Type 2 Diabetes and Lifestyle Changes - Northumbria...In Type 2 diabetes, extra weight around your waist can cause an increase in your insulin resistance. Ideally waist measurements

Northumbria HealthcareNHS Foundation Trust

Type 2 Diabetes andLifestyle Changes

Issued by Diabetes Service

152044 PIN055-V3 Type 2 Diabetes full colour 10/12/2014 15:41 Page 1

2


The purpose of this booklet is to help you understand foodand Type 2 diabetes.

What is diabetes?

• Diabetes is a condition in which there is too much glucose(sugar) in the blood

• There are different types of diabetes; you have Type 2• Type 2 diabetes occurs because your body does not use a

hormone called insulin very well• Diabetes is progressive and will change over time• Because of this progression you will need regular check ups• Keeping glucose levels under control can limit the long-term

complications of diabetes• Managing other risk factors such as blood pressure, smoking

and blood cholesterol can also reduce your risk of long-termcomplications

3


4

What happens in your body when you have Type 2 Diabetes

• Food we eat is stored in the stomach and is broken down tocreate glucose

• The glucose is transported around the body in the blood.• The glucose needs to get into cells/parts of the body where it

is used or stored for energy• Imagine cells are like a room with a locked door. In order for

glucose to get into the cell, insulin must act as a key to unlockthe door

• In Type 2 diabetes, the lock to the door becomes rusty – thisis called insulin resistance – and insulin cannot unlock thedoor

• The glucose therefore gets stuck in the blood and over thelong term this can cause damage to your body


5

How can I manage my diabetes?

Here are some changes that you can make to your lifestylewhich will help you manage your diabetes.

• Try to be more active• Losing weight will be helpful if you are overweight• Eat less animal fats (saturated fat), but include some healthy

oils, for example olive or rapeseed oil (monounsaturated fat)in moderate amounts

• Eat less sugar, sugary foods and sugary drinks• Starchy carbohydrate, such as bread, potatoes, cereals, rice

and pasta, should be included as part of each meal, howeverbe careful with the portion size

• Have five portions of vegetables and fruit a day• Alcohol can be enjoyed but needs to be taken in sensible

amounts• Salt can cause a rise in blood pressure therefore it’s a good

idea to limit the amount you use

All these points are discussed in this leaflet


6

Being more active

Increasing your activity can work like taking a tablet for yourdiabetes. It will also help you to manage your weight.

What activity should you do?

Any sort of activity is suitable as long as you enjoy it.

It can be something you do as part of your usual routine e.g.housework, cleaning, gardening, walking or it can be somethingyou do as a hobby, such as swimming, cycling, football ordancing.

How much activity should you do?

Adults should aim to be active daily. Over a week, activity shouldadd up to at least 150 minutes (2½ hours) of moderate intensityactivity in bouts of 10 minutes or more – one way to approachthis is to do 30 minutes on at least five days a week.

What are the benefits of activity?

• It helps you feel more energetic and good about yourself• It helps your body use your own insulin more effectively• It helps your blood pressure and weight• It helps keep your blood glucose levels down• It helps your heart and circulation


7

Weight Management

Watching your weightBeing overweight increases your insulin resistance. This meansyour insulin cannot work properly to bring down your bloodglucose. Losing even a little weight will help your diabetes andreduce your risk of heart disease and lower your blood pressure.However, the most important thing is to avoid putting on weight.

ShapeIn Type 2 diabetes, extra weight around your waist can cause anincrease in your insulin resistance. Ideally waist measurementsfor men and women should be less than:Men (white and black men) —94 cms / 37inSouth Asian men – 90cm / 35inWomen (white, black or South Asian)— 80 cms / 31.5 in

Managing your weightSmall changes in what you eat or in your activity can increase orreduce your weight. Just eating 100 calories less each day orusing 100 calories up for physical activity will either help you loseweight or stop you from gaining weight.If you have high blood glucose levels, you may lose glucose, andtherefore calories in your urine, keeping your weight down. Asyou lower your blood glucose levels you may gain some weightbut this can be prevented with small changes to food or activitylevels.


8

Calories

Calories are a way of measuring the energy in food and drinks orthe energy used for activity. To lose weight you need to either:

• Increase your activity and use more energyor

• Reduce your calories from food and drinksor ideally a bit of both

Here is an example of how just eating 100 calories less each daycan help you lose weight.

If an 80kg (12 stone and 8 pounds) man or woman was to eat100 calories less each day they would lose 1 stone in about 1year. If he or she would continue to eat 100 calories less eachday, they would keep this weight off.

For a man, it would mean reducing from 2500 calories each dayto 2400 calories each day.

For a woman it would mean reducing from 2000 calories eachday to 1900 calories each day.

Small changes can make a big difference


9

100 Calories

Starchy foods 1 thick slice bread1 finger roll½ bagel1 crumpet¼ naan breadSmall flatbread/tortillaMini croissant2 egg sized potatoes5 large chips10 oven chips2 tablespoon cooked pasta2 tablespoon cooked rice4 tablespoon unsweetened cereal

Protein/savoury foods1 large egg2 slices lean meat/poultryMedium portion white fish2/3 tin tuna in brineVery small can baked beans1 slice cheese (25g)Half jar meat paste

Pastry and snacksSmall packet low fat crisps1 tablespoon peanuts4 breadstick2 tablespoons sultanas½ party pork pie2 mini sausage rolls2 mini savoury eggs4 cocktail sausages


10

Fats and oils1 pat butter1 individual serving of margarine1 tablespoon oil1 tablespoon mayonnaise2 tablespoon salad cream

Drinks1 latte coffee½ pint beer or lagerSmall glass wine2 single spirits

Fruit and sweet foods1 large banana1 large pear3 large plums2 large clementines5 tinned peach halves1 standard low fat fruit yoghurtSmall portion rice pudding1 ladle custard2 small scoops vanilla ice-cream

Biscuits/sweet baked goods2 finger chocolate wafer biscuit3 rich tea biscuits2 shortcake biscuits2 ginger biscuits2 jaffa cakes1 ½ digestives½ hot cross bun1 scotch pancakeSmall plain sponge cake1 fondant fancy


11

Physical activities and calories

Want to increase the amount of physical activity in your daily life?

Would the ‘little and often’ approach suit you best?

The table below shows calories burnt up in 15 minutes withvarious activities.

Remember! This must be in addition to what you normally doeach day.

70kg

(11stones) 95.2kg (15 stones)

127kg (20 stones)

152.2kg (24 stones)

177.8kg (28 stones)

Vacuuming

40 60 80 90 110

Gardening

80 120 160 190 220

Washing windows

80 110 140 170 200

Stair climbing

140 190 250 300 390

Ironing

40 50 70 90 100

Football kick around with kids

140 190 260 310 360

Moderate walk (3 mph)

60 80 110 140 160

Fast walk (4-5 mph)

90 120 160 190 220

Dancing socially

80 110 160 190 220

Swimming (breast stroke)

170 230 310 370 430

Bowling

50 70 90 110 130


12

Reducing your calories from food choices

Example of a day’sfood

Sausage sandwich(2 sausages, 2 slices ofmedium bread and 10gbutter) = 543 kcals

2 large boiled eggs and2 slices of mediumtoast with 10g low fatmargarine = 374 kcals

saving = 169 kcals

Cheese and picklesandwich (50g cheese,30g pickle, 10g butter,2 slices thick bread)

= 511 kcals

Tuna sandwich (1/2 tinof tuna in brine, 15mllight mayonnaise,

2 slice medium bread)= 253 kcals

saving = 258 kcals

Cornish pasty andoven chips (300g)

= 991 kcals

1 skinless chickenbreast, medium jacketpotato and 80g green

beans= 580 kcals

saving = 411 kcals

Fruit creamy yogurt= 150 kcals

Low fat yogurt= 100 kcals

saving = 50 kcals

Cashew nuts (100g)= 582 kcals

Popcorn (50g)= 240 kcals

saving = 342 kcals

Total = 2777 kcals Total = 1547 kcals Total saving = 1230kcals

Lower calorie option Calorie saving


13

Fat and fatty foods

Why is fat so important in diabetes?

Eating less fat can help you: -• reduce insulin resistance• lower your blood fat (cholesterol) levels• lose weight

Types of fat

All fats and oils are very high in calories.

There are different types of fat in the foods that we eat.Research has shown that some types of fat are less damagingthan others. The table below shows which fats will be of mostbenefit to your insulin resistance and your heart.Less damaging/best choiceMonounsaturated

rapeseed oilvegetable oilolive oilolive oil spreads

Polyunsaturated

sunflower oilcorn oilsoya oilmargarines orspreads labelled‘high inpolyunsaturates’

Saturated

lardbuttergheeblock cooking fatsand hardmargarinespalm oilpies and pastriescakes and biscuitshydrogenatedvegetable oilcheesefat on meat

Next best Most damaging/eat sparingly


14

Studies have shown that the people of the Mediterranean regionare some of the healthiest. Their diets are high in vegetables,fruits, grains, beans, and fish, and low in saturated fats, refinedcarbohydrates and sugars.

The Mediterranean diet is very well-known for its protectiveeffects against heart disease, stroke, and some cancers.

What about cholesterol?This depends on whether you are asking about the bloodcholesterol in your food or in your blood.

Blood cholesterol can be high because of the amount ofsaturated fat we eat or because of our genetic make up.Lowering your blood cholesterol is one way to reduce your riskof a heart attack or stroke. The table opposite show thesaturated fats. They are damaging for your heart and insulinresistance.

Cholesterol in FoodA few foods contain cholesterol (shellfish and eggs areexamples) but evidence shows that these foods don't directlycause high cholesterol in the blood. Reducing the amount ofsaturated fat that you eat and adopting the Mediterraneanstyle diet is a more effective way to reduce your bloodcholesterol level.


15

Fat continuum

The top of the table shows foods which have lower fat andcalorie content. For this reason choosing these kinds of foods isa good idea. The foods at the bottom of the table are higher fatand calorie content. These foods should only be consumed insmall amounts or ideally avoided.

Low fat and low calorie Vegetables (lettuce, tomatoes, onions,

peas and carrots) Diet and low calorie drinks Sour fruit (lemon, grapefruit) Water Sugarfree gum/jelly

Low fat but not calorie free

Medium fat foods Chocolate Cakes Biscuits Crisps Chips and roast potatoes Yogurt

High fat foods Fried foods Take away foods Pizza Most cheeses Pastries and pies (sweet and savoury) Desserts made with cream/pastry Burgers and sausages Fish tinned in oil Some ready meals

Very high fat foods Oil, butter and margarine Cream Nuts Mayonnaise (light and regular)

Low protein: chicken, fish, leanham, beef, cottage cheeseBeans and lentilsStarchy carbohydrates: pasta andrice, cereal, potato, breadCrumpets and teacakesSemi skimmed milk / low fat yoghurt


16

Fat and fatty foods

These suggestions are ways of cutting down on fat. It may seemthere are lots of changes to make. Plan a few small targets andmake gradual changes.

Tick off the things you do already. What further changes couldyou make?

• Grill, dry roast, oven bake, microwave, stew, steam or boilinstead of frying

• Use an olive oil or monounsaturated based margarine. Spreadthinly and aim for no more than 4oz (100g) per week

• Try to keep hard or cream cheese to 4oz (100g) per week orbetter choose lower fat varieties such as Dairylea Light,Philadelphia Light or cottage cheese

• Keep cheese dishes and cheese sauces for example pizza,macaroni cheese, lasagne to once per week

• Choose lower fat dressings, mayonnaise and salad cream usesmall amounts. Take care with portion size for potato saladand coleslaw. Avoid dips unless low fat

• Try not to eat between meals but if you are hungry you couldchoose a slice of bread, plain popcorn or fresh fruit instead ofnibbling on crisps, biscuits or nuts

• Try to use a potato topping instead of pastries and dumplingsfor example shepherd’s pie or hot pot

• Yorkshire pudding and pancakes can be made with low fatmilk


17

Fat and fatty foods continued

• Go for boiled, mashed and jacket potato without butter ormargarine if possible. Try oven chips, wedges or croquettepotatoes instead of fried chips or roast potatoes

• Try to eat more fish, including fish such as cod, haddock andplaice and oily fish such as salmon, trout, and sardines. Try toavoid deep fried battered or breaded fish

• Choose chicken or turkey, without the skin, lean meat or eggs.Keep portions small

• Meat products such as burgers, sausages or chicken kiev,tinned meat or pies are high in fat. Try not to eat pastry morethan once per week this includes quiche and sausage rolls

• Try low fat fromage fraise and natural yoghurt instead ofcream

• Keep takeaways for an occasional treat. Tandoori, Tikka or stirfry dishes often have less fat. Serve with boiled rice ornoodles

• Choose low fat milk - skimmed or semi-skimmed - for drinksand cooking

• Go for vegetables or tomato based sauces. Skim the fat offgravy and stocks. Avoid sauces that are based on cream,cheese or contain a lot of oil

• If using ready-made meals choose ones that contain ideally3g fat (or less) per 100g of product. Some food labels can beconfusing - products that claim to be ’reduced/lower in fat’ canstill have high levels of fat. Be sure to check the food label


18

Carbohydrate foods Carbohydrate foods are sugars and starches.Both are broken down in the stomach into glucose, and so causethe blood glucose level to rise.

Food and drinks that have sugar as the main or only ingredienttend to cause the blood glucose levels to rise very quickly.

Starchy foods are usually digested more slowly. Starchy foodsshould be included as part of each meal but be careful with yourportion size. Eating a large portion of starchy foods can causeblood glucose to rise above target.

By monitoring your glucose levels you can work out how much ofthese foods your body can cope with.

C

Starches Sugars Breads Rice Potato Cereal Pasta Cous cous Naan bread Chapattis Crackers Crumpets Pitta bread Bagel Tortilla Foods containing flour

Table sugar Syrup Honey Boiled sugars Mints Jelly Fizzy pop Fruit juice Jam Marmalade


19

Sugar and sugary foods

Sugary foods and sugary drinks are more likely to cause a rapidrise in your blood glucose level. For this reason it is best toreplace high sugar foods and drinks with sugar free and lowsugar alternatives.

Remember you only need to avoid foods that contain largeamounts of sugar. The small amount of sugar in items such asbaked beans, brown sauce and cornflakes are not enough toaffect your blood sugars.

Here are some suggestions for how to cut down on sugar.

Tick off the things you do already; what further changes couldyou make?

• Instead of using sugar in drinks and on cereal, try artificialsweeteners, for example Sweetex, Canderel, Hermesetas orSplenda

• Choose ‘diet’, ‘low calorie’ or ‘slimline’ drinks. Have no morethan one small glass of pure fruit juice daily and have this withfood. Avoid ordinary pop

• Milkshakes, condensed milk, drinking chocolate and malteddrinks contain sugar however there are some low caloriealternatives

• Sweets are very concentrated in sugar. Try to avoid coughsweets, mints, toffees, chocolates, boiled sweets, blackbullets, fruit gums, ice-lollies and diabetic sweets. Sugar freechewing gum has no effect on blood glucose levels


20

• Instead of ordinary puddings such as sponge, fruit pie,cheesecake, meringues or trifle, try having fruit tinned innatural juice, custard or milk pudding made with low fat milkand artificial sweetener, fruit, low fat yoghurt, sugar freepacket desserts and sugar free jelly

• Instead of cakes such as swiss roll, sandwich cake, gateau,carrot cake, gingerbread, Danish pastry, icing and marzipan.Try scotch pancakes, crumpets or tea cakes

• Try to reduce the amount of biscuits you eat. Varieties such asRich Tea, Ginger Nuts, Jaffa Cakes, Fig Rolls or Garibaldi arebetter choices than chocolate or cream biscuits.(1-2 per day)

• Choose breakfast cereals such as Weetabix, Branflakes,Cornflakes and Porridge instead of sugar coated varieties (e.gFrosties, Cocopops). If you enjoy muesli choose a ’no addedsugar’ type. Aim for 3 - 4 tablespoons as a portion

Diabetes UK produces recipes with many alternative recipes forcakes, biscuits and puddings. These can be found on theDiabetes UK website. However, these still contain calories so trynot to eat them regularly if you are trying to lose weight.

Can I eat some sweet foods?Once you have got your diabetes well managed, you can includesmall portions of sweet foods with your meals.If you test your blood glucose levels you can see how thesefoods affect them.

‘Diabetic’ foodsThere is no need to buy special diabetic foods. They are oftenexpensive, contain a lot of calories and can act as a laxative.


21

How is your plate divided?

Using your plate as a rough guide will help you to eat foods inrecommended proportions.

Breads, potato (boiled,mashed and new potatoes)pasta, rice, cous cous andnoodles

Chicken, lamb, beef, pork,fish, Quorn, tofu andother meat alternatives

Lettuce, tomato,cucumber, green beans,carrots, peas, onions,asparagus, broccoli,cauliflower and cabbage

1/4 starchcarbohydrates

1/2 vegetables

1/4 leanproteins


22

Fruit and Vegetables

Eating more fruit and vegetables can help reduce your bloodpressure, and helps your heart and circulation. If you replaceother food choices with more fruit and vegetables this could helpyou lose weight.

Here are some tips to help you eat more• Bulk up meat dishes by cutting down on the meat and adding

more vegetables or beans, for example chilli con carne,casseroles with extra beans

• Try to make homemade soups or broths• Try fresh fruit or fruit tinned in natural juice as a dessert or a

snack• Frozen vegetables contain as many vitamins as fresh

vegetables and are easy to use• Try stir-frying vegetables. Cook all vegetables for a short time

only so that vitamins are not lost• For a barbecue, try roasted vegetable kebabs or barbecued

corn on the cob• Bananas make good sandwich fillings or can be chopped and

added to cereal

It is recommended that you eat 5 portions of fruit and vegetablesday.

One portion is:• 2– 3 tablespoons of vegetables• 1 dessert bowl of salad• 1 piece of fruit• 2 small fruits for example satsumas or plums• 2 tomatoes• 2 - 3 tablespoons of fruit tinned in natural juice


23

Blood pressurePeople with diabetes should have their blood pressure checkedregularly. Ask your doctor or nurse for your own blood pressuretarget. You may need medication to treat high blood pressure,but some lifestyle changes can help. These include-

• Keeping your weight down

• Doing regular physical activity

• Taking care not to use too much salt

• Not drinking more than the recommended amount of alcohol

SaltEating salt and salty foods can increase your blood pressure.Most of the salt in your food is hidden in foods in tins, packetsand jars.

Try not to add salt at the table.

Try herbs, spices, pepper and vinegar to add flavour to food inplace of salt and salt substitutes.

SmokingSmoking is especially risky for people with diabetes.If you are concerned about preventing weight gain when youquit, you could discuss this with your nurse or dietitian

If you wish to quit contact our Smoking Cessation service:If you live in North Tyneside telephone 0191 2292911If you live in Northumberland telephone 01670 813135


24

AlcoholIt is important to be sensible about the amount of alcohol youdrink because it is high in calories and can increase your weightand your blood pressure. A sensible limit is:

Women: 2-3 units (or less) per dayMen: 3-4 units (or less) per day

1 unit of alcohol is• 1 very small glass of wine or sherry• 1 single measure of spirits • half pint of beer or lager.

Try to have some alcohol free days. Alcohol is high in calories.To lose weight, think about cutting back.

Remember• When using mixers choose the sugar-free types• Try not to drink on an empty stomach• Do not drive or attempt any dangerous tasks after alcoholic

drinks• Alcohol-free lagers contain sugar• Low carbohydrate / diabetic beers and lagers are not good

alternatives• One bottle of wine = 10 units of alcohol


25

Menu ideas

Ideas for breakfast

• Porridge with low fat milk

• Toast, teacake, crumpet or scotch pancake with a scraping ofmonounsaturated spread and marmalade or jam

• Wholegrain cereal with low fat milk and a banana

• Beans, tomatoes or scrambled egg on toast

• Grilled kippers on toast

Ideas for snacks

• A low fat yogurt

• A piece of fruit

• 2 rice cakes

• 1 small lightly fruited scone


26

Ideas for lunch

• Sandwiches with lean meat, chicken, tuna or boiled egg andsalad. And a banana

• Lentil, bean or vegetable soup with 1-2 slices of bread. A lowfat yogurt

• Jacket potato with cottage cheese and pineapple or tuna andsweetcorn (minimal or no mayonnaise) or baked beans. Sugarfree jelly

• Beans, spaghetti, mackerel or sardines on toast. Canned fruitin natural juice

• Pitta bread filled with hummus and salad or lean meat andsalad

• Lentil dahl and 1-2 chapattis. Small handful of blueberries orcherries (80g)

• Toasted bagel with low fat cream cheese, tomato and rocket


27

Ideas for main meals

• Spaghetti Bolognaise made with lean mince beef andvegetables (onions, peppers, mushrooms and courgettes).Angel Delight (no added sugar) made with skimmed milk

• 3-4 grilled fish fingers or 1 oven baked breaded fish withmushy peas and a handful of oven baked chips. Stewedrhubarb and ginger (use sweetener as needed) with 1-2tablespoons of low fat natural yogurt

• Fish, chicken, vegetable or Quorn curry with 3-4 tablespoonsof rice and salad. Low fat fruit yogurt

• Lean roast beef, pork or lamb with 3-4 boiled potatoes (eggsized) with carrots and broccoli. Baked apple with 1-2tablespoons of low fat custard

• Chilli con carne (made with lean mince or vegetables) with 3-4tablespoons of rice, with peas and sweetcorn

• 2 grilled sausages (meat or Quorn) with 3 scoops of mashedpotato and baked beans. Sugar free lime jelly with freshstrawberries

• Shepherds pie with garden peas and cauliflower

• Chicken, vegetable, fish or lean meat stir fry with fresh ginger,garlic and a dash of soya sauce served with noodles

Avoid having a pudding everyday


28

Making changes – Action PlanYou may find it difficult to make all the changes needed. It mightbe useful to write down 3-4 changes you plan to make. Onceyou’ve done that, you may want to put down some morechanges. Your dietitian can help you plan.

Date Change you would like to make

Date achieved

Example 1st January

Stop putting sugar in my coffee and switch to sweetener. Start walking 1 mile at least 3 times a week

1st February


29

Glossary

Insulin:This is a hormone made by the pancreas. It is used by the bodyto control the amount of glucose (sugar) in the blood. It does thisby ‘carrying’ the glucose from the blood to the muscles, wherethe glucose is turned into energy.

Insulin Resistance: This is the cause of Type 2 Diabetes and it means the body’sinsulin cannot work properly. This is because insulin resistanceinterferes with the process of insulin transporting glucose fromthe blood to the muscles.

Calories:Are the measure of the amount of energy in food. If you eat morecalories than your body needs you will gain weight.


30

Notes


31

Useful ContactsDiabetes UK is the leading UK charity that cares for, connects with andcampaigns on behalf of all people affected by and at risk of diabetes.

Careline: 0845 120 2960Monday-Friday, 9am-5pm

Email: [email protected]

Website: www.diabetes.org.uk

Contact number

.................................................................................................................

Your Dietitian

.................................................................................................................

Diabetes Nurse/Team

.................................................................................................................

North Tyneside General HospitalRake LaneNorth ShieldsNE29 8NH0344 811 8111 ext. 2911

Wansbeck General HospitalWoodhorn LaneAshingtonNE63 9JJ01670 564 025

Hexham General HospitalCorbridge RoadHexhamNE46 1QJ01434 655 095


Alternative Formats

If you would like a copy of this information in large print,another language, audio tape or other format please call theContact Centre on 03 44 811 8118

Other sources of information

NHS 111

NHS Choiceswww.nhs.uk/pages/homepage.aspx

NICE (National Institute for Health and Clinical Excellence)www.nice.org.uk

Patient Advice and Liaison Service (PALS)Freephone: 0800 032 0202Text: 01670 511098Email: [email protected]

Northumbria Healthcare NHS Foundation TrustGeneral Enquiries 03 44 811 8111www.northumbria.nhs.uk

© This material is the copyright of the Northumbria Healthcare NHS Foundation Trust

PIN 055/V5

Review date: March 2017


Documents

Type 2 Diabetes and Lifestyle Changes - Northumbria...In Type 2 diabetes, extra weight around your waist can cause an increase in your insulin resistance. Ideally waist measurements