How to manage and live with Type2 Diabetes
“Living with Type 2 Diabetes is tough, it does not let you live freely, nor does it kill you immediately.” I wanted to begin with this poignant quote by my father, a caring Indian migrant who has lived the past 26 years with Type 2 Diabetes Mellitus (T2DM). He said so because he feels frustrated with trying to control his blood sugar levels. My hope is that after reading this article, if you have been diagnosed with T2DM or have a loved one with the condition you understand what this means and know that with proper lifestyle changes T2DM can be controlled.
T2DM is a condition where there are high levels of glucose (sugar) in your blood. Glucose comes from the diet, specifically from carbohydrates (maida, mithai, potatoes) and is required by the body’s cells for energy. Once the body has enough glucose, a non-diabetic will store glucose in their liver and muscles for later use. Too much glucose in the blood (T2DM) is associated with long-term complications which negatively effects your eyesight, kidneys, nerves and heart. People with undiagnosed and poorly managed T2DM have increased risk of having a heart attack or stroke.
The Indian population have an alarmingly high rate of T2DM. In New Zealand (NZ), Indians are disproportionately affected by T2DM. In 2014, when population size was standardised, it was found that there were relatively more Indians with T2DM in NZ compared to in India. More recent statistics have shown that Indians in NZ have higher rates of T2DM compared to other Asian populations and Europeans (Counties Manukau Health, 2020).
An important hormone for maintaining “safe” blood glucose levels is insulin. Insulin is produced and released by the pancreas. After a meal, blood glucose levels rise which causes insulin release. Insulin removes glucose from the blood and allows cells to use glucose for energy. In T2DM, the body’s cells become insulin resistant which means there is reduced insulin action as the cells no longer respond to insulin, so glucose remains in the blood. As T2DM progresses the pancreas produces less insulin which further increases blood glucose levels. Finally, because less glucose is entering the cells the liver starts producing more glucose which further increases blood glucose levels.
The main cause for T2DM in Indians is high levels of central obesity (fat around the waist). Obesity is due to physical inactivity and eating high calorie diets. Having excess fat around your waist promotes insulin resistance and thus T2DM. Specialised cells that store fat (adipocytes) accumulate in obese people. These cells release small proteins that stop glucose uptake from the blood. Unfortunately compared to other ethnic groups Indians have higher abdominal fat at any Body Mass Index.
The Western diet and lifestyle differ from the way of life in India. Several characteristics of the Western diet predispose people to obesity and therefore also T2DM. After migrating, Indians alter their diet to one high in saturated fat, overconsumption of refined grains, less fruits and vegetables and more processed meats. This is different to the traditional Indian diet which contains wholegrain carbohydrates, organic lentils, herbs, yogurt (“dahi”) and considerably more fresh fruits and vegetables. Moreover, after migrating Indians tend to adopt a sedentary lifestyle. Back in India, people usually have a physically vigorous lifestyle. In NZ, Indians often work sedentary jobs and do not prioritise exercise.
To manage T2DM, you must eat properly. This means choosing nutritious complex carbohydrates. You can do this by using wholegrain flour to make roti, replacing white rice with brown rice, and eating rolled oats for breakfast. These foods are low Glycaemic Index (GI) which are good for controlling blood glucose levels. Next, high protein vegetables like lentils (dal), kidney beans (rajma), kala chana are recommended. However, when cooking curries, healthy low-fat oils like olive oil should be used instead of high fat desi ghee and cream. Dairy products like dahi and paneer should be made from trim milk because it has lower fat content. If you eat meat, choose lean cuts of meat such as chicken breast instead of thigh and trim the fat before cooking. Added sugar in chai and from mithai should be minimised and thought of as rare treats. Food portions are also important. Each plate should be 1⁄2 vegetables, 1⁄4 protein and 1⁄4 carbohydrates.
Regular exercise is important for T2DM diabetics as it helps manage weight. The recommended type of exercise for T2DM diabetics is ‘aerobic’ exercise, this is exercise which uses oxygen and requires you to breathe harder than when you are sitting. Aerobic activities include walking, mowing lawns, washing the car or dance classes. You should aim to get 150 minutes of moderate-vigorous exercise per week, at this intensity you would find it difficult to maintain a conversation with someone while exercising.
My last piece of advice is to have regular check-ups with your GP. In NZ we have a green prescription program which supports patients with T2DM. Your GP can write a green prescription which connects you to cultural groups which help you become more physically active and help with nutrition.
I appreciate that managing T2DM can be difficult and at times you feel lost. But we are fortunate to live in NZ because there are a lot of support services available. Changing your eating habits and prioritising exercise can be difficult at the start, but like someone once told me “difficult roads lead to beautiful destinations”.
Disclaimer: This article was written by a student doctor from the University of Auckland Migrant Health Group. The information and opinions expressed in the article are not endorsed by the Indian Weekender nor are they a reflection of the University, our employers or any DHB. We hope that you find them useful. Always chat to your GP or specialist if you have any concerns.
“Living with Type 2 Diabetes is tough, it does not let you live freely, nor does it kill you immediately.” I wanted to begin with this poignant quote by my father, a caring Indian migrant who has lived the past 26 years with Type 2 Diabetes Mellitus (T2DM). He said so because he feels frustrated...
“Living with Type 2 Diabetes is tough, it does not let you live freely, nor does it kill you immediately.” I wanted to begin with this poignant quote by my father, a caring Indian migrant who has lived the past 26 years with Type 2 Diabetes Mellitus (T2DM). He said so because he feels frustrated with trying to control his blood sugar levels. My hope is that after reading this article, if you have been diagnosed with T2DM or have a loved one with the condition you understand what this means and know that with proper lifestyle changes T2DM can be controlled.
T2DM is a condition where there are high levels of glucose (sugar) in your blood. Glucose comes from the diet, specifically from carbohydrates (maida, mithai, potatoes) and is required by the body’s cells for energy. Once the body has enough glucose, a non-diabetic will store glucose in their liver and muscles for later use. Too much glucose in the blood (T2DM) is associated with long-term complications which negatively effects your eyesight, kidneys, nerves and heart. People with undiagnosed and poorly managed T2DM have increased risk of having a heart attack or stroke.
The Indian population have an alarmingly high rate of T2DM. In New Zealand (NZ), Indians are disproportionately affected by T2DM. In 2014, when population size was standardised, it was found that there were relatively more Indians with T2DM in NZ compared to in India. More recent statistics have shown that Indians in NZ have higher rates of T2DM compared to other Asian populations and Europeans (Counties Manukau Health, 2020).
An important hormone for maintaining “safe” blood glucose levels is insulin. Insulin is produced and released by the pancreas. After a meal, blood glucose levels rise which causes insulin release. Insulin removes glucose from the blood and allows cells to use glucose for energy. In T2DM, the body’s cells become insulin resistant which means there is reduced insulin action as the cells no longer respond to insulin, so glucose remains in the blood. As T2DM progresses the pancreas produces less insulin which further increases blood glucose levels. Finally, because less glucose is entering the cells the liver starts producing more glucose which further increases blood glucose levels.
The main cause for T2DM in Indians is high levels of central obesity (fat around the waist). Obesity is due to physical inactivity and eating high calorie diets. Having excess fat around your waist promotes insulin resistance and thus T2DM. Specialised cells that store fat (adipocytes) accumulate in obese people. These cells release small proteins that stop glucose uptake from the blood. Unfortunately compared to other ethnic groups Indians have higher abdominal fat at any Body Mass Index.
The Western diet and lifestyle differ from the way of life in India. Several characteristics of the Western diet predispose people to obesity and therefore also T2DM. After migrating, Indians alter their diet to one high in saturated fat, overconsumption of refined grains, less fruits and vegetables and more processed meats. This is different to the traditional Indian diet which contains wholegrain carbohydrates, organic lentils, herbs, yogurt (“dahi”) and considerably more fresh fruits and vegetables. Moreover, after migrating Indians tend to adopt a sedentary lifestyle. Back in India, people usually have a physically vigorous lifestyle. In NZ, Indians often work sedentary jobs and do not prioritise exercise.
To manage T2DM, you must eat properly. This means choosing nutritious complex carbohydrates. You can do this by using wholegrain flour to make roti, replacing white rice with brown rice, and eating rolled oats for breakfast. These foods are low Glycaemic Index (GI) which are good for controlling blood glucose levels. Next, high protein vegetables like lentils (dal), kidney beans (rajma), kala chana are recommended. However, when cooking curries, healthy low-fat oils like olive oil should be used instead of high fat desi ghee and cream. Dairy products like dahi and paneer should be made from trim milk because it has lower fat content. If you eat meat, choose lean cuts of meat such as chicken breast instead of thigh and trim the fat before cooking. Added sugar in chai and from mithai should be minimised and thought of as rare treats. Food portions are also important. Each plate should be 1⁄2 vegetables, 1⁄4 protein and 1⁄4 carbohydrates.
Regular exercise is important for T2DM diabetics as it helps manage weight. The recommended type of exercise for T2DM diabetics is ‘aerobic’ exercise, this is exercise which uses oxygen and requires you to breathe harder than when you are sitting. Aerobic activities include walking, mowing lawns, washing the car or dance classes. You should aim to get 150 minutes of moderate-vigorous exercise per week, at this intensity you would find it difficult to maintain a conversation with someone while exercising.
My last piece of advice is to have regular check-ups with your GP. In NZ we have a green prescription program which supports patients with T2DM. Your GP can write a green prescription which connects you to cultural groups which help you become more physically active and help with nutrition.
I appreciate that managing T2DM can be difficult and at times you feel lost. But we are fortunate to live in NZ because there are a lot of support services available. Changing your eating habits and prioritising exercise can be difficult at the start, but like someone once told me “difficult roads lead to beautiful destinations”.
Disclaimer: This article was written by a student doctor from the University of Auckland Migrant Health Group. The information and opinions expressed in the article are not endorsed by the Indian Weekender nor are they a reflection of the University, our employers or any DHB. We hope that you find them useful. Always chat to your GP or specialist if you have any concerns.
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