HOW MUCH SHOULD A DIABETIC EAT? INSULIN AND ENERGY Most foods eaten will eventually become glucose. Glucose in the blood is like petrol in a car that provides fuel and energy. But unlike the car, our body needs insulin, a hormone secreted by the pancreas, to transport blood glucose into our muscle cells to generate energy. As a result, insulin is intimately linked to how our body uses food energy, and blood glucose levels. Normally, as soon as food is digested and glucose is absorbed into our blood from the small intestine, the pancreas is immediately stimulated to produce an unlimited supply of insulin to transport this absorbed glucose. With a normal pancreas, the blood glucose after a meal is always within the range between 80 and 140 mg/dl (4.4 mmol/litre-6.6 mmol/litre). But without adequate insulin, glucose cannot enter the cells but instead accumulates in the blood to push blood sugar way above 140 mg/dl to cause hyperglycaemia, or high blood sugar level — the hallmark of untreated diabetes. There are essentially two broad types of diabetics. In Type I, hyperglycaemia is the result of not enough insulin produced and injected insulin is needed to supplement the shortfall — hence the term insulin-dependent diabetic. However, the problem with Type II, especially the obese, is quite different. In their case, the pancreas is capable of producing sufficient insulin but the insulin produced does not function well. Sometimes, in spite of the high circulating insulin level, blood glucose is not utilized and piles up in the blood causing hyperglycaemia. Obesity is often the cause of defective insulin action in Type II diabetics, a condition referred to as insulin resistance. To worsen matter, a heavier or fatter person also needs more insulin, which in turn may burden the pancreas to cause insulin insufficiency. Thus, an obese Type II individual may suffer from both insulin resistance and insulin inadequacy. But regardless of type, obesity will definitely hasten the onset of diabetes or worsen the existing diabetic condition. On the other hand, weight reduction usually improves or reverses insulin resistance to reduce insulin requirement and bring about better blood sugar control in the majority of cases. Needless to say, for an overweight diabetic, the most effective treatment is losing surplus weight through diet and regular exercise. As weight is gradually lost, constant reassessment of medication is necessary because weight loss increases insulin sensitivity and reduces the need for insulin or pills. FOOD AND ENERGY Our body requires a certain daily supply of fuel for the work we do, much like car requiring petrol to run. Breathing quietly and sleeping require minimal energy, while manual labour like digging trenches and exercise like playing squash or tennis call for more energy. Energy is also needed for growth, development and reproduction. Food supplies us with energy through the three basic energy nutrients, carbohydrates, protein and fat. Food energy is measured In terms of kilocalories (commonly called calories) or kilojoules. Most foods contain calories, but some more than others, depending on the proportion of water, fat, carbohydrate and protein present. When digested, most of the food we eat will end up as blood glucose - our body's most important fuel. Regardless of source, excess flood calories not used immediately for energy are transformed into fat and stored in our fat cells. As such, if you eat more than you can "burn", you will put on fat weight. For example, if you are a sedentary person who sits in the office all day, comes home to a huge dinner and watches television all evening, your daily caloric expenditure is probably quite low, say about 1500 calories.