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Sweets, treats and choco-mania

Just because you have diabetes doesn’t mean you have to go without sweets and desserts. My experience is that sweets, chocolate, ice cream and other treats can be included in a healthy diet that still allows you to keep your blood glucose under control. For instance, when I went on holiday to Cornwall at Easter, I was able to have an ice cream in Padstow because I was about to cycle back along the Camel Trail. And, at my friend’s birthday party, I was allowed a slice of birthday cake because I had an extra unit of insulin to deal with it. And, every so often, a cake or choc ice after dinner is not a problem at all.

Everyone knows that sweets aren’t the healthiest thing ever; it would be much easier if we all craved broccoli and Brussels sprouts rather than choccies and sugar-coated E-numbers. Sweets may be a totally delicious treat, but they’re full of sugar. And – for everyone, not just people with diabetes – too much sugar is bad.

So, how do you eat sweets and treats and avoid hypers? It’s simple. Try to save sweets for after lunch or dinner, because this way the starch in your other food slows down the sugar in the sweets, and the effect on your blood glucose is much less. Also, think about the types of sweets you eat. Chewing gum and chocolate are far better for your blood sugar than sherbet or lollipops. This is because the sugar in chewing gum is released from the gum slowly (that’s how it keeps its flavour) and the fat in chocolate slows down the emptying of the stomach so that the sugar gets into your system more gradually; whereas sherbet and lollipops are both virtually pure sugar, which doesn’t have to be broken down or refined once inside the body, so it can get into the bloodstream straight away. Another way to enjoy sweets and chocolates is by eating them whilst you are playing sport, doing other exercise or taking part in a P.E. lesson.

So being diabetic doesn’t mean you can’t have sweets or desserts, but you do have to think about their effect on your blood sugar, and there are instances where eating sweets would just be out of the question (for instance if you are hyper). It can be really annoying, and as ridiculous as it sounds, it can become a kind of psychological barrier. I’ve experienced this myself.

A couple of months after I was diagnosed, I was starting to become used to the idea that I had a condition that would not go away. It was hard to get it into my head, though, that I’d have to have injections every day just to stay alive. I used to get upset almost every time I did my Lantus (glargine), then get angry with myself for being so miserable, and try to justify my anger by thinking up all the things I hated about diabetes: I had to stick needles in myself every mealtime, which hurt; I was always going hypo or hyper and it made me feel ill; I was constantly having to worry about my blood sugar and I could never just go and help myself to sweets or chocolate.
I told Mom about the way that I felt so angry a lot of the time. “Think about it,” she said, “What are you actually missing out on? Is there actually anything you used to do that you can’t do any more?”

There was only one thing I could think of: I couldn’t just have sweets whenever I felt like it. I picked up on this and felt really annoyed about it. It may seem like a really sad thing if you’ve never experienced this yourself, but I became practically obsessed with chocolate.

Dad tried to rationalise it by pointing out that I wouldn’t be allowed to just go and help myself to sweets whenever I wanted to anyway. It didn’t make a bit of difference, though. The thing is, I wouldn’t be allowed, but I could have. Now not only would I get in to trouble for gorging on sweets, but it would actually make me ill. And there was no point in arguing that I’d still feel sick after eating loads of chocolate anyway – I may have felt sick but I wouldn’t have actually been medically ill. Now I would be.

I decided that this was the thing that diabetes actually stopped me from doing and quickly became fixated on sweets and chocolate; I used to feel depressed if I missed a P.E. lesson and therefore couldn’t have my chocolate exercise snack, and I used to get what I can only call cravings for sweets. Chocolate, chewing gum, mints, ice cream, even dextrose tablets; as long as I had something sugary to eat I’d be okay. But when I couldn’t have anything sweet I’d get annoyed or upset, and feel like I simply had to have something. I turned to sugar-free gum. I bought massive multipacks of the stuff with my pocket money and often had three or four packs on the go at one time. At my worst point, I was chomping through four pieces of gum daily – and that was on a good day.

The gum worked well, but although I always tried to make sure I was stocked up, I sometimes ran out. I usually managed okay for the day or so until I could go to the shops and buy some more, but sometimes I ended up sneaking an extra exercise snack in P.E., or serving myself slightly more ice cream with dinner than I was supposed to have.

And gum didn’t stop me wanting sweets forever.

Once, I had had a really boring day at school and got home feeling really fed up. I wanted some chocolate – but I knew that I wasn’t supposed to have any between meals. I wanted it anyway, so I tiptoed into the kitchen and took a bag of mini chocolate eggs, rummaged around the bag to find one that had broken in half so that I could just have part of it and not go hyper; then I ate it.

I wanted more. I tipped a few chocolate eggs out into my hand and ate them all in one go. Then, still craving more, I took another few and tried to keep them in my mouth and savour the chocolate. A minute or so later, they’d melted and dissolved. But I still wanted more.

I knew that my brother would be able to tell I’d had some of his sweets if I took any more, so instead I took the packet of dextrose from my blazer pocket and ate a couple of the tablets. I suddenly realised I was going to go really hyper if I didn’t have any extra insulin.

So I found my insulin and injected another half unit. But while I was holding the needle in my stomach I remembered that too much insulin would make me go low, too – and I had no idea how much insulin I needed for what I’d just had because I couldn’t remember how much I’d eaten. I pulled the needle out of my stomach before I’d counted ten seconds. Now I had no idea how much insulin had actually got into me either. I got really upset and into a real panic.
Then Mom and my brother came into the kitchen and I burst out in tears and told my Mom what I’d just done. I knew all along it wasn’t really sensible, but all that had mattered at the time had been that I wanted the chocolate.

Half an hour or so later, my blood sugar went up a bit to about 13 mmol/l, but it came down quickly, dropping to 4 mmol/l about another hour on, because of the insulin peaking. I had a snack at this point and then my blood sugar stayed okay for the rest of the day.

After this experience, I started to think that perhaps I had a mental problem or was developing a literal addiction to sugar. I felt really bad about myself and thought I seriously could be going mad. Now I know I wasn’t going mad – I’m sure other people are like this when they feel like they’re not allowed sweets any more…

Unfortunately, there’s no substitute for willpower. The thing that made me stop chewing so much gum was when I was sorting out my bag ready to go on holiday and found that I had (I’m not joking) about six packs of gum on the go. In the cupboard I found a brand new pack that I’d just bought, and I realised just how much I was getting through. I’d also spent most of my pocket money for the last few weeks on chewing gum. I decided it was getting ridiculous and made a pact with myself that I would take one pack, and one pack only, on holiday. I wouldn’t buy any more while I was away, and if I still had some left by the last day, I could keep the rest that I‘d left at home. If I didn’t manage it, I thought, it could possibly mean that I was actually addicted to chewing gum, in which case I would throw away every last piece of gum in the house and never buy any again. I would have to stop the habit.

I did actually manage it. However, when I got back, I’d pretty much stopped feeling like I had to have gum or sweets. I finished off what I had left – but this time it lasted much longer. Since then, I have continued to buy gum, but only occasionally – and because I want to, not because I feel I need it.

If you crave sweets…

  • It’s important to remember that you can still eat sweets. And if you eat only a reasonable amount with meals or exercise, they will cause you no problems.
  • If you’re a chocoholic or have a serious sweet tooth, try sugar-free gum instead of your usual sugary stuff.
  • When you’re out with your friends, you might find it less tempting to eat sweets if you keep a pack of sugar-free gum in your pocket. You can offer it to your friends, too, so you’re not the only one having gum rather than sugary stuff.
  • Bubblegum containing sugar is better than sweets that are swallowed, too, as one piece will not affect your blood sugar nearly so much as a pack of chewy sweets or a tube of sherbet. It also has the advantage that it lasts for longer – a piece of bubblegum can be chewed for an hour or so until it loses its flavour, but a chewy sweet of the same size and weight satisfies your sweet tooth for only a minute or so, and then you want another one.
  • Be aware, though, that most brands of sugar-free gum can cause laxative effects if you get through loads and loads of it, so if you find yourself getting through half a pack every day, try to cut down a bit.

This blog is an extract taken from Fibi Ward’s book, No Added Sugar – A chatty but practical guide to coping with a diagnosis of type 1 diabetes in your teens, by a teenager, for teenagers

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Prevent and Cure Diabetes – The blood-sugar roller coaster

The blood-sugar rollercoaster

Sugar is extremely damaging to the body for many reasons. It is damaging to the body in high levels, it is damaging to the body in low levels, and the swinging of levels between the two is additionally damaging because of the hormonal response to those rapid changes. I call this the blood-sugar rollercoaster – it is often described as a ‘hypoglycaemic tendency’ (‘hypo’ meaning ‘below’, from the Greek) – but it is the whole rollercoaster that causes metabolic havoc – not just the dips. If we constantly eat carbohydrate foods, this is a rollercoaster which just keeps on going, and along with the metabolic havoc, there are associated mood swings which mirror the ride. These emotions are very similar to those documented by Barry Ritholtz, in his financial writings on the rollercoaster ride experienced by investors in risky stocks. People who are regularly feeling these emotions, and in particular are experiencing them cyclically, are most likely already on the blood-sugar rollercoaster: Returning to the medical case in point, in metabolic syndrome and diabetes any or all of the following problems can result. In each case, a description of the problem is followed by symptoms and diseases that may result from that problem, thereby giving clues as to whether this may be an issue in a particular individual.

The financial rollercoaster ride

The blood-sugar rollercoaster

The blood-sugar rollercoaster, as I explained earlier, is my name for the process of rapidly rising levels of blood sugar prompting a release of insulin and the ‘happy’ brain neurotransmitters followed by rapidly falling levels of blood sugar causing a release of adrenaline. This combined effect switches on addiction. Wobbly blood sugar levels are highly damaging because of their hormonal effects. These hormonal effects I suspect relate to the rate at which levels of sugar rise and fall in the bloodstream. As we lose control of our blood sugar, then eating a high-carbohydrate snack or meal will cause blood sugar levels to spike, and as blood sugar levels make this rapid rise there is an outpouring of insulin in order to protect the body from this dangerous (but addictive) sugar spike. Insulin brings the blood sugar level down by shunting it into fat. However, if this occurs quickly, then blood sugar levels fall precipitously and that results in an outpouring of adrenaline. Adrenaline is responsible for all the symptoms that we call ‘hypoglycaemia’.

Hypoglycaemia comes from the Greek words ‘hypo’ meaning low, ‘gly’ meaning sugar and ‘aemia’ meaning blood, and hence has a literal meaning of ‘low sugar blood’.

However, the term hypoglycaemia I suspect is a misnomer that relates to at least two issues. Firstly, adrenaline is released in response to poor fuel delivery (lack of sugar and/or ketones in the bloodstream). This means that, in the keto-adapted, the adrenaline symptoms do not arise because these people can switch into fat burning mode. Secondly, in those who cannot make this switch, it is not just the absolute level of blood sugar that causes the symptoms but also the rate of change; this means that often people who complain of hypoglycaemia wil d their blood sugar level is normal from a ‘snapshot’ blood-sugar test result. What they need is a ‘video’ of their blood sugar level changing over time to make the diagnosis. Consequences of the rollercoaster spikes in insulin and adrenaline include the following:

a.) High levels of insulin put us into a metabolic state of laying down fat, and prevent fat burning – this is the major problem of
metabolic inflexibility. It is almost impossible to lose weight when insulin levels are high. Furthermore this effect can be sustained for hours.

b.) High levels of adrenaline make us anxious, irritable and sleepless. This adrenaline release is a major cause of high blood pressure. Indeed, it astonishes me that doctors appear completely unaware of this link so that hypertension is described as ‘essential’ (of unknown cause) or ‘idiopathic’ (again, of unknown cause). They may accurately describe it as due to ‘stress’, but fail to realise the cause of this stress is actually nutritional stress due to loss of control of blood sugar levels.

Sugar has immediate effects on the brain, by various mechanisms, and this is partly responsible for why sugar is so addictive. For people who have lost control of their blood sugar, in the very short term, a carbohydrate rush, or ‘hit’, will have a calming effect which allows them to concentrate. Inspector Morse used the carbohydrate hit of a pint of beer to solve his murder mysteries – but ended up diabetic and died prematurely. Falstaff too found that alcohol had an inspirational effect.

‘It ascends me into the brain, dries me there all the foolish and dull and crudy vapours which environ it, makes it apprehensive, quick, forgetive, full of nimble, fiery, and delectable shapes, which delivered o’er to the voice, the tongue, which is the birth, becomes excellent wit.’  Act IV scene iii of Henry IV, Part 2 William Shakespeare (1564–1616)

Any parent will report how their child’s behaviour changes abruptly with a sugar hit and, much more noticeably, when blood sugar dives and they become irritable and moody. My daughters were often tired and irritable when they came in from school – it was not until supper that their normal good humour and energy were restored.

Problems with sugar – hyperglycaemia

Symptoms of blood sugar rising rapidly (due to the sugar hit and insulin) Diseases of blood sugar rising rapidly (due to the sugar hit and insulin)
Brain function improves – better concentration, feel calm, relief from depression.
Satiety
Triglycerides in the blood are high as insulin shunts excessive sugar into fat. 
Obesity and Inability to lose weight. (It is important to recognise that obesity is not the cause of diabetes but may be a symptom of metabolic syndrome – indeed, many people with normal weight have metabolic syndrome and diabetes.)

Problems with sugar – the rollercoaster

Symptoms of blood sugar falling rapidly (due to adrenaline release) Diseases of blood sugar falling rapidly (due to adrenaline release)
Acute anxiety and low mood.
Panic attacks.
Insomnia.
Shaking.
Palpitations.
Fearfulness.
Hunger and intense desire to eat.
Weakness.
High blood pressure.
 
Chronic high blood pressure.
Premenstrual tension.
Chronic anxiety.
Depression.
Eating disorders (anorexia and bulimia). Obsessive compulsive disorders.
Increased tendency to addiction – caffeine, chocolate, nicotine, cannabis, ‘social highs’, gambling, sexual perversions, exercise.

You will again see the similarities between the mood changes here and those noted by Barry Ritholtz in his financial writings on the rollercoaster ride experienced by investors in risky stocks.

This extract was taken from Prevent and Cure Diabetes: Delicious Diets, Not Dangerous Drugs by Dr Sarah Myhill.

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Diagnosis of diabetes and its precursor, metabolic syndrome

Before getting to the testing stage we can get some very useful clues from a combination of the clinical picture together with commonly done routine tests. However, if you eat what is generally considered a ‘normal, healthy, balanced diet’ (ho! ho!) based on the intellectually risible food pyramid, then it is likely that you have carbohydrate addiction and are on the way to metabolic syndrome and diabetes.

In order of priority and ease, the diagnosis can be made from:

  • The contents of the supermarket trolley
  • Diet
  • Snacking
  • Tendency to go for other addictions
  • Obesity
  • The clinical picture

The contents of the supermarket trolley

  • Bread, biscuits, cake, pasta, cereals, sugar, waffles, bagels, dough nuts and other such
  • Fruit juice, pop, alcohol, “energy” drinks and general junk drinks
  • Fruit basket with tropical sweet fruits such as pineapple, melon, bananas, grapes. Apples and pears
  • Sweet dried fruits – sultanas, raisins, dates
  • Snack foods – cereal bars, ‘energy bars’
  • Sweets, toffees, fudges
  • Honey, fructose, syrups
  • Jams, marmalades, choc spreads
  • Artificial sweeteners
  • Ice creams and puddings, like cheesecakes and trifles
  • Low cocoa-percentage chocolate
  • Crisps, corn snacks, popcorn…you get the idea – we call it junk food!

Such a supermarket trolley is very indicative of a diagnosis of carbohydrate addiction, metabolic syndrome and/or diabetes.

“Indeed, I have just returned from a trip to the supermarket. The man in front was placing his purchases at the check-out. I felt myself sighing as the packets of chocolate biscuits, crisps, white bread and sweet drinks piled up. But what moved me to an intense desire to shout out were the final three items – paracetamol, ibuprofen and a box of antacids. He was poisoning himself with the carbs, then symptom-suppressing with the drugs. Addiction has blinded him to the obvious.”

Diet

Breakfast gives the game away. This is because no food has been consumed overnight and with carbohydrate addiction, blood sugar levels are low in the morning. The need for a carbohydrate-based breakfast indicates metabolic syndrome – typically with consumption of fruit, fruit juice, sweetened tea or coffee, cereals, toast, bread or croissants. ‘Oh, but surely porridge and muesli are OK?’ so many cry. Often they are not OK – the only way to really find out is to measure blood sugar levels.

“Even now my daughters can hear me groaning when the adverts on the telly for breakfast cereals come on. I really cannot stop myself. The Telegraph recently reported that, ‘Children’s breakfast cereals can contain as much as three teaspoons of sugar – the equivalent of two and a half chocolate biscuits,’ and so there are also ‘hidden’ dangers.”

Snacking

The need for a carbohydrate snack or sweet drink is often triggered by falling blood sugar. Many people comment that when they go on holiday and treat themselves to a fry-up for breakfast, they no longer feel hungry before lunch. Snacking is a disaster – it feeds the fermenting mouth and gut, prevents the glycogen sponges squeezing dry, spikes insulin and prevents fat burning.

Carbohydrates with every meal

The symptom of ‘not being satisfied’ with meat and vegetables is particularly indicative of carbohydrate addiction, with the need for a sweet pudding to ‘hit the spot’.

Tendency to go for other addictions

Also highly indicative of carbohydrate addiction is the tendency to have other addictions … such as alcohol, smoking, coffee, chocolate, prescription drugs (yes – many of these are addictive), and ‘legal’ and illegal highs.

Obesity

Obesity is not the cause of metabolic syndrome and diabetes, but may be a symptom of both. Many people with type 2 diabetes have metabolic syndrome and normal weight and vice versa – obese people may have no signs of metabolic syndrome. It is the constant sugar spikes in the portal vein, the effect of which eventually spills over into the systemic (whole body) circulation, when the liver is overwhelmed, this characterises metabolic syndrome and diabetes. We cannot measure these spikes because the portal vein is buried deep in the abdomen and links the gut to the liver. Interestingly, it is the fatty liver which is highly correlated with metabolic syndrome and diabetes – not the fatty rest of the body. Fat in the liver can be measured with MRI scans, but this is an expensive test not routinely available.

The ability to gain and lose weight is an essential survival ploy for all mammals. Think of the hibernating female brown bear who has to survive months of intense cold, pregnancy and breast feeding with no food intake. She achieves this on autumn fat together with the ability to switch into fat burning. She remains completely healthy throughout.

Share your story for Diabetes Week by using the hashtag #knowdiabetes.

This blog was originally published in Prevent and Cure Diabetes: Delicious diets, not dangerous drugs by Dr Sarah Myhill and Craig Robinson.