Type 2 diabetes (previously known as late-onset diabetes) is a chronic disease that is characterised by an inability to effectively regulate the amount of sugar in your blood. Whenever you eat sweet foods (e.g. cake, chocolate, fruit juices etc.) or refined carbohydrates (e.g. white bread, white rice etc.), your body experiences a large influx of sugar that you can use to produce energy to fuel your activities or can be stored as body fat for later use. However, the sugar needs help from a hormone called insulin in order for the cells to recognise that sugar is ready to be used. Insulin is secreted from the pancreas and the more sugar there is in the blood, the more insulin is released by the pancreas to meet demands.
When consuming a diet that contains lots of sweet foods or lots of refined carbohydrates, the demand to release more and more insulin can cause a fatiguing of the pancreas until it can no longer secrete enough insulin to keep up with demands. This leads to blood sugar levels remaining high and the cells being starved of needed energy. Increased blood sugar levels can lead to several health complications including cardiovascular diseases such as heart attacks and strokes, kidney damage, nerve damage, sight loss, bone and joint problems, poor blood flow and poor sensation that can lead to amputation and more.
Your risk of developing diabetes is predominately determined by three modifiable lifestyle factors, plus some non-modifiable risk factors such as age and ethnicity. While being older or being from certain ethnic groups increases your risk of developing diabetes, very few people are 100% destined to develop diabetes if they follow a healthy lifestyle. The three most significant modifiable lifestyle factors that increase your risk of developing diabetes are diet, weight, and exercise levels.
Following a nutritious diet that minimises the amount of refined and processed foods you consume can significantly reduce the strain placed upon your pancreas to release insulin and lower your risk of developing diabetes. While any diet that gets you thinking about what you put in your body can potentially have benefits, there is one diet that has a large amount of research around its multiple health benefits and it’s ability to lower your risk of numerous lifestyle diseases, including diabetes. This diet is known as the Mediterranean Diet. The Mediterranean Diet is based upon the eating and lifestyle habits of some of the healthiest people in world and I have included a full breakdown of the diet below:
All meals should contain 3 basic elements: cereals (1-2 servings per meal from breads, pasta, rice, couscous etc. preferably wholegrain), vegetables (2+ servings per meal), and fruit (1-2 servings per meal and the default dessert of choice).
Drink 1.5 – 2 Litres of water/day.
Moderate amounts of dairy (2 servings per day) with a preference for low-fat dairy or traditional healthier forms such as Greek yoghurt or Skyr.
Extra virgin olive oil forms a large part of the Mediterranean diet and should be the primary source of fat and used for both cooking and dressing.
Olives, nuts, and seeds as healthy snack options and another source of good fats.
Spices, herbs, garlic, and onions are great sources of micronutrients and add flavour and palatability to your meals.
Alcohol can be consumed at no more than 1 small glass of wine/day for women and 2 glasses/day for men. Alcohol is not a vital part of the Mediterranean diet and can be completely omitted if desired.
Fish and shellfish (2+ servings/week), white meats (2 servings/week), and eggs (2-4 servings/week) are all great sources of protein. A variety of fatty fish is highly recommended including salmon, tuna, mackerel, etc.
Red meat (less than 2 servings/week) preferably from lean cuts of meat and minimally processed.
Legumes and pulses (2+ servings/week) are another great source of fibre and plant proteins.
Potatoes (3 or less servings/week).
Sweet/sugary foods, heavily processed/refined foods, and unhealthy fats should all be consumed as little as possible with a guide of no more than twice/week. These foods are very calorific and heavily contribute toward excess weight gain due to their easy over consumption.
In addition to food recommendations, the Mediterranean diet includes lifestyle recommendations that aid in maintaining a healthy balance in your life and encourage healthier eating behaviours and activity levels. These recommendations include: moderate portion sizes, eating with others, cooking, being physically active, and getting adequate rest.
Your body composition (i.e. how much of you is made from fat or muscle), has a significant impact on your risk for developing diabetes. Excess body fat, specifically excess fat carried around the waist leads to a de-sensitivity to the effects of insulin’s signals and a need for the pancreas to secrete more insulin to make up for this desensitisation. As a result, this may accelerate the “burnout” effect of the pancreas and speed up the risk of you developing diabetes. Therefore, try to maintain a healthy waist circumference of less than 94cm (Men) or 80cm (Women) for Non-South Asian populations or less than 90cm (Men) or 80cm (Women) for South Asian populations (South Asian populations include those from the India, Pakistan, Bangladesh, South East Asia, Japan, and China). Your waist circumference is very easy to check. Using a tape measure, wrap the tape measure around the narrowest point between the bottom of your ribs and the top of your hip bone, for most people this will be around 2-3 cm above your belly-button (make sure to keep the tape measure level, unlike the picture below).
Exercise affects your risk of developing diabetes not only by helping you to maintain a healthy weight but also by improving a glucose transport system called GLUT4 translocation, that happens within the cells and helps pull the sugar in from the blood to be used for energy. Think of Insulin and GLUT4 working together. One moving the glucose to the cell and knocking on the door, the other opening the door and taking the glucose inside. If you are inactive (i.e. exercising less than 150 minutes/week of moderate-intensity exercise), then this system is not working properly and the cells think no sugar is in the blood to be used. As a result, the cells signal the brain to release sugar stored in the liver and muscles to help out, but this only makes matters worse and increases your risk for developing diabetes. Exercise recommendations for the prevention of type 2 diabetes are:
Perform at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week
Include resistance training (i.e. lifting weights or bodyweight exercises) at least twice/week focusing on predominately compound exercises (i.e. exercise that use multiple joints at the same time such as squats, deadlifts, bench press, pull-ups etc).
Include basic mobility/flexibility exercises to maintain full range of motion.
The most important aspect of these recommendations is the intensity. Your heart rate and/or breathing rate need to be notably increased during your exercise sessions for them to count as moderate-intensity exercise or harder. Activities such as yoga, Pilates, tai chi, Qi gong etc. while very good for other reasons such as improving mobility and building stress resilience, do not count as moderate-intensity exercise and cannot be counted toward your weekly targets.
Assessing Your Current Risk
There are a number of blood tests and questionnaires that you can complete to help assess your current risk of developing type 2 diabetes. These include:
Fasting blood glucose
Fasting insulin levels
QDiabetes online risk questionnaire
Your fasting blood glucose level is a snapshot of how much sugar remains in your blood following an 8-10 hour fast. Fasting blood glucose levels under 6.1 mmol/L indicate low risk, a result of 6.1 - 7.8 mmol/L indicates an increased risk, often called pre-diabetes or borderline diabetes, and a result over 7.8 mmo/L would indicate you are diabetic. All results above 6.1 mmol/L should be followed up with your GP urgently.
Your HbA1c levels are a measure of glycated haemoglobin or put simply how much sugar has stuck to the red blood cells. As your red blood cells take 8-12 weeks to be replaced within your body this can give a longer 3-month look at how much excess blood sugar has been in your blood and may serve as a better measure of diabetes risk than a single fasting glucose result. A HbA1c reading of less 42 mmol/mol / 6% indicate low risk of developing diabetes. Any results above this range indicate an increased risk or may be used to diagnose diabetes. Just like with fasting blood glucose results, any elevated results should be followed up with your GP urgently.
Your fasting insulin levels measures the amount of insulin that remains in the blood after an 8-10 hour fast. Elevated levels of insulin when fasted can indicate early signs of insulin resistance, the precursor to developing diabetes. Fasting insulin levels are not routinely checked by doctors in the UK but this is a cheap and very helpful test for assessing your risk of developing diabetes. Healthy fasting insulin levels are between 2.6 and 24.9 pmol/L.
The QDiabetes online questionnaire takes into account key medical and family history, body mass index (BMI), and some of the blood results discussed earlier. It was designed by doctors and academics working with the UK National Health Service (NHS) to determine an individual’s risk of developing diabetes within the next 10 years. The limitations of the questionnaire is the lack of lifestyle data such as diet and exercise levels, waist circumference, and fasting insulin results. However, this is a useful tool to assess your own risk and I have included a link below for those of you who want to calculate your QDiabetes risk score.
QDiabetes Online Risk Questionnaire - qdiabetes.org/2018/index.php
I hope you found this information helpful. If you have any questions about how the team at Eat Move Perform can help you with your own health, fitness, or performance goals then please get in touch and we’ll be more than happy to give our support and advice.