What is Diabetes?

Diabetes is a condition in which the body cannot properly use and store food (in the form of the simple sugar, glucose) for energy. Glucose in the blood comes from carbohydrates in our food that have been digested. If left untreated or improperly managed, diabetes can result in a variety of complications including: heart disease, kidney disease, eye disease, impotence and nerve damage.

Understanding Carbohydrates

Food contains different types of carbohydrates, such as sugar, starch and fibre. When managing diabetes, it’s important to pay attention to the type and amount of carbohydrates you eat. Sugars and starch raise blood glucose levels and fibre does not. The right amount of carbohydrate for you depends on your size, the medications you take and your physical activity level.

Starch: Starches are a type of carbohydrate found in grains (e.g. rice, pasta, breads, crackers, cereal), some vegetables (e.g. potatoes, yams, cassava, corn) and legumes (e.g. beans, lentils, dried peas). The starch value is not required to be displayed on the Nutrition Facts table, but it can be determined by subtracting the dietary fibre and sugars from the grams of total carbohydrate on the label.

Sugars: The amount of sugar displayed on the Nutrition Facts table includes sugars found naturally in foods like in fruit and milk, plus added sugars such as white sugar and syrups. Added sugars like honey and agave are no healthier than other types of added sugar. All types of sugar are digested in the same way.

Fibre: Fibre is a carbohydrate, but it does not affect your blood glucose levels. Consuming adequate dietary fibre is important for your overall health. The fibre in food is a blend of soluble and insoluble fibre.

• Soluble fibre has many health benefits including the ability to regulate blood glucose
• Insoluble fibre is not digested and helps to promote regularity and a healthy digestive system

If you are trying to count carbohydrates, subtract the fibre from the total amount of carbohydrate listed. This will give you the amount of carbohydrate that will affect your blood glucose levels (also called “available” carbohydrate). As a general rule, individuals should aim to consume 21g to 38g of fibre a day from a variety of sources. The exact amount for you will depend on your age and gender.

Glycemic Index

The glycemic index (GI) is a scale that ranks carbohydrate-containing foods by how much they raise blood sugar levels compared to a standard food (glucose or white bread). The higher the number, the greater the rise in blood sugar. Choose low GI (55 or less) and medium GI (56-69) foods more often.

The following list provides the GI classification of some foods:

Low GI Foods (55 or less)	Medium GI Foods (56-69)	High GI Foods (70 or greater)
Pumpernickel bread	Rye bread	White bread
Bran cereal	Oatmeal	Corn flake cereal
Parboiled or converted rice	Brown rice	Short grain rice
Sweet potato	Popcorn	Rice cakes
Legumes	Sweet corn	Soda crackers

Nutrition Label

When reading a nutrition label, consider the following:

• Look at the reference serving size on the package (under the Nutrition Facts title) and calculate the amount of any nutrient on the label (e.g. sugar, fibre) by comparing it to the amount you are actually eating.
• Example: If you look on a nutrition label and the reference serving size is 50g and the label indicates that serving size contains 10g of sugar, eating 100g will mean you consume 20g of sugar (10g per serving x 2 servings)

• % Daily Value (% DV) classifies nutrients on a scale from 0% to 100% and tells you if there is a little (5% DV or less) or a lot of a nutrient (15% DV or more) in one serving of a packaged food. You can also use this percentage to compare the nutrient content of different foods.
• Choose products with higher % DV of fibre.
• Choose products with lower % DV of sodium, saturated fat and trans fat.

• “Carbohydrate” is displayed on the label and represents the total of fibre, sugar and starch added together. Starch may or may not be displayed on the label but the starch composition of the food would be what remains after you subtract fi bre and sugar from the total grams of carbohydrate.
• If any of the following names for added sugar are listed in the first few ingredients on a food package, the food is likely high in added sugar: glucose, fructose, sucrose, maltose, lactose, galactose or dextrose, concentrated fruit juice, cane juice or evaporated cane juice syrups, honey, agave, liquid invert sugar, maple syrup, corn syrup, molasses, barley malt syrup, brown rice syrup or palm syrup.

Nutrition Tips

• Eat 3 meals per day at regular times to help control your blood sugar levels.
• Eat a snack if your meals are spaced more than 4 hours apart.
• The portion of carbohydrate at a meal should be about ¼ of your plate (size of your fist) – the remainder of the plate should be ½ vegetables and ¼ protein. Fruit and milk can be on the side.
• Too much or too little carbohydrate can lead to fluctuations in blood sugar.
• Eat consistent amounts of carbohydrates throughout the day. Have a similar amount at each meal to help control blood sugar.
• Limit your intake of high fat foods such as fried foods, chips and pastries.

At Home

• Try snacks that have a source of protein such as Greek yogurt, cheese, peanut butter or a hard-boiled egg.
• Planning your meals and snacks ahead of time can also help control your appetite and prevent you from overeating foods that may cause your blood sugar to go up.
• Reach for water rather than juice or pop.
• Combining carbohydrates with fat and/or protein at meals and snacks will help control blood sugar.

At the Grocery Store

• When shopping compare food labels and select foods low in saturated and trans fat, whenever possible.
• Choose breads, cereals and grains that are whole grains. Look for the words “whole grain” as the first ingredient.
• Carbohydrate choices to include: whole grains, high fibre cereals and breads, whole fruits, legumes (such as kidney bean, chickpeas, lentils), brown rice.
• Look for products that are high in fibre such as bread that contains at least 2g of fibre per serving and cereals that contain at least 5g of fibre per serving.
• Look for products with less than 10g of sugar per serving.
• “Sugar free” and “no added sugar” claims on a product do not always mean carbohydrate free and it’s the carbohydrates that affect blood sugar. These products may also be high in fat, sodium or calories and low in nutrients.
• Carbohydrate choices to limit or avoid: refined grains (white breads, white rice), sugars, sweets, jam, honey, desserts, candies, juice, regular pop.

Speak to our pharmacist for more information about how we can help you monitor your blood sugar levels.

Healthy Behaviours to Manage Diabetes

Physical Activity
Regular physical activity is a key element for maintaining good health. Everyone should aim for 150 minutes of moderate (e.g. brisk walking, biking) to vigorous (e.g. jogging, aerobics) activity each week. This amount is equal to 30 minutes of activity at least 5 days per week.

Limit Tobacco Use
The use of tobacco products is associated with many health risks. Recognizing that every individual faces different circumstances that lead to tobacco use, those who are interested are encouraged to reduce the amount used or quit completely. A combination of medication, counseling and simple lifestyle changes can all be integrated into a successful quit plan. Speak with your healthcare provider for information and support on reducing tobacco use.

Limit Alcohol Consumption
Excess alcohol consumption is associated with health risks. Canada’s low-risk alcohol drinking guidelines provide limits to support a healthy lifestyle.

The guidelines are as follows:

• Aim to limit alcohol to no more than 2 drinks per week
• Visit Canada’s Guidance on Alcohol and Health for more information