blood glucose is a beneficial part of diabetes management. As part of the day-to-day routine it can inform of necessary lifestyle and treatment choices as well as help to monitor for symptoms of hypo- or hyperglycaemia, or signs of long-term complications.
Self monitoring supported by education is therefore one of the key tools available to people with diabetes to enable them to self manage effectively. Essential to this is the person being able to discuss the purpose of self monitoring, how to interpret and act upon results.
It is important that the blood glucose levels being aimed for are as near normal as possible (that is in the range of those of a person who does not have diabetes).
These are:
3.5 - 5.5mmols/l before meals
less than 8mmols/l, 2 hours after meals.There are many different opinions about the ideal range to aim for. As this is so individual to each person, the target levels must be agreed between the person and their diabetes team.
The target blood glucose ranges below are indicated as a guide.
Children with Type 1 diabetes (NICE 2004)
Before meals: 4-8mmols/L
Two hours after meals: less than 10mmols/L
Adults with Type 1 diabetes (NICE 2004)
Before meals: 4- 7mmols/L
2 hours after meals: less than 9mmols/L
Type 2 diabetes (NICE 2008)
Before meals: 4-7mmol/L
Two hours after meals: less than 8.5mmols/L

Diabetes the cause of 100 amputations each week

Diabetes UK today released some research showing that 100 people each week are undergoing amputations as a result of complications caused by their diabetes. mydiabetes.com will soon be available for patients with diabetes to learn more about their disease and to share their stories

Restrictions for patients self testing blood glucose levels

Diabetes UK have the following position statement on patient self testing of blood glucose levels.

mydiabetes supports this stance and will in the near future be offering a sensible way forward to help both local health authority managers, budget holders, PCT's, practitioners and patients to achieve their joint goals.

Diabetes UK Position statement on self monitoring of blood glucose is;

People with Type 1 and Type 2 diabetes should have access to self-monitoring of blood glucose (SMBG) based on individual clinical need, type of diabetes, personal circumstances and informed consent - not on ability to pay. 95 per cent of diabetes care is self-care. As such, self-monitoring supported by education, is essential to inform the day-to-day lifestyle and treatment choices of individuals, as part of an integrated management strategy. Decisions about the type and frequency of self-monitoring should be made on a case-by-case basis and not on blanket decisions and removal of strips from prescriptions.
Diabetes is a life-long condition, and can have a profound impact on lifestyle, relationships, work, income, health, wellbeing and life expectancy. Clinical trials have demonstrated the value of tight glycaemic control to reduce the risk of costly and life threatening complications (1-7). Prolonged raised blood glucose levels are extremely detrimental to health, as it is associated with increased risk of heart disease, strokes, blindness, amputations and kidney disease (8-10).
National guidelines and frameworks set the standards of care that people with diabetes should expect and prioritise information, education, training and support to enable people to manage their diabetes themselves (11-19). SMBG, by blood and/or urine testing, combined with education, provides information for people with Type 1 and Type 2 diabetes to make day-to-day decisions about food, physical activity and treatment to maintain optimum control of blood glucose.
The debate
It is generally recognised that routine SMBG is beneficial, when supported with education, for all people with Type 1 diabetes and those with Type 2 diabetes using insulin (12,18-21). The debate largely focuses on the clinical and cost effectiveness of SMBG for people with non-insulin treated diabetes (22,23,24 ).
The Health Technology Assessment Review (25) was not supportive of SMBG, owing to a lack of evidence for clinical or cost effectiveness, particularly in relation to those with Type 2 diabetes. National Institute for Health and Clinical Excellence (NICE) guidelines for Type 2 diabetes state that self-monitoring be used as part of an integrated package of care in conjunction with appropriate therapy and education (13,12). The guidelines focus on the use of HbA1c to give a picture of overall control and for that control to be stable. It is however difficult to make recommendations and take action on treatment and lifestyle adjustment, without at least some form of home monitoring. To use the guideline as a basis to restrict access is a misinterpretation and was not the intention of the Guideline Development Group.
Current evidence is either lacking or contradictory. It can be argued that this is due to the limitations of the trials undertaken to date and the lack of focus on patient preferences. Sound evidence is needed to review all the factors contributing to optimum blood glucose management and its relationship to and with self-monitoring over time. This needs to include effects of education, actions taken by those self-monitoring, motivation, behaviour change, and patient related outcomes such as quality of life, well-being and satisfaction (26). The current lack of evidence does not mean that SMBG is not effective for those not treated by insulin, it just means that there is no evidence. Research commissioned by Diabetes UK, and others, is in progress.
Costs and benefits
In 2001 the UK spent approximately £90 million on self-blood glucose monitoring (27). It has been cited that more is spent on testing strips than on oral glycaemic agents. The implication being that this is not a good use of resources. This does not consider that for some people with diabetes, being able to monitor blood glucose levels may be as beneficial to them as taking the medication. In order not to waste resources it is important that people with diabetes are able to utilise self-monitoring effectively through diabetes education. Without the education to know when and how to test, and what to do with the results, there is little point in self-monitoring. It is short-sighted to look to reducing costs through restrictive policies that prevent people from having the information they need to self-care. This is likely to result in increased prevalence of complications, costs to society and individuals themselves.
Considerable cost savings and improvements in quality of life are to be made from supporting people with diabetes to self care, in line with health policy, including improved health and well-being, prevention of unnecessary hospital admissions, and reduced frequency of support from the NHS (28). People with diabetes do generally take on board the issues of cost and should use blood glucose testing responsibly and appropriately. Evidence has shown that SMBG is beneficial to, and valued by, people with diabetes to:
enable better management of short and longer term metabolic control (12, 23,29-35) assisting in the prevention of short and long term complications (36)
monitor effectiveness of medication, eating and physical activity on blood glucose levels (35-38, 43)
help to maintain or improve motivation for managing diabetes (38,43)
provide reassurance and reducing anxiety and fear of hypoglycaemia (30,37)
improve feelings of confidence and control over their own diabetes (30,37).
Local restrictions
An increasing number of people with diabetes are reporting restrictions or denial of blood glucose testing equipment causing distress and anger among those who rely on these tools to self-manage their diabetes (39). 27 per cent of PCTs in England (40) report the existence of a policy restricting the provision of blood glucose test strips for people with diabetes.
Actions
Decisions about blood glucose monitoring should be made on a case-by-case basis and not by blanket removal of strips from prescriptions or local restrictive policies. Local guidelines should be in place to encourage healthcare professionals to work in partnership with individuals with diabetes to inform them of the role that SMBG plays in self-management.
Increased awareness is needed of the importance of people with diabetes being able to access appropriate tools and support to manage their own diabetes.
Diabetes care teams should discuss the advantages and disadvantages of monitoring either by blood or urine, at diagnosis to enable people with diabetes to make informed choices. Those choosing to monitor their blood glucose should do so as part of an integrated package of care as defined in national guidelines.
Training and education should be provided about testing methods, how to interpret results and how to use results to adapt diet, lifestyle and medication to achieve optimum control (41-43). Methods and frequency of testing should be jointly agreed between the person with diabetes and healthcare professional through care planning. Any changes or reviews must only be made through discussion with, and agreement of, the person with diabetes.
This position should be interpreted as the basis upon which discussions are initiated about whether a person with diabetes wishes to or should monitor their blood glucose levels. The decision should be jointly agreed between the person with diabetes and their own healthcare team.