Simple tweaks to your diet can
help prevent insulin spikes.
Food is the most potent weapon in
your fight against diabetes, says Mark Hyman, MD, author of The Blood Sugar
Solution (Little, Brown and Company). Evidence shows that eating the right
foods can manage your blood sugar level and, according to Hyman, even help
reverse diabetes.
It's easier than you might think.
Consistently tune into the following factors when choosing your foods and
you'll be rewarded with stable blood sugar, insulin, and energy levels
throughout the day.
Glycemic Load
Glycemic load (GL) measures how
much carbohydrates in a food affect your blood sugar level. (Carbohydrates is
the food group that impacts blood sugar the most; protein and fat don't as
much.) Factors such as fiber content, serving size, and even shape come into
play when the body is breaking down food into sugar molecules. The more
challenging a food is to break down, the slower it digests and the more stable
your blood sugar will be. Foods made with refined carbs, such as white pasta,
are digested quickly and have a higher GL that causes blood sugar to rise
rapidly, but foods made with complex carbs, such as whole-wheat pasta, have a
lower GL that has a much smaller affect on blood sugar.
Portion Size
"Excessive portion sizes can
impact blood sugar," says Amy Jamieson-Petonic, RD, spokesperson for the
Academy of Nutrition and Dietetics, and director of coaching at the Cleveland
Clinic. A large meal means more sugar (from carbohydrates) enters the
bloodstream at one time. Eating smaller portions beefed up by low GL snacks,
such as nuts, keeps your blood sugar even throughout the day.
Shape of Food
Food that's in its full
"package," such as a whole grain, takes longer to digest than food
that's been partially or fully processed. Whole barley, for instance, has a GL
that's less than half that of cracked barley.
Food Combinations
What you eat with your
carbohydrates matters, too. "Protein and fat slow the absorption of
glucose into the bloodstream, which helps prevent [insulin] spikes and
drops," says Jamieson-Petonic. Pairing an apple with peanut butter or
serving rice with beans and avocado can lessen the blood-sugar impact of the
whole plate.
That all might sound pretty
complex, but the bottom line is simple: The less processed your food and the
more work your body has to do to digest it, the better it is for your blood
sugar. "It's about eating real food," Hyman says. If a food's label
reads like a science project filled with ingredients you don't recognize,
"we shouldn't eat it," Hyman says. "If it's raised in a field,
we're good."
Don't forget these safety
precautions before your next workout.
You know exercise is key to
better living with diabetes. It enhances insulin sensitivity and lowers blood
sugar levels. But if you have diabetes, you need to take extra safety
precautions whenever you work out.
Check with your doc. If you're
overweight or have high blood pressure, a heart condition, or vision or foot
problems, talk to your doctor before starting an exercise routine. Ask which
kind of exercise -- and how much -- is safe for you. To prevent you from
overdoing it, your doctor may ask you to break up your daily workout into mini
sessions.
Measure your blood sugar level
before, during, and after exercise. If your blood sugar is too high or too low,
or if you have ketones in your blood or urine, avoid strenuous physical
activity. In some people with diabetes, exercise can actually worsen high or
low blood sugar.
Fuel up. If your blood sugar is
below 100 mg/dL, eat something light before you exercise. Keep a carb-rich
snack, such as fruit, crackers, or rice cakes (or glucose tablets) on hand in
case your blood sugar drops too low.
Hydrate. Diabetes can inhibit the
brain's signal for thirst and lead to dehydration. Be sure to drink extra water
before, during, and after exercise.
Avoid hot weather workouts. Some
folks with diabetes lose the ability to regulate body temperature. (This is
caused when diabetes disrupts the body's autonomic nervous system, which
inhibits normal blood flow to the skin and the ability to sweat.) Avoid heat
exhaustion by exercising indoors on very hot days.
Take care of your feet. Diabetes
can cause numbness and decreased blood circulation in the feet (peripheral
neuropathy). Wear shoes that fit well, never exercise barefoot, and inspect
your feet before and after every workout. Treat any blisters, abrasions, or
injuries promptly.
Wear a medical ID tag whenever
you exercise. If an emergency arises, it will alert caregivers that you have
diabetes.
3 Lifestyle Changes to Help Reverse Type 2 Diabetes
Celebrity Rob Kardashian may be best known for his roles in reality TV, but the health crisis that landed him in the hospital in late December 2015 was all too real. The cause: complications due to previously undiagnosed type 2 diabetes, a chronic disease that can lead to other serious conditions, including heart disease, kidney disease and more. According to the Centers for Disease Control and Prevention, two people die from diabetes-related causes every five minutes. But there's good news: If caught early, type 2 diabetes can be managed and sometimes even reversed with simple lifestyle changes. Here are three that can make a difference.
1. Lose weight. Kardashian has reportedly gained about 100 pounds, so his first step—and yours, if you’ve been diagnosed with diabetes—should be to lose weight. Excess fat increases insulin resistance, which is one of the main drivers of diabetes. Insulin helps bring sugar from the blood into cells; people with diabetes either don’t make enough insulin or their bodies become resistant to it, resulting in a buildup of sugar in the bloodstream. Losing just 5% to 8% of bodyweight can help the body produce more insulin and use it more efficiently.
2. Track your food. One of the best ways to manage diabetes is to limit your carbohydrates, which will help you control your blood sugar levels – and that's critical when you have diabetes. Counting carbs and calories is a great way to lose weight, too, but it can be tricky and tedious. Luckily, it’s easier than ever, with websites and apps such as MyFitnessPal and Lose It!. These apps have nutritional information for thousands of foods, with macronutrients like carbs, protein and fat already broken out. MyFitnessPal even has a feature where you can use your phone’s camera to scan the barcode on a package and automatically log your meals. That means there’s no more excuses for tracking what you eat.
3. Move more. Exercise provides a ton of benefits for people with diabetes. Physical activity improves insulin’s ability to regulate blood pressure, which is what managing your diabetes is all about. Moving more can also help you lose weight, and it’s good for the heart as well. Your goal: 30 minutes of moderate exercise a day, five days a week. If you can’t work out that much, don’t worry: Some is better than none. Research suggests that high intensity interval training, where you go all out for a short period (say, 30 seconds) and rest for a longer period (90 seconds), burns calories faster and improves blood sugar control compared to slow, continuous exercise.
Take this assessment to prevent or manage your diabetes symptoms with personalized advice on how to keep your blood sugar levels under control.
Try these fun, safe workouts for
better blood sugar.
FUN, SAFE WORKOUTS FOR BETTER
BLOOD SUGAR
No doubt you’ve heard about the
wonders of exercise (how it helps you lose weight, sleep better, and feel more
energetic), but for people who have diabetes, exercise is absolutely essential.
"Trying to manage diabetes without being physically active is like a
singer performing without a microphone," says Gary Scheiner, MS, CDE,
author of Think Like a Pancreas: A Practical Guide to Managing Diabetes with
Insulin (Da Capo Press). "Exercise is one of the most empowering things
you can do to lower your blood glucose and control your diabetes." Try one
of these 8 expert-recommended workouts.
TRY WEIGHT LIFTING
Weight lifting isn’t just for bodybuilders.
It’s a critical exercise for people with diabetes. Resistance training, or
strength training, lowers your blood glucose level by giving your muscles more
room to store extra carbs as glycogen for energy, says Sheri R. Colberg, PhD, a
professor of exercise science at Old Dominion University in Norfolk, Va., and
author of Diabetic Athlete’s Handbook: Your Guide to Peak Performance (Human
Kinetics). Resistance training also boosts metabolism so you burn more
calories. Start with resistance bands or small hand weights two to three times
a week for 15 to 20 minutes at a time. Increase the weight or resistance as you
get stronger
TAKE A WALK
The simple act of walking is
still one of the best exercises you can do for diabetes, says Betul Hatipoglu,
MD, an endocrinologist at Cleveland Clinic. "It’s easy," she says.
"You just need a pair of shoes. You can do it anywhere, anytime." If
it’s been a while since you exercised, start by taking three 10- to 15-minute
walks a day. Do errands on foot, walk through the mall, or take a midday walk
at lunch. Aim to walk a total of 30 to 45 minutes a day, or strap on a
pedometer and try to log 10,000 steps daily.
AKE CONTROL WITH TAI CHI
Tai chi originated in China as a
martial art and is touted today as a way to reduce stress, improve balance, and
enhance flexibility. In people with diabetes, it can even lower blood glucose
levels. According to a study in the Journal of Alternative and Complementary
Medicine, patients who did an hour of tai chi twice a week in a class and 20
minutes three times a week at home reduced their blood glucose levels, improved
their overall diabetes care, and had a better quality of life, including mental
well-being. "Tai chi is really good for both balance and flexibility at
the same time," Colberg says. "It also works on muscle strength and
helps lower glucose because it lowers stress."
GET INTO THE POOL
For people who have diabetes,
pool exercises, such as water aerobics and pool walking, are great
low-intensity cardio workouts that burn calories and improve flexibility.
They’re even safe for people who have diabetic neuropathy, which often causes
weakness, numbness, tingling, and pain in the hands and feet. For people with
loss of feeling in their feet, pool exercises are a lot kinder and gentler on
the feet, Colberg says. If you have arthritis as well, water workouts are a
good bet because they have low impact on the joints.
PICK UP THE PACE WITH INTERVAL
TRAINING
Injecting bursts of high
intensity into your workouts -- known as interval training -- helps lower your
blood glucose level, improve cardiovascular health, and build stamina. Next
time you’re walking on a treadmill, try adding short bursts of speed to your
workout. On the elliptical machine? Crank up the resistance. Out on a walk? Alternate
between a fast pace and slow pace. Colberg recommends starting with short 15-
to 30-second bursts of intensity and gradually working up to longer intervals
of a minute or two.
PRACTICE YOUR BALANCE
Diabetic neuropathy can throw off
your gait and make balance more difficult. "With age, you naturally lose
some balancing ability," Colberg says. "People with diabetes often
lose sensation in their feet, so they don’t know where they’re placing their
feet." Balance exercises help counteract that. Try standing on one foot
near a chair or countertop. Once you’re able to stand on one foot without
toppling over, try doing it with your eyes closed. Practice balancing on each
foot.
ADD PHYSICAL ACTIVITY TO YOUR DAY
Try as they might, some people
just don’t enjoy exercise. For them, everyday chores can help add more physical
activity to their routine. "There is plenty you can accomplish while
burning calories and lowering blood sugar," Scheiner says. "Just
about any form of movement is helpful." Gardening, housecleaning, and
washing the car are all great ways to be active, he notes. Walking the dog,
doing errands on foot, or playing active games with your children or
grandchildren count, too.
DO WHAT YOU LOVE
Whether it's ballroom dancing
with your honey, hiking in the mountains, or a rigorous game of ping pong, the
key to exercise is to do something you love. "Any type of exercise is good
for people with diabetes," says Steve Edelman, MD, founder of the
educational organization Taking Control of Your Diabetes. "Do what you
enjoy or else you will not be consistent." If you love an activity --
whether it's a formal exercise program or a physically active hobby -- you're
more likely to stick with it.
High blood sugar levels are bad
news for your body. So you have to choose carefully when it comes to choosing
snacks. You want to keep hunger and hypoglycemia at bay without increasing your
blood sugar. High-fiber, slowly digested, healthy snacks will curb your hunger
while producing a steady release of blood sugar to help control diabetes. Just
remember to balance those snacks with your meals so you're not adding excessive
calories to your day (which would mean more blood sugar than your system
needs). Here are 7 smart and delicious snack ideas to quell the munchies while
keeping blood sugar steady.
WALNUTS
Nuts are high in protein, fiber,
and unsaturated fat, which means they're not only nutritious but slowly
digested, too. And research suggests that nuts also may boost insulin
sensitivity -- a nice bonus. Even better, though? Walnuts may be particularly
useful for people managing diabetes. In one study, regularly eating walnuts
seemed to improve endothelial function in people with diabetes. And that's a
really great thing because endothelia -- the cells lining your arteries -- are
one of the first things to suffer when high blood sugar begins to wreak havoc
in the body.
WHOLE
GRAIN CRACKERS
The fiber in whole-grain crackers
slows digestion and leads to a steadier release of blood sugar. And those
crackers will help you feel full longer if you smear them with some
heart-healthy peanut butter. Top those peanut butter crackers with a dash of
cinnamon, and you've got a real diabetes-friendly gourmet treat. Studies show
that cinnamon may help tamp down blood sugar levels.
AVOCADO
WITH BALSAMIC
When you're in the mood for a
luscious snack, slice an avocado in half, remove the pit, and drizzle with
balsamic vinegar. Spoon each bite right out of the skin and enjoy. If you have
diabetes, you can't go wrong with avocado because of its high fiber and healthy
fat content -- both of which help steady blood sugar. Avocados are also loaded
with potassium, a mineral that aids nerve function to help prevent diabetic
neuropathy.
SWEET
POTATO FRIES
Not the deep-fried kind. But
baked sweet potato fries are a super-healthy choice for people concerned about
their blood sugar. Sweet potatoes may actually help stabilize blood sugar and
lower insulin resistance. Sweet potatoes have a lower glycemic index than other
spuds, which helps soften their impact on your blood sugar. And research shows
that their high carotenoid content may be particularly useful in the blood
sugar battle when it comes to managing diabetes.
APPLE AND
PEAR SLICES
Juicy, crunchy, fresh,
low-calorie fruit is always a smart choice for the health-conscious nibbler
with diabetes. But your blood sugar will be best served if you opt for fruits
that are high in fiber, like apples and pears. Thanks to the fiber, they'll
fill you up without sending your blood sugar levels soaring.
PLAIN
YOGURT
The calcium and vitamin D combo
in yogurt may help prevent insulin resistance, which is a great thing if you're
worried about chronically high blood sugar. And the calcium in dairy foods like
yogurt may hinder the absorption of fat from the small intestine and stymie the
birth of new fat cells -- good news for your waistline if you need to trim some
belly fat. For a snack to best manage diabetes, choose low-fat or fat-free
unsweetened yogurt. Top it with fruit for a naturally sweet treat or use it in
place of sour cream in veggie dips.
POPCORN
Low-fat popcorn cooks up in a
snap. And it's packed with slowly digested whole-grain fiber as well as
disease-thwarting antioxidants, making it perfect for people concerned about
blood sugar and diabetes. And because popcorn is so light and fluffy, you fill
up on fewer calories than you would with more energy-dense snacks like potato
chips. Air-popped popcorn is great, but you also can drizzle it with olive oil
for a healthier alternative to butter.
Avoid these not-so-friendly foods
in your daily meals and snacks.
NOT-SO-FRIENDLY FOODS
Certain foods can send your blood
sugar level on a roller coaster, with insulin rushing to keep up. The good news
is, while there are some surprises, most of these foods fall under the same
category: processed food, such as white flour and sugar. "Refined flours
and sugar cause huge spikes in insulin and get absorbed quickly, which causes
problems," says Mark Hyman, author of The Blood Sugar Solution (Little,
Brown and Company). Look at the whole meal instead of just individual
ingredients, adds Jackie Mills, MS, RD. Pairing carbohydrates with protein,
fat, or fiber helps slow down the absorption process. Watch out for these 10
blood-sugar saboteurs.
WHITE RICE
White rice is a whole rice grain
that has been polished until just the endosperm -- essentially an easily
digestible starch bomb -- is left. Not surprisingly, recent studies have shown
that eating white rice can raise blood glucose significantly, especially if
eaten often or in large quantities. One study showed an 11% increase in
diabetes risk with each daily serving of white rice. If you love rice with your
stir-fries, switch to brown rice. Your blood sugar will thank you.
POTATOES
Potatoes may be a whole, natural
root veggie, but they’re also notorious for causing blood sugar to spike
because they're digested into the bloodstream quickly. To mitigate this
negative effect, cook potatoes with a healthy fat, such as olive oil, and bump
up the fiber by adding hearty leafy greens or another vegetable to the mix. Or,
make potato salad with plenty of lemon juice and chill it in the fridge. The
acid and cold alter the starch molecules in the spuds to slow digestion.
KETCHUP
We tend to think of ketchup as a
salty condiment, but many brands list some sort of sweetener as the second
ingredient, which can have a disastrous effect on your blood sugar level.
"It doesn’t matter if it’s called sugar, evaporated cane juice, high
fructose corn syrup, or malt syrup," Mills says. "They’re all sugar,
and all of them will elevate blood glucose."
WHITE PASTA
White pasta is made from refined
white flour, which is an easily digestible starch. That raises your blood sugar
level. It also tends to provoke overeating because it's quickly digested, so
you want to eat again, according to Amy Jamieson-Petonic, RD, spokesperson for
the Academy of Nutrition and Dietetics and director of coaching at Cleveland
Clinic. As if that's not bad enough, overcooking the pasta worsens the blood
sugar impact.
BAGELS
Back during the low-fat diet
craze, bagels were darlings because of their "no-fat/low-fat" label,
but that’s one of the very reasons they wreak such havoc on blood sugar.
"Refined flours cause huge spikes in insulin and get absorbed quickly,
which causes problems," Hyman says. If you must get your bagel fix, pair
it with a smear of avocado, which is loaded with healthy unsaturated fat, and a
few slices of smoked salmon (a great source of both protein and omega-3 fatty
acids) to help slow down digestion and regulate your blood sugar. You get extra
points if you have a whole-grain bagel.
ARTIFICIAL SWEETENERS
Many people think artificial
sweeteners are harmless additives and a good choice if you have diabetes. Not
so, Hyman says. "Artificial sweeteners slow metabolism and increase fat
deposition, and can increase the risk of diabetes by 67%." If you need to
satisfy a sweet tooth, Mills says, you're better off enjoying foods made with
real sweeteners on occasion and in moderation.
FRUIT JUICE
"If your blood sugar is
extremely low and you need to bring it up quickly, juice is your thing,"
Jamieson-Petonic says. But that’s not an effect you want when you’re looking to
keep your blood sugar level the rest of the time. "The concentration of
carbohydrates is very high and tends to cause severe spikes and drops,” she
adds. Keep fruit juice on hand to counteract hypoglycemia (low blood sugar),
but make water your go-to beverage as part of your everyday diabetes diet.
ENERGY BARS
Because of all the added sugar,
"some energy bars may as well be labeled candy bars," Mills says.
Indeed, a single bar can carry a glycemic load over 49 (anything over 20 is
considered "high"). That's more than a king-size Snickers bar! Bars
made from refined flours and sugars are the worst culprits, since these have
the harshest impact on blood sugar. If you like the convenience of energy bars,
read labels carefully and choose bars made with nuts, whole grains, and few
added natural sweeteners. Don't forget to account for the carbs in your daily
tally.
LOW-FAT SWEETENED YOGURT
It's obvious that low-fat yogurt
has had fat removed, and that seems like a good choice if you have diabetes.
While low-fat yogurt has a (small) positive impact on calorie count, it’s not
so great for your blood sugar. Manufacturers compensate for that loss of fat by
adding stabilizers, thickeners, and sugars that can have a detrimental impact
on blood glucose. A better approach is to skip the fruit-flavored yogurt and
choose plain yogurt sweetened with real, whole fruit.
SPORTS DRINKS AND ENERGY DRINKS
Energy drinks and sports drinks
carry all the woes of fruit juice with the added no-no of more sugars.
"They’re basically lots of sugar and very low nutrition,"
Jamieson-Petonic warns. If you're trying to stabilize blood sugar, steer clear
of energy drinks and sports drinks. Go for water flavored with a spritz of
citrus instead.
Try these foods to keep blood
glucose under control.
THE POWER OF FOOD
Some foods have a bigger impact
on your blood sugar than others. Knowing which ones are the best for keeping
blood sugar levels steady is especially important when you have diabetes, but
it's a good idea for everyone. Your dietary goal is to choose foods that help
keep your blood sugar level on an even keel. That typically means whole,
minimally processed foods. Here are 10 of the best foods that stabilize–or even
lower–your blood sugar so you can better manage your diabetes.
LOAD UP ON SPINACH
Looking for a diabetes-friendly
food? Follow Popeye's example. Spinach, kale, chard, and other leafy greens are
loaded with vitamins, such as folate; minerals, such as magnesium; a range of
phytonutrients; and insoluble fiber–all of which have virtually no impact on your
blood sugar level. Mark Hyman, MD, author of The Blood Sugar Solution (Little,
Brown and Company), calls leafy greens "free foods," which means you
should eat as many of them as you can. Bonus: The fiber in leafy greens will
slow absorption of any carbohydrates (e.g., potatoes or bread) they’re paired
with, resulting in a healthier overall glycemic load.
NUTS OF ALL SORTS
walnuts, pecans, take your
choice!–are great for controlling blood sugar. Despite their diminutive size,
nuts are power packages of protein, unsaturated (healthy) fat, and fiber. Those
three factors have a positive impact on blood sugar levels. In a recent study,
participants who ate 2 1/2 ounces of nuts daily had an 8% decrease in their A1c
levels. Keep in mind that nuts also pack plenty of calories. Your best bet is
to substitute nuts for high-carbohydrate foods, such as croutons or pretzels.
Sprinkle them on yogurt and salads, or nibble them for a snack.
OPEN A CAN OF SARDINES
When you have diabetes, you want
to land fish on your plate, especially fatty, cold-water fish. Sardines and
other small, fatty fish are high in essential omega-3 fatty acids that our
bodies can only get from the food we eat. Sardines and other omega-3-rich fish
help in a couple of ways: They're a great source of fat and protein to slow
absorption of blood sugars, and they help protect your cardiovascular system,
which irregular blood sugar fluctuations that can come with diabetes can
damage. The healthy fat in sardines is good for your brain, too, and may help fend
off Alzheimer's disease and dementia.
DIP INTO HUMMUS
Hummus, a Middle Eastern
specialty, is a great addition to a diabetes-friendly plate. The fiber and
protein in chickpeas–12 grams of dietary fiber and 15 grams of protein per
cup–help regulate the absorption of the sugars from the starch so your blood
sugar stays on an even keel. The healthy fats from the tahini (made from ground
sesame seeds) and olive oil slows the absorption of sugars even more. Pair your
hummus with vegetables and whole-grain crackers for an even greater effect.
TRY CHIA SEEDS
High in protein, fiber and
omega-3s, chia seeds are a nutritional powerhouse. The flour made from these
nutty seeds is a great addition to a diabetes-friendly kitchen. “It actually
lowers blood sugar due to the fiber and omega-3 fatty acid content,” says Amy
Jamieson-Petonic, RD, spokesperson for the Academy of Nutrition and Dietetics
and director of coaching at Cleveland Clinic. And chia seeds may help reduce
belly fat–the kind that contributes to insulin resistance. Substitute a quarter
of your regular flour with chia flour (and experiment with higher ratios) in
just about any baked good. Order the flour online, find it at health-food
stores, or grind chia seeds in a food processor.
SPRINKLE ON CINNAMON
If you have diabetes, be sure
there's cinnamon in your spice rack. Studies have shown that as little as a
teaspoon of cinnamon a day may significantly decrease fasting blood glucose
levels and increase insulin sensitivity. There are lots of ways to add more cinnamon
to your diet. Sprinkle some in your coffee, stir it into your morning oatmeal,
or add it to rubs for chicken or fish.
LOVE YOUR LENTILS
Lentils are smart legumes when
managing your blood sugar. They contain a good amount of starch (normally a
no-no when managing blood sugar), which gives them a satisfying, hearty
creaminess. Lentils are also packed with both soluble and insoluble dietary
fiber. Soluble fiber turns into a gel-like consistency during digestion, which
slows absorption of the sugar molecules in the starch. Insoluble fiber passes
through the digestive tract without "registering" as a carbohydrate,
while slowing down the whole digestive process so you stay satisfied and your
blood sugar remains steady
MAKE ROOM FOR QUINOA
Quinoa is a super grain for many
reasons: It’s one of the few non-animal proteins that's considered a
"complete protein" in that it has all of the essential amino acids
your body needs to build protein molecules. Plus, quinoa is a whole grain with
germ, endosperm, and bran intact, bringing a host of nutrients and healthy fat
to the mix. Even better, all those benefits come with very little impact on
your blood sugar level. A half-cup of cooked quinoa ranks just under 10 (that's
low!) on the glycemic load scale. It's easy to add quinoa to meals. Try using
it in place of white rice as a side.
SWITCH TO WHOLE-GRAIN PASTA
Think comforting bowls of pasta
are off the menu because you have diabetes? Think again. "Whole-grain
pastas are a great source of B vitamins and fiber, and reduce inflammation in
the blood vessels," says Jamieson-Petonic. However, this food does come
with a couple warning flags. First, overcooking pasta raises its glycemic load
(follow the package directions and pull the pasta off the heat when it's al dente).
Second, beware of portion size. A good bet is to pair 1/2 to 1 cup of cooked
pasta with a bevy of vegetables and a bit of lean protein and healthy fat for a
dish that's easy on your blood sugar.
Complications of poorly managed type 1
diabetes mellitus may include cardiovascular disease, diabetic neuropathy, and
diabetic retinopathy, among others. However, cardiovascular disease as well as
neuropathy may have an autoimmune basis, as well. Women with type 1 DM have a
40% higher risk of death as compared to men with type 1 DM. The life expectancy
of an individual with type 1 diabetes is 11 years less for men and 13 years
less for women.
Urinary tract infection
People with diabetes show an increased rate of
urinary tract infection. The reason is bladder dysfunction that is more common
in diabetics than in non-diabetics due to diabetic nephropathy. When present,
nephropathy can cause a decrease in bladder sensation, which in turn, can cause
increased residual urine, a risk factor for urinary tract infections.
Sexual dysfunction
Sexual dysfunction in diabetics is often a
result of physical factors such as nerve damage and/or poor circulation, and
psychological factors such as stress and/or depression caused by the demands of
the disease.
Males
The most common sexual issues in diabetic
males are problems with erections and ejaculation: "With diabetes, blood
vessels supplying the penis’s erectile tissue can get hard and narrow,
preventing the adequate blood supply needed for a firm erection. The nerve
damage caused by poor blood glucose control can also cause ejaculate to go into
the bladder instead of through the penis during ejaculation, called retrograde
ejaculation. When this happens, semen leaves the body in the urine."
Another cause for erectile dysfunction are the reactive oxygen species created
as a result of the disease. Antioxidants can be used to help combat this.
Females
While there is less material on the
correlation between diabetes and female sexual dysfunction than male sexual
dysfunction, studies have shown there to be a significant prevalence of sexual
problems in diabetic women. Common problems include reduced sensation in the
genitals, dryness, difficulty/inability to orgasm, pain during sex, and
decreased libido. In some cases diabetes has been shown to decrease oestrogen
levels in females, which can affect vaginal lubrication.
Oral contraceptives can be taken by diabetics.
Sometimes, contraceptive pills can cause a blood sugar imbalance, but this
usually can be corrected by a dosage change. As with any medication, side
effects should be taken into account and monitored to prevent serious
complications with diabetes.Women with type 1 diabetes show a higher than
normal rate of polycystic ovarian syndrome (PCOS). The reason may be that the
ovaries are exposed to high insulin concentrations since women with type 1
diabetes can have frequent hyperglycemia.
Learn how specialists such as
endocrinologists, dietitians and diabetes educators can help you cope with
diabetes.
The best way to manage diabetes?
Build your healthcare team. Diabetes is a complex disease that affects several
systems in your body -- so it takes a village to effectively treat it. Your
primary doctor, although an important member of your team, is not equipped to
go it alone. That's where specialists like endocrinologists, dieticians, and
certified diabetes educators come in. Here's a list of the specialists you may
need to include in your diabetes care:
Primary care physician. Your primary care physician provides the
foundation of your diabetes healthcare team. See your doctor at least twice a
year (more, if recommended) for a wellness exam and an A1c blood sugar test.
Ask for a check of your blood pressure, cholesterol, triglycerides, and kidney
values, too.
Endocrinologist. An endocrinologist treats problems with the body's
hormone-producing system and is specifically trained to treat the insulin
problems common in diabetes. People with type 1 diabetes normally see an
endocrinologist, but those with type 2 may not need to if their blood sugar is
well controlled.
Diabetes educator. A diabetes educator, also called a certified
diabetes educator (CDE), can teach you several ways to better cope with
diabetes. This includes instructions on how to use diabetes medications, how to
give yourself insulin shots, and how to check your blood sugar levels.
Dietitian. In addition to helping you choose foods that will
stabilize rather than increase your blood sugar, a registered dietitian can
show you how to read food labels, plan meals, and schedule meals around
medications and exercise.
Dentist. People with high blood sugar have less saliva and more
salivary sugars in their mouths. This can feed oral bacteria and increase your
risk of gum disease, tooth decay, and tooth loss. See your dentist at least
twice a year.
Eye doctor. Diabetes can damage the small blood vessels in your
retina and affect your eyesight. Go to an eye doctor who is familiar with
diabetes at least once yearly to get screened for cataracts, glaucoma, and any
other vision changes.
Foot doctor. Diabetes can get in the way of good circulation and
damage the nerves in your feet. Visit a podiatrist twice yearly and inspect
your own feet daily for cuts or sores, blisters, injuries, ingrown toenails, or
signs of infection.
Exercise physiologist. If your doctor is unable to recommend a safe
exercise regimen, ask for a referral to an exercise physiologist trained in
diabetes.
Pharmacist. Your pharmacist can educate you about your diabetes
medications, their side effects, effects they can have on your blood sugar, and
potential drug interactions.
Counselor or therapist. The right mental health expert can help you
cope with the emotional impact of diabetes. Also, a social worker can provide
resources to help you with any medical or financial difficulties.
Support group. Talking with other people who live with diabetes can
give you support and valuable insight into how to cope with your condition. In
fact, a recent study found that, compared to normal care or financial
incentives, talking with peers with good blood sugar control helped people with
diabetes better control their own blood sugar levels.
Friends and family. Nurture ties with friends and family members.
They are your first line of understanding, support, and comfort.
You. The most important member of your diabetes healthcare team?
You. Ultimately, you're in charge of your healthcare team and your diabetes
care plan. So take the driver's seat on your road trip to a younger, healthier
life with diabetes.
Diabetes Food Basics
A healthy diabetic diet is your
best strategy for blood sugar and weight control.
Your diet is a key part of your
diabetes-management plan. The food you eat can help you regulate your blood
sugar, maintain or move toward a healthy weight, and meet your treatment goals.
Like any smart eating plan, a diabetic diet embraces a wide range of delicious
fare -- lots of fruits and vegetables, whole grains and legumes, low-fat dairy,
fish, and more. If you plan your meals right, there's even room for dessert.
Work with your dietician to
create a personal plan that is manageable, helps you meet your targets, and
accommodates your personal food preferences. If a registered dietician isn't
part of your diabetes healthcare team, talk to your nurse-educator or doctor to
recommend a nutrition specialist.
Dietary advice should be tailored
to each individual, but general guidelines for diabetes management include the
following recommendations:
Dietary Recommendations for Diabetes
Carbohydrates
Monitoring your carbohydrates is
a key part of diabetes nutrition therapy and blood sugar control. Aim to get
about 45 grams to 60 grams of carbohydrates at each meal, and opt for mostly
complex carbs, such as fruit, vegetables, whole grains, and legumes. They
slowly release glucose into your bloodstream to keep your blood sugar stable.
Protein
Aim to get 15% to 20% of your
calories from protein.
Fat
Unsaturated fats (e.g., olive
oil, nuts, fish, avocados) are good for you and can help you meet your diabetes
goals. Make those your go-to fats. Limit saturated fats (e.g., butter, cream,
beef) to less than 7% of total calories. Avoid trans fats (check food labels)
altogether.
Fiber
Fiber recommendations for people
with diabetes are the same as those for the general population. Aim to get at
least 25 grams of fiber a day from a variety of sources, including whole
grains, vegetables, fruit, and legumes.
Other conditions can arise after
a diabetes diagnosis. Know how you can stay healthy.
SOME GOOD
NEWS
Having diabetes is challenging
enough. So it's good to know diabetes complications don't have to be
inevitable. There are things you can do to help prevent them. But if diabetes
isn't controlled, it leads to more health problems over time. Some people develop
heart disease. Others experience vision loss. Still, others end up with kidney
disease. "Preventing complications is pretty straightforward," says
Steve Edelman, MD, founder of Taking Control of Your Diabetes (TCOYD).
"Keep your blood sugar levels as close to normal as possible to prevent
and delay the progression of eye, kidney, and nerve disease."
Here are 10 diabetes
complications you can learn to prevent or delay:
HEART
DISEASE AND STROKE
People with diabetes are at least
twice as likely to have a heart attack or stroke. They're also more likely to
have a heart attack or stroke at an earlier age. To reduce your risk, lower
your blood pressure and cholesterol with regular exercise and a healthy
low-fat, low-salt diet that includes more fruits, vegetables, and whole grains.
Quit smoking. And do your best to lose at 5% to 10% of your body weight. If you
still need help, talk to your doctor about medication for high blood pressure
and/or high cholesterol.
VISION
PROBLEMS
Blurry vision. Floating spots. Distorted
images. If excess glucose (high blood sugar) damages the blood vessels that
feed your retina, you may develop an eye problem called diabetic retinopathy.
Diabetic retinopathy often starts with no symptoms, but over time, can destroy
your eyesight and cause vision loss. In fact, diabetes is the leading cause of
blindness in adults between the ages of 20 and 74. To prevent retinopathy,
watch your blood sugar levels closely and see an eye doctor once a year for a
complete eye exam.
KIDNEY
DISEASE
Think of your kidneys as your
body's filtration system. When blood vessels in the kidneys are damaged by
excess glucose, your kidneys can't filter toxins. You end up with high levels
of protein in your urine and waste products in your blood. Over time, your kidney
function gets worse. And this can lead to kidney failure, dialysis or a kidney
transplant. "Diabetes with hypertension is now the number one cause of
end-stage kidney disease," says Betul Hatipoglu, MD, an endocrinologist at
the Cleveland Clinic. Ask your doctor about routine tests to detect proteins in
your urine. To keep your kidney disease from getting worse, your doctor may
also prescribe medication to lower your blood pressure.
TINGLING
HANDS AND FEET
Up to 70% of people with diabetes
have some degree of damage to their nervous system, known as neuropathy. The
damage can result in loss of feeling or pain in the hands or feet, slow
digestion of food in the stomach, carpal tunnel syndrome, or other nerve
problems. Mild cases may go completely unnoticed. Severe cases—most likely
involving the feet and lower limbs—may lead to infections that require
amputation. To keep neuropathy at bay, get a diabetes foot exam that tests your
sensation every year.
TUMMY
TROUBLE
Gastroparesis, a form of
neuropathy, interferes with the emptying of the stomach and leads to poor
digestion. In people with diabetes, it's often caused by extended periods of
high blood glucose. "Food can get stuck in stomach because the nerves
aren't working right, so the food isn't passing into the intestines," says
Melinda Maryniuk, RD, CDE, director of clinical education programs for the
Joslin Center in Boston. The result may be digestive problems, such as
heartburn, stomach pain, constipation, and weight loss. If you have diabetes and
problems with digestion, talk to your doctor about getting tested for
gastroparesis.
YOUR SEX LIFE
Both men and women may struggle
with sexual dysfunction as a result of diabetes. Men who have diabetes are two
to three times more likely to have erectile dysfunction than men who do not.
Women may experience vaginal dryness, pain during intercourse, or loss of
libido (low sex drive). If you're having problems with your sex life due to
diabetes, talk to your doctor about treatment options.
SADNESS
AND DEPRESSION
Managing diabetes can be
stressful and exhausting. Between the constant vigilance over what you eat, the
cost of care, and frequent glucose testing, you might find yourself feeling
depressed. Depression can get in the way of good diabetes care. If you feel sad
or hopeless due to diabetes, talk to your doctor or a mental health
professional. You may need medications, therapy, or a combination of both.
HEARING
LOSS
Everyone experiences a little
hearing loss with age. But in people with diabetes, hearing loss is often
worse, especially if the disease isn't well-controlled. In fact, according to
the American Diabetes Association, the rate of hearing loss is 30% higher in
people with diabetes than it is in people without diabetes. That's because
hearing relies on small blood vessels and nerves in the inner ear. High glucose
levels can damage those vessels and nerves, which weakens hearing. Ask your
doctor for a hearing test if you're having trouble.
DEMENTIA
AND ALZHEIMER'S
High blood glucose levels can
cause poor blood flow to your brain, making it more likely that you'll have
dementia or Alzheimer's someday. A recent study showed that people with
diabetes had more deterioration in the parts of their brain where
problem-solving, decision-making, and memory take place. Due to brain damage
caused by diabetes, they also had more depression, walked slower, and had more
problems with balance. The best prevention—you guessed it!—is to keep your
blood glucose levels as close to normal as possible.
GUM
DISEASE
Having diabetes puts you at risk
for periodontal disease (gum disease). Over time, gum disease breaks down the
bone and tissue that hold your teeth in place—leading to infection and tooth
loss. If you have diabetes, your risk of gum disease is higher due to your body's
lower resistance to infection. The high-sugar environment (brought on by high
blood glucose) also gives bacteria in your mouth a chance to thrive. Diabetes
can cause dry mouth, mouth infections, and cavities, too. If you have diabetes,
see your dentist at least twice a year, maybe more. And be sure to practice
good oral hygiene, including regular brushing, flossing, and rinsing every day.
Why You Need to Monitor Your
Blood Sugar for Diabetes
Testing your blood sugar level at
home helps you gauge how well you're managing your diabetes.
How can you tell if your diabetes
management plan is working? Monitor your blood sugar at home. Daily testing
with a computerized glucose meter tells you whether your diet, exercise
regimen, and medication are working -- or need adjustment. In-home blood
glucose tests can also alert you to dangerous spikes or dips in your blood
sugar level.
When to Test Your Blood Sugar
You may or may not need to test
your blood sugar every day. It depends on the type of diabetes you have, how
long you've had it, and how well it's controlled. Ask your doctor for a
personalized daily schedule. This might include testing before or after meals
or exercise, before bedtime or upon waking, or additional testing on days when
you're ill or highly stressed.
How to Test Your Blood Sugar
Keep a daily log of your
readings, follow the instructions in your user manual, and use these guidelines
to ensure accurate readings:
Wash your hands before testing.
Make sure glucose meter and test
strip are at room temperature.
Make sure test strip hasn't
expired.
Calibrate your meter for the
current box of test strips.
Make sure the drop of blood you
draw is large enough.
Types of Blood Glucose Meters
You can choose from a variety of
glucose meters. They're all fairly equal in accuracy, but vary in cost,
ease-of-use, and features. Some meters have memory to store your results.
Others require fewer steps to get a reading. The newest meter to hit the market
provides an automated log for insulin doses and blood sugar level readings,
along with software that tracks your progress and transmits your readings to
your doctor. Ask your doctor for a recommendation and check with your insurance
company to make sure the meter you buy is covered under your plan.
Insulin Information:
Dispelling the Myths and Misconceptions
Is insulin dangerous? Get the
facts about insulin and insulin safety.
If you take insulin to manage
your diabetes, you've probably wondered at one time or another if insulin could
make you gain weight or cause your quality of life to decline. It's not
uncommon thinking. But you'll be happy to know that these thoughts are
unfounded, and that insulin is safe and effective when used properly. In fact,
there are many myths and misconceptions about insulin that we would like to
clear up for you. So let's get started.
Myth: Insulin makes you fat.
Fact: Insulin can stimulate your
appetite but you can fight weight gain by eating more fruit, vegetables, and
high fiber foods and by exercising more. Visit our Weight Loss Center for
eating and exercise tips to help you stay slim.
Myth: If you need insulin, you
failed to control your diabetes properly.
Fact: No way! Diabetes is a
progressive disease that can't be cured. If your pancreas can no longer produce
enough insulin, and other medications don't work to control your blood sugar,
it's normal for your doctor to prescribe insulin. It's not your fault.
Myth: Insulin injections hurt a
lot.
Fact: The needles used to inject
insulin are very thin and relatively painless. Many people who take insulin
feel the injections hurt less than finger pricks to monitor blood glucose. And
if you're afraid of needles, ask your doctor about effective strategies that
can help you overcome needle phobias. Feel better fast with this deep breathing
relaxation strategy.
Myth: Insulin makes your blood
sugar too low.
Fact: Your concerns about insulin
and hypoglycemia are valid, but you can avoid this potential side effect of
insulin by learning the signs and symptoms of low blood sugar and by treating
it promptly.
Myth: It's hard to have a normal
life if you take insulin.
Fact: Taking insulin does require
that you plan ahead according to your diet and physical activity levels. But
people who take insulin can still travel, eat out, and live very active and
independent lives. Speak to a diabetes educator if you're concerned about how
taking insulin fits into your life.
Myth: Insulin always has to be
refrigerated.
Fact: Regardless of whether it's
opened or unopened, some types of insulin can stay at room temperature for days
and still be effective. Talk to your doctor or pharmacist about insulin storage
for your particular type of insulin.
Myth: If you start insulin,
you'll have to take it for life.
Fact: With type 2 diabetes, you
could start on insulin, yet still be able to switch to other medications at
another time. And although it's not common, some people may even stop
medications altogether if they manage to get their blood sugar under control by
losing enough weight and making other healthy changes.
Myth: Once you are on insulin,
you can eat however and whatever you want.
Fact: Medications like insulin
are just one part of treatment. You still need to eat right to help control
your blood sugar. In fact, eating poorly could mean needing more insulin.
From
oral medications to insulin injections, learn about different treatment options
for diabetes.
How do you control your blood sugar levels? Many people
with type 2 diabetes manage theirs just fine with diet, exercise, and weight
loss—especially in the early stages of the disease. Others need medication,
too. If diet and exercise alone aren't reducing your blood sugar, ask your
doctor whether medications or insulin therapy can help.
There are three main types of diabetes medications:
Oral Diabetes Medications
Oral medications (pills or tablets) are prescribed exclusively for people with
type 2 diabetes. Why? For these drugs to work, the body must still produce at
least some insulin. However, oral medications don't work for everyone with type
2 diabetes, especially for those who've had the disease for more than 10 years
or who take more than 20 units of insulin a day.
Some common oral medications include
second-generation sulfonylura, biguanide, thiazolidinedione, and alpha-glucosidase
inhibitor -- all of which reduce blood sugar in a variety of ways. Some
stimulate the pancreas to pump out more insulin. Others help insulin move
glucose out of the blood and into the body's cells. Other oral diabetes
medications slow the digestion of carbohydrates to help stabilize blood sugar.
Non-Insulin Injectable
Diabetes Medications
Two kinds of injectable diabetes medications -- taken before meals -- also help
control your blood sugar level. Exenatide is a fairly new drug that increases
insulin production and delays stomach emptying (so you feel full, which helps
with weight loss). Exenatide is often combined with certain oral medications to
enhance blood sugar control in people with type 2 diabetes.
Pramlintide helps reduce A1c blood sugar levels in people
with both type 1 and type 2 diabetes. It also promotes modest weight loss.
Insulin
People with type 1 diabetes can't produce insulin and must take insulin
injections or use an insulin pump to survive. People with type 2 diabetes also
need insulin if healthy habits and other diabetes medications aren't enough.
There are more than 20 types of insulin, so ask your doctor which kind is right
for you. Because certain oral medications enhance insulin's effectiveness, your
doctor may recommend that these be taken in combination with insulin injections
to stabilize your blood sugar even more.
Like any drug, diabetes medications have side effects,
including stomach upset, vomiting, hypoglycemia (low blood sugar), skin rashes,
and weight gain. Fortunately, most side effects tend to lessen with time. Ask
your doctor for strategies to minimize side effects.
Keep in mind that diabetes is a progressive
condition that advances over time, even with good management. As a result, your
diabetes medication needs will likely change in response to your body's ability
to regulate glucose and new developments in diabetes care.
Having
diabetes is difficult, but here's encouraging news: Aggressively managing your
diabetes can make your RealAge up to 7.3 years younger.
Whether
you've just been diagnosed with diabetes or you've had it for a while, your
doctor can guide you through the steps to live better with diabetes–everything
from how to manage diabetes drugs to understanding how diabetes affects the
rest of your health.
Start
by asking your doctor these eight questions about diabetes treatment.
SHOULD
I WORK WITH A CERTIFIED DIABETES EDUCATOR?
Wondering
how to read a food label, manage your frustration with diabetes, or build
exercise into your day? If so, a certified diabetes educator (CDE) can help. A
CDE is a healthcare professional trained to help people with diabetes improve
their health and cope with the challenges.
"A
CDE may be the single most important provider to ensure success in living well
with diabetes," says Gregg F. Gerety, MD, an endocrinologist in Albany,
N.Y. "Working with a diabetes educator leads to a better understanding of
what diabetes is and how it can be best managed to live well and remain
problem-free. The patients who do best have the right treatment tools and
self-management skills."
WHAT
ARE MY NUMBERS?
Knowing
your ABCs (A1c, blood pressure, and cholesterol levels) is important when you
have diabetes, says Melinda Maryniuk, RD, CDE, director of clinical education
programs for the Joslin Center in Boston. Understanding your goals helps you
take steps to bring those numbers down.
"The
more you know and understand about how your body works, the more motivated you
are to do something to continue to improve your health," Maryniuk says.
A1c, which is your average blood glucose level in the last two to three months,
is especially important because it tells you how well your blood sugar is being
controlled. Lowering your A1c by just one point can reduce your risk for
complications by 40%.
WHAT
SHOULD I DO FOR EXERCISE?
Regular
physical activity is critical for people with diabetes. "Exercise makes
body cells more sensitive to insulin, which helps lower blood glucose,"
Gerety says. "It also lowers blood pressure, improves lipids, and burns
calories, which helps with weight loss.
It
improves your overall sense of well-being, so it helps control stress."
Ask your doctor which types of exercise are best for diabetes. Even taking
three 10-minute walks a day can help lower your blood glucose level
HOW
CAN I LOSE WEIGHT?
More
than 85% of people who have type 2 diabetes are overweight or obese. Losing
even a little of the extra weight can help improve insulin sensitivity. (In
people who have prediabetes–a state in which blood glucose is elevated but not
high enough to be diabetes–losing just 5% to 10% of your body weight with diet
and exercise helps reduce the risk of progressing to full-blown diabetes.)
Ask
your doctor for specific weight loss programs that have helped other diabetes
patients. "People know intuitively what they need to do to lose
weight," Maryniuk says. "But they’re often more successful if they
have support from a program like Weight Watchers, or just having your doctor
check in."
HOW
OFTEN SHOULD I CHECK MY BLOOD SUGAR?
Checking
your blood glucose (blood sugar) is an important way to gauge how well you’re
managing your diabetes. How often you check typically depends on whether you’re
taking insulin or oral diabetes medications, says Betul Hatipoglu, MD, an
endocrinologist at Cleveland Clinic.
"Even
for people who take no medications, it’s always good to know what’s going on in
your body," she says. "Blood sugars are like light in a dark tunnel.
It’s information against your enemy. If you don’t have information, you can’t fight
as well as you can. Are you going up? Are you doing well? It gives you a
snapshot of how you’re doing."
HOW
WILL I KNOW IF MY BLOOD SUGAR LEVEL IS LOW?
Almost
everyone with diabetes experiences low blood sugar or hypoglycemia at one time
or another. If your blood sugar gets too low, you’re at risk of losing
consciousness, which can be dangerous. The key is to recognize the symptoms of
hypoglycemia and treat them before your blood glucose level drops too low.
People
on the brink of hypoglycemia often feel shaky, dizzy, and weak. Ask your doctor
about strategies to quickly boost your blood sugar by eating carbs–a half-cup
of juice, for instance–or taking an injection of glucagon, a
blood-sugar-raising drug prescribed by your doctor.
HOW
DO I AVOID DIABETES COMPLICATIONS?
Over
time, high blood glucose levels boost the odds that you’ll have diabetes
complications, such as heart disease, kidney disease, and neuropathy, so it’s
important to ask your doctor about ways to avoid these problems. "Keeping
blood glucose levels down is the best insurance to guard against
complications," Maryniuk says.
Since
heart disease is the most common diabetes complication, she adds, keeping blood
pressure close to your target will help protect your heart health. Also, ask
your doctor about the tests and exams you need, such as kidney function tests,
eye exams, and biannual dental visits.
WHO
SHOULD BE ON MY DIABETES HEALTHCARE TEAM?
Assembling
a strong team of medical experts is critical to good diabetes healthcare.
Although most of your visits may be with your primary care doctor, you'll also
need other specialists, such as an endocrinologist, eye doctor, podiatrist,
certified diabetes educator, and dentist. It also doesn’t hurt to befriend your
local pharmacist, too, and/or seek out advice from a dietitian. Ask your doctor
for referrals. Working with a team–with you as the captain–will allow you to
create a custom plan that helps you take charge of your diabetes and live
younger.
A low-carbohydrate
diet, in addition to medications, is useful in type 1 DM. There are camps for
children to teach them how and when to use or monitor their insulin without
parental help. As psychological stress may have a negative effect on diabetes,
a number of measures have been recommended including: exercising, taking up a
new hobby, or joining a charity among others.
Insulin
There are four main
types of insulin: rapid acting insulin, short acting insulin, intermediate
acting insulin, and long acting insulin. The rapid acting insulin is used as a
bolus dosage. The action onsets in 15 minutes with peak actions in 30 to 90
minutes. Short acting insulin action onsets within 30 minutes with the peak
action around 2 to 4 hours.
Intermediate acting
insulin action onsets within 1 to 2 hours with peak action of 4 to 10 hours.
Long acting insulin is usually given once per day. The action onset is roughly
1 to 2 hours with a sustained action of up to 24 hours.
Injections of
insulin either via subcutaneous
injection or insulin pump— are necessary for those living with type 1 diabetes
because it cannot be treated by diet and exercise alone. In addition to insulin
therapy dietary management is important. This includes keeping track of the
carbohydrate content of food and careful monitoring of blood glucose levels
using glucose meters.
Today, the most common insulins are
biosynthetic products produced using genetic recombination techniques;
formerly, cattle or pig insulins were used, and even sometimes insulin from
fish.Untreated type 1 diabetes can commonly lead to diabetic ketoacidosis which
is a diabetic coma which can be fatal if untreated. Diabetic ketoacidosis can
cause cerebral edema (accumulation of liquid in the brain).
This is a
life-threatening issue and children are at a higher risk for cerebral edema
than adults, causing ketoacidosis to be the most common cause of death in
pediatric diabetes. Treatment of diabetes focuses on lowering blood sugar or
glucose (BG) to the near normal range, approximately 80 to140 mg/dl (4.4 to 7.8
mmol/L). The ultimate goal of normalizing BG is to avoid long-term
complications that affect the nervous system (e.g. peripheral neuropathy
leading to pain and/or loss of feeling in the extremities), and the
cardiovascular system (e.g. heart attacks, vision loss).
This level of
control over a prolonged period of time can be varied by a target HbA1c level
of less than 7.5%. People with type 1 diabetes always need to use insulin, but
treatment can lead to low BG (hypoglycemia), i.e. BG less than 70 mg/dl (3.9
mmol/l). Hypoglycemia is a very common occurrence in people with diabetes,
usually the result of a mismatch in the balance among insulin, food and
physical activity.
Mild cases are
self-treated by eating or drinking something high in sugar. Severe cases can
lead to unconsciousness and are treated with intravenous glucose or injections
with glucagon. Continuous glucose monitors can alert patients to the presence
of dangerously high or low blood sugar levels, but technical issues have
limited the effect these devices have had on clinical practice. As of 2016 an
artificial pancreas looks promising with safety issues still being studied.
Pancreas
transplantation
In some cases, a
pancreas transplant can restore proper glucose regulation. However, the surgery
and accompanying immunosuppression required may be more dangerous than
continued insulin replacement therapy, so is generally only used with or some
time after a kidney transplant.
One reason for this
is that introducing a new kidney requires taking immunosuppressive drugs such
as cyclosporine. Nevertheless, this allows the introduction of a new pancreas
to a person with diabetes without any additional immunosuppressive therapy.
However, pancreas transplants alone may be beneficial in people with extremely
labile type 1 diabetes mellitus.
Islet cell
transplantation
Islet cell
transplantation may be an option for some people with type 1 diabetes that are
not well controlled with insulin. Difficulties include finding donors that are
a compatible, getting the new islets to survive, and the side effects from the
medications used to prevent rejection. Success rates, defined as not needing
insulin at 3 years follow the procedure occurred in 44% in on registry from
2010.
