Type 1 diabetes: How diet, lifestyle changes help to control diabetes?

Type 1 diabetes is a form of diabetes where the blood sugar elevations and fluctuations are far more unpredictable and life-threatening compared to the commonly seen type 2 diabetes(T2D). 

Due to the unique challenges in recognizing and treating type 1 diabetes(T1D), many researchers even call for changing the name of the disease, so as not to confuse it with T2D. 

T1D predominantly affects children but can affect people of any age. T1D comprises 5-7% of the total diabetes in the community. 

In T1D, the pancreas produces no insulin at all. T1D is not a lifestyle disorder and does not result from overeating, lack of exercise, or obesity. The exact etiology of T1D, until very recently, was unclear. It is an autoimmune disorder where the body’s immune protective mechanism starts destroying one’s own beta cells from producing insulin. 

Diet and lifestyle
Healthy eating is the cornerstone for the treatment of type 1 diabetes. The diet advice in T1D is ideally customized since the insulin requirement varies from individual to individual based on insulin sensitivity, speed of absorption of carbohydrates, physical activity, mental status, and multiple other factors. 

Carbohydrates, proteins, and fats are the 3 main nutrients in food we eat. While everyone needs a balance of these three nutrients to stay healthy, eating right is extra important for people with diabetes. The dietary recommendations for children with diabetes are the same as for healthy children. 

Carbohydrate counting is an integral part of treating T1D. Carbohydrates can be classified in several ways and the indexes expressing their quantitative and qualitative characteristics and effects on blood glucose are represented by the glycemic index (GI) and glycemic load (GL).

The glycemic index is a value given to carbohydrate containing foods according to their potential to raise your blood sugar level. It is classified as low GI, moderate GI, and high GI foods. Foods with a high glycemic index value tend to raise your blood sugar higher and faster than foods with a lower value.

The use of the glycemic index (GI) has been shown to provide additional benefits to glycemic management when used in addition to total carbohydrates. A low GI can help lower the post-prandial hyperglycemia when replaced with high GI foods. The timing and type of insulin delivery may be adjusted depending on the GI of the food.

Early delivery of insulin with high GI foods may blunt postprandial glucose spikes and the use of a combination type bolus may be beneficial with lower GI foods. Several factors can determine the GI of a food such as cooking method, the type of carbohydrate (amylo pectin/amylose rich starch) degree of ripeness, amount of protein and fat taken along with food, quantity and type of fiber etc.

Whole wheat, brown rice, rolled oats, vegetables like cucumber, ladies finger, broccoli, lettuce etc and fruits like apple, guava, grapefruit etc, curd, nuts, beans, peas etc comes under low to moderate GI foods.

Glycemic load (GL) is a relatively new way to assess the impact of carbohydrate consumption on the rise of blood sugar in the body. It gives a fuller picture than GI alone. GL uses GI and the amount of total carbohydrates per serving of a specific food to estimate both how quickly a food causes blood sugar to rise and how much blood sugar levels will rise in total after eating.

A healthy dietary pattern means making consistently healthy choices over time. The quantity as well as the quality of foods are important factors to be considered. A healthy dietary pattern also includes whole-grain foods that are high in fiber and other nutrients, a variety of fruits and vegetables that provide vitamins, minerals and fiber. Beans, legumes, fish, low-fat dairy, and lean meats, are also good choices.

Following a healthy diet and promoting low GI carbs and limiting high GI ones is an important adjuvant together with insulin therapy for achieving balance in children with T1D.

Physical activity It is advised to have at least 1 hr of physical activity every day in T1D. The response of glucose to exercise interestingly varies from person to person. Over time, the patients, and the parents will continue to learn, and the enthusiastic educated ones will master the game.

Inputs from Dr.Jothydev Kesavadev MD, FRCP (London,Glasgow,Edinburgh),FACP,FACE(USA)