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It used to be said that having diabetes aged people an additional 20
years. Today, thanks to
better tools for managing diabetes and
preventing and treating its complications, people with
diabetes have the
opportunity to live longer than ever before.
The 101 Tips Series is a reference tool to cover your diabetes care
from head to toe.
Whether you're looking for tips on nutrition or footcare, the
easy-to-read,
Q&A format appeals to all types of readers.
View titles in the series!
White Flour Carbs Sugary carbs, especially table sugar (sucrose),
used to be seen as causing adverse health
effects for
diabetics and people with
symptoms
of impaired glucose tolerance or insulin
insensitivity.
Although a high sugar diet can
cause problems for these groups,
most
nutritionists now view refined white flour foods
(most of which have a high GI-value; and no
fibre !!)
as causing
more glycemic
health problems, such as insulin
resistance, and digestive disorders.
Tight control
means getting as close to a normal (nondiabetic) blood
sugar level as you safely can.
Ideally, this means levels between 70 mg/dl (3.8 mmol/l)
and 130 mg/dl before meals (7.2 mmol/L),
and less than 180 (10mmol/L) two hours after starting a
meal, with a glycated hemoglobin (A1C) level
less than 7 percent. The target number for glycated
hemoglobin will vary depending on the type of test your
doctor's laboratory uses.
In real life, you should set your goals with your
doctor. Keeping a normal level all the time is not
practical.
And it's not needed to get results.
Every bit you
lower your blood sugar level helps to prevent
complications.
Living with tight control
To get tight control, you must do the following:
Pay more
attention to your diet and exercise.
Measure
your blood sugar levels more often.
If you take insulin, change how much you use and
your injection schedule.
By Richard
R. Rubin, PhD, CDE, ADA's Past-President, Health Care & Education
Tip 1: Learn about diabetes. Tip 2: Understand your loved one's diabetes. Tip 3: Find out what your loved one really needs. Tip 4: Offer the help your loved one asks for. Tip 5: Talk about your feelings. Tip 6: Get help. Tip 7: Get started
On each of our expert pages, you will find a list of Top
10 Questions with helpful answers about preventing and managing
diabetes. If you do not see the answer you need, please submit a
new question. And don't forget to check back regularly for new
information.
Diabetes Information Diabetes Mellitus (the longhand
name for diabetes) is a chronic metabolic disease characterized
by
elevated levels of glucose in
the bloodstream. This excessive level of
blood sugar is caused
either by an insufficiency of the pancreatic
hormone "insulin",
or by the body's inability to use the
insulin it
produces.
Choosing a
healthy lifestyle can help you improve your
health and reduce your risk of heart
disease and
diabetes.
Healthy lifestyles include eating a healthy
diet, maintaining a healthy weight, exercising
regularly,
quitting smoking (or not starting),
and minimizing stress. (Note: Specific guidance
for maintaining
a healthy lifestyle may change
over time as new scientific recommendations
become available.) Learn more about each of the
factors that affect your lifestyle.
Excess body fat leads to health
problems such as Diabetes 2, high
blood pressure, and high cholesterol.
Health professionals use a
measurement called body mass index (BMI)
to classify an adult's weight
as
healthy, overweight, or obese.
BMI
describes body weight relative to height
and is correlated with total body fat
content in most adults.
Having excess abdominal body fat is
also a health risk. Men with a waist of
more than 40 inches
around and women
with a waist
of 35 inches or
more are at
risk for health problems.
More than 60 percent of U.S. adults
are either overweight or obese,
according to the Centers for Disease
Control and
Prevention (CDC). While the number of overweight people has been
slowly climbing
since the 1980s, the
number of obese adults has nearly
doubled since then.
Excess weight and physical inactivity
account for more than 300,000 premature
deaths each year
in the United States,
second only to deaths
related to
smoking, says the CDC. People who are
overweight
or obese are more likely to
develop heart disease, stroke,
high
blood pressure,
diabetes,
gallbladder
disease and joint pain caused by excess
uric acid (gout). Excess weight can also
cause interrupted
breathing during sleep
(sleep apnea) and wearing away of the
joints (osteoarthritis).
To lose weight, you must eat less and
move more. Your body needs to burn more
calories than you take in.
Exercise improves heart function, lowers blood pressure and blood
cholesterol, helps manage diabetes, and
helps
control weight.
The National Heart, Lung, and Blood
Institute (NHLBI) at NIH recommends that
adults get at least 30 minutes of
moderate physical activity on
most days
of the week.
Talk to your doctor about what forms
of exercise are best for you.
For more information about exercise
and physical fitness, see:
Choosing a
healthy lifestyle can help you improve
your
health and reduce your risk of heart disease and
diabetes.
Minimize Stress The link between stress and coronary
heart disease is not entirely clear.
However, people who have too much stress
or who have
unhealthy responses to
stress may be at greater risk of having
coronary heart disease.
Facts about stress and coronary heart
disease:
Stress speeds up
the heart rate.
People with heart
disease are more likely to have a
heart attack during times of stress.
People sometimes
respond to stress with unhealthy
habits such as smoking or eating
salty
or high-fat foods.
Nearly 65 percent of people
with diabetes will die from a heart attack or
stroke; because of a
lack of available
information,
two out of three people with
diabetes are unaware of their heightened risk.
In order for those with
diabetes to stay heart healthy, having the most
up-to-date information is crucial.
Now, there's
a place
where people can go for the latest
resources that can help them control their
diabetes, as well as monitor their blood
pressure and cholesterol levels.
When those with diabetes take
steps to also ensure good cardiovascular health,
they can live long,
healthy lives.
The National Diabetes
Education Program is a federally funded program
sponsored by the
U.S. Department of Health and
Human
Services'
National Institutes of Health and the
Centers for Disease Control and Prevention and
includes over 200 partners at the federal, state,
and local
levels, working together to reduce the
morbidity and mortality associated with diabetes.
The Glycemic Index On-line,
the University of Sydney's GI Website, is a comprehensive and
authoritative guide to the glycemic index.
Dr. Jennie
Brand-Miller, who authorized me to summarize her work in 1995 or
1996,
finally has a Web presence in November 2000.
And what a
presence it is! Her site is now the key Internet resource on
this subject.
The URL is http://www.glycemicindex.com
Here's another excellent glycemic index resource for
athletes. Cycling Performance Tips:
Glycemic Index shows how
athletes can make
use of the glycemic index. The URL is http://www.cptips.com/gi.htm
Much of the information on this site is taken from Michel
Montignac, (1999), Eat yourself Slim,
Montignac Publishing (UK) Ltd.
Information about the book, the method, and the
Glycćmic Index can
be found at the Montignac
website.
How does your glucose level compare
with your HbA1c
HbA1c %
Average
blood sugar level
mg/dl
Average
blood sugar level mmol/l
13
324 mg/dl
18
mmol/l
12
306 mg/dl
17
mmol/l
11
270 mg/dl
15
mmol/l
10
234 mg/dl
13
mmol/l
9
216 mg/dl
12
mmol/l
8
180 mg/dl
10
mmol/l
7
141 mg/dl
8
mmol/l
6
125 mg/dl
7
mmol/l
5
90 mg/dl
5
mmol/l
HbA1c levels by coincidence nearly equate to glucose levels. So
an HbA1c level of 10%
means the average glucose level for the
previous
10 weeks was 234 mg/dl (13 mmol/l).
But at lower levels there is even less difference, so an HbA1c
of 7% means the average glucose
level was 141 mg/dl (8 mmol/l ).
"My task is to give you an overview of treating
Diabetes 2 and of
all the medications that we
have at our disposal. Life has changed a lot
through the years in terms of Diabetes 2.
Twenty-five years ago, all we had was insulin and sulfonylureas.
Consequently, we put patients
on sulfonylureas and when they failed over
time, they all ended up on insulin. Today we have
many more medications
to choose from. These medications work differently and they target
the
multiple pathophysiologic defects that we have in Diabetes 2.
We understand that behind all of this there is the insulin-resistant
liver overproducing glucose.
We have insulin resistance in the
adipocytes.
We have high free fatty acids, worsening insulin resistance,
and perhaps worsening beta-cell function.
We have insulin resistance in
skeletal muscles as well. All of these defects are coming into play, as
well as declining insulin
over time because of progressive apoptosis or
programmed cell death of beta cells."
You will need to register at Medscape to read the full article.
Diabetes 2 can sometimes be turned around with
weight loss, a healthy diet and exercise.
If your
doctor feels that is the case,
then positive
lifestyle changes that help you lose the
excess
weight, and regular daily exercise may be enough.
With medication or not,
diabetes still requires a
healthy diet and physical activity for optimum
health.
Medications are usually prescribed in addition to
lifestyle changes. The medications work in
different
ways but their effect is to lower
blood sugar and
help the body's own insulin become
more effective.
If oral medications are not enough, insulin
injections may be used to
help gain control of
glucose levels.
A diagnosis of diabetes can really derail your lifestyle. All of a
sudden, there are a lot of new
things to learn and many changes
that
have to take place. Where do you start?
David Kinshuck, Pat Lamb, Urmilla Griffiths (Pat & Urmila: diabetes
specialist nurses, Good Hope Hospital)
Embrace your diabetes
Learning how to control Diabetes 2...take control
What is happening in Diabetes 2
First, there is a shortage of insulin
Second, there is insulin resistance.
Third, there are genes
These factors combine to cause Diabetes 2
Pattern of progression
At the beginning of
Diabetes 2 a healthy diet may
be sufficient to lower the sugar and keep the HbA1c below 7%
Later, metformin is needed.
Later still, add Exanatide if overweight or other drug.
Later still insulin may be required
Testing you sugar/glucose level
See
testing.
If you 'embrace' your diabetes, you will gradually learn to control it
and achieve an
HbA1c of 7% or below.
But to
do this, you need to check to see your
fasting
blood sugar levels are
72-126 mg/dl (4 - 7 mmol/l) (when you
wake up)
test your
blood sugar levels before meals between
72-126 mg/dl (4 - 7 mmol/l)
remember, you still need tablets if you are ill; if you
are being sick or cannot swallow the tablets,
|let your
doctor
or nurse know.
occasionally test after meals (preferred levels less
than 180 mg/dl (10 mmol/l)
To achieve very good control (HbA1c 6.5-7.0%) you need a
fasting pre-breakfast glucose
less than 99 mg/dl (5.5 mmol/l), pre-meal levels at other
times less than 108 mg/dl (6.0 mmol/l) and
after-meal levels
(2 hours after a meal) less than 141 mg/dl (8.0 mmol/l).
These levels cannot be achieved in all patients..but if
you are well and are prepared to stick to a healthy
diet and
exercise your medication should be adjusted to achieve these
levels, even if that
means starting insulin.
has guided recommendations
concerning tight diabetic control and low sugars.
It cost Ł23 million and took 20 years,
and the results are still being interpreted.
UKPDS
Diabetes is a condition where people don't produce enough insulin to
meet their body's needs
or their cells don't respond properly
to
insulin.
Diabetes
2 is mainly caused by insulin resistance.
Symptoms
Treatment
Frequent measurement of
blood sugar levels is the best way to know
whether blood
glucose levels are in the target range.
This is easily
done at home with a blood sugar monitor.
Taking Aspirin to Protect Your Heart Studies have shown that taking a low-dose
aspirin every day significantly lowers the risk of
heart attacks.
All About Stroke If you have diabetes, you're much more likely to
have a stroke, heart disease, or a heart attack. But
you can cut your chances of having these problems by
taking special care of your heart and blood vessels.
Make Wise Food Choices Learn how food choices help keep your heart and
blood vessels healthy.
Choose Fats Wisely Diabetes increases your chances of having a
heart attack or a stroke. Learn how making the right
choices can help reduce the risk of having a heart
attack or stroke.
Cook with Heart Healthy Foods You can protect your heart and blood vessels by
eating less saturated fat and by choosing the types
of fats that help your cholesterol levels.
The Honest Food Guide (HFG)
is now available for downloading
free of charge and is:
Free from the corruption
and influence of various
food industries (dairy,
beef, junk foods, etc.)
Designed to benefit you,
not Big Business
Offers genuine
nutritional information, not
watered-down information
designed to boost the sale
of
milk, beef and grains
The HFG was created by
Mike Adams, the Health Ranger, a man with a mission
of teaching people how to be healthy.
Adams is a
holistic nutritionist who overcame obesity, crippling
pain and chronic disease using natural health strategies
he freely shares with others.
To learn more about the Health Ranger and his
articles, reports and books (many are freely available),
click here.
It's proven: Diabetes can be reversed. According to a
groundbreaking new study completed by
researchers at UCLA and
other
California universities, changes in diet and moderate exercise actually reverse diabetes in at least 50% of patients
in only three weeks!
In only three weeks time, the amount of cholesterol and free radicals
in
the test subjects' blood was lower
and their nitric oxide levels were
higher, which are all factors
in stopping diabetes before it takes its
toll on limbs and life.
Step 1: Eat whatever you've
been eating and write it all down
Step 2: For the next few days
cut back on your carbohydrates
Step 3: Test Test Test!
Download the Flyer here
Exercise
Exercise works like a charm to lower glucose levels. The best time of
the day to exercise is after a meal.
This doesn't mean that you put your
fork down and run out the door, but maybe within the following
two
hours. Even a brief 10-minute walk can make a difference
in postprandial
(after meals) glucose levels.
Sugar in the
form of fruit contains fiber that delays absorption and thus moderates
the rise in blood
sugar values when fruit is consumed.
Refined white
sugar, sucrose, and dextrose lack fiber and nutrients.
When consumed in
food or drinks the refined sugar rapidly goes into the blood stream and
produces
a sharp rise in blood sugar values. The pancreas secretes large
amounts of insulin to promptly return
high blood sugar values to normal.
When consumed
in food or drinks the refined sugar rapidly goes into the blood stream
and produces
a sharp rise in blood sugar values.
The pancreas secretes
large amounts of insulin to promptly return high blood sugar values to
normal.
Sharp rises
in insulin output may cause overshooting the desired blood sugar and it
is common for
these individuals to have blood sugar
values plummet to
low levels with symptoms of low blood sugar
(weakness, sweating, cloudy
thinking, lack of energy, hunger, shakiness).
With the
passage of time this massive output of insulin provoked by huge sugar
intakes takes a
toll on the pancreas and reaches the point
where the
pancreas is unable to produce any greater
quantities of insulin. When
this occurs sugar no longer enters the cells in adequate
amounts to
prevent rising blood sugar values. The diagnosis of diabetes can be made
with now elevated blood sugar values but the
problem obviously began
many years earlier
with the first signs of insulin excess.
What
Causes Insulin Resistance and Diabetes 2?
Why
Does Arteriosclerosis Plague Diabetic Patients?
Why Do
Diabetics Become Obese? What Role Does U.S. Soil Play In The Diabetic Problem? Diabetics are at increased risk for mineral deficiencies
When consumed
in food or drinks the refined sugar rapidly goes into the blood stream
and produces
a sharp rise in blood sugar values.
The pancreas secretes
large amounts of insulin to promptly return high blood sugar values to
normal.
Sharp rises
in insulin output may cause overshooting the desired blood sugar and it
is common for
these individuals to have blood sugar
values plummet to
low levels with symptoms of low blood sugar
(weakness, sweating, cloudy
thinking, lack of energy, hunger, shakiness).
With the
passage of time this massive output of insulin provoked by huge sugar
intakes takes a
toll on the pancreas and reaches the point
where the
pancreas is unable to produce any greater
quantities of insulin. When
this occurs sugar no longer enters the cells in adequate
amounts to
prevent rising blood sugar values. The diagnosis of diabetes can be made
with now elevated blood sugar values but the
problem obviously began
many years earlier
with the first signs of insulin excess.
What
Causes Insulin Resistance and Diabetes 2?
Why
Does Arteriosclerosis Plague Diabetic Patients?
Why Do
Diabetics Become Obese? What Role Does U.S. Soil Play In The Diabetic Problem? Diabetics are at increased risk for mineral deficiencies
When consumed
in food or drinks the refined sugar rapidly goes into the blood stream
and produces a sharp rise
in blood sugar values.
The pancreas secretes
large amounts of insulin to promptly return high blood sugar values to
normal.
Sharp rises
in insulin output may cause overshooting the desired blood sugar and it
is common
for these individuals to have blood sugar values plummet to
low levels with symptoms of low blood sugar
(weakness, sweating, cloudy
thinking, lack of energy, hunger, shakiness).
With the
passage of time this massive output of insulin provoked by huge sugar
intakes takes a toll on the
pancreas and reaches the point where the
pancreas is unable to produce any greater quantities of insulin.
When
this occurs sugar no longer enters the cells in adequate
amounts to
prevent rising blood
sugar values. The diagnosis of diabetes can be made
with now elevated blood sugar values but the problem
obviously began
many years earlier with the first signs of insulin excess.
What
Causes Insulin Resistance and Diabetes 2?
Why
Does Arteriosclerosis Plague Diabetic Patients?
Why Do
Diabetics Become Obese? What Role Does U.S. Soil Play In The Diabetic Problem? Diabetics are at increased risk for mineral deficiencies
Why Do
Diabetics Become Obese? When the pre-diabetic person is experiencing chronic high insulin values
with too many carbohydrate calories,
this insulin is converting
some of
the excess glucose into the fat triglyceride, which gets stored in
fat
cells which end up distended in an obese patient.
Conceptually, identifying the metabolic
syndrome (or insulin resistance) identifies risk for
cardiovascular disease (CVD)
or diabetes.
This article explains how, historically,
insulin resistance brought together facets of the
metabolic
syndrome and the pathogenesis of diabetes
and atheroma (thicklening of arteries in CVD) but has
since
been clinically “overtaken” by central obesity,
now accepted as the core component
of the metabolic
syndrome.
The metabolic syndrome encompasses a wide
range of metabolic disturbances in glucose, insulin and
lipid metabolism, and is associated with
central
abdominal obesity.
Conceptually, identifying the metabolic
syndrome (or insulin resistance) identifies risk for
cardiovascular
disease (CVD) or diabetes.
This article explains how, historically,
insulin resistance brought together facets of the
metabolic syndrome
and the pathogenesis of diabetes and
atheroma (thicklening of arteries in CVD) but has
since been clinically
“overtaken” by central obesity,
now accepted as the core component of the
metabolic
syndrome.
The metabolic syndrome encompasses a wide
range of metabolic disturbances in glucose, insulin
and
lipid metabolism, and is associated with
central
abdominal obesity.
Knowing which fats
raise LDL cholesterol and which ones don't is the first step in
lowering your risk of heart disease. In addition to the LDL
produced naturally by your body, saturated fat,
trans-fatty acids and dietary cholesterol can also raise
blood cholesterol. Monounsaturated fats and polyunsaturated fats
appear to not raise LDL cholesterol; some studies suggest they
might even help lower LDL cholesterol slightly when eaten as
part of a low-saturated and
trans-fat diet.
The American Heart Association's Nutrition
Committee strongly advises these fat guidelines for healthy
Americans over age 2: read more ......
For example, a sedentary female who is 31–50 years old needs
about 2,000 calories each day. Therefore, she should consume
less than 16 g saturated fat, less than 2 g
trans
fat and between 50 and 70 grams of total fat each day (with most
fats coming from sources of polyunsaturated and monounsaturated
fats, such as fish, nuts, seeds and vegetable oils).
The ADA currently recommends keeping
blood sugar levels before meals
between 90 mg/dl (5
mmol/L)
and 130 mg/dl
(7 mmol/L) and keeping
blood sugar levels one to
two hours after meals below 180 mg/dl (10
mmol/L) for most people.
The American Diabetes Association (ADA) has
identified an increased risk of ulcers and
amputations
in the following groups of
people with diabetes:
Those who have had diabetes for ten
years or longer
Men
People whose
blood sugar control
is less than optimal
People who already have other
diabetes complications, such as
cardiovascular (heart) disease,
retinopathy (eye disease),
or
nephropathy (kidney disease)
People with a history of smoking,
because smoking is associated with early
development
of vascular (blood vessel)
complications in diabetes.
Taking Steps Toward Healthy Feet
Here are some of the most important steps you can take now to prevent
diabetes-related foot complications:
By
Dr Michael Hutch PhD
