What Do You Know About Diabetes?

Diabetes has become a global epidemic. Today, over half a million diabetics live in Israel and another half a million are prediabetic, with 80% of them completely unaware of their condition. Additionally, uncontrolled diabetes can lead to cardiovascular diseases (such as heart attacks, strokes) and consequently - mortality. Furthermore, it can affect other organs such as kidneys, retinas, and nerves. Early and optimal treatment of the disease prevents its complications. In honor of Diabetes Awareness Week - what do you know about diabetes? We examined a few myths.

You should eat a snack after treating your hypoglycemia.

Incorrect. The common opinion was that treating hypoglycemia requires two medications: quickly absorbed glucose and a snack afterward. To treat hypoglycemia, you should eat or drink 15 grams of fast-absorbing carbohydrates (for example: 3-4 glucose tablets of 4 grams, a bottle of glucose liquid, or half a cup of sweet juice), wait 15 minutes, and check your blood sugar level. Only if necessary should you repeat the treatment. Usually, 15-30 grams of simple carbohydrates will suffice to raise the sugar level to the normal range, and this depends on the severity of the hypoglycemia. Overeating during hypoglycemia can cause blood sugar levels to rise beyond the desired range. When treating hypoglycemia, it's recommended to skip using chocolate or cookies due to their high fat content, which requires more time to raise blood sugar levels.

Only food affects blood sugar levels.

Incorrect. Carbohydrates, and to a lesser degree proteins, are the main factors affecting blood sugar. However, food is only one factor among several that influence.

Stress - Stress from pain, arguments with a loved one, or a busy period at work can influence sugar balance and raise blood sugar levels.

Illness – Inflammations or other illnesses in the body cause insulin resistance and can lead to increased blood sugar levels. During illness, it is advisable to consult with the treating physician for temporary changes in medication to maintain sugar balance.

Physical activity – Intense exercise can also raise blood sugar levels. It is recommended to check sugar levels before and after physical activity to anticipate sugar behavior and adjust accordingly.

Diabetics cannot eat fruits.

Incorrect. Within a balanced diet that includes carbohydrate counting, a diabetic person can incorporate fruits. The recommendation is to consume up to 2 fruits a day for diabetics whose blood sugar levels are balanced. It is advisable to eat the fruit along with 7 almonds or two walnuts, which will slow down the absorption of sugar in the body and affect the meal's glycemic index. Also, it is recommended to spread the consumption of fruits throughout the day and not to consume them all at once. Furthermore, it is advised to check how each fruit personally influences blood sugar levels using flash technology for continuous sugar monitoring.

Starting insulin treatment signifies worsening of the disease and reaching an irreversible state.

Incorrect. Insulin treatment can lead to better balance and improvement in the patient's health and quality of life. In many cases, delaying insulin use can lead to significant worsening and complications of diabetes. The current medical perception is to treat as early as possible based on the metabolic memory approach, where starting intensive treatment early allows the body to remember and respond accordingly in the future. The reverse is also true. If you don't achieve good glycemic balance at the start of treatment, your chances of developing complications are significantly higher in the future, even if you start intensive treatment later in the disease.

Fruits are a healthy food that does not cause weight gain.

Incorrect. Fruits are a healthy food and a vital source of vitamins and minerals such as potassium, vitamin C, folic acid, dietary fibers, and antioxidants. Fruits reduce the risk of various diseases, aid digestion, prevent inflammations, and more. However, it's important to remember that fruits contain simple sugars and a certain amount of calories, so they should be consumed in moderation. Excessive sugar consumption can lead to excess caloric intake, weight gain, and obesity.

Drinking fruit juice is good and similar to eating the fruit itself.

Incorrect. Many people enjoy drinking juices but do not like eating fruits. It is important to know that juice is a source of available sugar that quickly raises blood sugar levels, so it is better to eat the fruit whole. The fruit peel is rich in dietary fibers that aid digestion, promote satiety, and slow the rate of sugar breakdown and absorption in the body. A glass of squeezed juice (about 200 ml) equals eating 2 fruits, so calorically, a store-bought juice drink can contain about 5 fruits or more and a significant amount of sugar and calories.

Physical activity lowers blood sugar.

Correct. Physical activity usually lowers blood sugar levels, however, various high-intensity exercises (spinning, short-distance sprinting, strength training) may increase sugar levels.

Ketoacidosis is one of the severe complications of diabetes.

Correct. One of the immediate and severe complications of diabetes is "ketoacidosis" which occurs when blood sugar levels rise to very high values, above 300 – 400 mg/dL, mainly in type 1 diabetes but can also occur in type 2. This is essentially a medical emergency that requires rapid treatment with fluids and intravenous insulin. Those experiencing this complication feel weakness, nausea, vomiting, and abdominal pain. If not treated in time, the situation can deteriorate and even become life-threatening. Recently, it has been found that, although very rare, this condition can develop even when blood sugar levels are not as high, just 200-250 mg/dL. This condition may occur among patients taking new types of medications like Jardiance and/or Forxiga. Therefore, it is important to use a system for testing sugar and ketones in the blood.

Dr. Mariana Yaron is a specialist in Internal Medicine and Endocrinology at the DMC Center for Diabetes Treatment and the Institute of Endocrinology, Metabolism, and Hypertension at Sourasky Medical Center in Tel Aviv.