The truth about carbs

"Carbs" are a hotly-debated topic, especially in the weight loss world, due in no small part to the popularity of low-carb diets such as the Atkins, Dukan and South Beach.

The "carbs are bad" mantra from Dr Atkins and co. has left many people confused about carbohydrates and their importance for our health, including maintaining a healthy weight.

Dietitian Sian Porter says: "Carbohydrates are such a broad category and people need to know that not all carbs are the same and it is the type, quality and quantity of carbohydrate in our diet that is important.

"While we should reduce the amount of sugar in our diet, particularly added sugars, we should base our meals on starchy carbs, particularly the less processed wholegrain varieties.

"There is strong evidence that fibre, found in wholegrain versions of starchy carbs for example, is good for our health.”

On this page you can find out all you need to know about carbohydrates, their health benefits, healthier sources of carbohydrates and how they can help you lose weight.

Many people don't get enough fibre.

We are advised to eat about 18g a day.

What are carbs?

Carbohydrates are one of three macronutrients (nutrients that form a large part of our diet) found in food – the others being fat and protein. Hardly any foods contain only one nutrient and most are a combination of carbohydrates, fats and proteins in varying amounts. There are three different types of carbohydrates found in food: sugar, starch and fibre.

• Sugar is found naturally in some foods, including fruit, honey, fruit juices, milk (lactose) and vegetables. Other forms of sugar (for example table sugar) can be added to food and drink such as sweets, chocolates, biscuits and soft drinks during manufacture, or added when cooking or baking at home. Find out more about sugar.
• Starch, made up of many sugar units bonded together, is found in foods that come from plants. Starchy foods, such as bread, rice, potatoes and pasta, provide a slow and steady release of energy throughout the day. Find out more about starchy foods.
• Fibre is the name given to the diverse range of compounds found in the cell walls of foods that come from plants. Good sources of fibre include vegetables with skins on, wholegrain bread, wholewheat pasta and pulses (beans and lentils). Find out more about fibre.

Why do we need carbs?

Carbohydrates are important to your health for a number of reasons.

Energy
Carbohydrates should be the body's main source of energy in a healthy balanced diet, providing about 4kcal (17kJ) per gram. They are broken down into glucose (sugar) before being absorbed into the bloodstream. From there, the glucose enters the body's cells with the help of insulin. Glucose is used by your body for energy, fuelling all of your activities, whether going for a run or simply breathing.

Unused glucose can be converted to glycogen found in the liver and muscles. If more glucose is consumed than can be stored as glycogen, it is converted to fat, for long-term storage of energy. High fibre, starchy carbohydrates release sugar into the blood more slowly than sugary foods and drinks.

Disease risk
Vegetables, pulses, wholegrain varieties of starchy foods, and potatoes eaten with their skins on are good sources of fibre. Fibre is an important part of a healthy balanced diet. It can promote good bowel health, reduce the risk of constipation, and some forms of fibre have been shown to reduce cholesterol levels.

Research shows diets high in fibre are associated with a lower risk of cardiovascular disease, type 2 diabetes and bowel cancer. Many people don't get enough fibre. On average, most people in the UK get about 18g of fibre a day. We are advised to eat an average of 30g a day.

Calorie intake
Carbohydrate contains fewer calories gram for gram than fat, and starchy foods can be a good source of fibre, which means they can be a useful part of a weight loss plan. By replacing fatty, sugary foods and drinks with high-fibre starchy foods, it is more likely you will reduce the number of calories in your diet.

Also, high fibre foods add bulk to your meal helping you feel full. "You still need to watch your portion sizes to avoid overeating," says Sian. "Also watch the amount of fat you add when cooking and serving them: this is what increases the calorie content."

Should I cut out carbohydrates?

While we can most certainly survive without sugar, it would be quite difficult to eliminate carbohydrates entirely from your diet. Carbohydrates are the body's main source of energy. In their absence, your body will use protein and fat for energy.

It may also be hard to get enough fibre, which is important for a healthy digestive system and to prevent constipation. Healthy sources of carbohydrates such as starchy foods, vegetables, fruits, legumes and lower fat dairy products are also an important source of nutrients such as calcium, iron and B vitamins.

Cutting out carbohydrates from your diet could put you at increased risk of a deficiency in certain nutrients, leading to health problems, unless you're able to make up for the nutritional shortfall with healthy substitutes.

Replacing carbohydrates with fats and higher fat sources of protein could increase your intake of saturated fat, which can raise the amount of cholesterol in your blood – a risk factor for heart disease.

When you are low on glucose, the body breaks down stored fat to convert it into energy. This process causes a build-up of ketones in the blood, resulting in ketosis. Ketosis as a result of a low carbohydrate diet can be linked, at least in the short term, to headaches, weakness, nausea, dehydration, dizziness and irritability.

Try to limit the amount of sugary foods you eat and instead include healthier sources of carbohydrate in your diet such as wholegrains, potatoes, vegetables, fruits, legumes and lower fat dairy products. Read the British Dietetic Association's review of low-carb diets, including the paleo, Dukan, Atkins, and South Beach diets.

Don't protein and fat provide energy?

While carbohydrates, fat and protein are all sources of energy in the diet, the amount of energy that each one provides varies:

• carbohydrate provides: about 4kcal (17kJ) per gram
• protein provides: 4kcal (17kJ) per gram
• fat provides: 9kcal (37kJ) per gram

In the absence of carbohydrates in the diet your body will convert protein (or other non-carbohydrate substances) into glucose, so it's not just carbohydrates that can raise your blood sugar and insulin levels.

If you consume more calories than you burn from whatever source, you will gain weight. So cutting out carbohydrates or fat does not necessarily mean cutting out calories if you are replacing them with other foods containing the same amount of calories.

Are carbohydrates more filling than protein?

Carbohydrates and protein contain roughly the same number of calories per gram but other factors influence the sensation of feeling full such as the type and variety of food eaten, eating behaviour and environmental factors, such as portion size and availability of food choices.

The sensation of feeling full can also vary from person to person. Among other things, protein-rich foods can help you feel full and we should have some beans, pulses, fish, eggs, meat and other protein foods as part of a healthy balanced diet. But we shouldn't eat too much of these foods. Remember that starchy foods should make up about a third of the food we eat and we all need to eat more fruit and vegetables.

How much carbohydrate should I eat?

The Government's healthy eating advice, illustrated by the Eatwell Guide, recommends that just over a third of your diet should be made up of starchy foods, such as potatoes, bread, rice and pasta, and another third should be fruit and vegetables. This means that over half of your daily calorie intake should come from starchy foods, fruit and vegetables.

What carbohydrates should I be eating?

Data from the National Diet and Nutrition Survey, which looks at food consumption in the UK, shows that most of us should also be eating more fibre and starchy foods and fewer sweets, chocolates, biscuits, pastries, cakes and soft drinks with added sugar. These are usually high in sugar and calories, which can increase the risk of tooth decay and contribute to weight gain if you eat them too often, while providing few other nutrients.

Fruit, vegetables, pulses and starchy foods (especially wholegrain varieties) provide a wider range of nutrients (such as vitamins and minerals) which can benefit our health. The fibre in these foods can help to keep your bowels healthy and adds bulk to your meal, helping you to feel full.

Sian says: "Cutting out a whole food group (such as starchy foods) as some diets recommend could put your health at risk because as well as cutting out the body's main source of energy you'd be cutting back essential nutrients like B vitamins, zinc and iron from your diet."

How can I increase my fibre intake?

To increase the amount of fibre in your diet, aim for at least five portions of a variety of fruit and veg a day, go for wholegrain varieties of starchy foods and eat potatoes with skins on. Try to aim for an average intake of 30g of fibre a day.

Here are some examples of the typical fibre content in some common foods:

• two breakfast wheat biscuits (approx. 37.5g) – 3.6g of fibre
• one slice of wholemeal bread – 2.5g (one slice of white bread – 0.9g)
• 80g of uncooked wholewheat pasta – 7.6g
• one medium (180g) baked potato (with skin) – 4.7g
• 80g (4 heaped tablespoons) of cooked runner beans – 1.6g
• 80g (3 heaped tablespoons) of cooked carrots – 2.2g
• 1 small cob (3 heaped tablespoons) of sweetcorn – 2.2g
• 200g of baked beans – 9.8g
• 1 medium orange – 1.9g
• 1 medium banana – 1.4g

Can eating low GI (glycaemic index) foods help me lose weight?

The glycaemic index (GI) is a rating system for foods containing carbohydrates. It shows how quickly each food affects glucose (sugar) levels in your blood, when that food is eaten on its own. Some low GI foods, such as wholegrain foods, fruit, vegetables, beans and lentils are foods we should eat as part of a healthy balanced diet. However, using GI to decide whether foods or a combination of foods are healthy or can help with weight reduction can be misleading.

Although low GI foods cause blood sugar levels to rise and fall slowly, and which may help you to feel fuller for longer, not all low GI foods are healthy. For example, watermelon and parsnips are high GI foods, while chocolate cake has a lower GI value. Also, the cooking method and eating foods in combination as part of a meal, will change the GI rating. Therefore, GI alone is not a reliable way of deciding whether foods or combinations of foods are healthy or will help you to lose weight.

Find out more about the glycaemic index (GI).

Do carbohydrates make you fat?

Any food can be fattening if you overeat. Whether your diet is high in fat or high in carbohydrates, if you frequently consume more energy than your body uses you are likely to put on weight. In fact, gram for gram, carbohydrate contains fewer than half the calories of fat and wholegrain varieties of starchy foods are good sources of fibre. Foods high in fibre add bulk to your meal and help you to feel full.

However, foods high in sugar are often high in calories and eating these foods too often can contribute to you becoming overweight. There is some evidence that diets high in sugar are associated with an increased energy content of the diet overall, which over time can lead to weight gain.

"When people cut out carbs and lose weight, it's not just carbs they're cutting out, they're cutting out the high-calorie ingredients mixed in or eaten with it, such as butter, cheese, cream, sugar and oil," says Sian. "Eating too many calories – whether they are carbs, protein or fat – will contribute to weight gain."

Can cutting out wheat help me lose weight?

Some people point to bread and other wheat-based foods as the main culprit for their weight gain. Wheat is found in a wide range of foods, from bread, pasta and pizza, to cereals and many other foods. However, there is no evidence that wheat is more likely to cause weight gain than any other food.

Unless you have a diagnosed health condition such as wheat allergy, wheat sensitivity or coeliac disease, there is little evidence that cutting out wheat and other grains from your diet would benefit your health. Grains, especially wholegrains, are an important part of a healthy balanced diet. Wholegrain, wholemeal and brown breads give us energy and contain B vitamins, vitamin E, fibre and a wide range of minerals.

White bread also contains a range of vitamins and minerals, but it has less fibre than wholegrain, wholemeal or brown breads. If you prefer white bread, look for higher-fibre options. Grains are also naturally low in fat.

Find out if cutting out bread could help ease bloating or other digestive symptoms.

Should people with diabetes avoid carbs?

Diabetes UK recommends that people with diabetes should try to eat a healthy balanced diet, as depicted in the Eatwell Guide, and to include starchy foods at every meal. Steer clear of cutting out entire food groups. It is recommended that everyone with diabetes sees a registered dietitian for specific advice on their food choices. Your GP can refer you to a registered dietitian.

Diabetes UK says there is some evidence which suggests that low-carb diets can lead to weight loss and improvements in blood glucose control in people with type 2 diabetes in the short term. However, it is unclear whether the diet is a safe and effective way to manage type 2 diabetes in the long term.

Weight loss from a low-carb diet may be because of a reduced intake of calories overall and not specifically as a result of eating less carbohydrate. There is also not enough evidence to support the use of low-carb diets in people with type 1 diabetes.

Douglas Twenefour, Diabetes UK clinical adviser, says: "When considering a low-carbohydrate diet as an option, people with diabetes should be made aware of possible side effects such as the risk of hypoglycaemia (low blood sugar). We also advise that people with diabetes discuss the amount of carbohydrate to be restricted with their healthcare team.

"The best way to manage diabetes is by taking prescribed medications and by maintaining a healthy lifestyle that includes plenty of physical activity and a balanced diet that is low in saturated fat, salt and sugar and rich in fruit and vegetables, without completely cutting out any particular food groups."

Read Diabetes UK's review of the evidence on low-carb diets and their conclusions.

What's the role of carbohydrates in exercise?

Carbohydrates, fat and protein all provide energy, but exercising muscles rely on carbohydrates as their main source of fuel. However, muscles have limited carbohydrates stores (glycogen) and they need to be topped up regularly to keep your energy up. A diet low in carbohydrates can lead to a lack of energy during exercise, early fatigue and delayed recovery.

When is the best time to eat carbohydrates?

When you should eat carbohydrates particularly for weight loss is the subject of much debate, but there's little scientific evidence that one time is better than any other. It is recommended that you base all your meals around starchy carbohydrate foods, try and choose higher-fibre, wholegrain varieties when you can.

10 medical reasons for feeling tired

Any serious illness, especially painful ones, can make you tired. But some quite minor illnesses can also leave you feeling washed out. Here are 10 health conditions known to cause fatigue.

Sick or tired?

If you’re getting your eight hours of sleep a night but still feel exhausted, it’s time to see a doctor.

It’s also worth seeking medical advice if you have any of these symptoms:

• confusion
• dizziness
• blurred vision
• unexplained weight loss or gain
• swelling
• constipation
• insomnia
• depression
• headaches

1. Coeliac disease

This is a type of food intolerance, where your body reacts badly when you eat gluten – a substance found in bread, cakes and cereals.

One in 100 people in the UK are affected, but research suggests up to 90% of them don't know they have the condition, according to patient group Coeliac UK.

Other symptoms of coeliac disease, apart from tiredness, are diarrhoea, anaemia and weight loss. Your GP can check if you have coeliac disease through a blood test.

Read more about coeliac disease.

2. Anaemia

One of the most common medical reasons for feeling constantly run down is iron deficiency anaemia. It affects around 1 in 20 men and postmenopausal women, but may be even more common in women who are still having periods.

Typically, you'll feel you can't be bothered to do anything, your muscles will feel heavy, and you'll get tired very quickly.

Women with heavy periods and pregnant women are especially prone to anaemia.

Read more about iron deficiency anaemia.

3. Chronic fatigue syndrome

Chronic fatigue syndrome (myalgic encephalomyelitis, or ME) is a severe and disabling tiredness that goes on for at least six months. There are usually other symptoms, such as a sore throat, muscle or joint pain, and headache.

Read more about chronic fatigue syndrome.

4. Sleep apnoea

Sleep apnoea is a condition where your throat narrows or closes during sleep and repeatedly interrupts your breathing.

This results in bad snoring and a drop in your blood's oxygen levels. The difficulty in breathing means you wake up often in the night and feel exhausted the next day.

It's most common in overweight middle-aged men. Drinking alcohol and smoking makes it worse.

Read more about sleep apnoea.

5. Underactive thyroid

An underactive thyroid gland means you have too little thyroid hormone (thyroxine) in your body. This makes you feel tired.

You're also likely to put on weight and have aching muscles. It's most common in women and happens more often as you get older.

Your GP can diagnose an underactive thyroid by taking a blood test.

Read more about having an underactive thyroid.

6. Diabetes

One of the main symptoms of diabetes, a long-term condition caused by too much sugar in the blood, is feeling very tired. The other key symptoms are feeling very thirsty, going to the toilet a lot, and weight loss. Your GP can diagnose diabetes with a blood test.

Read more about diabetes and find out how to make smart sugar swaps.

Find your local diabetes support services.

7. Glandular fever

Glandular fever is a common viral infection that causes fatigue, along with fever, sore throat and swollen glands.

Most cases happen in teenagers and young adults. Symptoms usually clear up within four to six weeks, but the fatigue can linger for several more months.

Read more about glandular fever.

8. Depression

As well as making you feel very sad, depression can also make you feel drained of energy. It can stop you falling asleep or cause you to wake up early in the morning, which makes you feel more tired during the day.

Read more about depression.

Find your local depression support services and your local depression self-help groups.

9. Restless legs

This is when you get uncomfortable sensations in your legs, which keep you awake at night.

You might have an overwhelming urge to keep moving your legs, a deep ache in your legs, or your legs might jerk spontaneously through the night.

Whatever your symptoms, your sleep will be disrupted and of poor quality, so you'll feel very tired throughout the day.

Read more about restless legs.

10. Anxiety

Feeling anxious is sometimes perfectly normal. But some people have constant uncontrollable feelings of anxiety, which are so strong they affect their daily life.

Doctors call this generalised anxiety disorder (GAD). It affects around 1 in 20 people in the UK. As well as feeling worried and irritable, people with GAD often feel tired.

Read more about anxiety.

Find your local anxiety support services.

10 surefire ways to ease pain

Whether your pain has just come on or you’ve lived with it for years, these tried-and-tested self-help steps can bring you relief.

Where does it hurt?

• Head
• Sinuses
• Ear (children)
• Tongue
• Teeth
• Neck
• Shoulder
• Arm
• Chest
• Breast
• Back
• Stomach
• Pelvis
• Bottom
• Knee
• Heel

Get some gentle exercise

Simple, everyday activity like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain.

Activity also helps lessen pain by stretching stiff and tense muscles, ligaments and joints.

It's natural to be hesitant if exercise is painful and you’re worried about doing more damage. But if you become more active gradually, it's unlikely you will cause any damage or harm. The pain you feel when you start gentle exercise is because the muscles and joints are getting fitter.

In the long term, the benefits of exercise far outweigh any increase in pain.

Read our articles on getting exercise.

Breathe right to ease pain

Concentrating on your breathing when you’re in pain can help.

When the pain is intense it's very easy to start taking shallow, rapid breaths which can make you feel dizzy, anxious or panicked. Instead, breathe slowly and deeply. This will help you to feel more in control of the situation and will keep you relaxed and prevent any muscle tension or anxiety from worsening your pain.

Read books and leaflets on pain

The Pain Toolkit is a free NHS-endorsed booklet packed with simple practical advice on how to live better with long-term pain. Download the booklet (PDF).

There is also a list of suggested self-help books and leaflets on The British Pain Society's website.

Counselling can help with pain

Pain can make you tired, anxious, depressed and grumpy. This can make the pain even worse, making you fall into a downward spiral. Be kinder to yourself. Living with pain isn't easy and you can be your own worst enemy by being stubborn, not pacing your activities every day and not accepting your limitations.

Some people find it useful to seek help from a counsellor, psychologist or hypnotherapist to discover how to deal with their emotions in relation to their pain. Ask your GP for advice and a referral, or read this article on getting access to counselling.

Distract yourself

Shift your attention on to something else so the pain isn't the only thing on your mind. Get stuck into an activity that you enjoy or find stimulating. Many hobbies, like photography, sewing or knitting, are possible even when your mobility is restricted.

Share your story about pain

It can help to talk to someone else who has experienced similar pain themselves and understands what you’re going through.

Pain Concern, Action on Pain, Arthritis Care and BackCare all have telephone helplines manned by people with long-term pain, who can put you in touch with local patient support groups.

The healthtalk.org and youthhealthtalk websites let you watch or listen to videos of other people's experiences of pain.

The sleep cure for pain

"Many people with chronic pain dread going to bed as that's when the pain is worst," says Heather Wallace from Pain Concern. But it's important to try to stick to a normal sleep routine so you've got the best chance of sleeping through the night.

Also, "sleep deprivation can worsen pain", says Heather. Go to bed at the same time each evening, and get up at a regular time in the morning and avoid taking naps in the day. If sleep problems persist, see your GP.

Read 10 tips to get a good night's sleep.

The Pain Concern website has produced a useful leaflet on getting a good night's sleep

Take a course

Self management courses are free NHS-based training programmes for people who live with long-term chronic conditions such as arthritis and diabetes to develop new skills to manage their condition (and any related pain) better on a day-to-day basis.

Many people who have been on a self-management course say they take fewer painkillers afterwards.

The best examples are:

• Pain Management Programmes
• Expert Patients Programmes, which are run by local NHS organisations.
• Pain Toolkit workshops

Keep in touch with friends and family

Don't let pain mean that you lose contact with people.

Keeping in touch with friends and family is good for your health and can help you feel much better. Try shorter visits, maybe more often, and if you can't get out to visit people, phone a friend, invite a family member round for a coffee or have a chat with your neighbour.

Aim to talk about anything other than your pain, even if other people want to talk about it.

Relax to beat pain

Practising relaxation techniques regularly can help to reduce persistent pain.

There are many types of relaxation techniques, varying from breathing exercises to types of meditation.

Ask your GP for advice in the first instance. There may be classes available locally or at your local hospital's pain clinic.

Read about the top 10 stressbusters.

Long-term health conditions at school

If your child has a long-term health condition, such as asthma or diabetes, talk to their school about how their condition will be managed during the school day.

Watch a video about children with diabetes

There are more than a million children in the UK who have a long-term, or even lifelong, illness and need medicines for the forseeable future.

Children with medical needs have the same rights of admission to schools as other children.

Schools are legally obliged to ensure that all children with health needs are properly supported in school and have full access to education, including school trips and PE.

Schools, local authorities, health professionals and other support services are advised to work together to ensure that children with medical conditions receive a full education.

Common long-term health conditions in schoolchildren

Common long-term conditions that mainstream schools can manage include diabetes, asthma, epilepsy and allergies.

If your child has a long-term health condition, your school must ensure that arrangements are in place to support them.

The school may draw up an individual healthcare plan to help staff identify any necessary safety measures. This will help to protect your child and ensure that others aren't put at risk. As a parent, you and your child should be fully involved with and contribute as much as possible to the individual health plan.

How to talk to the school about your child's health condition

If your child has recently been diagnosed with a long-term condition, or you have a child with a long-term condition who is about to start school, contact your child's school to discuss how it will be managed.

Talk to your child’s GP or hospital specialist about the information you’ll need to give the school. They can also give you advice on the arrangements that the school may have to make, such as keeping medicines on site or helping to administer medicines. The information you give the school should include:

• details of medicines your child needs to take and when they're needed
• any side effects of the medicines
• what constitutes an emergency
• what to do, and not to do, in an emergency
• special requirements, such as dietary needs, and measures that must be taken before your child is physically active
• whether your child will need to be absent from school regularly to meet medical appointments.

Discuss with your GP or consultant how your child’s condition should be managed during the school day. For example, it may be possible to prescribe medicine for your child that can be taken before and after school, instead of in the middle of the day. It will probably be easier if your child’s condition can be managed effectively with minimal involvement from the school.

What to expect from the school

Your child’s school should have a medical conditions policy setting out how it supports children with long-term conditions. This policy will usually be published on the school's website. If it isn't, ask the school for a copy.

This policy will cover the following:

• How medicines will be managed and administered during the school day. Any member of staff administering medicines should be fully trained.
• How medicines will be managed and administered during school outings.
• Who the school will contact if there's an emergency.
• How the school will meet special needs, such as diet.
• How the school will help your child to participate in physical activity and school trips, if needed.
• The school should be able to agree with you on how it will manage your child’s condition during the school day.

Read our information on learning difficulties.

'How diabetes affects my daily life'

Brian Hunte was born in Trinidad and now lives in London. He was diagnosed with diabetes around 34 years ago, when he was 43. He talks about living with the condition.

Watch a video on diabetes

"When I was diagnosed with diabetes, it was a surprise. I didn't feel unwell, but I had been losing weight and felt thirsty all the time.

"I was drinking lots of water and going to the loo more often. I had to get up twice in the night to urinate, which wasn't normal for me."

Seeing the doctor

"When I described my symptoms to the GP, he said it sounded like diabetes symptoms. Blood tests confirmed I had type 1, which usually develops earlier than 43, but can develop in older people.

"I was worried because I didn't know anything about diabetes. I didn't like the idea of giving myself injections.

"At first, I was given tablets to stimulate the pancreas to produce insulin. I also had to change my diet.

"I needed to avoid sugar, so I gave up cakes, chocolates, sweets, and sugar in my tea and coffee. It wasn't as difficult as I'd expected, but I confess I still eat cakes every now and then."

'When your blood sugar levels get too high, you start feeling tired and unable to deal with problems so well. You feel groggy' Brian Hunte

Fried and sugary food

"The doctors also recommended a healthy diet with no fatty foods, so no chips or anything else fried. I loved sausages, eggs, bacon and black pudding, but it wasn't too hard to give them up.

"I ate more fibre and fruit (but fruit is sugary, so I don't have more than three portions a day), steamed or boiled vegetables and grilled meat. It was a normal diet, really. I could go to a restaurant with friends and order from the menu easily.

"I never ate too much Trinidadian food because my wife is Irish. Growing up with three sisters in Trinidad meant I was never allowed in the kitchen. It was only when I emigrated to Dublin in 1959 that I learned to cook for myself.

"I taught my wife some Trinidadian dishes, including pot-roasted beef. You put oil and sugar in a pot, caramelise the sugar, then add the meat so it gets a nice distinctive flavour and colour. I should stop eating it, but still have it once in a while.

"I'm a bit freer with my diet now, having attended an excellent dose adjustment for normal eating (DAFNE) course at hospital. This taught me how to work out exactly how much insulin to take depending on what I eat."

Insulin injections

"After a year of managing my diabetes with tablets and a healthy diet, I had to start insulin injections. My glucose levels were rising, and I felt lethargic.

"When your blood sugar levels get too high, you feel tired and can't deal with problems so well. You feel groggy.

"When the doctor told me I had to start injections, he stuck a syringe into his own stomach to show me it wasn't that bad.

"The needles are so good that you don't feel anything. I inject into my stomach before every meal, then in the morning I inject a long-lasting insulin that releases slowly over the next 14 hours."

Blood sugar levels

"I also have to test my blood sugar levels before every meal with a finger-prick kit so I know how much insulin I need.

"These days, I don't always test before each meal because I can guess my blood sugar by how I feel. But I do at least two tests a day.

"When you've taken your insulin, you need to eat soon afterwards. I forgot once, when some guests arrived unexpectedly.

"I put some chairs out in the garden, forgetting I'd just taken my insulin. Next thing, I collapsed on to the kitchen floor, so my wife called an ambulance.

"I was taken to hospital and stayed there until night time. My blood sugar levels had fallen too low. I was OK in the end.

"If your blood sugar levels become dangerously low, you can have a hypoglycaemic attack and there's a risk that you may fall into a coma. This can be fatal.

"I've lived on my own since my wife died with frontal lobe dementia in 2009. I phone a safety confirmation company twice a day to let them know I'm still in the land of the living.

"If they don't hear from me, they check with a friend and a neighbour, and can then take further steps if necessary."

Eye problems

"As well as a healthy diet, doctors recommend exercise and watching my weight. They say 30 minutes of exercise a day, such as walking, is good. I don't take exercise, but I should. I've put on a little weight recently, and I see a dietitian.

"Because of the diabetes, I've had problems with my eyes. I've had laser surgery on the retina in both of them because of diabetic retinopathy [damage to tiny blood vessels in the eye].

"I go for regular eye checks – I see my optician once a year, and attend an eye clinic at hospital once a year.

"I visit the hospital every six months for routine diabetes check-ups, including blood tests and to check my feet for neuropathy." Neuropathy is damage to the nerves, which can happen when you have diabetes.

Diabetes, driving and holidays

"The DVLA require me to renew my driving license every three years, but I believe I would have to do that anyway now I'm in my 77th year.

"The other way diabetes has affected my life is that I have to be careful when I'm on holiday. I have to carry all my medication as hand luggage, so I bring a letter from my doctor explaining that I'm diabetic and need to carry insulin syringes.

"I can visit my GP if I want to ask questions about my health, but I don't go often. I can manage the diabetes very easily."

Diabetes in children: what to expect

If your child is diagnosed with diabetes, you may feel overwhelmed, angry and worried about the future. A diabetes care team can help with the challenges that lie ahead.

Most children who develop diabetes will have type 1 diabetes, which is where the body is unable to produce insulin. This means they will need regular insulin injections.

A small but increasing number of children in the UK are being diagnosed with type 2 diabetes, which can be associated with being overweight.

Type 1 diabetes, which this page focuses on, is not caused by being overweight.

It's perfectly normal to feel upset or worried when your child is diagnosed with diabetes. But having the condition doesn't have to take away your child's freedom, or end your usual family life.

What it does mean is that you have to carefully manage your child's condition as part of daily life.

Professor Peter Hindmarsh of the University College Hospital in London explains what you should expect if your child is diagnosed with type 1 diabetes.

The first few days

You and your child should be introduced to a specialist diabetes care team within one working day of diagnosis.

Your child will be offered care from this team, either as a hospital in-patient, or delivered in your own home. This will depend on your preferences and your child's needs.

If your child is admitted to hospital, there should be facilities for you to stay at the hospital too.

"The first few days with your care team is the starting point of your education about diabetes," says Professor Hindmarsh.

"You'll learn all about the condition, from blood glucose testing and giving insulin to your child, to food and exercise."

Your care team can include, among others:

• a consultant paediatrician who specialises in diabetes
• a children's diabetes specialist nurse
• a dietitian who is familiar with the needs of children
• a psychologist with a speciality in children

"Our aim is to get parents to a level where they're safe to go home with their child," says Professor Hindmarsh. "That typically takes around five days, but this can vary. The process should happen at your pace."

What can I expect from the care team?

You can expect detailed, practical sessions on how and when to test your child's blood sugar level using the finger-prick test, and how to give insulin injections.

A dietitian will assess your child's diet and discuss how the family diet can be adapted to the condition.

If relevant, your care team will also talk to you about how your child's diabetes will be managed at school or nursery. Your care team should contact the school or nursery – usually, a member of the team will visit the school to discuss what care your child will need.

If your child is younger than five years old, the team will discuss with you starting insulin treatment using an insulin pump system. This sounds daunting at first but it is a better way of giving insulin to younger children.

Your child's emotional response

"How the diagnosis affects your child emotionally is important. There's often a period of shock, then anger, then rejection of the idea, followed by gradual acceptance," says Professor Hindmarsh.

"Parents should talk about their feelings and those of the child, ideally with a psychologist."

The first few months

After a few days, you'll be confident enough to take the first steps towards managing your child's diabetes. This means taking them home if they had their first treatment in hospital.

You should still be in regular touch with your diabetes care team.

"At this stage, parents and children come to see the care team at the hospital around every one-to-two weeks," says Professor Hindmarsh. "We'll discuss how you and your child are doing, and answer any questions.

"There's regular telephone and email contact to make sure that parents have access to the team whenever they need it."

The diabetes care team will give you a 24-hour number in case of an emergency.

You and your child may find it difficult to adjust to life with diabetes at first. For example:

• you may have to change your family's diet
• your child may worry about being different from their friends
• you will both have to get used to a new routine of blood glucose tests and insulin injections

All this will get easier over time. Never hesitate to contact your care team with questions or concerns.

Once the condition is stable

Eventually, you'll feel confident that you can manage your child's diabetes without regular support from the care team.

By this time, you'll have a good understanding of how food and exercise affect your child's blood sugar level, and how to manage this with insulin.

You'll also understand hypoglycaemia, or 'hypos', when your child's blood glucose level drops too low and they have symptoms such as shakiness, sweating, tiredness, headaches or behaviour changes. You'll be taught how to prevent and treat hypoglycaemia and other situations.

"Once the parents and child are really settled, I'd expect to see them once every three months," says Professor Hindmarsh.

From the age of 12, these visits should include a comprehensive health check at least once a year. Your child will be checked for signs of damage to their eyes, feet, circulation and kidneys.

As your child gets older, it's important to work with your care team to teach your child how to manage the condition on their own.

"When your child is very young, ask them to do things like fetching the injecting kit, or pinching their skin while you do the injection," says Professor Hindmarsh. "Greater involvement grows from there."

During visits, the care team should let your child discuss their feelings and concerns, as they gradually get used to becoming an adult with diabetes.

Diabetes in teenagers

With so much going on at school or college, it's not surprising that teenagers can sometimes drop the ball when it comes to following their recommended treatment regimen. This can include missing their insulin injections and eating foods that they shouldn't.

A natural parental reaction to this is to try to monitor them every minute of the day, but this can undermine your child's growing sense of independence. Some experts recommend trying to foster a spirit of self-reliance in your teenager, discussing their condition in an open and adult way.

It's also important that your teenager understands that smoking and drinking too much alcohol can worsen their diabetes symptoms.

They may find it useful to talk to other people of their age who share their condition. The JDRF website provides details of support groups and events in your local area.

Teenage pregnancy and diabetes

Women with type 1 diabetes can experience complications during pregnancy, which means any pregnancy needs to be carefully planned.

For this reason, it's particularly important for teenage girls who are sexually active and not planning a pregnancy to be aware of reliable methods of contraception.

Diabetes support groups

Look up diabetes information and support groups in your area.

You and your child could also have a look at Upbete, an online forum supporting young people with diabetes.

Reduce your diabetes risk

Type 2 diabetes is often linked to being overweight. That means there are steps you can take to reduce your risk of developing it.

Around 90% of people with diabetes have type 2 diabetes. If you maintain a healthy weight, you can reduce your risk of developing the condition.

If you think that you may already have symptoms of diabetes, see your GP.

There are no lifestyle changes that can lower your risk of type 1 diabetes.

Diabetes and your weight

If you are overweight or obese, you're at an increased risk of type 2 diabetes.

You can find out if you're a healthy weight by calculating your BMI using our healthy weight calculator.

BMI and diabetes risk

For most people in the UK, if your BMI is 25 or above, you are in the overweight range, while a BMI of 30 or above puts you in the obese range.

However, some groups have a higher risk of developing type 2 diabetes than white populations.

These groups are advised to maintain a BMI lower than the standard 25. The advice is:

• Asians with a BMI score of 23 or more are at increased risk of developing type 2 diabetes.
• Asians with a BMI of 27.5 or more are at high risk of developing type 2 diabetes.

Although the evidence is less clear-cut, black people and other minority groups are also advised to maintain a BMI below 25, to reduce their risk of type 2 diabetes.

Your waist and diabetes risk

BMI isn't the only important measurement when it comes to your diabetes risk. Your waistline may also indicate that you're carrying extra body fat, and are therefore at risk.

• All women have an increased risk of diabetes if their waist measures more than 80cm (31.5 inches).
• White or black men have an increased risk if their waist measures more than 94cm (37 inches).
• Asian men have an increased risk if their waist measures more than 90cm (35 inches).

Find out more about why waist size is important and how to measure it accurately.

If you lose excess weight, you'll lower your risk of type 2 diabetes.

The healthy way to lose weight

A healthy diet and physical activity are the key to a healthy weight, but that doesn't have to mean going on a strict diet and spending hours at the gym.

Find out more about losing weight the healthy way and start today.

Causes of diabetes you can't control

A number of other risk factors can increase your risk of developing type 2 diabetes, most of which can't be controlled.

These include:

• being over 40, or over 25 if you're black or south Asian
• having a close family member (parent, brother or sister) who has type 2 diabetes
• being south Asian or African-Caribbean; these ethnic groups are five times more likely to get type 2 diabetes
• having polycystic ovary syndrome (PCOS), especially if you're also overweight
• having had gestational diabetes (diabetes that lasts for the duration of a pregnancy)
• having impaired fasting glycaemia or impaired glucose tolerance, sometimes referred to as pre-diabetes

If you have any of these risk factors, you should maintain a healthy weight to ensure that your risk of diabetes doesn't increase further.

Find out more about the causes of type 2 diabetes.

Look after your eyes

Find out why regular eye tests are important, and how a healthy lifestyle can help maintain good vision.

Why are regular eye tests (sight tests) so important?

It's easy to neglect your eyes because they rarely hurt when there's a problem.

Having an eye test won't just tell you if you need new glasses or a change of prescription – it's also an important eye health check.

It can spot many general health problems and early signs of eye conditions before you're aware of any symptoms, many of which can be treated if found early enough.

How often should I have an eye test?

Optometrists recommend that most people have an eye test about every two years. People over 40 and people from black or minority ethnic groups may need sight tests more often.

What should I do if I notice a change in my sight?

Visit your optician or GP if you're concerned about any aspect of your vision at any time.

Are some people more at risk from eye disease than others?

Anyone can develop sight problems, but some people have a higher risk of eye disease.

It's especially important to have regular eye tests if you are:

• above 60 years old
• from certain ethnic groups – for example, people from African-Caribbean communities are at greater risk of developing glaucoma and diabetes, and people from south Asian communities are at a greater risk of developing diabetes; diabetic retinopathy, where the retina becomes damaged, is a common complication of diabetes
• someone with a learning disability
• from a family with a history of eye disease

What about my child's sight?

Children do not usually complain about their sight, but may show signs of not being able to see properly.

Things to look out for include sitting close to the TV, holding objects very close to their face, blinking a lot, eye rubbing, or one eye turning in or out.

If your child is having any sort of sight problems, take them to an optometrist for further investigation.

Children don't have to be able to read letters to have their eyes examined. Like adults, children should have regular eye checks around every two years.

What else can I do to look after my eyes?

Give up smoking

Smokers are much more likely to develop age-related macular degeneration and cataracts compared with non-smokers. Find out about the help and support available to stop smoking.

Get moving

While it might seem odd that exercise can help the eyes, it can be important. Research shows that exercise may reduce the risk of sight loss, which can occur as a result of high blood pressure, diabetes, and narrowing or hardening of the arteries. See some ideas for getting fit your way.

Eat healthily

A healthy, balanced diet that includes a wide variety of fruit and vegetables will benefit your overall health, and may help keep the retina healthy. Get tips on healthy eating.

Drink within the recommended limits

Heavy alcohol consumption is associated with an increased risk of early age-related macular degeneration.

To keep health risks from alcohol to a low level:

• men and women are advised not to drink more than 14 units a week on a regular basis
• spread your drinking over three or more days if you regularly drink as much as 14 units a week
• if you want to cut down, try to have several drink-free days each week

Keep tabs on your drinking with the Drinkaware alcohol tracker.

Protect your eyes from the sun

Never look at the sun directly, even when something exciting is happening, such as an eclipse. Doing so can cause irreversible damage to your eyesight and even lead to blindness. Several studies also suggest sunlight exposure is a risk factor for cataracts.

Wearing a wide-brimmed hat or sunglasses can help protect your eyes from UV rays. The College of Optometrists recommends buying good-quality dark sunglasses – these needn't be expensive.

Look for glasses carrying the CE mark or the British Standard BS EN ISO 12312: 2013, which ensures they offer a safe level of ultraviolet protection.

Can I get help with the cost of a sight test or glasses?

Lots of people are entitled to free NHS-funded sight tests and an optical voucher, which will help with the cost of glasses or contact lenses.

Find out more about eyecare entitlement, including mobile sight tests when an optometrist visits you in your own home.

Why we should sit less

We all know we need to be more active, but there is increasing evidence that we also need to spend less time sitting down.

Get tips on reducing sitting time for:

• children aged under 5
• young people
• adults
• older adults

To reduce our risk of ill health from inactivity, we are advised to exercise regularly – at least 150 minutes a week – and reduce sitting time.

Studies have linked excessive sitting with being overweight and obese, type 2 diabetes, some types of cancer, and early death.

Sitting for long periods is thought to slow the metabolism, which affects the body's ability to regulate blood sugar, blood pressure and break down body fat.

Many adults in the UK spend more than seven hours a day sitting or lying, and this typically increases with age to 10 hours or more.

This includes watching TV, using a computer, reading, doing homework, travelling by car, bus or train but does not include sleeping.

Move more, sit less

The Start Active, Stay Active report (PDF, 1.34Mb) recommends breaking up long periods of sitting time with "shorter bouts of activity for just one to two minutes".

A panel of leading experts (PDF, 964kb), chaired by Professor Stuart Biddle, who reviewed the evidence on sitting for the report recommended taking "an active break from sitting every 30 minutes".

However, there is currently not enough evidence to set a time limit on how much time people should sit each day.

Nevertheless, some countries – such as Australia, the US and Finland – have made recommendations that children limit screen time, such as TV and video games, to just one to two hours a day.

Recent research has suggested that exercising at least 60 minutes a day can offset the negative effects of sitting too much throughout the day.

London bus drivers and astronauts

The link between illness and sitting first emerged in the 1950s, when researchers found London bus drivers were twice as likely to have heart attacks as their bus conductor colleagues.

There has been an explosion of research on the ills of sitting in the past few years, prompted by our increasingly sedentary lifestyles.

It is thought excessive sitting slows the metabolism – which affects our ability to regulate blood sugar and blood pressure, and metabolise fat – and may cause weaker muscles and bones.

"Essentially, the body is 'shutting down' while sitting and there is little muscle activity," says Professor Biddle.

Research on astronauts in the early 70s found life in zero gravity was linked with accelerated bone and muscle loss and ageing.

"Sitting for an extended period of time is thought to simulate, albeit to a lesser degree, the effects of weightlessness on astronauts," says Professor Biddle.

Limitations with current research

Most of the evidence is based on observational studies, which have only shown an association between sitting and ill health but not a direct cause.

"With the current body of evidence, we don't have a definitive answer to what's happening," says Professor David Dunstan of the Baker IDI Heart and Diabetes Institute, Melbourne, Australia. "We're now expanding on what's seen in observational research in the lab."

The research on NASA astronauts suggests that on their return from space, even light walking was effective in overcoming the negative effects of weightlessness.

"Breaking up sitting time engages your muscles and bones, and gives all our bodily functions a boost – a bit like revving a car's engine," says Professor Dunstan.

Age-specific advice

The recommendations to reduce sitting time apply to all age groups.

Under-5s
In children under five, the advice is to limit the time they spend watching TV, travelling by car, bus or train, or being strapped into a buggy.

"There is emerging evidence that sedentary behaviour in the early years is associated with overweight and obesity, as well as lower cognitive development," says the Start Active, Stay Active report.

While this may be a challenge for busy parents, the advice reflects growing awareness that early life experiences and habits impact upon our health as adults.

"There is a need to establish healthy patterns of behaviour during the early years in order to protect against possible health detriments in the future," says the report.

Tips to reduce sitting time:

• reduce time spent in infant carriers, car seats or highchairs
• reduce time spent in walking aids or baby bouncers
• reduce time spent in front of the TV or other screens

Get more activity ideas for under 5s.

Children and young people
Research suggests that children and young people in households with multiple TVs and computers tend to sit more.

For children aged 5 to 18 years, reducing sitting time includes anything that involves moving in and around the home, classroom or community.

Tips to reduce sitting time:

• consider ways for children to "earn" screen time
• agree a family limit to screen time per day
• make bedrooms a TV- and computer-free zone
• set "no screen time" rules to encourage kids to be active
• encourage participation in house chores such as setting the table or taking the bins out
• choose gifts such as a scooter, skateboard, ball or kite to encourage active play

Parents could lead by example by also reducing their TV time and other sitting-based tasks.

Get more activity ideas for young people.

Adults
Adults aged 19 to 64 are advised to try to sit down less throughout the day, including at work, when travelling and at home.

Tips to reduce sitting time:

• stand on the train or bus
• take the stairs and walk up escalators
• set a reminder to get up every 30 minutes
• place a laptop on a box or similar to work standing
• stand or walk around while on the phone
• take a walk break every time you take a coffee or tea break
• walk to a co-worker's desk instead of emailing or calling
• swap some TV time for more active tasks or hobbies

Get more tips on getting active and staying healthy at work.

Older adults
Some older adults (aged 65 and over) are known to spend 10 hours or more each day sitting or lying down, making them the most sedentary population group.

"It could be partly due to reduced functionality or ill health, but there are also social norms expecting those in later years to 'slow down' and rest," says Professor Biddle. "That's not helpful."

Older adults should aim to minimise the time they spend in extended periods of sitting each day.

"Sitting needs breaking up," says Professor Biddle. "Long periods of TV should be avoided, and you should try to do activities that involve light movement and being 'on your feet' as much as possible.

"Do some tasks standing, like having coffee and chats, or even writing a letter – Ernest Hemingway wrote his novels standing."

Tips to reduce sitting time:

• avoid long periods sat in front of a TV or computer
• stand up and move during TV advert breaks
• stand or walk while on the phone
• use the stairs as much as possible
• take up active hobbies such as gardening and DIY
• join in community-based activities, such as dance classes and walking groups
• take up active play with the grandchildren
• do most types of housework

Get more tips on getting active.

Travelling with diabetes

Having diabetes should not prevent you from travelling and enjoying your holidays.

Planning ahead is key to having a great time away and dealing with any potential problems with your diabetes.

Health experts advise preparing for a trip four to six weeks before you travel.

What will I need if I travel with diabetes?

Carry your diabetes ID and a letter from your GP, which says you have diabetes and the medication you need to treat it if you are carrying insulin or another injectable medication.

Things to consider as part of your preparation include:

• diet
• medicines and travel vaccines
• travel insurance
• air travel

Food and diabetes

Whether you're at home or abroad, make sure you still eat healthily.

You should be able to choose foods from local menus and still eat a balanced diet.

If you're flying to your destination, airlines can provide information on the times of most meals so you can plan your insulin.

It's best to order the standard meal, though this may not supply you with enough carbohydrate if you are on insulin or certain diabetes tablets, so pack some healthy snacks.

Blood glucose is measured differently from the UK in some countries. See Diabetes UK's blood glucose conversion chart.

Medicines and travel vaccines

Bring twice the quantity of medical supplies you would normally use for your diabetes.

Find out where you can get supplies of insulin at your destination in case of emergency.

See your GP or diabetes specialist for information on travel jabs and how the local weather and changing time zones can affect your condition.

Diabetes shouldn't affect what vaccinations you have, but it's worth asking your doctor if certain jabs could disrupt your diabetes control and how you should manage this.

Travelling to a hot or cold climate may affect how your insulin and blood glucose monitor work.

Travel insurance for diabetes

For travel in Europe, make sure you have a European Health Insurance Card (EHIC). This entitles you to reduced-cost and, sometimes, free medical treatment.

Also take out travel insurance – an EHIC may not cover all the costs of your treatment. An EHIC doesn't cover the cost of being flown back to the UK.

Make sure you declare all your medical conditions, including your diabetes. Making a mistake or omission could result in a claim being refused.

Find out more about getting travel insurance from Diabetes UK.

Air travel with diabetes

Contact your airline several weeks before travelling to discuss medical devices you intend to take on board the aircraft, such as a pump or glucose monitor.

If you use an insulin pump, contact the device manufacturer, the airline and the airport for advice about going through airport screening equipment, such as X-ray machines.

Bring a letter from your GP explaining your need to carry syringes or injection devices, insulin and any other medication.

Some GPs charge for writing a letter. If you travel frequently, ask them to write it in such a way that it can be used more than once.

Carry all your diabetes medicines as hand luggage in case your checked-in bags go missing or your medicines are damaged in the baggage hold.