South African Cookbook for Diabetes & Insulin Resistance 2

South African cookbook for diabetes and insulin resistance 2

Hilda Lategan RD (SA)

Tafelberg

Acknowledgments and Thanks

A cookbook of this kind evolves over a long period of time and goes through many phases of development. Thank you to everyone who contributed to the conceptualisation, compilation and polishing of every aspect of it.

Perhaps you supplied a recipe or offered constructive criticism on one, you may have helped develop a computer program for the nutritional analysis of the recipes, or perhaps you were involved in the layout and overall look of the book.

Your words may, knowingly or unknowingly, have provided encouragement when I most needed it. There were times dinner was late, the house was a mess and other everyday chores just had to wait.

I dedicate this book to each and every one of you.

Foreword

For most people eating tasty food is part of their daily routine.

The idea that you may need to adapt your eating habits as part of a balanced lifestyle to ensure improved health and quality of life, may make you anxious if you are not equipped with the knowledge and skills to prepare such meals and if you have been led to believe that healthier food equates to being dull and tasteless.

In the South African Cookbook for Diabetes and Insulin Resistance 2 I have once again tried to include reliable recipes for the entire family which, besides having a low glycaemic index (GI), low fat content and being low in kilojoules, are also healthy and easy to prepare.

Notwithstanding the title of this book, these recipes are also suitable for the control of elevated blood lipids (such as cholesterol and triglycerides), high blood pressure, gout, low blood sugar and constipation, and are suitable for healthy weight reduction.

During my daily consultations with patients I am very aware of how little time people have to prepare proper meals, which is why most of these recipes will go a long way in helping you to prepare fast, easy and nutritious meals and snacks. Most contain affordable, well-known and readily available ingredients, which in many cases make healthy eating habits cheaper than takeaways and junk food!

The South African Cookbook for Diabetes and Insulin Resistance 2 is a useful aid in the preparation of healthy dishes, but does not replace your visit to a

registered dietician. With the correct meal plan you will be able to use this recipe book more effectively to achieve improved blood sugar control.

The glycaemic index (GI) and the glycaemic load (GL) are once again included in the recipes, but they are simply aids and as such will only be effective if you make use of balanced meal planning. This means far more than receiving a list of low-GI foods and using it to eat low GI and then thinking that your problem has been solved!

It is my wish that the South African Cookbook for Diabetes and Insulin Resistance 2 will help you to enjoy tasty and nutritious meals with the benefit of effective control of blood sugar and blood lipids in order to promote optimal health and a better quality of life.

Bon appetit!

Hilda Lategan RD (SA)

Introduction

It is estimated that approximately seven million people throughout the world develop diabetes annually and that the 246 million people who had diabetes by 2007 will increase to 380 million by 2025 if this trend continues. It is also believed that Type 2 diabetes will be responsible for 85-95% of these statistics. Diabetes-related deaths are at present among the four leading causes of mortality. The International Diabetes Federation (IDF) also refers to Type 2 diabetes as the epidemic of the 21st century.

Regardless of these scary statistics, we can take comfort from the knowledge that diabetes is not an isolated, unknown illness targeting you or your family, and that medical research, nutrition information and medication are readily available to assist with the control of the disease.

The early diagnosis and recognition of diabetes, along with proactive treatment, are important to prevent long-term complications to ensure an improved quality of life and life expectancy. It is, however, important to understand that a well-controlled diabetic is not an ill person and can lead a healthy, active and happy life without complications. Like any other person without diabetes, a diabetic ought to strive for a healthy lifestyle that includes regular exercise, balanced eating and drinking habits, as well as appropriate rest and relaxation.

What causes diabetes?

Insulin is the hormone that assists body cells to absorb glucose and convert it into energy. Insulin is also involved in the conversion and storage of unused glucose and energy in the form of body fat.

Diabetes is a condition where the human body is unable to control its blood sugar levels effectively because the pancreas (the organ producing insulin) produces too little or no insulin. In some cases the pancreas does produce insulin, but it is not effectively utilised because of circumstances that will be discussed later under Type 2 diabetes.

If there is too little or no insulin available, glucose cannot be effectively absorbed by the cells of the body. Blood sugar levels increase, causing the blood to become thick and syrupy while excess glucose is also excreted in the urine. A high blood sugar level is dangerous and can lead to serious complications if it is not treated.

What are the symptoms of diabetes?

The symptoms of uncontrolled high blood sugar concentrations include:

Overwhelming thirst because the body tries to dilute the glucose in the blood so that it can be excreted by the kidneys. This process leads to excessive excretion of urine and can eventually result in dehydration and loss of electrolytes.

Tiredness and weakness because too little glucose reaches the cells where energy is produced.

Aches, pains and flu-like symptoms as a result of metabolic malfunction and inflammation.

Blurred vision because the changes in blood sugar levels increase the pressure in the eyeball, while the position and shape of the lens in the eyeball also change.

Pins and needles in the feet and hands because of damage to nerve endings.

Gnawing hunger, a need to eat continuously and weight loss because glucose is not effectively absorbed by the cells of the body and converted into energy. The body then breaks down its own fat and protein (muscles) to meet its energy needs.

Itchy skin, infections and poor wound healing occur because of the conditions created by the presence of sugar which are advantageous for the development of bacteria and other organisms.

Coma – loss of consciousness, a dangerous condition.

Unhealthy high blood sugar concentrations and diabetes mellitus are diagnosed when capillary blood glucose concentrations are 7,1 mmol/litre (fasting) and 11,1 mmol/litre (two hours after a meal).

Blood sugar concentrations can also drop too low (below 3,5 mmol/litre) if too much insulin is injected, if the prescribed meal plan is not adhered to, if meals are skipped, if unexpected physical activity requires more energy than has been provided for in the meal plan, or if alcoholic beverages are consumed without being followed by a snack or meal.

The symptoms of hypoglycaemia or a low blood sugar concentration include:

Hunger, tiredness

Shaking, dizziness, pallor, palpitations

Blurred vision, reduced concentration, pounding headache

Nausea, sweating

Mood swings, including irritability, confusion, aggression

Coma

Different types of diabetes

We differentiate the following types of diabetes:

Type 1 diabetes

Type 2 diabetes

Gestational diabetes

Impaired glucose tolerance

Type 1 diabetes

Type 1 diabetes occurs less frequently than Type 2 diabetes. Type 1 diabetes is the result of an absolute lack of insulin caused by damage to the Islets of Langerhans in the pancreas, where insulin is produced. Type 1 diabetics are often not overweight and the condition is irreversible. Insulin injections in combination with a healthy, balanced diet are an important part of treatment. Uncontrolled blood sugar levels can in the long term contribute to damage of the blood vessels, which in turn can cause heart disease, kidney damage, kidney failure, diabetic retinopathy (eye damage), neuropathy (damage to the nerve endings) and even necessitate the amputation of lower limbs due to poor blood circulation and gangrene. In poorly controlled paediatric Type 1 diabetics, significant problems include growth retardation and delayed puberty.

Type 2 diabetes

It is estimated that Type 2 diabetes constitutes approximately 85-95% of the incidence of diabetes and that it has a genetic component, which means that this illness can occur in families.

The symptoms and a diagnosis of Type 2 diabetes are often overlooked for between nine to twelve years while the malfunction of the insulin-producing ß-cells of the pancreas is already present. This means that, while the person is unaware that they have the condition, chronic increased blood sugar may be contributing to damage of the blood vessels, which in later years may result in heart disease, stroke, kidney damage, kidney failure, diabetic retinopathy (eye damage), neuropathy (damage to the nerve endings) and even the amputation of lower limbs due to poor blood circulation and gangrene.

Type 2 diabetes is an illness often associated with obesity and inactivity, although in older patients obesity is not always present. Type 2 diabetes is often the metabolic result of excess fat in the abdomen, muscles and liver. This fatty infiltration, in combination with high blood sugar levels, contributes to the malfunction of the ß-cells, increased blood pressure, a typical lipid profile (with moderately increased cholesterol, low serum HDL cholesterol, increased triglycerides and increased LDL cholesterol) and insulin resistance.

With insulin resistance the insulin-producing ß-cells of the pancreas are overstimulated to produce too much insulin in an attempt to keep the blood glucose levels within normal limits. Despite the elevated levels of insulin circulating in the body, it seems that the body cells develop a resistance to the normal functioning of insulin.

Stress, both emotional and physical, can also be a contributing factor to

Type 2 diabetes. The body is exposed to more stress when long working hours lead to physical exhaustion and if meals are being skipped simultaneously this may result in a lack of nutrients for the maintenance of body tissue that in turn could lead to inflammation.

Weight loss, a healthy lifestyle, healthy eating habits and regular exercise are regarded as important facets of treatment. Depending on the patient’s blood values, medication is often added. Nowadays, Type 2 diabetics tend to start insulin therapy earlier, as determined by the malfunction of their ß-cells, to delay the long-term deterioration caused by diabetes.

While Type 2 diabetes was previously regarded as an illness affecting older people, it is increasingly being detected in children and it is recommended that such children be referred to a specialist for evaluation.

Gestational diabetes

Gestational diabetes occurs as a result of hormonal changes during pregnancy. Although this condition usually improves spontaneously after the birth of the baby, the possibility exists that women with gestational diabetes may develop Type 2 diabetes over time or at a later age. It is important that blood sugar be well controlled with a balanced meal plan during pregnancy and that good eating habits be maintained after the baby’s birth.

Impaired glucose tolerance

Individuals with impaired glucose tolerance have increased blood sugar

values, but not elevated to the extent that diabetes can be diagnosed. Treatment includes healthy eating habits, regular exercise and long-term weight control. This condition may improve, remain unchanged or develop into

Type 2 diabetes.

Sensitivity to sugar

During consultations with allergic patients, I often encounter individuals who experience symptoms such as tiredness, headaches, migraine, abdominal discomfort, abdominal bloating and flatulence or loose stools – all of which may be caused by sugar and refined carbohydrates.

In the case of true sugar intolerance, there is a deficiency of the enzyme sucrase, which breaks down sucrose into glucose and fructose. Symptoms include diarrhoea and bloating due to fermentation and gas production in the digestive tract. This sensitivity to sugar is not related to diabetes, but such patients will benefit from a sugar-free diet.

What is well-controlled diabetes?

As mentioned previously, blood sugar levels can fluctuate or remain high for long periods, damaging the blood vessels that supply blood to the heart,

kidneys, eyes and nerve endings.

Although fasting blood sugar values are important, more attention is now being focused on blood sugar values two hours after a meal.

According to the 2009 SEMDSA* guidelines for South Africans, the ideal finger-prick values for blood