Diabetes Mellitus: A Practical Handbook

By Sue K. Milchovich and Barbara Dunn-Long

Updated to include the latest developments in medicine and practices for diabetes treatment, as well as the most current information on new medication delivery methods, this comprehensive guide covers every aspect of living with diabetes. This user-friendly book takes a look at both the medical and nutritional sides of the disease and teaches diabetics how to balance diet, medication, and exercise for optimal health from the start. The diet and exercise plans that are included feature portion sizes and sample meal plansalong withlow-impact workout routines and have been revised to reflect new food pyramid guidelines and current minimum exercise suggestions. While an absolute cure for diabetes has not yet been discovered, this health manual makes living with the disease manageable.

• Language: English
• Publisher: Independent Publishers Group
• Release date: Apr 1, 2011
• ISBN: 9781936693108

Book preview

Diabetes

Mellitus

Diabetes mellitus has been known to man since about 2000–3000 B.C. The Greeks and Romans gave diabetes its name:

DIABETES = SIPHON (frequent urination)

MELLITUS = HONEY (sugar in the urine)

At the present time, diabetes affects about 21 million Americans. As long as more and more people become overweight, and as we live longer, we will continue to see an increase in the number of people with diabetes. It is estimated that for every person who is known to have diabetes there is one person who does not know.

HEREDITY

Diabetes is not a contagious disease. You cannot catch it from or give it to anyone. Heredity plays a very important role in its occurrence. It is believed that the susceptibility to diabetes is passed from generation to generation via genes, but not in any specific pattern. Heredity plays a stronger role in Type 2 diabetes (non-insulin-dependent) than in Type 1 diabetes (insulin-dependent) (see pages 4–5), but the nature of these genetic factors and how they are inherited are not yet understood. You may or may not know of other family members who have diabetes.

VIRUSES AND THE IMMUNE SYSTEM

Understanding the way the human body’s immune system works may someday answer a lot of questions about the cause of Type 1 diabetes (insulin-dependent). The immune system normally works to protect the body from harmful viruses and bacteria, but, for reasons not completely understood, in some people this protective system fails. It begins to destroy the cells of the pancreas that make insulin, so the body can no longer produce its own insulin.

There is also a seasonal factor in Type 1 diabetes—a greater number of people are diagnosed with it during the flu and virus season.

NUTRITION AND OBESITY

There is a direct connection between being overweight and having Type 2 diabetes (non-insulin-dependent). The pancreas of a person with Type 2 diabetes produces insulin, but the excess weight prevents the body cells or tissues from using it. We call this INSULIN RESISTANCE. Many times a person will also have high blood pressure and high cholesterols forming what is called the Insulin Resistance Syndrome. Losing weight and exercising can result in the body’s cells or tissues once again being able to use the insulin made by the pancreas. Blood sugars, blood pressure, and cholesterol all drop to healthier levels.

Currently there is a rapid rise in the number of people in the world with Type 2 diabetes, including teenagers and children. This type of diabetes occurs more often in people who:

  Have family members with diabetes

  Are overweight

  Have high blood pressure

  Have high cholesterols, especially high triglycerides and low HDL (see page 187)

  Are Hispanic American

  Are African American

  Are Native American

  Are Asian/Pacific Islander American

  Have had diabetes during pregnancy (gestational diabetes)

  Have had large babies (over nine pounds)

These are called the risk factors for diabetes. How many do you have? How many do your family members have?

TYPES OF DIABETES

Type 1 Diabetes (Insulin-Dependent)

  Formerly called juvenile diabetes

  Usually occurs before age 20 but can occur at any age

  Affects 10% of the total diabetes population

  No insulin production in the pancreas

  Has some connection to heredity

  Affects males and females equally

  Rapid weight loss

  Many symptoms plus ketones

  Seasonal: more often diagnosed during flu season

  Treatment:

Insulin: learning how to adjust insulin for changes in eating, exercise, illness, or pregnancy

Personal plan of meals and snacks to allow usual or ethnic foods

Good nutrition meeting needs for growth or pregnancy (and breastfeeding)

Exercise

Education

Type 2 Diabetes (Non-Insulin-Dependent)

  Formerly called maturity onset diabetes

  Occurs in adults and children

  Affects 90% of the total diabetes population

  Insulin is made by pancreas, but there is not enough or the body cannot use it correctly

  Has strong connection to heredity and being overweight

  Is slow to develop

  Majority are overweight, few are normal weight

  Has no seasonal connection

  Treatment:   Weight loss (if overweight)

Maintain weight (if weight is good)

Personal plan of meals and/or snacks to:

Include usual or ethnic foods

Adjusted for work, school, activities

Work for target blood sugars

Work for normal levels of blood fats (cholesterol and triglycerides)

Work for normal blood pressure

Exercise

Oral medication and/or insulin if needed

Education

At Risk for Diabetes

  Also known as Impaired Fasting Glucose or Impaired Glucose Tolerance

  Formerly called borderline diabetes

  Have fasting blood sugars over 100 but under 126 mg/dl

  In a glucose tolerance test, have a 2 hour blood sugar between 140–199 mg/dl

  Have a Hemoglobin A1c result 5.7%–6.4%

  Are usually overweight

  Have insulin resistance

  Treatment: Healthy eating for weight loss

normal blood sugars

normal blood fats (cholesterol and triglycerides)

normal blood pressure

Exercise

Education

Gestational Diabetes

  Occurs during pregnancy, in the last trimester

  Have insulin resistance

  Many pregnant women are tested between 24 and 28 weeks of pregnancy

  Treatment: diet and sometimes insulin

  Good control of blood sugars is an absolute must to protect the baby

  Blood sugars usually return to normal once the baby is born.

  Many women develop diabetes later

  It is important to maintain normal weight

GLUCOSE AND INSULIN

In order to control your blood sugar, you must understand glucose and insulin.

Let’s Start with GLUCOSE

All the foods we eat consist of CARBOHYDRATES, PROTEINS, and FATS.

  CARBOHYDRATES (see pages 43–55) include:

Foods high in sugar—sweets, honey, syrup, sugar, etc.

Starches—cereals, bread, potatoes, rice, pasta, corn, peas, beans, etc.

Fruits

Milk, yogurt

  PROTEINS (see pages 57–63) include:

Meat—poultry, beef, fish, etc.

Eggs

Cheese, cottage cheese

Peanut butter

Tofu

  FATS (see pages 63–65) include:

Oils

Margarine and butter

Salad dressing

Mayonnaise

Bacon

Avocado

Nuts and seeds

The stomach and intestines break down 100% of all the CARBOHYDRATES you eat to glucose. This glucose enters the blood, causing your blood sugar to rise. Be aware of the TOTAL AMOUNT of carbohydrate foods you eat at any one time.

Eat a large amount of carbohydrate foods. Blood sugar rises too high.

Eat little or no carbohydrate foods. Blood sugar may drop too low.

Your blood sugar will remain more stable if you keep the TOTAL AMOUNT of carbohydrate foods eaten from meal to meal constant and balance them with some protein, fat, and vegetables. Do not focus on the sugar content of foods—look at the TOTAL CARBOHYDRATE amount (see nutrition label on page 83).

Vegetables contain carbohydrates, but because they have so few calories and little carbohydrate, they do not affect blood sugar unless eaten in large amounts.

PROTEIN does not affect blood sugar. The type and amount of protein foods you choose to eat depend on what you need to do about your weight (lose, gain, or maintain) and whether your cholesterol is high or normal. INCLUDE A SMALL AMOUNT OF PROTEIN WITH EACH MEAL to help control the rise in blood sugar that occurs after eating and help you go 4 to 5 hours between meals.

FAT does not cause blood sugar to rise. The type and amount of fat you choose to eat depend on what you need to do about your weight (lose, gain, or maintain) and whether your cholesterol is high or normal. A meal that is high in fat (for example, pizza) will keep your blood sugar up longer.

The perfect meal is made up of small amounts of foods from all the groups.

AMOUNT IS THE KEY!¹

Insulin

INSULIN is a hormone made in the pancreas, which is located behind and below the stomach.

When the blood sugar rises, insulin is released into the blood. Both insulin and glucose travel all over the body via the blood.

In the MUSCLES, glucose is turned into ENERGY.

The LIVER stores glucose for future use (especially if blood sugar drops too low).

FAT cells take and store all the excess glucose as fat.

For glucose to enter a cell and do its work, INSULIN must be present to act as a transporter. Think of it as glucose coming upon a locked door, and insulin as the key that opens the door.

When you have diabetes, there is a problem with insulin:

Type 2 diabetes

In someone who is thin or of normal weight, the cells of the pancreas do not make enough insulin.

In those who are overweight, a lot of insulin is made at first but will decrease over time. Also the insulin does not work correctly. It cannot get into the muscle and fat cells to do its work. This is called insulin resistance.

There are 2 ways to break the insulin resistance and get the body to use the insulin:

  LOSE WEIGHT—10 to 20 pounds is the key amount.

  EXERCISE : See exercise on pages 147–158.

Presently, the exact cause of diabetes (Type 1 and Type 2) is unknown, and there is no cure. Once you have diabetes, you have it for the rest of your life.

You will learn how to keep your blood sugars as close to normal as possible by balancing food, body weight, medication, and exercise. The best way to do this is to work with several people (no one person can teach you all you need to know) known as your diabetes team.

You must be the center of the team. The other members may include any or all of the following people: