Hydration, Balanced Diet, & Exercise: How To Manage Diabetes in the Summer

Summer is one of the seasons which can both be admiring and challenging. Enjoying a fair amount of sunshine is fun but can be unpleasant and tiring in extreme conditions.

Managing diabetes in such sweltering conditions can be hard. People with type 1 and type 2 diabetes can feel the heat more than those who don’t have diabetes.

Certain diabetes complications, such as damage to blood vessels and nerves, can affect your sweat glands so your body can’t cool as effectively. That can lead to heat exhaustion and heat stroke, which is a medical emergency.

High temperatures can change how your body uses insulin. You may need to test your blood sugar more often and adjust your insulin dose and what you eat and drink.

It is therefore crucial for people living with diabetes to take extra care and aim to manage blood sugars at optimal levels.

What To Take Care Of?

Dehydration

People with diabetes have an increased risk of dehydration as high blood glucose levels lead to decreased hydration in the body.

When blood sugars are high, the kidneys try to get rid of the excess sugars through urine, when this happens, water will also be removed from our blood and will need replenishing, this is why we tend to have increased thirst when our blood sugars run high.

Symptoms of dehydration include:

• Thirst

• Headache

• Dry mouth and dry eyes

• Dizziness

• Tiredness

• Dark yellow coloured urine

Symptoms of severe dehydration include:

• Low blood pressure

• Sunken eyes

• A weak pulse and/or rapid heartbeat

• Feeling confused

• Lethargy

So, how can dehydration be prevented?

Stay well hydrated. Extreme heat can easily dehydrate you and it is important to keep yourself well-hydrated with low-calorie/low-sugar/sugar-free fluids. Staying hydrated can also prevent you from frequent cravings as ‘hunger’ signals get mixed up with ‘thirst’ signals.

Fluids (Applicable to both diabetes and weight management)

Include Freely:

• Water - plenty

• Plain diluted butter milk – preferably without salt or a pinch and without any rice or ragi or millets added to it

• Lemon juice with little salt or sweetener

• Sugar-free squash – check labels and choose drinks that are low in sugar (low sugar = <5g of sugar in 100g of product)

• Decaf tea or coffee with low-fat milk and sweeteners or without honey or sugar

Include in Moderation:

• Tender coconut water (1 small glass - 250mls/ day) – as they contain calories and sugar

• Sugar-free fizzy drinks such as diet pepsi/ coke zero/ pepsi maxx – limit caffeine – small glass/ once a day

• Unsweetened milk as they contain calories – can be taken as a snack in moderation

• Unsweetened coffee/ tea – as they contain caffeine which can cause dehydration

• Unsweetened low-fat curd or dahi

• Sugar-free ice cream (mind the calories!)

What to avoid/restrict:

• Energy drinks like Lucozide, Monster, RedBull, Glucon D, Hell Rock, Sting, Combu, Beast etc.

• Sugary drinks – fruit juice – even natural/ fresh fruit juice as fruits naturally contain sugar

• Sugary fizzy drinks – fanta, 7’up, tango, pepsi, coke etc.,

• Milkshakes – chocolate/ fruit

• Smoothies made of fruits/ sherbet

• Ice cream/ ice lollies

• Sugar cane juice/ honey containing juice/ honey in warm/ cold water

• Energy supplements – avoid even if you are not adding sugar as these products already contain a lot of sugar, can cause blood sugar spikes and weight gain

• Millet drinks – e.g., ragi porridge/ ragi malt/ rice porridge/ ragi drink made with milk or buttermilk/ any millet drinks as they contain calories and carbohydrates. In liquid form, they could spike blood sugars rapidly and can cause weight gain.

• Alcohol – as they can cause dehydration/ cravings/ hypoglycemia and contains calories.

Recommendation <14 units per week = e.g., 6 glasses (175ml) of 13% ABV wine

Eating Healthy

• Eat plenty of vegetables for extra fibre especially those with high water content such as gourd varieties/ cucumber/ tomatoes/ spinach/ mushrooms/ Zucchini/ green leafy vegetables.

• Consider a balanced meal approach starting with ½ plate of vegetables or salad in any form; ¼ portions of lean proteins (baked/ grilled/ gravy) and last ¼ portion of carbohydrates (one small handful)

• Restrict greasy/ fatty foods e.g., fried foods/ foods containing butter/ ghee/ cream

• Cut down on takeaways/ outside meals which may contain a lot of calories in small quantities and can result in weight gain. Have them in restricted quantities once or twice a month.

• Desserts: - Limit intake of sweets/ sugar in any form (e.g., jaggery/ white or brown sugar/ palm sugar/ honey) and swap to sugar free desserts (but mind the calories!!) – take them as treats in small portions once a week.

• Try to eat at regular intervals without leaving long gaps in-between meals. This could help prevent blood sugar fluctuations and potentially restrict you from over eating in the next meal.

• Include healthy snacks – ideally 3-4hrs post meals – e.g., sprouts salad or seasoned lentil/ small portion of unsalted nuts/ fruit with a cup of low-fat milk/ cucumber or carrot sticks etc.

• Be mindful with dried fruits such as raisins/ kismis/ sultanas/ dates/ apricots/ figs coated with sugar etc. as these are concentrated source of sugar (carbohydrates) – if you would like to include – have them in small portions (30g) along with any proteins.

• Restrict or avoid yogurt bars or snack bars as these are mostly high in sugar and calories. Do not get carried away with fancy packaging/ captions or labels. 

• Check nutritional information, read labels and choose if only they are less in sugar/ saturated fat (i.e., <5g of sugar in 100g of product and/ or <3g of fat in 100g of product).

What About Fruits?

Eat mindfully as fruits are also carbohydrates and overindulgence will spike blood sugars and/ or result in weight gain.

Some fruits such as mangoes/ watermelons/ other melons/ pineapple/ jackfruits have high sugar content and could spike blood sugars rapidly, so please exercise caution and choose to take no more than one small 5” inch slice.

• Have fruits in moderation with chewable proteins such as unsalted nuts (30g) or seasoned boiled lentils.

• Avoid taking fruits or fruit juice with meals. Eat fruit as a whole without blending. Prefer them as a snack (3-4hrs post meals).

• Choose medium sized fruits that can fit on your one palm (e.g., small handful of grapes/ berries OR one medium apple or pomegranate or guava).

• Avoid tinned/ canned fruits in syrup/ fruit compote/ marmalade/ jam as they may contain preservatives and, in most cases, this is ‘sugar’.
  

  Physical Activity

  It is important to incorporate some form of physical activity/ exercise into your daily routine. 150mins of aerobic and anaerobic exercise per week is recommended. Try to think about how activity can fit in with your life, not the other way around!

  Exercise can be done in any form, whether you are choosing to go for a run or walk or swim or on spot walking or jogging while the kettle boils – it all makes a difference!

Studies have shown that structured aerobic or resistance exercises reduce HbA1c levels, on average, about 0.6 % in patients with type 2 diabetes.

Some tips to incorporate exercise into your daily routine:

Keeping Active At Home:

• On-the-spot walking during TV ad breaks 

• Stretches for your arms and legs whilst sat in a chair 

• Sweeping your home or washing your car 

• Gardening - if you have a garden. If you don’t, do you have any houseplants you can water, prune and repot while standing up

Keeping Active On The Move:

• Getting off the bus or tube one stop earlier, or parking further away from your destination 

• Taking the stairs instead of the lift or escalator 

• Using your food shopping as weights  

• Cycling 

• Walking

  Keeping Active At The Workplace

• Walking meetings, using hands-free equipment to chat whilst moving around in a safe environment   

• Standing when you’re on the phone or trying to use a standing desk 

• Chair exercises like sitting and lifting your arms up 

• Putting set break times in your work diary every day and using the time to be more active - e.g., going for a walk and getting some fresh air 

• Stretching for 5 minutes after every meeting; this can also be a great way to relieve stress

In Sam Keen’s words “Deep summer is when laziness finds respectability”; So remember, excuses don’t burn calories – Get Up and Move!!!

(Vilasini Bhaskaran is a Specialist Dietitian with NHS UK. She is also the Dietetic Lead at Practo)