Sugar aka…

Registered dietitian and diabetes nurse educator, Tammy Jardine, educates us on the many hidden names of sugar (there are over 50) and why sugar is seen as a villain.


Sugar is the new villain in the diet industry and making it even more wicked is that sugar is a master of disguise. Historically, the misconceptions about sugar in the greater health industry has revolved around white sugar, otherwise known as table sugar. 

White sugar is the end product of refining and processing of cane sugar. During this process, moisture, minerals and compounds that give them their darker colour are removed, as a result forming white refined sugar. With these nutrients removed, sugar provides energy but has no other nutritional value. Sugar is therefore often referred to as empty calories, adding no value to a healthy diet. Cancer, obesity and diabetes have been linked to white sugar consumption.

For decades, it has been advised that people with diabetes avoid sugar as it has a high glycaemic index (GI), which implies a rapid increase of blood glucose after eating.

Daily sugar limit

The Scientific Advisory Committee on Nutrition (SACN) recommends the following limit for added sugars in the diet for the general population.

Age group Maximum added sugar value per day
4 to 6 years old No more than 19g
7 to 10 years old No more than 24g
11 or over No more than 30g
People with diabetes 25g or less

For reference:4 grams of sugar is equal to a teaspoon of sugar.

The hidden names of sugar

However, just because you don’t see ‘sugar’ on the ingredient list when scanning a food label does not guarantee the item is sugar or sweetener-free. Sugar goes by a number of different names, making it easily unnoticed. Sugar has over 50 different names. While some of these names are more obvious, like brown and cane sugar, others are trickier to spot (e.g. maltodextrin and dextrose).

Most common names for sugar that you may find on an ingredient list

  • Basic Simple Sugars (monosaccharides and disaccharides) – dextrose, fructose, galactose, glucose, lactose, maltose, sucrose.
  • Solid or Granulated Sugars – beet sugar, brown sugar, cane juice crystals, cane sugar, coconut sugar, castor sugar, corn syrup solids, date sugar, demerara sugar, malt, glucose syrup, grape sugar, icing sugar, ethyl maltitol, dextrin, maltodextrin, muscovado, raw sugar, sucanat, turbinado.
  • Liquid or Syrup Sugars – agave nectar, syrup, barley malt, molasses, rice syrup, caramel, carob syrup, corn syrup, evaporated cane juice, fruit juice, golden syrup, high fructose corn syrup, honey, invert sugar, malt syrup, maple syrup, sorghum syrup, treacle.

Why is sugar added to food?

Sugars are being added to a huge range of foods from bread and hams to more obvious foods, such as cakes and biscuits. Sugar is added to foods to increase the shelf life since sugar is a preservative and it also makes foods more palatable. Most of us will be aware of more obvious sugar, such as sugary fizzy drinks, cakes and biscuits but there are also other foods which contain a lot of sugar that may not be immediately obvious.

However, it’s not just added sugar that can increase blood glucose levels. Sugar is a form of carbohydrate. Carbohydrate is one of three macronutrients found in food. Carbohydrates breakdown to glucose (sugar) through the process of digestion. We now know that all carbohydrate raises blood glucose levels.

Forms of sugar

Sugar can be found in three forms.

  • Natural – There are natural sugars found in fruit, milk-based products, honey, and vegetables.
  • Added – Also called free sugars, these are the sugars that are added to a whole range of processed foods and drinks, including microwave meals, pasta sauces, breakfast cereals, biscuits, sweetened drinks and desserts. These are the sugars listed above.
  • The product of the digestion of more complex carbohydrates – Many of us are unaware that starchy foods like bread, rice or potatoes are broken down by digestion into surprisingly large amounts of sugar. A small slice of whole-meal bread is equivalent to three teaspoons of sugar. It’s important therefore that your diet does not contain too much carbohydrate either (e.g. bread, pasta, rice).

Clarifying Total carbohydrate on nutrition label

Therefore, for somebody with diabetes, it’s the total sugar burden from any of the three sources (natural, added or as a product of the digestion of complex carbohydrate) which need considering to keep blood glucose levels low. This is identified as the total carbohydrate on a nutrition label.

Carbohydrates and sugar raise blood glucose levels quickly and require insulin to be produced (or taken by injection) as high blood glucose levels over time cause damage. Many people find that sugar has addictive qualities meaning that we may crave sugary foods even if we know they’re not good for us. Insulin causes the cells of your body to take up the free glucose in your bloodstream. So, having too much sugar means having or needing more insulin.

Nutrition label laws

By law, all packaged food and beverage nutrition labels must display the carbohydrate and sugar content per serving. The best way to ensure you’re not consuming excess added sugars is to get in the habit of always scanning the ingredient list before you throw the item in your trolley.

Keep in mind that ingredients are listed by quantity from high to low: the closer to the front of the list, the more the product contains. If you spot any of above sugar names listed on a label, keep in mind it’s not automatically a no-go. It’s the amount of sugar that counts. If the total carbohydrate count is 1-2 grams, it’s still fine to have if you’re following a low-carb lifestyle. That’s why it’s also important to always look at the total carbohydrate content.

Three different sources of sugars that make up our total dietary ‘sugar burden’

Shown as 4g teaspoon of table sugar equivalents:

Naturally occurring sugar (1) Foods with added sugar (2) Foods digested down into sugars (3)
Banana
4.9 teaspoons/100g
Coco pops
21.85 teaspoons/100g
Sasko brown bread
10 teaspoons/100g
Honey (Floaris group Organic raw)
20.6 teaspoons/100g
Coca Cola
2 teaspoons/100ml
Boiled spaghetti
3.7 teaspoons/100g
Spar low fat Milk
1.25 teaspoons/100ml
Marie biscuits
18.5 teaspoons/100g
Mc Cains Skinny fries
4.75 teaspoons/100g
Raisins
17.1 teaspoons/100g
Medium fat strawberry yoghurt
(Parmalat)3.75 teaspoons/100g
Basmati rice
6.8 teaspoons/100g
Apple juice
4.3 teaspoons/100ml
Lindt dark chocolate mint intense

12.75 teaspoons/100g

Baked potato
6.3 teaspoons/100g

When it comes to picking starchy foods, such as rice, bread and any other products made from flour, it’s best to opt for whole grain versions of these products. This is because the fibre in wholegrains impact upon blood glucose levels more slowly than the more refined forms of carbohydrate. However, portion control is still the most important as higher levels of fibre rich or unprocessed carbohydrate can still raise blood glucose levels substantially.

To identify how much total carbohydrate you can tolerate, test your blood glucose before you eat, and two hours after you eat the food. Ideally your blood glucose should not increase by more than 2mmol/L after the food is eaten.

How to cut down on sugar

The good news is that reducing sugar intake reduces the likelihood of needing medication and diabetes-related complications. Cutting back on all sources of sugar is a great strategy to stay healthy.

  • Cut down on sugary drinks – non-diet versions of cola, lemonade, tonic water.
  • Swap fruit juices for water and whole fruit.
  • Replace sugary cereals with plain porridge, whole grain cereals or lower carb breakfasts.
  • Avoid having ready meals on a regular basis.
  • Make your own pasta or curry sauce. You can make larger portions and freeze what you don’t need for a future meal.
  • Get into the practice of having fruit instead of sugary snacks or desserts.
  • Don’t have takeaways more than once a fortnight.

MEET THE EXPERT


Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: tamjdiet@gmail.com


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What’s in Shape Diet Meal Replacement Shakes?

There were many comments from our readers after we shared the article on Shape Diet Meal Replacement Shakes. We share the relevant ones with feedback by registered dietitian and diabetes nurse educator, Tammy Jardine.


The carbs in Shape is high. How can it be diabetic friendly?

Diabetes management is tricky since every person is affected differently by this disease and the amount of carbs that one person can tolerate is not the same as somebody else.

A basic rule is to have no more than 45g carbs per meal which is about equal to a meat and salad sandwich. Every person is different and to determine your individual limit it is advisable to see a dietitian who specialises in diabetes. 

I currently use a meal replacement shake with high nutrition and am happy with my choice. Must I change it?

There are many meal replacement options on the market. Always seek the advice of a qualified dietitian to ensure you are getting the best option that works for you.

Is there sucrose in Shape?

No, there is no sucrose but sucralose (an artificial sweetener).

The non-nutritive sweeteners, sucralose (in the shakes), and sugar alcohols (xylitol) are safe to use for people living with diabetes. They don’t cause a rise in blood glucose levels.

There will always be controversy about sugar substitutes since they require processing to achieve final product. The debate is not whether it’s natural (since sucrose sugar is natural), but rather about the process and the chemicals required to process the product. In studies, there is no scientific reason to avoid sugar substitutes in diabetes.

What is the carbohydrate source in Shape?

The first three ingredients listed on the label are: skim milk powder, maltodextrin, whey protein concentrate and does not include sugar at all. The carbohydrate source of this product is maltodextrin.


MEET THE EXPERT


Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: tamjdiet@gmail.com


Insulin: overdosing and underdosing

Diabetes nurse educator, Tammy Jardine, explains the various reasons for overdosing and underdosing of insulin.


There are serious consequences of insulin-related medication errors. The first is overdosing which results in severe hypoglycaemia, causing seizures, coma and even death. The second is underdosing which results in hyperglycaemia and sometimes diabetic ketoacidosis and long-term diabetes complications.

Overdosing

Giving too much insulin will result in hypoglycaemia. A hypo is when your blood glucose level is too low, usually below 4mmol/L.

Low blood glucose can occur if the insulin, the food you eat, and the physical activity you do are not balanced correctly and it can happen very quickly.

Overdosing may happen for various reasons

  • You give too much insulin for the meal that you have eaten. This is common if you give a standard dose of rapid-acting insulin with meals. Often the amount of carbohydrate in the meals you eat is not the same, and giving a standard dose of rapid insulin with all meals when you do not need it will cause your blood glucose to drop. For example, if you give a standard dose of 8 units of rapid insulin with breakfast. It may be a suitable amount when you have oats for breakfast but too much if you have an omelette instead.Also, if you overestimate the amount of carbohydrates in a meal you may overestimate the amount of insulin needed and cause a hypo if you are carb-counting.
  • Giving insulin to correct high blood glucose can also cause a hypo if you give too much insulin. This can often happen when you correct a high blood glucose after exercise. Some types of exercise can increase your blood glucose straight after performing the exercise and then drop rapidly over the next few hours as the muscles absorb the glucose from the bloodstream. It is advised to not correct high blood glucose in the six hours after exercise.
  • It may happen if you give your rapid-acting insulin instead of your basal (long-acting insulin) by mistake. Since the basal insulin is usually a higher dose than the rapid-acting insulin, it could be that you give a large amount of rapid-acting insulin which will drop your blood glucose quickly.
  • You can also overdose on insulin on a pump if your basal and bolus pump settings are incorrect.

Notice the symptoms

Everyone has different symptoms of a hypo, but the most common signs are trembling and shaking, feeling disorientated, sweating, being anxious or irritable, going pale, palpitation and a fast pulse, lips tingling, blurred vision, feeling hungry, tiredness, losing concentration, headache, and a fogginess in your head.

Sometimes you may already feel these symptoms when your blood glucose is falling quickly but are not yet below 4mmol/L. Testing your blood glucose regularly can help you to identify a hypo before you get any symptoms and prevent it from dropping too low.

If you are unable to tell when your blood glucose is low, you will only know by checking your level.

How to treat a hypo

You must act as soon as you notice symptoms of a hypo or if your blood glucose level is too low. If you don’t act quickly, it could get worse and you could start feeling confused and drowsy, and you could even become unconscious or have a fit. This is called a severe hypo.

To treat a hypo, immediately eat or drink something that has 15-20g of fast-acting carbohydrate. For example, three Super C sweets or five jelly babies or 200ml coke less sugar (new original taste) or 120ml litchi juice. Choose whatever you have on hand, or is preferable to your taste, or is easy to store.

If you are not sure how much carbohydrates are in a product, check the nutrition label on the product but be sure to look for the amount of carbs in the portion that you will be consuming. Wait 15 minutes and re-test your blood glucose. If they are not increasing at all then repeat the process.

Once you see your blood glucose rising, to prevent them from dropping again, eat 15-20g of slow-acting carbohydrate. For example, a slice of wholegrain bread with cheese or peanut butter, or a fruit and some nuts, or a glass of milk.

When help is needed

If you are feeling too confused or drowsy to eat or drink then ask someone to help you. It is important that your family, friends and colleagues know what to do if you have a severe hypo or become unconscious. If you are unconscious, they should put you on your side and call an ambulance.

Always keep hypo treatments by your bed in case you have a hypo at night. If a hypo doesn’t wake you up, you may realise that you had one if you feel very tired or have a headache the next morning.

Do a blood test before you go to sleep and during the night, If you think you may be having a hypo at night. If the one during the night is much lower, you may need to change your insulin dose. Speak to your healthcare provider about this.

Underdosing

Giving too little insulin will cause your blood glucose to rise above acceptable levels. This is called hyperglycaemia. A hyper is when your blood glucose levels are above 7mmol/L before a meal, or above 8,5mmol/L two hours after a meal.

If your blood glucose level is slightly higher than normal, you will not usually experience any symptoms but as they rise you may need to urinate more often especially at night, feel thirsty, have headaches, or feel lethargic and sleepy.

Underdosing may happen for various reasons

  • If you do not give enough insulin for the amount of food that you have eaten. Make sure you are aware of the amount of carbohydrate foods you are eating and how they affect your blood glucose after you eat them. Testing regularly will help you to identify foods that push your blood glucose up and need more insulin to prevent a hyper.
  • Not giving insulin or missing doses dose of insulin. Don’t skip insulin doses, specifically the long-acting bolus amount. You may occasionally fluctuate your rapid-acting insulin doses according to your blood glucose and what you are eating, but keep your long-acting insulin stable.
  • Your blood glucose levels could be higher than normal when you are unwell. You may need to drink more fluids, take more insulin and check your blood glucose more than you would usually. The amount of extra insulin needed will vary from person to person. Your diabetes team will help you to work out the correct dose for you.
  • Blood glucose levels may also spike because of a growth spurt or puberty, high stress period like exams, surgery or injury, and sometimes menstruation can increase blood glucose as well.

Diabetic ketoacidosis (DKA)

One of the risks of a rising blood glucose is DKA. If you blood glucose is more than 15mmol/L, you should check for ketones. If ketones are present, it is likely that you do not have enough insulin in your body.

DKA happens when there is severe lack of insulin in the body. Since glucose needs insulin to be able to make energy, this means the body can’t use glucose for energy and starts to use fat instead. When this happens, chemicals called ketones are released.

The difference between ketones when your blood glucose is high and you need more insulin, and the ketones that are produced on a (low carbohydrate diet) is the presence of excess blood glucose. Together with the ketones, the excess blood glucose will cause an acid build-up in your body, hence the name acidosis. If left unchecked, this can cause serious damage to your organs.

Warning signs

The warning signs for DKA are the same as for a hyper except that often there will be stomach pain, with or without vomiting. Sometimes there may also be a sweet smell on the breath that will smell like nail polish remover or boiled sweets.

Check your blood glucose straight away if you have any of the signs of a DKA. If your blood glucose is above 15mmol/L, check for ketones using urine sticks or a blood ketone meter. A blood test will show your ketone levels in real time but a urine test will show what they were a few hours ago.

If your blood glucose are high and you have ketones present in your blood or urine, you should get medical help straight away especially if you have abdominal pain or are vomiting. DKA is serious and must be treated in hospital quickly with insulin and fluids to prevent dehydration. Left untreated, it could lead to a life-threatening situation.

Avoiding DKA

You can avoid DKA by monitoring your blood glucose levels regularly and altering your insulin dose in response to your blood glucose levels and what you eat. Speak to your healthcare provider on how you can individualise this.

It is still a good idea to contact your GP or diabetes team if you feel fine but are getting higher than usual readings for blood glucose and ketones, or if you feel unwell but your blood glucose and ketones are only slightly higher than normal.

Besides the risk of DKA, having high blood glucose levels regularly can increase your long-term risk in developing complications, including problem with your eyes, feet, and kidneys, erectile dysfunction if you are male, and an increased risk of stroke and heart attack.

If you notice that your blood glucose levels are often high, you should contact your diabetes healthcare team. They will review your treatment and provide you with advice on how to get your blood glucose levels back within your target range.

MEET THE EXPERT


Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: tamjdiet@gmail.com


Header image by FreePik