28 October 2013

An endocrinologist tells Meena Sreenivasan how to manage low blood sugar through balanced carbohydrate consumption

IF you have diabetes, the glycaemic index (GI) is one tool to note when determining your diet. People with diabetes commonly use the GI as a guide for selecting foods, especially carbohydrates.

The GI measures how quickly blood sugar levels rise after eating a particular type of food.

Although diabetes control programmes are available, there is still lack of awareness about hypoglycaemia and weight gain — the two most common barriers for diabetic patients when achieving optimum glycaemic control.

“Many people are unaware that they have diabetes until a complication develops. Diabetes complications are numerous, sometimes extremely frightening and life-threatening,” says senior consultant endocrinologist Dr Zanariah Hussein during a recent media workshop aimed at educating type-2 diabetes patients on blood sugar levels and weight gain.

“Early detection of symptoms can significantly reduce the risk of developing complication from diabetes, so, it is important to provide diabetes prevention education.”


For those with type-2 diabetes, hypoglycaemia is a common adverse effect of some oral anti-hyperglycemic agents, principally the insulin treatment. It occurs when the level of glucose in the blood drops too low for the body’s needs.

While some hypoglycaemic episodes are mild, others can be severe and costly. If left untreated, it can lead to serious medical problems including loss of consciousness, convulsions or seizures.

“GI measures how a carbohydrate-containing food raises blood glucose. Foods are ranked based on how they compare to a reference food like white bread or white rice,”

“Food with a high GI raises blood glucose more than a food with a medium or low GI,” she says.

Patients are advised to consume more foods with lower GI as it won’t stress the pancreas to produce more insulin.

Theoretically, she says, it is a difficult concept to teach patients to count carbohydrates when they consume food.

“For one thing, although some food labels give a general idea if they have lower GI, most foods are not ranked by GI. Packaged foods don’t generally list their GI ranking on the label and it can be hard to estimate what it might be. Still, the basic principles of GI may help you better manage and control your blood sugar,” says Dr Zanariah who adds that meal planning with GI involves choosing foods that have a low or medium GI.

High GI food should be combined with low GI ones to balance blood glucose levels.

“Many nutritious foods have a higher GI than foods with little nutritional value. For example, oatmeal has higher GI than chocolate,” she says.

“Other low GI foods include high-fibre foods such as dried beans, lentils, and legumes like kidney beans, non-starchy vegetables and some starchy vegetable, most fruits, whole grain breads, whole wheat bread, rye bread and all-bran cereal.”


According to the World Health Organisation, weight gain may result in insulin resistance.

So progressive weight gain in diabetics may contribute to eventual deterioration of glycaemia control over time as many diabetics are already overweight, if not obese, and are prone to obesity-related cardiovascular risks.

“One way in which we get patients to control their glucose levels is through higher consumption of fibre. For example, if you take high fibre bread, in one hour, your glucose level rises but not to the point that it stresses the system. The higher the fibre, the lesser the glucose elevation.” she says.

“As you get older, the risk of diabetes increases. We need to educate the public that if certain people have risk factors, it is advisable to be screened,” she says.

“There is a high rate of undetected diabetes which has doubled in five years. More active screening programmes need to be planned as the diabetes prevalence in Malaysia has almost doubled in the last decade, and reached the international estimates for 2030 already (which is 19 years earlier)”.


Possible benefits

  • Lowers blood sugar level.
  • Helps regulate blood sugar level throughout the day, which may reduce the risk of insulin resistance.
  • Reduces the need for diabetes medication.
  • Controls appetite and delays hunger pangs. This may help with weight management.

Potential problems

  • Focuses on single food items rather than food combinations which can impact blood sugar differently.
  • Doesn’t consider all variables that affect blood sugar, such as how food is prepared or how much is eaten.
  • Only includes foods that contain carbohydrates.
  • Doesn’t rank food based on nutrient content — food with a low GI ranking may be high in calories, sugar or saturated fat.

Source: www.mayoclinic.com


  • Ripeness and storage duration: The more ripe a fruit or vegetable, the higher the GI.
  • Processing: Juices have higher GI than whole fruit, mashed potato rather than whole baked potato have higher GI, stone ground whole wheat bread has lower GI than whole wheat bread.
  • Variety: Long-grain white rice has a lower GI than brown rice but short-grain white rice has a higher GI than brown rice.


  • Choose high-fibre foods such as whole grains, legumes, fruit and vegetables.
  • Choose fresh foods over processed foods.


There is no single diet or meal plan that works for all diabetics. The important thing is to follow a meal plan that is tailored to personal preferences and lifestyle and helps achieve goals for blood glucose, cholesterol and triglycerides levels, blood pressure, and weight management.

Research shows that both the amount and the type of carbohydrate in food affect blood glucose levels. Studies also show that the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response than the GI.

Based on research, for most people with diabetes, the first tool for managing blood glucose is some type of carbohydrate counting.

Balancing total carbohydrate intake with physical activity and diabetes pills or insulin is key to managing blood glucose levels.

Because the type of carbohydrate does have an effect on blood glucose, using GI may be helpful in fine-tuning blood glucose management.

In other words, combined with carbohydrate counting, the GI may provide an additional benefit for achieving blood glucose goals for individuals who can and want to put extra effort into monitoring their food choices.

Source: www.diabetes.org


According to the National Health and Morbidity Survey 2011, the prevalence of diabetes for those aged 30 and above has increased 40 per cent in five years, from 14.9 per cent in 2006 to 20.8 per cent in 2011, where the increase was mostly attributed to the increased proportion of “undiagnosed diabetes” (at eight per cent).

About one in five adults above 30 in our country has diabetes. In total, there are about 2.6 million diabetics in our country and 23,800 deaths due to diabetes (2010).


Some medications, says Dr Zanariah Hussein, even if you don’t eat food, won’t lower your glucose level.

“Most people fast despite being diabetic and we need to teach Muslim patients that they need well-controlled diabetes and prepare themselves before Ramadan.

Doctors will adjust their medications during fasting month. For those who are not prone to hypoglycaemia, it is quite safe to fast.”

By Meena Sreenivasan

This article was first published in www.nst.com.my on 25 June 2013.