4 minute read
On the Line
The Diabetes WA Helpline and Telehealth Service provides free comprehensive access to personalised diabetes management adviceand support from a Credentialed Diabetes Educator. Meet our educators as they share some of the common concerns they hear from our members.
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PRISCILLA LEE
Dietitian Priscilla grew up in Hong Kong and moved to Perth for university to study her growing passion in nutrition. She joined Diabetes WA in 2019 to provide diabetes education to clients via the Telehealth Service, our Helpline and group education workshops. Priscilla speaks English, Mandarin and Cantonese. Her areas of speciality include diabetes, weight management, bariatric surgery, nutrition, cardiovascular disease and IBS.
“Now, my GP told me that I’ve got diabetes. What food can I eat?Give me a list please!”
This is one of the most common questions asked by my clients with diabetes. Then, my clients may mention, “I heard from other people, and they say that having bananas is not good for
people with diabetes, is it true?”.
Feeling frustration is a normal emotional response when people are told they’ve got diabetes. Some people may feel nervous to see a diabetes dietitian because they think that their favourite foods will be made off-limits. There is a deep misconception that dietitians act as the food police, instructing people to "eat this, not that".
The truth is that diabetes educators or dietitians do not ask people to totally cut out their favourite foods or carbohydrates from their diet. There are three reasons for this:
1. Carbohydrates break down into glucose in our digestive system and glucose is our primary source of energy. It affects our blood glucose levels but the levels vary depending on the amount and type of carbohydrates. 2. Food with carbohydrates provide dietary fibre, vitamins and minerals which are important to our health.
3. Carbohydrates are found in a range of foods and drinks, meaning some essential nutrients would be lacking if we completely cut out carbohydrates from our diet. (As you'll see on page 28, being more aware of the sorts and quantities of carbs we're consuming also assists gut health.) As a diabetes dietitian, my motto is “eat healthily but enjoy the good stuff too”. Generally, diabetes educators or dietitians suggest people choose lower GI foods in their diet because these foods cause blood glucose to rise more slowly. Instead of asking for a list of foods TO HAVE and TO AVOID, it is better to focus on F.A.T.: F How often we are having the food? (frequency) A How much of it do we have? (amount) T What type of foods do we have in our diet? (type) The best way to find out how foods impact on blood glucose levels is to keep a food record for 3-5 days and start self-blood glucose monitoring (doing finger prick checks) at certain times, for example fasting or before meals and two hours after the start of a meal. Working with a diabetes educator or dietitian to develop a personalised plan is important as individuals can have different reactions to the amount and type of food and different target ranges of blood glucose levels. We all have different energy and nutrient requirements based on factors such as age, sex, medical conditions and activity levels. With a personalised plan, people can learn and adapt it to their lifestyle for successful diabetes management.
CATE MITCHELL
Cate is a registered nurse, midwife and diabetes educator, with experience in paediatrics, adolescents, remote community nursing and Aboriginal and school health including health care planning, diabetes education and selfmanagement group education. She is passionate about making a difference and supporting people to manage their diabetes in a way that recognises their uniqueness and diversity. Her favourite things in life are family, her dog (probably the dog first), glamping – because who goes camping without a coffee machine? – and long walks (with the dog, of course!) One of the most common queries I deal with comes from clients living with gestational diabetes.
“I have cut out carbs in my diet and my blood glucose levels (BGLs) in the morning are higher than my target of <5.1mmol/L. what can I do?”
Fasting BGLs are not usually related to carbohydrate intake but instead come from glucose being released into the bloodstream from stores in the liver.
The liver releases glucose into the blood to be used by the body as fuel, during any fasting state (like sleep), so cutting out carbohydrates the day before will not have any impact on BGLs taken in the morning. A fasting blood glucose reading is taken to see what impact the hormones from the placenta are having on blood glucose levels during the fasting state. The reading is to check if the body’s cells are resistant to insulin or a result of blood glucose levels dropping in the night, which causes your liver to release glucose into the bloodstream. It’s important to take this reading to keep the blood glucose levels within the optimum range for you. Your health care professional or diabetes educator will suggest checking your blood glucose levels at 2 or 3am to see if the high blood glucose levels (>5.1mmol/L) are a result of going low (<4mmol/L) overnight and may suggest a supper before bed with a low GI carbohydrate, making sure you are only fasting for around 8-10 hours.
