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Diabetes: Diabetes Management: Diabetes, What You Need to Know  Previous Next

Diabetes, What You Need to Know

by: Laura S. Garrett, RD

Diabetes is one of the leading causes of death in America today claiming more than 160,000 victims each year. Sixteen million Americans have diabetes, yet only half are aware they have the disease. Most people are not diagnosed as having diabetes until they develop a life-threatening complication. In most of these cases, had the person known he had diabetes, the complication could have been avoided.

Complications associated with Diabetes:

(1) Blindness: Diabetes is the number one cause of blindness in people ages 25-74. Each year more than 15,000 people with the disease develop blindness.

(2) Heart Disease: People with diabetes are 2 to 4 times more likely to experience heart disease.

(3) Stroke: If you have diabetes, you are 5 times more likely to suffer from a stroke.

(4) Amputations: The number one cause of lower limb amputations that is not related to a traumatic injury is - you guessed it - diabetes!

(5) Kidney failure: Diabetes is the leading cause of kidney failure.

(6) Nerve damage: It is estimated that 65% of people with diabetes suffer from mild to severe nerve damage.

Am I trying to use scare tactics? You bet I am. I will never forget a lady I met with diabetes. She had lost one leg, was partially blind, had suffered a stroke, and her kidneys no longer functioned properly. Why did this poor woman suffer these maladies? She refused to keep her diabetes under control.

It is not a hard task to accomplish. It simply takes commitment and discipline. I cannot stress enough to those of you who suffer from diabetes: Following a STRICT diet regimen monitoring your blood glucose level frequently, and following your prescription drug regimen are absolutely imperative if you wish to live a long, happy life free of complications. Pretty bold statement, but it is the truth.

If you go through life with the attitude that diabetes is no big deal, chances are very good you will suffer one or more of the complications listed above. Enough with the scare tactics. The rest of this article covering diabetes will discuss important issues related to diet and provide you with resources for looking up information yourself.

Before continuing, I feel it is important for you to know the difference between the 2 different types of diabetes.

Type I Diabetes:
Type I is also known as "insulin-dependent" or "juvenile diabetes". Type I most commonly occurs during childhood, but not always. Type I results when the pancreas can no longer produce insulin. The body uses insulin to breakdown sugars found in the foods we consume. Since the body is not making the insulin it needs, insulin injections are necessary to control sugar levels. Type I is usually hereditary. Common symptoms include extreme thirst, rapid weight loss, frequent urination, fatigue, and nausea. This type of diabetes represents only five percent of the diabetic cases.

Type II Diabetes:
Type II makes up the other 95 percent of diabetic cases. It is commonly referred to as "non-insulin dependent". In this type, the pancreas are producing insulin, but the body is unable to use it properly. Type II typically has a gradual onset, appearing in adults around the age of 30, sometimes older. It is usually not necessary to take insulin injections (unlike Type I where it is imperative). Type II can often be managed through strict diet and exercise alone. Very often, a prescription drug is taken to help the body properly manage sugar levels. Warning signs include blurred vision, drowsiness, excessive weight gain, numbness in the hands or feet and slow healing of cuts/wounds.

One of the best sources for information pertaining to diabetes is the American Diabetes Association (ADA). Here is a link to their Web site: http://www.diabetes.org/.

On the side bar of ADA's Web site, look for "Diabetes Information". Under that sub-heading, click on "Take the Risk Test" for a quick online test to see if your are at risk. Under the same sub-heading, you will find "General Information", information for "Newly Diagnosed" patients, "In the News" for the latest updates, "Tip of the Day", and so much more. Be sure to check out the "Recipe of the Day".

If you are at risk, see your doctor to be tested. Development of Type II diabetes can be postponed. Through proper diet and exercise habits, you may never develop this disease. Use this article as your wake up call to start eating healthy.

Guidelines for a diabetic diet rely on the proportion of carbohydrates to proteins and fats. The diet needs to provide some dietary fat to help prevent post-meal spikes in blood sugar levels. However, saturated fats should be limited to reduce the risk of heart disease. Protein should be kept to 20% or less of your daily calories in order to prevent or delay the onset of diabetic kidney disease.

In May 1994, the American Dietetic Association and the American Diabetes Association issued "Nutrition Recommendations" for diabetic medical nutrition therapy.

These include:

Having near-normal blood glucose levels
Blood fats in acceptable ranges (total cholesterol, LDL, HDL)
Proper calories for maintaining reasonable weight
Prevention and treatment of complications
Improvement of overall health

These goals can be achieved by eating regular meals and exercising on a regular basis. It is important to understand how foods affect your blood glucose level. Incorporating a variety of foods at each meal can help prevent levels from getting too high.



Diet Therapy for Type I Diabetes:

(1) The timing of your meals must be regular. A sample meal schedule should look something like this: Breakfast 7:00 am, Snack 10:00 am, Lunch 12:00 p.m., Snack 3:00 p.m., Supper 6:00 p.m., Snack 8:00 p.m. The key is to not go too long without eating something.

Prolonged periods without supplying your body with some food can be dangerous resulting in hypoglycemia. Hypoglycemia is a fancy term for low blood sugar. People end up in the hospital because they let their blood glucose level get too LOW - Yes, too low. Symptoms of hypoglycemia include sweating, rapid heart rate, tremors, nervousness, hunger, faintness, and weakness.

Your blood sugar can get so low (40 mg/dl or below) as to cause damage to nerve tissue. If you are experiencing a headache, double vision, confusion, or irregular motor skills, you need to take action. What do you do? Eat! You need to get something in your body that will increase your blood glucose level. People with type I diabetes should always carry a source of food that will help bring the blood glucose level up fast. I would recommend candy, juice, glucose tablets - anything sugary.

(2) Eat about the same amount of food at the same time each day. It is very important for you to know correct portion sizes and be able to incorporate them into your meal planning. Learn how to incorporate the Exchange Lists into your diet. If "Exchange Lists" is foreign to you, I have put together a packet that you really should get your hands on. Learning the exchange system makes it easy for you to manage your food distribution throughout the day. This results in keeping your blood glucose level at a safe, healthy level.

If you are interested in ordering the packet, Click Here.

(3) Monitor your blood glucose levels throughout the day adjusting your insulin doses for the amount of food eaten. Insulin doses should also take into account your level of activity. Consult your doctor for adjusting insulin doses. You should be familiar with he sliding scale.

Diet Therapy for Type II Diabetes:

(1) Diet therapy does not have to be as strict with type II diabetes. If you have type II diabetes, your emphasis should be to achieve and maintain recommended blood glucose levels (70-140 mg/dl), cholesterol levels (200 mg/dl or less), and blood pressure (120/80 is normal).

(2) Weight loss is often beneficial for people with type II diabetes. Mild to moderate weight loss is known to help control this type of diabetes significantly, even if the desirable body weight is not achieved. Losing 20 to 30 pounds of excess weight results in significant improvement in respect to the goals listed above in number (1). Weight loss can help so much that your medications to help control your blood glucose level will probably need to be decreased.

If you would like to search for more information on diabetes, here is a link to the Centers for Disease Control and Prevention's Diabetes Homepage: http://www.cdc.gov/diabetes/ddthome.htm.

The following link will take you to a site with Diabetic Recipes: http://diabeticgourmet.com/dgarchiv2.shtml

Calorie Recommendations:
(While this article has been written for people with diabetes, the information contained in it can help anyone achieve a healthier diet. )

First, it is important for you to eat foods in proper amounts. How much you should eat depends on a number of factors including:

(1) Gender:
Men require more calories than women

(2) Weight:
The more your normal body weight, the more calories you may consume to maintain that weight.

(3) Height:
The taller you are, the more calories your body needs to maintain a normal body weight.

(4) Age:
The older you get, typically the fewer calories your body requires.

(5) Activity Level:
The more active you are, the more energy you burn, the more calories you need to eat.

(6) Pregnant or Breastfeeding:
If you are pregnant, you need to consume 300 more calories than usual. If you are breastfeeding, you need to consume 500 more calories than usual.

To determine your calorie needs, you may want to consult with a dietitian or another health professional who is an expert on diabetes. You can do so by either (1) Call the American Association of Diabetes Educators toll-free at 1-800-TEAMUP4 (1-800-832-6874), (2) Go to http://www.eatright.org, the American Dietetic Association's Web site, and go to their Find a Dietitian page, or (3) Use NutrActive's services. If you are interested in how we can help you, check out our Diabetes Center - Click Here.

To incorporate healthy eating habits, you should eat foods like fruits, vegetables, grains, low-fat dairy foods, and lean meats. Healthy or not, it is important to eat foods in the proper amounts. Even healthy foods can cause blood glucose levels to be uncontrolled if you eat too much of them.

You should get in the habit of measuring your food before you eat and during preparation. You may use a simple tool such as measuring spoons/cups. You might want to get real control on the amount of food you prepare yourself and use a food scale. For a free serving size guide, Click Here.

Eating sugary foods is something you should definitely limit. The following list should help you decrease how much sugary food you eat:

(1) If you must order dessert when dining out, split it and share it with your companion.
(2) Do not have candy dishes around areas you spend a lot of time.
(3) Order small or child-size servings of ice cream or frozen yogurt.
(4) Divide homemade desserts into small servings and wrap each piece separately. Freeze the extra servings.



Glycemic Index:

What? The glycemic index is a method that classifies a food according to its potential to elevate blood glucose levels. The standard for comparison is usually the simple sugar glucose or white bread (more typical of what we actually eat).

This "reference" food is set at 100. So, grapefruit with a glycemic index of 36 is considered low. What does this mean? Grapefruit produces a rise in blood glucose that is 36 percent of the effect caused by the standard food. Or, the rise in blood glucose is 64% less than the standard food's effect.

The popular diets today that oust carbohydrates are numerous and seem to grow in numbers weekly. These diets include Scarsdale Diet; Dr. Atkin's Diet; The Carbohydrate Addict's Diet; Rachael and Richard Heller's diet; Michael and Mary Eades, Protein Power diet; Sugar Busters!; The Zone by Barry Sears; and Suzanne Somers' Get Skinny on Fabulous Foods. Many base their claims on the effects of various foods on blood glucose levels.

According to many of the carbohydrate-busting diets, eating foods with high glycemic indexes will send blood glucose levels soaring. They claim this causes the body to produce excessive amounts of insulin. Allegedly, the body's overproduction of insulin causes low blood glucose levels (hypoglycemia) thus triggering overeating. According to these unsubstantiated diets, by eliminating the foods with high glycemic indexes, you will be less apt to overeat. [Important note: The authors of these fad diets have never published data to validate their claims!]

The medical evidence for many of these diets is flimsy. Many different factors can affect the glycemic index of a food. Examples: Cooking certain foods versus eating it raw can effect the glycemic index. The glycemic index can be different for a specific food item depending on whether it is whole, mashed, or ground. A food with a high glycemic index will be lower when eaten in combination with a food high in protein or fat. The science is not simple or exact.

In regards to diabetes, knowing the glycemic index of different foods may be helpful in controlling your blood glucose levels. A food with a high glycemic index will raise blood glucose levels quicker than foods that have a low glycemic index. You should not eliminate high glycemic index foods from your diet. However knowing which foods are more likely to raise your blood glucose level can be helpful in knowing when it might be necessary to adjust medications/insulin.

Eating a food with a high glycemic index by itself is going to have a greater effect on your blood glucose level. Eating that same food with foods high in protein and fat will have less of an effect. If you discover that some of your favorite foods are high on the glycemic index, learn how to plan your meals to include this food. Try not to eat high glycemic index foods as snacks.

Remember the previous what was said above about hypoglycemia? If you experience hypoglycemia, this would be an ideal time to eat a food with a high glycemic index - it will help level out your blood glucose faster.

Suggestions for low glycemic index snacks include the following:
1 cup cherries
1/2 grapefruit
1 small to medium sized apple
1 ounce of cheese
1/4 cup nuts
8 ounce sugar-free yogurt that is low-fat or fat-free
8 ounce milk, 1% or 2%

If curiosity now has the best of you and you would like to know the glycemic index of the foods you eat, here is a link that will provide you with that information: http://www.mendosa.com/gilists.htm.

Let me stress right now - DO NOT go on an all-meat, no-carbohydrate diet. You will be eliminating too many healthy foods that have good research supporting their health benefits including fruits, vegetables, legumes, and whole grains. If you would like more information on high-protein, high-fat diets and their effects on your health, click on the following link: http://www.nutractive.com/faq_diets.htm.

I hope you have found the information contained in this article helpful. If you or someone you know has diabetes, please take it seriously. Diabetes does not have to be the devastating disease that it has the potential for being. Uncontrolled, diabetes can eventually destroy one's life. Controlled, diabetes can go practically unnoticed.

Written by Laura S. Garrett, RD, LD, Fitness Trainer, & Owner of www.NutrActive.com Nutrition & Active Lifestyle Center **Weight Loss, Fitness, and Diabetes Programs** Contact via e-mail: Laura.RD@NutrActive.com ( mailto:laura.rd@nutractive.com ) Subscribe to one or ALL of NutrActive's FREE weekly e-zines for tips on how to lose weight, tone muscle, prevent disease, & cook healthy: Click Here to Subscribe Now!

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