Diabetes Recipes from Around the World

By Jane Frank

Over 100 international recipes designed to help maintain a healthy blood glucose level without sacrificing flavor.

Today worldwide there are approximately 200 million people with diabetes, more than two million of those are in the UK—with at least a million more thought to have diabetes but not yet aware of it. Diabetes is indeed a serious disease, but it is still possible to lead a relatively normal life. The key to coping successfully with diabetes is self-management, and the most important aspect of self-management is making healthy food choices.

In this book, Jane Frank explains exactly what diabetes is, its likely causes, and how to manage it by improving your lifestyle and discusses the principles behind healthy eating, the glycaemic index (GI) of foods, and their glycaemic load. She has collected over 100 recipes from many different cuisines around the world, including Spanish, Moroccan, Thai, and Indian recipes. She has picked out dishes that will help you keep blood glucose on an even keel, as well as being nutritionally balanced, tasty, and easy to cook. Some of these recipes are traditional dishes reworked to be more diabetes-friendly, whilst others are new recipes using culinary traditions from many different countries. Each recipe carries an easy-to-read traffic light code for the glycaemic load as well as a nutritional analysis showing calories, proteins, carbohydrate, and fat content.

So, if you have diabetes or if there is someone in your family who does, you will all be able to enjoy a delicious, healthy, normal diet by following this practical, down to earth collection of recipes, meals and menus.

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Nov 15, 2012
• ISBN: 9781909166622

Jane Frank

Jane Frank specializes in cooking.

Book preview

introduction

A diagnosis of diabetes can seem at first like a shattering blow. If you have been told you have diabetes, your first reaction might well be ‘why me?’ And yet you’re far from being alone. Worldwide today there are approximately 200 million people with diabetes, more than two million of whom are in the UK. At least a million more in the UK alone – ‘the missing million’ – are thought to have diabetes but are not aware of it yet.

When you are first diagnosed with diabetes and you learn that you are going to have to live with it for the rest of your life, you may react with anger, shock or fear. This reaction is understandable. Diabetes is indeed a serious disease, but it is possible to lead a relatively normal life with diabetes, as many people throughout the world do. There are numerous international diabetes organisations such as the International Diabetes Federation, and most countries have diabetes support groups and charities such as Diabetes UK, the American Diabetes Association and Diabetes India. Help and information is available from all these bodies, and from the numerous diabetes forums and chat rooms on the internet. But the key to successfully coping with diabetes is still self-management, and the most important aspect of self-management is making healthy food choices. In this book I’ve collected together recipes from several different cuisines around the world, picking out dishes that will help you keep your blood glucose on an even keel as well as being nutritionally balanced, tasty and easy to cook. Some of these recipes are traditional dishes reworked to be more diabetes-friendly, whilst others are new recipes using culinary traditions from many different countries.

What Is Diabetes?

If you have diabetes, this means that there is too much glucose in your blood. This glucose comes from the carbohydrate foods in our diet, and is our principal source of energy. In a normal person, the level of blood glucose is strictly regulated by two hormones called insulin and glucagon, secreted by the pancreas. The job of insulin is to move glucose out of the blood and into the cells after a meal, while the role of glucagon is to raise blood glucose between meals if it is sinking too low. In a person with diabetes, this mechanism fails to work, and the blood glucose level stays too high. This could be either because the pancreas is making too little or no insulin, or because the cells have become resistant to insulin and fail to respond to its message. The action of glucagon is seldom impaired in the same way.

Signs and Symptoms of Diabetes

The first effect of high blood glucose levels is that glucose passes into the urine because it can’t get into the cells where it is needed. This glucose makes the urine of a person with undiagnosed diabetes sweet, hence the name ‘diabetes mellitus’ — ‘mellitus’ deriving from the Greek word for honey. Because the urine is syrupy with glucose, the kidneys respond by excreting more fluid to try and dilute it. This results in the need to pass urine more frequently which, in turn, causes extreme thirst. The excessive fluid loss often causes the patient to lose weight, which may make them feel very hungry. These are the three classic symptoms of diabetes. Other symptoms include extreme fatigue, blurred vision, nausea and tingling or numbness in the hands and feet. Frequent or recurring infections and slow wound healing are also signs of undiagnosed diabetes. The symptoms are quickly relieved once the diabetes is treated, so it is important to get a diagnosis as early as possible. Early treatment will also reduce the chances of developing serious health problems.

The Three Classic Symptoms of Diabetes

Polyuria – frequent urination

Polydipsia – excessive thirst

Polyphagia – excessive hunger

Types of Diabetes

There are broadly two types of diabetes: Type 1 and Type 2. About 5% of people with diabetes have Type 1, while the remainder have Type 2. The two types are very different diseases with different causes and different mechanisms at work, but management of the two conditions is fairly similar.

Type 1 or Insulin-Dependent Diabetes Mellitus (IDDM)

In this type, which used to be called juvenile diabetes to distinguish it from the later-onset Type 2, the symptoms listed above usually appear quickly, over a period of weeks or even days, and must receive immediate medical attention. The person’s blood glucose rises alarmingly because insulin production is inadequate or fails altogether.

Type 2 or Non-Insulin Dependent Diabetes Mellitus (NIDDM)

In Type 2, the same symptoms as those associated with Type 1 may occur, although not necessarily. However, they progress gradually, sometimes so gradually that you can have Type 2 without even being aware of it, and could remain undiagnosed for several years. One of the reasons Type 2 diabetes may not be recognised is that many of its symptoms, such as increased urination, lack of energy, weight loss, skin infections and wounds that are slow to heal, are things that may occur anyway as a part of ageing. Type 2 used to be called senile diabetes, but it is appearing in younger and younger people, especially in certain ethnic groups.

Other types of diabetes include Maturity-Onset Diabetes of the Young (MODY), which is a hereditary form of Type 2 diabetes that occurs in young adults; Gestational Diabetes, which occurs in pregnancy and usually disappears after the baby is born; and Secondary Diabetes, which develops as the result of another condition, such as pancreatitis, cystic fibrosis or haemochromatosis. This last is an inherited disease that causes excessive amounts of iron to accumulate in the body, and is often referred to as ‘bronze diabetes’ because it is sometimes accompanied by a bronze colour of the skin.

Diagnosis and Tests

The most usual test for diabetes is a fasting plasma glucose test (FPG) which is done in the morning after the patient has abstained from food for at least 8 hours. After this long without food the blood glucose should be below 7 millimoles per litre (mmol/l) in the UK, or below 125 milligrams per decilitre (mg/dl) in the US. A reading above this level is considered to be a sign of diabetes, if confirmed by a subsequent test.

The Oral Glucose Tolerance Test (OGTT) may also be used. It is more sensitive than the FPG test, but less easy to administer. The patient has to drink a glucose drink after an 8 hour fast, and the blood glucose is measured immediately beforehand, then again two hours later. The second reading should be below 11 mmol/l or 200mg/dl. Another test sometimes used is the random plasma glucose test, which can be done at any time without any preparation. Diabetes may be diagnosed on the basis of a single abnormal blood glucose test if the patient has the classic symptoms.

Causes of Type 1 Diabetes

To search for just one single cause of Type 1 diabetes would be misguided, as different mechanisms may be significant in different parts of the world. What we do know is that in about 90% of people with Type 1 diabetes, the pancreas stops making insulin because the beta cells which secrete insulin are destroyed by the body’s own immune system. Why this happens remains a mystery, although there appears to be a genetic predisposition which is activated by an environmental trigger.

About 10% of people with Type 1 have a genetic predisposition without an autoimmune reaction. Instead, they are more likely to have inherited certain types of white blood cells (called HLA types) which make them more at risk. But heredity is not the only factor. Studies of identical twins have shown that when one twin gets diabetes, the other twin only develops the disease in about half the cases, so there must be an environmental trigger as well.

During the last few decades, the worldwide incidence of Type 1 diabetes has been increasing significantly, by about 3% per year. This increase suggests that an environmental factor, such as a virus, is involved. It’s possible that the immune system, having fought off a virus, then turns on the beta cells because it confuses them with the virus. Type 1 has been associated with the coxsackie B virus among others.

Causes of Type 1 diabetes

Known causes:

Genetic predisposition

Autoimmune destruction of the beta cells

Possible environmental triggers:

Viral infection

Autoimmune reaction to:

– bovine insulin

– meat

– gluten

Vitamin D deficiency

Another environmental trigger could be food, and the most strongly implicated food so far is cow’s milk, specifically because it contains insulin. Researchers in Finland have discovered that babies fed on cow’s milk formula are five times more likely to develop Type 1 diabetes. The theory is that the baby’s immune system makes antibodies against the cow’s insulin, which then go on to destroy the beta cells in the baby’s pancreas.

A recent review of global eating habits concluded that the worldwide increase in Type 1 diabetes could be associated with increased meat consumption, although no one understands what the mechanism might be.

The third possible food culprit is gluten – the protein found in wheat, barley and rye and usually as a contaminant in commercially grown oats. It is known that up to 10% of people with Type 1 also have celiac disease (intolerance of gluten), and it may be that eating gluten is also partly responsible for the onset of the disease. Both are autoimmune diseases and there appears to be a familial link. One in 20 people with a relative with Type 1 diabetes may be celiac.

It has also been suggested that vitamin D deficiency may be a major factor in the development of Type 1 diabetes in children. Diabetes is less common in those areas of the world where genetically susceptible children get adequate amounts of vitamin D, either in the diet or through exposure to sunlight.

Causes of Type 2 Diabetes

There is a range of risk factors for Type 2. Firstly, it occurs mostly in people over the age of 45, although it is now appearing in younger and younger people. Next, there is a strong hereditary component – it is three to five times more common among African, Caribbean or Asian communities living in the UK, and tends to develop at a younger age in these groups. It seems that a large proportion of people in these ethnic groups have a genetic predisposition to develop diabetes if they diverge even very slightly from their traditional diet.

Risks for Type 2 diabetes include:

Age over 45

African or Asian heritage

Body Mass Index over 30 (over 25 for Asians)

Blood pressure over 140/85mm Hg

Parent or sibling with Type 2 diabetes

Nutritional deficiencies e.g. magnesium/ chromium

Poor dietary choices (diet high in refined and processed foods)

History of gestational diabetes or having given birth to a baby over 9lbs in weight

Obesity is definitely a risk factor. It is arguable whether obesity is the primary cause of diabetes, but there is no doubt that it nearly always accompanies diabetes. A diet high in processed foods, fat and sugar leads to obesity and therefore also to diabetes. High blood pressure is another risk factor. Lastly, if a woman has already had gestational diabetes or if she has given birth to a particularly large baby, diabetes is more likely to develop later on.

Insulin Resistance, Prediabetes and Metabolic Syndrome

Insulin resistance is the basic metabolic failure underlying Type 2 diabetes. When a person is insulin resistant, the pancreas is still making insulin but the cells do not respond to the normal amount of insulin, so the pancreas has to produce more insulin than normal to move glucose out of the blood and into the cells. Thus a person with insulin resistance may have high blood glucose and high insulin (hyperinsulinaemia) at the same time. Insulin resistance and hyperinsulinaemia are early warning indicators of the risk of prediabetes and Type 2 diabetes, or may indicate other medical disorders such as Polycystic Ovarian Syndrome. Insulin resistance may develop as a result of genetic predisposition; a diet high in refined and processed foods and lacking in nutrients; a sedentary lifestyle; consequent obesity; and finally stress. Stress uses up valuable nutrients such as magnesium. Acute stress, in which adrenaline is released, causes insulin levels to fluctuate wildly, whilst chronic high levels of the stress hormone, cortisol, lead to chronic high blood glucose.

As the body gradually loses sensitivity to insulin, prediabetes is the next step after the establishment of insulin resistance in the downward slope towards diabetes. Prediabetes used to be called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), but the use of the term prediabetes has been adopted to help people appreciate the serious nature of this metabolic condition and the urgency involved in making healthy lifestyle changes.

Metabolic Syndrome/Syndrome X/Insulin Resistance Syndrome (IRS) are all terms for the same collection of symptoms which, taken together, increase the risk not just for diabetes but also for cardiovascular disease and liver disease.

It is clear from a number of large-scale studies that the clock starts ticking for cardiovascular disease many years before a person is diagnosed with diabetes. Several large studies, including the Diabetes Prevention Program (DPP) in the USA, have showed how crucial healthy nutrition and exercise are in preventing diabetes and cardiovascular diseases in people with Metabolic Syndrome.

In fact, the DPP worked too well. The group on ‘lifestyle intervention’, i.e. healthy diet and exercise, turned out to have a 58% lower risk of developing diabetes than the control group who had made no lifestyle changes. This was felt to put the control group at an unfair disadvantage, and so the trial was abandoned.

Metabolic Syndrome includes at least three of these symptoms:

A waist measurement of more than 40/102cm in men or 35/89cm in women.

A waist to hip ratio of more than 0.95 for men or more than 0.8 for women. Asians are at risk at lower ratios.

High levels of triglycerides and LDL – the ‘bad’ cholesterol

Low levels of HDL – the ‘good’ cholesterol (less than 50 mmol/L in women and less than 40 mmol/L in men)

Blood pressure greater than 130/85mm Hg

High levels of blood glucose

Insulin resistance

Hypoglycaemia

Hypoglycaemia (a ‘hypo’) means low blood glucose, and is one of the effects of diabetes. It may seem illogical that low blood glucose is the most dangerous effect of diabetes, which by its very nature is a disease of high blood glucose. However, a hypo occurs if a person with diabetes injects too much insulin, or takes too high a dose of diabetes drugs. It may also happen if they skip a meal or delay eating, drink too much alcohol or exercise without eating beforehand. During a hypo the brain is starved of glucose, so the person may appear confused and behave abnormally. The only way to prevent the person going into a coma is to ensure that they eat some glucose immediately. Many insulin-dependent diabetics can feel the onset of a hypo before it happens and can thus avoid it by eating a glucose sweet or similar large dose of glucose.

Complications of Diabetes

Diabetes is such an important issue because of the long-term effects of the disease, which are serious, although they may take many years to appear. They include heart disease, high blood pressure, stroke and peripheral vascular disease (that is, diseases of the blood vessels outside the heart and brain). There are several complications of diabetes that develop over time. These include damage to the retina of the eye (retinopathy), which can lead to impaired vision and even blindness. Other complications are damage to the blood vessels, the nervous system and the kidneys. Studies show that keeping blood glucose levels as close to the normal, nondiabetic range as possible may help prevent or delay harmful effects to the eyes, kidneys, and nerves. The mechanism by which diabetes leads to these complications is complex, and not yet fully understood, but it appears to be the combined effects of high glucose levels, high blood pressure, high blood fats and damaged blood vessels.

If blood glucose levels are high over a long period, glucose molecules attach themselves to proteins, making them ‘sticky’ so they can’t function properly. This is called the glycosylation of proteins and, at