Type II diabetes

Alimentation Mode de vie Santé
Le diabète de type II
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There are two main types of diabetes, type I diabetes and type II diabetes.

In recent decades, the number of diabetes cases has exploded. In Quebec, between 2000 and 2007, the number of people diagnosed with diabetes increased from 295,039 to 453,491, a rise of 53.7%. Today, according to Diabetes Quebec, 880,000 Quebecers live with diabetes, about 10% of the population. Among them, 90% have type II diabetes.

Generally, type II diabetes develops in adults. However, due to the increase in childhood obesity rates, it has become increasingly common among children and adolescents. This highlights the importance of adopting healthy lifestyle habits early in life.

Here is an overview of this chronic disease. 

Definition of type II diabetes

Type II diabetes is a disease characterized by insulin resistance leading to an abnormally high level of glucose (sugar) in the blood, also called hyperglycemia. Insulin is a hormone produced by the pancreas that controls blood glucose levels by stimulating the transport of glucose to cells where it is converted into energy, then used or stored. However, in type II diabetes, even though the pancreas continues to secrete insulin, its production is insufficient due to the insulin resistance developed by the body. Indeed, with insulin resistance, cells do not respond normally to insulin secretion. Consequently, blood glucose levels remain high, leading to the symptoms and complications of type II diabetes.

Risk factors for type II diabetes

Various factors can increase the risk of developing type II diabetes. These factors notably include:

  • Being aged ≥ 45 years
  • Having a sedentary lifestyle
  • Being obese or overweight
  • Having a family history of type II diabetes
  • Belonging to certain ethnic groups (Black, Hispanic, Asian American, or Indigenous American)
  • Having a history of high blood pressure
  • Suffering from dyslipidemia (dyslipidemia is defined as a blood profile where lipid levels are abnormal)

Symptoms of type II diabetes

People with type II diabetes can be asymptomatic for several years before being diagnosed. Otherwise, symptoms may include:

  • Increased frequency and volume of urination
  • Increased thirst
  • Blurred vision
  • Extreme weakness
  • Dehydration

Complications of type II diabetes

Type II diabetes is a chronic disease that affects blood vessels. They become narrower, limiting blood flow to many organs. Among the organs that can be affected are:

  • The heart (e.g., heart attack)
  • The brain (e.g., stroke)
  • The eyes (e.g., blindness)
  • The kidneys (e.g., chronic kidney failure)
  • The nerves (e.g., foot ulcers)

High blood sugar also affects the immune system, making individuals with type II diabetes more susceptible to bacterial and fungal infections.

Diagnosis of type II diabetes

The diagnosis of type II diabetes is made by measuring blood glucose levels, called glycemia. This measurement can be done through various tests. The main diagnostic tests include:

Tests

Diagnostic values

Fasting blood glucose

≥ 126 mg/dL or 7.0 mmol/L

 

Oral glucose tolerance test (OGTT)

≥ 200 mg/dL or 11.1 mmol/L

 

Glycated or glycosylated hemoglobin (HbA1c)

 

≥ 6.5%

 

Treatment of type II diabetes

Treatment of type II diabetes includes several aspects, including lifestyle modification and sometimes medication:

  • Diet
  • Physical exercise
  • Weight loss in case of overweight or obesity
  • Education about the disease
  • Various medications and sometimes insulin

The goal of treatment is to control blood glucose, which reduces symptoms and the risk of complications. Lifestyle modification, including diet and physical exercise, is a key element of treatment. Indeed, some people with type II diabetes can avoid or stop taking medications if they manage to control their blood glucose through diet and physical activity alone. Smoking cessation and moderation of alcohol consumption are also recommended.

Nutritional approach for type II diabetes

Dietary modification is important in the treatment of type II diabetes. Indeed, nutritional therapy can reduce glycated hemoglobin (HbA1c) by 1 to 2% and even more when combined with other aspects of treatment. Moreover, diet is one of the main factors causing variations in blood glucose. Therefore, education on the role of diet in diabetes management by a dietitian is advised. This education may include the impact of diet on blood glucose, carbohydrate sources, different types of carbohydrates (e.g., fiber, simple sugars, complex carbohydrates), meal planning, carbohydrate counting, balanced plate, basics of healthy eating, and various personalized recommendations. Finally, the nutritional approach can also help achieve or maintain a healthy weight, improve quality of life, prevent symptoms and complications, allow better blood glucose control, and meet nutritional needs.

Dietary recommendations for type II diabetes

Recommendations for nutritional treatment of type II diabetes are based on the 2018 Canadian Diabetes Treatment Guidelines and advice from Diabetes Canada. These recommendations may include:

  • Losing weight in overweight or obese individuals.
  • Distributing macronutrients respecting reference ranges: between 45 and 60% of energy from carbohydrates, between 15 and 20% of energy from proteins, and between 20 and 35% of energy from lipids. Distribution should be individualized according to each person's preferences and treatment goals.
  • Maintaining a regular schedule of meals and snacks to optimize glycemic control.
  • Distributing food intake evenly throughout the day.
  • Added sugars can replace other carbohydrate sources in a meal, but their amount should not exceed 10% of daily energy intake.
  • Following the recommendations of the Canadian Food Guide.
  • Aiming for a consumption of 30 to 50 grams of fiber per day with one-third or more from soluble fibers that help reduce cholesterol. Fibers also allow better glycemic control.
  • Replacing carbohydrates with a high glycemic index (white bread, sweets, sugary drinks) with carbohydrates with a lower glycemic index (legumes, whole grains, vegetables, fruits) to optimize glycemic control.
  • Adopting a dietary pattern such as the Mediterranean, vegetarian, or vegan diet (See article: Demystifying vegetarianism and its nutrients to consume) and DASH (See article: Hypertension: how to control it and the DASH diet) or emphasizing the incorporation of legumes, fruits and vegetables, or nuts. These patterns have been shown to be beneficial for type II diabetes. Choose a pattern based on values, preferences, and goals to achieve better long-term adherence.
  • Cooking from unprocessed or minimally processed foods (See article: Processed foods and the NOVA classification).
  • Paying attention to the quality and quantity of carbohydrates.
  • Favoring unsaturated fats (nuts, seeds, certain vegetable oils, avocado, fatty fish), limiting saturated fats, and avoiding trans fats to reduce the risk of cardiovascular diseases.
  • Opting for lean animal proteins and consuming more plant proteins (legumes, tofu, tempeh, soy, edamame, nuts, seeds, etc.)
  • Preferring water as the daily beverage. Avoiding or limiting sugary drinks.
  • If consumed, limiting the amount of alcohol.
  • Consulting a dietitian to obtain individualized recommendations according to each person's unique needs and to increase adherence to the prescribed diet.

Prevention of type II diabetes

Finally, lifestyle modification can generally prevent the development of type II diabetes. Indeed, in overweight individuals, a weight loss of about 7% of initial weight combined with regular physical activity (e.g., 30 minutes of walking per day) can greatly (> 50%) reduce the risk of type II diabetes.

To learn more about prevention and take the test to know your risk of developing type II diabetes, visit the preventiondiabete.ca website.

In case of doubt or desire for management, support from health professionals (doctor, dietitian, kinesiologist, etc.) is strongly recommended.

References

Article written by:

Marie-Noël Marsan, written in 2021.

Tags: Alimentation, Mode de vie, Santé

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