THE LOW G.I. FOOD GLOSSARY

This glossary describes of some of the key foods that can form part of a low G.I. diet.

BurgenTM Soy Lin, Soy and Unseed loaf (G.I. of 19) • A mixed grain bread from Tip Top Bakeries. Sydney. Available in supermarkets. It has the lowest G.I. of all mixed grain breads. Other varieties of Burgen™ bread also have a low G.I.

Cherries (G.I. of 22) • The G.I. for cherries is based on European cherries. Australian cherries which are 6.1 per cent glucose and 4.2 per cent fructose may have a higher G.L value.

Custard (G.I. of 43) • Made with milk, so provides calcium, protein and B vitamins plus a little sugar, vanilla flavouring and a starch thickener.

Doongara rice (G.I. of 59) • An Australian grown rice with a high amylose content and low G.I. Available in supermarkets and in bulk quantities from wholesalers and some Asian food stores. Fruit loaf (G.I. of 47) • Available in wholemeal and white varieties, but choose the heavy types. The G.I. of fruit loaf is probably lowered by part substitution of flour (high G.I.) with fruit (lower G.I.).

Grapefruit (G.I. of 25) • The low G.I. factor of grapefruit may be due to their high acid content which slows absorption from the stomach.

Grapes (G.I. of 46) • An equal mix of fructose and glucose and a high acid content are characteristics of fruits with a low G.I. Grapes are a good example.

Icecream (G.I. of 61) • Most dairy products have very low G.I. factors. When we eat dairy foods a protein curd forms in the stomach and slows down its emptying. This has the effect of slowing down absorption and lowering the G.I. factor.

Kiwifruit (G.I. of 52) • Kiwifruit contain equal proportions of glucose and fructose and high acidity giving a reasonably low G.I. They are also a wonderful source of vitamin C with one kiwifruit meeting the total recommended daily intake.

Legumes (G.I. range: 14 to 56) • Abo known as pulses. These include dried peas, beans and lentils, mostly have a G.L factor of 50 or less.

Canned varieties have a slightly higher G.I. than their home-cooked counterpart due to the higher temperature during processing. Soya beans (G.I. of 18) have one of the lowest G.I. values, possibly due to their higher protein and fat content. The viscous fibre in legumes reduces physical availability of starch to digestive enzymes.

*155\33\4*

LIVING WITH DIABETES: BLOOD TESTS

The most useful information you can have in the day-to-day control of diabetes is to know how much glucose is present in the blood. This varies so much that it is essential to test frequently and on a regular basis at home. The tests are sometimes called Home Blood Glucose Monitoring.

The test is made on a drop of blood applied to a small test strip. You will need a fine needle or lancet to prick the skin, a small plastic device to ensure that the pricks are painless and easy, a supply of test strips, and for most people a meter to measure the glucose value.

The test is very reliable if it is done exactly correctly. It will give the wrong answer if it is done incorrectly.

Use the correct strip

There are several different types of test strip, and it is essential to use one that is right for the meter that you are using. Test strips must be stored properly. The container must be kept tightly closed at room temperature but not exposed to heat. Test strips should not be used after the expiry date shown on the container. The types of strips commonly used with blood glucose meters are: the AMES Test BG, BM Test BG, Glucostix, BM Test Glycemie 20/800 and Hypoguard GA. strips.

Obtain a large drop of blood

Use a fine lancet such as the Monolet either held in the hand or use an automatic pricking device such as the Autolet, Glucolet, Soft Touch or the Autoclix. You can use the lancet many times on one person, but if you do, you should keep it in spirit between uses and allow it to dry well before you use it.

The fingers are the easiest part to obtain blood. They need to be reasonably clean and must be dry. Do not use a spirit swab.

Warm fingers bleed more easily than cold.

You may do the test anywhere on the last joint of the finger to give a satisfactory drop of blood. It is often easiest to use the tip, but try not to use only the tip as eventually after many years this may lead to some loss of sensation. Try instead to use the edge of the fingers sometimes. Use a different finger each day to give them a rest.

You must get a large drop of blood; not just a smear. It should be applied to the strip by letting it almost fall on it. The strip should then have a drop of blood.

Time is vital

Blood must be on the strip for exactly the right time. The strip contains chemical reagents which react with the blood, and if the blood is on the strip for less than the proper time, the result will read too low. If the blood is on the strip too long, the result will read too high. If you are using a meter, it will have a timer and this will indicate exactly the right time to remove the blood. If you are not using a meter, you will need to time it exactly using a sweep second hand or a digital second timer on your watch or clock.

*30/54/5*

DIABETES IN CHILDREN: THE BASIS OF NUTRITION

You should know something about the main food groups which form the basis of good nutrition. These are carbohydrates, fats, proteins, vitamins, minerals and water. Most foods are mixtures of some or all of these ingredients.

Carbohydrates

Carbohydrates supply energy for body heat and activity and for growth. The commonest carbohydrates are sugars and starches and it is this group of foods which is quickly absorbed and turned by the digestive process to glucose in the bloodstream. It is therefore especially important to control the quantity of carbohydrates eaten by people with diabetes.

There are numbers of different kinds of carbohydrate. We are particularly concerned with those that are natural and unrefined: cereals, fruits and vegetables. They supply glucose for energy but they also have other important nutrients — vitamins, minerals and fibre. They tend to have a high proportion of starch or complex sugars and these may be more slowly absorbed than the simple sugars.

Differences in the types of carbohydrate are important in choosing food for good nutrition. The diet in diabetes depends on plenty of foods which contain starches and complex sugars because they are more gradually absorbed into the blood stream. The rate of absorption of carbohydrates into the blood is also influenced by food preparation (e.g. cooking a vegetable will increase the rate of absorption, as will juice extraction from fruit). Cane sugar, taken as part of a meal, is absorbed more slowly than when eaten alone as a sweet or in a sweet drink.

Milk contains carbohydrate as lactose (sugar of milk) and so this is also considered as an important source of carbohydrate in childhood.

Fats

Foods containing fats and oils are very concentrated forms of energy for heat and body activities. They can be used as fuel by the body, so these too may be controlled. Examples of foods with a high proportion of fat are butter, cream, margarine, oils and eggs. It is considered by most physicians that excessive quantities of fat in the diet are undesirable.

Proteins

Protein-containing foods are especially important for growth and maintenance of body tissues, so it is especially important that children have ample protein in their diet. Protein may also, to some extent, be used to supply energy by being converted in the body to glucose. Examples of foods with a high content of protein are meat, eggs, fish, cheese and milk.

Vitamins

Vitamins are needed for growth and the efficient running of the body and the maintenance of good health. If a good, well balanced diet is given, adequate vitamins will be provided in the natural foods, and extra vitamins should not be necessary. For example, fresh fruit and vegetables provide vitamin Ñ Milk, eggs, meat and wholegrain cereals provide the  group of vitamins.

Minerals

Minerals such as calcium, iron and many others are also necessary for the efficient running of the body and for growth and maintenance of health. Most of the minerals needed are contained in eggs, milk, meat, fish and vegetables and fruit.

*22/54/5*

DIABETES IN ADOLESCENCE: TEENAGERS DON’T ALWAYS OBEY ALL THE RULES

What is particularly worrying for some parents is the way teenagers with diabetes don’t seem to keep to the rules of proper care for diabetes. It is not easy for a teenager to keep to a strict medical regimen, and most fail to keep really good diabetic control in their early adolescent years. If it is a difficult time for them, it is often an anxious time for their parents.

In early teenage, almost all young people break their diet some of the time. Many don’t manage to keep to a food plan at all even though their mothers may provide a balanced meal with the correct exchanges. The teenager has strong drives to eat and drink at times other than usual mealtimes, and an overriding appetite may defeat even the best intentions. Eating and drinking are social activities, and it is hard to avoid having the wrong food and drinks when you are with friends. There have been a number of studies made on adolescent eating habits, and these confirm what most mothers of teenagers know very well. Many teenagers like to skip breakfast or lunch. Most teenagers have a high proportion of their food as snacks between meals particularly in late afternoon and in the evening. Teenagers often develop strong likes and dislikes and many take strong exception to the family meals which their parents provide. There is considerable reliance on take-away food which can be eaten quickly with friends. It would be unreasonable to expect teenagers with diabetes to be different in any of these ways from teenagers who do not have diabetes. It is not surprising then that a regulated meal plan prescribed for diabetes will be quite unacceptable for some teenagers and for others there will be times when social demands will override dietetic considerations.

Teenagers usually dislike blood tests, and some go through a period of not doing them. If they think this will distress their parents or their doctor, they even make up results. In a recent survey of teenagers attending our adolescent clinic for diabetes, half said that they sometimes made up their blood test results when they wrote them down.

Some teenagers resent parents supervising their diabetic care – even though it is only too obvious that some supervision is needed! Attempts by parents to advise or give gentle reminders about blood tests or meals on time may be met with accusations of nagging and interference. All this may make parents confused and upset and worried: how much can they sit back and watch their child neglect his health and risk complications of diabetes in later life?

Perhaps it is helpful to understand the reason for this contrary behaviour which is so common in adolescence.

*55/54/5*

DIABETES IN CHILDREN: YOUR OWN FEELINGS ABOUT DIABETES

How do you feel yourself about diabetes?

As a parent, you may want to consider quite carefully what attitude you should adopt towards your child who has diabetes. Before you can do this, you may first want to consider your own feelings about diabetes. Probably you felt considerably distressed when you first learnt your child had this condition. This is natural and you should discuss diabetes fully with your doctor at this time. However with realization that diabetes can be treated successfully, and the sight of your child returning to normal health and activities, this anxiety will gradually give way to acceptance. Not only your child, but also you as a parent must come to terms with diabetes. If parents cannot do this, they will have difficulty in helping their child do so.

This is in fact an important task; for you as a parent to help your child accept his or her diabetes.

Avoid pity

A natural reaction of most parents is one of sympathy for their child when they contemplate the prospect of lifetime insulin injections and diet restriction.

Perhaps you have worried about your child having to face the possibility of illness and insulin reactions, of the stigma of a chronic disorder, and having to fit in with school and social life.

Your child needs you to express confidence about him

However you will realize the need to try to resolve these anxieties so that they do not upset your child. He will be helped best if you can express confidence; confidence in his health, in your own ability to cope with his treatment, and confidence in the future.

Naturally you will feel sympathetic, but you must face the fact that pity will not help your child. The child needs his parents to care about him, but not ever to pity him. He wants his parents to know what he has to put up with in the way of needles and restrictions, but not to feel sorry for him because of it.

Other relatives can help too

You may wonder how to talk to grandparents, who may also be upset or worried about diabetes.

Avoid special attentions and favours.

In your discussion with relatives, you may point out that special favours and fussing will be harmful in the long run – and not fair to the child’s brothers and sisters either. Relatives, who tend to reward children with sweets and cakes and special puddings when they visit, will want to think of other methods of giving treats – perhaps savory foods, outings and games may replace sugary foods – and be better for all the family.

That is not saying that children with diabetes must be denied all party foods and sweets. Low calorie soft drinks, ice-cream, chocolate, jellies, pies, cocktail sausages can all be taken at parties provided allowance is made where necessary. Discuss this with your dietitian.

*47/54/5*

DIABETES IN CHILDREN: INSULIN HYPOGLYCEMIC REACTIONS

What is an insulin hypoglycemic reaction?

The term ‘insulin hypoglycemic reaction’ means the reaction of the body to an abnormally low level of glucose in the blood, due to the over effect of insulin. Abbreviations sometimes used are ‘hypo’ or ‘reaction’ or ‘insulin shock’. Literally, ‘hypo’ means below, or low, and glycaemic means sugar in the blood.

Because this may be experienced occasionally by any child with diabetes, you should know about the reasons for it developing, the signs of such a reaction, and its proper treatment.

The cause of a hypo reaction

What causes a hypo reaction?

If there is more insulin circulating in the body than is required at the time, the quantity of glucose in the blood will fall. This may occur if the insulin administered was greater than the needed dose or if less food than normal has been eaten, so that there is less glucose in the blood for the insulin to act on. A digestive upset may lead to the food not being absorbed fully. Or perhaps the child has had some unusual activity – a game of football for example – and used up more glucose than usual as extra energy expenditure.

There are also other things which can alter the body’s need for insulin, such as the state of general health, the presence of infections, rapid growth, emotional upsets and worry. Factors such as these may change and at times lead to a changing need for insulin. Thus there are many possible reasons why a child with diabetes may have an insulin reaction.

*38/54/5*