Diabetes Type 2 is hitting the world in epidemic proportions, and New Zealand is no exception. In South Canterbury alone, 4.2 per cent of the population, or 2,200 people, have diabetes and of those, 1900 or 3.6 per cent have type 2 diabetes which is lifestyle related. Consider, too, that for every person diagnosed with diabetes, it is estimated that one other person will have it but doesn't know it. 6.5 per cent of children are obese and 19.3 are overweight. Unless that trend changes, children are expected to have a shorter life expectancy than their parents for the first time ever, and there are signs of a pending epidemic of chronic disease, including diabetes. It used to be known as "non-insulin dependent" diabetes or "late-onset" diabetes as patients were most commonly over 40 years. However, it is now being diagnosed at increasingly younger ages. In Queensland, 80 cases have even been reported of children under 18 years and, over the next decade, another 8,000 are at risk. Its causes may be genetic, or age- or lifestyle-related. It may follow a period of hypoglycaemia or insulin resistance before turning into insulin deficiency, and it almost certainly relates to inappropriate diet, lack of specific nutrients, and lack of physical activity. 90 per cent of diabetes diagnosed is Type 2; the remaining 10 per cent representing Type 1.

Type 1 diabetes, which is also known as insulin-dependent diabetes mellitus (Type 1) is traditionally diagnosed under the age of 35, with average age of onset approximately 12 years. It is a chronic disease in which the pancreatic beta cells, which produce insulin, are destroyed and is considered to be an auto-immune (self-attacking) disease. It may be due to genetics, environmental damage or damage to the pancreas, resulting in the body's capacity to utilize glucose, fat and protein being disturbed due to insulin deficiency.

Both types of diabetes are projected to double over the next decade.

Risk factors for developing Type 2 include:

• Age - people over 50 years may be more susceptible
• Genes - having a first degree relative with Type 2
• Obesity - 4 times more likely to develop Type 2 if overweight
• Medication - corticosteroids and atypical anti-psychotic drugs (clozapine, Olanzapine). 50% of patients taking clozapine for 10 years will develop metabolic syndrome (insulin resistance, cardiovascular disease, high cholesterol)
• Depression - emerging date suggests depression may be an independent risk for diabetes due to poor food choices and reduced activity.
• High blood pressure (over 130/85)
• High "bad" cholesterol (LDL) and triglycerides.
• Low "good" cholesterol (HDL)
• Inactivity - those who do less than 150 minutes' exercise per week are twice as likely to develop diabetes
• 50% of women who experience gestational diabetes will develop Type 2 within 10 years
• Polycystic Ovarian syndrome
• High risk following the birth of a baby larger than 4kg (8lbs 8 oz)
• Excessive alcohol intake
• Ethnic background

Recent research also suggests that Vitamin D is involved in the stimulation of insulin secretion and in to-days climate of covering ourselves in sunscreen, it is easy to become deficient. Although the body can make Vitamin D itself, skin exposure to ultraviolet light is required in order to convert it to the active form. Dark-skinned people require 5-10 times greater sun exposure to manufacture adequate amounts of Vitamin D due to skin pigmentation acting as a natural sun block. Textbook symptoms of undiagnosed Type 2 include lethargy, frequent urination, thirst and pins and needles in the feet.

Traditionally, around three months of diet and physical activity are recommended, but if the initial target is not achieved then medication such as Metformin or the sulphonylureas are prescribed. These are designed to lower glucose absorption from the gut, improve the effects of insulin at receptor sites and stimulate insulin release from beta cells. They do, however, all potentially have side effects.

The good news is that Type 2 can be prevented or even reversed simply by adopting a lifestyle that keeps blood glucose and insulin levels within a healthy range. Although activity plays a major role, you don't have to rush out and join a gym or jogging club. Where practicable try to walk part of the way instead of driving; run up the stairs instead of taking the lift; take up swimming or cycling; garden; put a bit of extra energy into the household chores or dance to your favourite music.

Stress, too, plays a part in the development of diabetes, so try and find a few ways to relax on a regular basis. For some, that might mean yoga, tai chi or meditation, for others a massage or relaxing bath with some candles and aromatherapy oils (lavender, bergamot, rose, sandalwood, neroli) - or a walk in the bush or along the beach.

The saying "Let your food be your medicine, your medicine your food" (Hippocrates) is as true to-day as it ever was. Blood glucose balancing meals are not boring. As with hypoglycaemia and insulin resistance, foods should be as unrefined as possible, low on the Glycaemic Index of foods, thereby making less demand on insulin. Make sure you have at least five servings of vegetables per day, plus 2-3 of fresh fruit. Divide your dinner plate into four quarters: two of those should be filled with non-starchy vegetables; one with high quality protein such as fish, chicken, lean meat, eggs, beans and other pulses; and the fourth with a carbohydrate such as rice, quinoa, pasta, potato with its skin. Where possible, eat whole grains in the form of wholemeal bread and brown rice. Have a range of healthy snacks to hand - particularly nuts, seeds, fresh fruit, oat cakes or rice cakes with hummus or peanut butter. Pre-prepared vegetable sticks and a low-fat dip are great. If you can learn to love the chocolate which contains 70% cocoa solids, researchers have shown that the proanthocyanidins it contains might be beneficial in preventing high blood glucose levels. I would, however, suspect that moderation is the keyword here! It would also appear from reports that the sweetening agents Stevia and Xylitol. may actually help to keep blood glucose levels down.

Cut down on fats, but not the good, Omega 3 variety obtained from oily fish such as salmon, sardines, pilchards and tuna. If you're vegetarian, these can be obtained from flax seeds (linseeds) and pumpkin seeds. Olive oil, which is a monounsaturated oil, also helps to protect against diabetes and prediabetes.

Go easy on coffee and alcohol, which push up blood glucose levels. Tea - and particularly green tea - are healthier choices. And of course, plenty of water throughout the day. If you have fruit juice, dilute 50/50 with water and just have one small glass.

Two excellent websites will give you plenty of good ideas for healthy eating: www.glycemicindex.com and www.diabetes.org.nz who have recently published a very useful "Healthy Food Choices" pamphlet - a far cry from the old carbohydrate loading which was the vogue when I first started to practise.

One of the main constituents of the Glucose Tolerance Factor is chromium which is a key nutrient in reducing or reversing diabetes. This non-toxic mineral is essential for insulin regulation and glucose control. Although found in many foods such as meat, nuts, egg yolk, whole cereal grains and legumes, the absorption from these foods is less than 2 per cent. On top of this, consumption of a diet containing highly refined foods (already low in chromium) has been shown to increase chromium loss, which means that the majority of people will have less than optimum levels. There are no standard tests for this, but it can be checked with a hair mineral analysis that can be organized through a nutritionist or naturopath.

Cinnamon has also been found to contain an ingredient which mimics the action of insulin, and therefore increases glucose metabolism (we're talking about half a teaspoon per day here) in Type 2 diabetics. Because both chromium and cinnamon can reduce blood sugar levels, I would stress again that their use in combination with Metformin or any other blood sugar-lowering medication should be supervised by a doctor in order to avoid abnormally low blood sugar levels.

So, the answer seems to be to base your diet on foods which demand the least insulin and to take pleasure in your food. Try not to think of its preparation as a chore - more of a health-enhancing activity. Buy the best you can and look for new recipes which are quick and easy to prepare. Find a form of exercise which you can enjoy and look forward to, and take a long, hard look at your stress levels and what you might do to lower them.