According to Richard and James (2010), risk factors for diabetes depend on the type of diabetes:
Risk factors for type 1 diabetes mellitus
Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk as stated by Richard and James (2010) include:
- Family history: The risk of developing type 1 diabetes mellitus increases if a parent or sibling has type 1 diabetes.
- Environmental factors: Environmental circumstances such as exposure to a viral illness likely play some role in type 1 diabetes.
- The presence of damaging immune system cells (autoantibodies): Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If an individual have these autoantibodies, the individual have an increased risk of developing type 1 diabetes. However, not everyone who has these autoantibodies develops diabetes.
- Dietary factors: Dietary factor can lead to developing diabetes mellitus. These include low vitamin D consumption, early exposure to cow’s milk or cow’s milk formula, and exposure to cereals before 4 months of age.
Risk factors for prediabetes and type 2 diabetes
There has been a general confusion why some people develop prediabetes and type 2 diabetes and others do not. Richard and James (2010) stated that It is clear that certain factors increase the risk, however, including:
- Weight: The more fatty tissue an individual possess the more resistant the cells become to insulin which can trigger the occurrence of diabetes mellitus.
- Inactivity: Living a less active life such as sedentary daily routine can greatly increase the risk of developing diabetes mellitus. Physical activity helps to control weight, uses up glucose as energy and makes cells more sensitive to insulin while lack of physical activity can lead to a reverse condition.
- Family history: Just as in the case of how family history influences the development of diabetes type 1, so also the case of diabetes type 2. The risk is increases if a parent or sibling has type 2 diabetes.
- Age: The risk of diabetes increases as one gets older. This may be as a result of less exercise, lose muscle mass and weight gain as one gets older. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults due to poor dietary choices.
- Polycystic ovary syndrome: For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
- High blood pressure: Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
- Abnormal cholesterol and triglyceride levels: Having low levels of high-density lipoprotein (HDL), or “good,” cholesterol, lead to increase risk of type 2 diabetes. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes.
Dietary causes of diabetes mellitus
Haimoto, Sasakabe and Umegaki (2009) stated that a poor diet is probably the most important cause of type 2 diabetes. Studies of the eating habits of different populations have revealed that diets high in fat (especially animal fat), animal protein, refined sugars, processed carbohydrates, and trans fatty acids, and low in fiber and complex carbohydrates are associated with a greatly increased risk of type 2 diabetes.
This translates to a diet high in meat, dairy, margarine, refined vegetable oils, white flour products, and sugar. Unfortunately, this is the diet commonly consumed by people worldwide. Refined grains and the foods made from them (e.g., white breads, cookies, pastries, pasta and rice) have been linked not only to weight gain but to increased risk of insulin resistance (the precursor of type 2 diabetes) and the metabolic syndrome (a strong predictor of both type 2 diabetes and cardiovascular disease), while eating more wholegrain foods is being shown to protect against all these ills. Common features of the metabolic syndrome include visceral obesity (the “apple shaped” body), low levels of protective HDL cholesterol, high triglycerides, and high blood pressure.
Diagnosis and test of diabetes mellitus
Diabetes mellitus is characterized by recurrent or persistent high blood sugar, and which according to Leonid (2009) is diagnosed by demonstrating any one of the following:
- Glycated haemoglobin (A1C) test: This blood test indicates the average blood sugar level of an individual for the past two to three months. It measures the percentage of blood sugar attached to haemoglobin, the oxygen-carrying protein in red blood cells. The higher the blood sugar levels, the more haemoglobin the individual have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that the individual have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal.
- Random blood sugar test: A blood sample will be taken at a random time. Regardless of when the individual last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.
- Fasting blood sugar test: A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it is 126 mg/dL (7 mmol/L) or higher on two separate tests, the individual have diabetes.
- Oral glucose tolerance test: For this test, the individual fast overnight, and the fasting blood sugar level is measured. Then he or she is asked to drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.
| WHO diabetes diagnostic criteria | ||||
| Condition | 2 hour glucose | Fasting glucose | HbA1c | |
| Unit | mmol/l(mg/dl) | mmol/l(mg/dl) | mmol/mol | DCCT % |
| Normal | <7.8 (<140) | <6.1 (<110) | <42 | <6.0 |
| Impaired fasting glycaemia | <7.8 (<140) | ≥6.1(≥110) & <7.0(<126) | 42-46 | 6.0–6.4 |
| Impaired glucose tolerance | ≥7.8 (≥140) | <7.0 (<126) | 42-46 | 6.0–6.4 |
| Diabetes mellitus | ≥11.1 (≥200) | ≥7.0 (≥126) | ≥48 | ≥6.5 |
(Source: Vijan,2010).
Diet modification/management of diabetes mellitus
Haimoto, et al.,(2009) opined that the dietary management of diabetes mellitus requires well-organized, nutritious and goal oriented dietary decisions. To achieve this, one has to set out health goals, tastes and eating habits. The following are ways to that can health an individual to make calories count using nutritious foods:
- Healthy carbohydrates: During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates) break down into blood glucose. Focus on the healthiest carbohydrates, such as fruits, vegetables, whole grains, legumes (beans, peas and lentils) and low-fat dairy products.
- Fibre-rich foods: Dietary fibre includes all parts of plant foods that your body can’t digest or absorb. Fibre can decrease the risk of heart disease and help control blood sugar levels. Foods high in fibre include vegetables, fruits, nuts, legumes (beans, peas and lentils), whole-wheat flour and wheat bran.
- Heart-healthy fish: Eat heart-healthy fish at least twice a week. Fish can be a good alternative to high-fat meats. For example, cod, tuna and halibut have less total fat, saturated fat and cholesterol than do meat and poultry. Fish such as salmon, mackerel, tuna, sardines and bluefish are rich in omega-3 fatty acids, which promote heart health by lowering blood fats called triglycerides. However, avoid fried fish and fish with high levels of mercury, such as tilefish, swordfish and king mackerel.
- ‘Good’ fats: Foods containing monounsaturated and polyunsaturated fats — such as avocados, almonds, pecans, walnuts, olives, and canola, olive and peanut oils — can help lower your cholesterol levels. Eat them sparingly, however, as all fats are high in calories.
Foods to avoid
Diabetes increases the risk of heart disease and stroke by accelerating the development of clogged and hardened arteries. Foods containing the following according to Haimoto, et al.,(2009) can work against the goal of a heart-healthy diet. They include:
- Saturated fats: High-fat dairy products and animal proteins such as beef, hot dogs, sausage and bacon contain saturated fats. Get no more than 7 percent of your daily calories from saturated fat.
- Trans fats: These types of fats are found in processed snacks, baked goods, shortening and stick margarines and should be avoided completely.
- Cholesterol: Sources of cholesterol include high-fat dairy products and high-fat animal proteins, egg yolks, shellfish, liver, and other organ meats. Aim for no more than 300 milligrams (mg) of cholesterol a day.
- Aim for less than 2,300 mg of sodium a day.
Haimoto, et al.,(2009) summed it up by stating that there are a few different approaches to creating a diabetes diet that keeps blood glucose level within a normal range. These include:
- Counting carbohydrates: Because carbohydrates break down into glucose, they have the greatest impact on your blood glucose level. It’s important to make sure your timing and amount of carbohydrates are the same each day, especially if you take diabetes medications or insulin. Otherwise, your blood glucose level may fluctuate more.
- The food lists system: The food lists are organized by categories, such as carbohydrates, protein sources and fats. One serving in a category is called a “choice.” A food choice has about the same amount of carbohydrates, protein, fat and calories — and the same effect on your blood glucose — as a serving of every other food in that same category. So, for example, you could choose to eat half of a large ear of corn or 1/3 cup of cooked pasta for one starch choice.
- Glycemic index: Some people who have diabetes use the glycemic index to select foods, especially carbohydrates. Foods with a high glycemic index are associated with greater increases in blood sugar than are foods with a low glycemic index. Complex carbohydrates that are high in fibre — such as whole-grain rice, bread or cereals — have a lower glycemic index than do simple carbohydrates — white bread or white rice, for example — and usually are preferred to highly processed foods. But low-index foods aren’t necessarily always healthier, as foods that are high in fat tend to have lower glycemic index values than do some healthier options.
A sample menu
A sample daily meal plan for the management of diabetes mellitus should take into account the size as well as physical activity level. The following menu is tailored for someone who needs 1,200 to 1,600 calories a day.
- Whole-wheat pancakes or waffles, one piece of fruit or 3/4 cup of berries, 6 ounces of nonfat vanilla yogurt.
- Cheese and veggie pita, medium apple with 2 tablespoons of almond butter.
- Beef stroganoff; 1/2 cup carrots; side salad with 1 1/2 cups spinach, 1/2 of a tomato, 1/4 cup chopped bell pepper, 2 teaspoons olive oil, 1 1/2 teaspoons red wine vinegar.
- Two unsalted rice cakes topped with 1 ounce of light spreadable cheese or one orange with 1/2 cup 1 percent low-fat cottage cheese.
References
Richard, S. & James, M. (2010). Manual of intensive care medicine (5th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Haimoto, H., Sasakabe, T. & Umegaki, H. (2009). Acute metabolic responses to a high-carbohydrate meal in outpatients with type 2 diabetes treated with a low-carbohydrate diet: a crossover meal tolerance study. Nutrition & Metabolism, 6:52
Leonid, P. (2009). Principles of diabetes mellitus (2nd ed.). New York: Springer. p. 3
Vijan, S. (2010). “Type 2 diabetes”. Annals of Internal Medicine 152 (5): ITC31-15.