A sugar-free diet is not necessary for people managing diabetes. In fact, dietary recommendations for sugar for people with diabetes are the same as those for the rest of the population.

A healthy eating plan, as is recommended for the majority of the population, is also recommended for people with diabetes. This eating plan is for example high in fibre and vegetables, low in saturated fat, and low in free sugars.

Carbohydrates – our fuel source

Starchy carbohydrate foods, such as whole grain breads and cereals, potatoes, pasta, rice and noodles, are broken down into glucose (sugar) during digestion, and used by the body for energy. These foods also provide us with essential vitamins, minerals and fibre. In conclusion, eating moderate amounts of starchy carbohydrates at mealtimes helps regulate blood glucose levels.

Foods containing natural sugars, such as fruit, milk and yoghurts, also provide us with fibre, vitamins and calcium, and are a healthy addition to our eating plan.

Less healthy sugars

Free sugars, such as those found in table sugar, honey, syrups, biscuits, cakes and sugar-sweetened drinks, are not essential, and these foods are low in nutrients. Whether we have diabetes or not, it is important to remember that we all, limit our intake of free sugars to a maximum of 5% of total energy per day [1]. In other words this works out at 25g of free sugars for an average adult eating 2,000 kcals per day.

Sugar content of some common foods:

For those who like the sweet taste, but wish to reduce their sugar intake, artificial sweeteners are safe and can be used instead.

When free sugars are needed

Low blood glucose levels (hypoglycaemia or blood glucose less than 4mmol/l) may occur for people on certain diabetes medications. In fact, the fastest way to raise low blood glucose is to drink a liquid containing sugar. Fifteen grams of sugar is surely enough for an adult/teen of average build: younger children may need smaller quantities. 200ml of fruit juice or 150 – 200mls full-sugar fizzy drink, will in fact provide approximately 15g of sugar.

Individual dietetic advice

With this in mind, Dietary advice from a CORU-registered dietitian is recommended for people with diabetes. This can be provided on an individual basis or through structured group education programmes in either primary care or the hospital setting.

[1] Diabetes UK Evidence Based Nutritional Guidelines for the Prevention and Management of Diabetes, March 2018

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Abby Langtry

Director of Patient Advocacy and Community Engagement, Genomics Medicine Ireland

Genomics research could offer a significant healthcare breakthrough — that is to say, more targeted, personalised treatments for patients with Type 1, Type 2, rare… all forms of diabetes.

One-size-fits-all treatments are generally not the best way to treat all forms of diabetes. However, if you have diabetes, this is likely what is on offer.

However, genomic research offers the possibility of more targeted, personalised, precision treatments that promise better patient outcomes.

This can’t come too soon. Especially with rates soaring, there’s an urgent need to find new therapeutics that can treat all forms of diabetes more effectively.

Michael Higgins is Clinical Programme Manager at research company, Genomics Medicine Ireland (GMI), which was established in 2015 with the aim of building a world-class disease specific genomic database.

This in fact will include data from 400,000 volunteers in Ireland from both ‘healthy’ participants and patients with up to 60 different diseases (including diabetes). This is on the whole one of the largest genomics studies in the world.

Understanding all forms of diabetes and identifying new drugs

“Genomics is the large scale study of all our genes and their functions,” he explains. “Our genes contain sequences of DNA in our cells that act as the blueprint for every human being, controlling everything from our eye and hair colour to our likelihood of developing a particular disease.

Genomic research offers the possibility of more targeted, personalised, precision treatments that promise better patient outcomes.

“The hope is that this research will help us understand all forms of diabetes in more detail, and potentially identify drug targets for novel therapeutics for Type 1, Type 2 and rare forms of the disease.”

Naturally, in this case, this research wouldn’t be possible without patient participation. “We’re very grateful for the people who participate in our studies,” says Abby Langtry, GMI’s Director of Patient Advocacy and Community Engagement.

“We believe that every patient has the right to participate in research of this kind, should they so choose.”

Educating the public about the power of genomics

Participating in this research is on the whole a simple and straightforward process. Langtry says “If a person (over the age of 18) is deemed eligible for the study, they will be given a detailed information leaflet explaining how their data will be used, stored and accessed,”.

“Once they consent, volunteer participants complete a questionnaire and give research staff permission to access their medical records, in order for them to gain an understanding of contributing factors such as medical history and lifestyle. Participants also give a sample of blood — and that’s it.”

Data security is paramount. At GMI, personal identifiers are never used to label samples or clinical information, and data is stored on a platform with the highest GDPR-compliant standards of research and data protection regulations.

Langtry says that more needs to be done to inform people about the potential benefits of genomics.

“Last year, we carried out research into the understanding of genomics in the Irish general public,” she says. “The rate (of people who knew about it) was just 6%. So there’s a huge gap. That’s why we work with patient advocacy groups to explain our studies. This is helping educate people about how genomics could deliver real change to healthcare.”

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Type 1 diabetes onset is rapid (days-weeks) with aggressive deterioration once symptoms present. Prompt diagnosis prevents life-threatening illness and conveys better lifelong health outcomes; healthcare professionals must finger prick glucose check if in doubt.

What is Diabetes?

Type 1 diabetes is a lifelong condition in which the pancreas produces little or no insulin. Cells produce energy using glucose, which in-turn requires this hormone. The more common type 2 diabetes occurs when the body becomes resistant to insulin or doesn’t make enough insulin. While both type 1 and type 2 diabetes result in high blood glucose levels, the development and management are very distinct.

There is currently no cure for type 1 diabetes and insulin by injection is the only form of treatment.

What can happen if diagnosis is delayed

There is currently an alarming rise in the number of young people being admitted to hospitals with a new diagnosis of type 1 diabetes, which was not diagnosed immediately. This has resulted in a potentially life-threatening condition called diabetic ketoacidosis (DKA). This is 17% of the approximate 250 new cases annually.

Prompt diagnosis of type 1 diabetes means earlier administration of insulin and thereby better lifelong health.

These young people would have presented to a professional with symptom of high glucose levels such as thirst, weight loss, frequent urination etc, returning in subsequent days for a fasting blood test.

However, a simple finger prick glucose check, done immediately, could lead to prompt diagnosis and avoid the risk of developing DKA.

How does type 1 diabetes develop, what will show?

A combination of genetic (hereditary) and environmental (exposure) factors are thought to trigger the destruction of the pancreatic beta cells (insulin producing cells).

In fact the actual cause remains elusive, as does a cure or method of prevention. The destruction of the beta cells occurs over weeks/months when the young person usually presents with thirst and frequent urination. For this reason these symptoms can be mistaken for urinary tract infections.

If DKA is developing, the young person may complain of abdominal pain, dehydration and extreme lethargy. These symptoms are all similar to gastroenteritis. Although, unfortunately, if missed can lead to loss of consciousness and hyperventilation (i.e DKA) – requiring urgent, intensive therapy.

What can parents and guardians do?

Because parent know their children well, they can be the first to pick up minor changes such as being extra thirsty or needing the bathroom more frequently. If these signs are concern to the extent of seeking a medical explanation, don’t hesitate to ask your doctor/practice nurse or local pharmacy. They can help you do a finger prick blood glucose check (in a younger child, a urine glucose check).

Prompt action could avoid your child spending days in intensive care. Prompt diagnosis of type 1 diabetes means earlier administration of insulin and thereby better lifelong health.

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Lots of challenges come with a diabetes diagnosis, especially if that diagnosis comes at a young age, but new technological advancements are empowering those with diabetes.

When Eoghan Quinn was just four years old, he was diagnosed with Type 1 diabetes. The dash to the hospital became one of his first memories. “I remember the look on my mother’s face, the term, ‘diabetic’ was something completely foreign to us and a steep learning curve awaited,” he says.

It was a diagnosis that was to change how he lived his life, from concentrating in class to sleepovers at friends’ houses. “I can see it must have been incredibly challenging for my parents to put their trust in a youngster when it came to monitoring blood glucose levels.”

Frustrations with the blood glucose monitoring kit

Eoghan had always been diligent as a young child, and found that sport was a great way to burn off energy, reducing the amount of insulin needed. In 2008, Eoghan took on a challenge to cycle from Ireland to Gaza, a gruelling 6,000 km in 40 days. The environment was so extreme that he had used all of his blood glucose measuring strips within a the first half of the challenge. It was these sorts of frustrations with his kit that led Eoghan to embrace the technology advancements that were on the market, which could ultimately empower him to take on new challenges with confidence.

He says: “I’ve always believed that we must embrace it, and so I was quick to get an insulin pump when it was made available. But I like a challenge, and I think it sets an example to other people with diabetes that there are no boundaries to this condition. There may never be a cure for Type 1 diabetes, but I believe we will be able to manage it.”

New technology

It was while living in Australia that Eoghan came across a new technology that promised to continuously measure his blood glucose levels and worked via a simple scan, even when wet or through clothing.

There may never be a cure for Type 1 diabetes, but I believe we will be able to manage it.

I could check my blood glucose levels out there on the water, out on a run or while in a work meeting.

Eoghan says: “It was life changing for me, suddenly I could go kitesurfing for hours and not worry about getting back to the shore. With a waterproof phone I could check my blood glucose levels right then and there on the water.”

He was delighted when a move to Scotland meant that he was now eligible to receive the technology on the NHS.

He says: “It allowed me to plan bigger and better challenges to raise awareness of diabetes. Earlier this summer, I attempted to kitesurf from France to Ireland. But it was the weather, not my medical condition, that stopped me from completing the journey.”

No state funding for this life-changing tech

The only thing that worries Eoghan is a potential move back to Ireland where the technology is only offered privately.

He says: “I had hoped that the complications of diabetes – such as surgery and care – would encourage governments to look at prevention first, but the technology isn’t yet available in Ireland and that surprises me. After all, we need to show everyone, especially children, that with good monitoring diabetes shouldn’t stop us from doing anything.”

Flash glucose monitoring has helped Eoghan to reach the peak of fitness, and also track trends to see just why his blood glucose levels may be high or low. With his blood glucose monitoring now made easy, the 31-year old will soon be planning his next adventure.

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In Ireland, diabetes is in fact accounted for an estimated seven thousand deaths in 2017. Worldwide, the number of diabetes-related deaths was altogether an estimated four million. If more had been done to detect diabetes early and prevent its complications, many of these deaths could have been prevented.

Diabetes is a growing global epidemic that does not just affect individuals but has an impact on entire families, currently affecting over 425 million people.

The global impact of diabetes

Generally speaking it is fair to say that most of us know someone living with diabetes. Today, diabetes represents a concern for every family – from parents of a child with Type 1 diabetes, to people caring for an older family member with complications caused by diabetes.

The impact of this condition is after all all around us.

Limited awareness of the warning signs of diabetes

A lack of knowledge means that spotting the warning signs can be a real problem for families. It is a disturbing trend we are seeing worldwide.

A recent study found that four-in-five adults failed to correctly identify the warning signs of diabetes. The signs can be very mild in Type 2 diabetes, responsible for around 90% of all diabetes cases worldwide, so knowing what to look out for is vital to ensure prompt diagnosis and treatment. Half of people currently living with Type 2 are as a result undiagnosed.

Diabetes is a growing global epidemic that does not just affect individuals but has an impact on entire families.

The numbers are alarming but there is much that can be done to reduce the impact of this condition. With early diagnosis and access to appropriate care, it can be managed, and its complications prevented.

Furthermore, a majority Type 2 diabetes can be prevented through simple lifestyle measures such as regular physical activity and a healthy diet.

The barriers to prevention

Lifestyle behaviours commonly associated with urbanisation are fuelling the rise of Type 2 diabetes so interventions and policies that facilitate and encourage individuals and families to make healthy choices are required. It takes knowledge and resources to help families to live healthier lives.

However, the sad truth is that many families are unable to afford to adopt a healthy diet as the cheapest food is often the unhealthiest.

In addition, powerful advertising continues to tempt children and adults alike to over-consume foods high in sugar, salt and fat.

An appealing healthy diet is vital in achieving this and more action needs to be done. Therefore, governments should adopt a health-in-all-policies approach to secure the best possible quality of life for all people potentially at risk of Type 2 diabetes.

We all have a role to play to protect family members from developing Type 2 diabetes and its life-threatening complications.

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There are two distinct types of diabetes with a common dominator – raised blood glucose levels.

Today, the majority of us know someone with diabetes. There are in fact 225,000 people with diabetes in Ireland. With the prevalence of diabetes steadily increasing, we are going to see more and more people developing diabetes. In other words, there will approximately be 280,000 Irish people living with diabetes by 2030.

This is due largely to the number of adults who are overweight and not taking the recommended 150 minutes of physical activity in a week, therefore increasing their chances of developing Type 2 diabetes in the future. A 2015 survey from Healthy Ireland showed that 37% of adults are overweight and 23% are obese. We are seeing an increase in diagnosis of Type 2 diabetes as a result of these unhealthy lifestyle behaviours.

What is diabetes?

Diabetes occurs when the body cannot use glucose (sugar). Type 1 diabetes is the result of complete failure of insulin production and therefore insulin must be given as an injection. There is currently no known cause or cure and type 1 is a lifelong condition.

Type 2 diabetes is in general the result of over-demand of the body for insulin or reduced insulin production. Healthy eating and increased activity is in this case the main treatment with medications and sometimes insulin injections required. Being overweight or inactive contribute to insulin demand while carrying weight around the middle is particularly dangerous, hence major weight loss may prevent and even reverse Type 2 diabetes.  

How Diabetes Ireland is supporting those affected by diabetes

Diabetes Ireland is the national charity supporting people with – and at risk of developing – diabetes, working to actively improve access to care, support, education and information services. It supports people with diabetes and their families through a wide range of services including face-to-face contact, literature provision, a diabetes ‘lo-call’ helpline and online.

Through its care centres, Community Diabetes Education (CODE) programme and volunteer support network, it also provides community-based professional education and peer group support to people with diabetes and their families throughout Ireland.

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Diabetes is a misunderstood condition that can make or break you. We can moan about the lack of services or we can take charge of our own destiny.

What can you do?

• Carbohydrates (carbs) are the currency of insulin. Get to know them; the good, the bad and the ugly.

• Use a carb counting or fitness app to keep track of what you eating. Don’t have a smart phone? Buy a copy of Carbs and Cals, by Chris Cheyette and Yello Balolia, which gives the carbs for lots of everyday food.

• Learn to read food labels. It’s not hard once you get used to it.

• Know your portion size. Packet labels often have crazy portion sizes. Getting familiar with the carbs in the portion size you usually eat will serve you well.

• If your fitness app doesn’t have a built-in step counter, get one. If you start using a step counter you are likely to see improvement in your blood sugar readings.

• Drinking water through the day is beneficial. For anyone wearing a continuous glucose monitor being well hydrated ensures more closely matched readings to blood tests.

• If your blood sugar is too high, try taking one part of the day and work on that. Change your portion size, eat something healthier or exercise. Then move on to the next part of the day.

• Remember having good overnight levels means one third of your life is in a healthy range. A bit of thought about what you do in the evening can help a lot.

Out for dinner and had a crazy night of highs and lows?

• Even after 50+ years of living with Type 1 Diabetes I still miscalculate meals in restaurants. After all who knows what sneaky ingredients the chef added? This is a learning opportunity not a mistake.

• Dealing with blood sugar results can seem like a never-ending exam. Try to see blood sugar results as information to help you make decisions.

• Keep your diet full of unprocessed fresh food and keep your stress levels in check will help your blood sugar levels and keep your whole body healthy.

Go with it!

What worked for me 20 years ago doesn’t work now. Live in the now and use what you learn to help you make decisions. Research what you don’t understand or get professional help if necessary. Every day is a school day with Diabetes!

Doing the same thing and expecting a different result won’t get us anywhere! Take charge of your health today.

Carbs and Cals by Chris Cheyette and Yello Balolia can be ordered in good book stores or purchased online from Amazon or the Book Depository.

Anne Daly is a Nutritional Coach living with Type One Diabetes for over 50 years, seeing clients on a one to one basis. Help with pre-diabetes and all types of Diabetes. Head to The Artisan Diabetic to find some of Anne’s recipes and top-tips.

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Diabetes peer support has many benefits including empowering people with diabetes and relieving the burden on our health service. Yet it is under-valued as a resource.

Managing diabetes can be lonely

Living with diabetes can feel like a very lonely place: most of diabetes management is done by the person living with it, outside of a medical setting. When I met other people with diabetes, it was like finding something I never knew was missing!

I had moved to a new town where I knew nobody and within two years, my diabetes was floundering. My healthcare service proved increasingly frustrating. But I knew if I could find other people with diabetes, I would find information on better services. However, I helped set up our support group and haven’t looked back since. Our group continues to be a source of information, motivation and inspiration.

Sharing the best diabetes information and advice

We learn so much from sharing practical advice to overcoming the challenges of diabetes. This has been the most valuable information in helping me live well with Type 1 diabetes. We also keep each other up to date on research, technologies and treatments. Finding others who understand what living with diabetes involves often lifts our spirits and encourages us to stay strong.

Health professionals benefit from diabetes peer support

Diabetes peer support is beneficial to health professionals also. It’s very difficult for any healthcare professional to cover absolutely all the information that a person with diabetes needs to know. They also don’t have the lived experience knowledge. Diabetes peer support fills those gaps. Often, by the time a new treatment is offered in clinic, the patient is already informed about it, thus saving time for our healthcare professionals.

Medical Futurist, Dr Bertalan Mesko, says “Empowered patients, empower health professionals” and evidence of this is growing. Research published in 2018 on the Effect of Diabetes Online Community Engagement on Health concluded that people with diabetes who are engaged with support groups improve their quality of life and improve health outcomes. This decreases hospitalisations, inpatient days, and reduces the overall cost for health services.

The impact of social media on peer support groups

It’s never been easier to find diabetes peer support with social media. An online search or using diabetes hashtags like #IreDOC (on Twitter) will send you in the right direction.

Diabetes peer support is the most under-valued, under-used resource we have, and I’d love to see that change.

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