Ways to Live Well with Diabetes
Each day some 12 million diabetics in this country walk a tightrope between too little sugar in the bloodstream and too much. Too little which may come from a complication of medication and they may quickly be overcome by dizziness, fatigue, headache, sweating, trembling, and, in severe cases, loss of consciousness and coma. Too much which can happen after eating too much, especially if the person is older and overweight and the person may experience weakness, fatigue, excessive thirst, labored breathing, and loss of consciousness. Left untreated, the picture is bleak: Blindness, kidney disease, blood vessel damage, infection, heart disease, nerve damage, high blood pressure, stroke, limb amputation, and coma may result.
Because the early warning symptoms (fatigue, weakness, frequent urination) are usually mild. half of all diabetics do not realize that they have the disease. And that's a real shame, because with early diagnosis and treatment, the chances of living a long and productive life are higher than if the disease creeps along undetected until irreversible problems set in.
If you'd like some proof that diabetes is clearly a disease you can live with, take a look at these prolific diabetics: jazz musician Dizzy Gillespie. singer Ella Fitzgerald, actress Mary Tyler Moore, baseball Hall of Fame great Jim(Catfish) Hunter. Even before treatment was as sophisticated as it is today, author Ernest Hemingway and inventor Thomas Edison, both of whom were diabetic, managed to leave their marks on history.
If you are one of the lucky ones whose diabetes has been diagnosed by a doctor, you have an idea of what has gone awry in your body. The disorder stems from the way your body processes carbohydrates, which you take in through food. Normally, these foods are converted into a form of sugar called glucose which floats along in the bloodstream until the pancreas, a large gland located behind the stomach, goes into action. The pancreas produces insulin, a hormone that signals body cells to soak up the glucose. Once inside the cell, the glucose is either used to produce heat or energy or is stored as fat. A person with diabetes produces little or no insulin or else becomes resistant to the hormone's action and can't compensate. Either way, the glucose can't get into the cells; it accumulates in the blood and is later expelled in the urine. In short, blood
sugar rises while cells starve.
Only about one-tenth of all diabetics have the severe form of the disease, called Type I, which usually affects children and young adults and requires daily injections of insulin. Most have what doctors refer to as Type II, or adult-onset diabetes. While about one-third of Type II diabetics do require insulin to control blood sugar, and another one-third use medications to increase insulin production, the remaining Type II diabetics rely on nonmedical measures (such as diet, weight loss, and exercise) alone to control their disease. No matter which group you fall into, you can benefit from taking an active role in your treatment. But don't make a move without consulting your doctor first. He or she will call the shots; then it's up to you to carry through. Here's how:
Dish up a special diet.
The goal of dietary intervention for Type I diabetes is to help minimize short- and long-term complications by normalizing blood sugar levels. The goal of dietary intervention in Type II diabetes is to help the patient achieve and maintain normal body weight," says John Buse, M.D., Ph.D., assistant professor in the Department of Medicine, Section of Endocrinology, at the University of Chicago and director of the Endocrinology Clinic at the University of Chicago Medical Center. Both Type I and Type II diabetics should follow the guidelines offered by the American Diabetes Association (ADA), which were revised in 1986 based on new research findings.
Know your carbohydrates.
The traditional dogma for diabetics was this: Avoid simple carbohydrates, or simple sugars (such as table sugar), because they raise blood sugar quickly, and choose complex carbohydrates (such as the starches and fiber found in grains, potatoes, beans, and peas), because they raise blood sugar more slowly. But this dogma has given way recently to newer rules, which really aren't rules at all in the strictest sense.
Diabetic meal planning must account for many factors, says Harold E. Lebovitz, M.D., professor of medicine, chief of the Division of Endo-crinology and Diabetes, and director of the Clinical Research Center at State University of New York Health Science Center at Brooklyn. A food eaten alone may affect blood sugar differently than when it is eaten with another food. The same variations can be noted with cooked foods versus raw foods and even with different brands of foods. And not least, different foods affect blood sugar differently in different people.
Consequently, while complex carbohydrates like lentils, soy beans, peanuts, and kidney beans are still best for causing the slowest and lowest rise in blood sugar after a meal, present evidence suggests that sucrose (table sugar) may not be off limits for Type II diabetics if blood glucose levels stay normal after their ingestion. Experimenting with forbidden foods may be possible with a doctor's consent, says Lebovitz. But before you start bingeing on bonbons, it's important to be prepared.
Get fond of fiber.
The key to the effectiveness of complex carbohydrates may lie in the fiber content. While the cause and effect of fiber in control of Type II diabetes has yet to be established, we do know that such foods are very satiating and can help enormously toward weight loss and maintenance," says Buse.
Understand sweet talk.
Actually, there are a number of different kinds of sugar, and each has a potentially different effect on blood sugar levels. The most basic form of sugar is glucose, or dextrose, which will raise blood sugar levels faster than any other kind when swallowed," says Ira J. Laufer, M.D., clinical associate professor of medicine at New York University School of Medicine and medical director of The New York Eye and Ear Infirmary Diabetes Treatment Center in New York. Sucrose also tends to raise blood sugar almost as quickly as dextrose. But fructose, sometimes called fruit sugar, generally has a very mild effect on blood sugar. If your diabetes is in good control, dietetic desserts and candies sweetened with pure fructose are not likely to
raise your blood sugar levels very much, he adds. On the other hand, fructose provides as many calories as other sugars, so it may not be the wisest choice for diabetics who need to lose weight.
Reduce your risks.
To emphasize the fact that excess weight is a Type II diabetic's most serious problem, experts on diabetes are fond of saying that if you want to find out if there's a possibility of getting diabetes, just keep on eating and get fat. You can do other things, too, but the main thing is get fat. An estimated 80 percent of those with Type II diabetes are obese when diagnosed with the disease. Added weight can both accelerate the diabetes and bring on its complications, especially cardiovascular disease and stroke.
In contrast, even a modest weight loss can have dramatic effects: High insulin levels drop, the liver begins to secrete less glucose into the blood, and peripheral muscle tissues begin to respond to insulin and take up glucose better. Just as obesity leads to insulin resistance, so weight loss reverses the condition. When persons with Type II diabetes lose weight, they frequently are no longer diabetic. Type II diabetics may only need to get and stay at an ideal body weight." says Buse. And unless they do that, nothing else will work very well. (See Changing Your Ways for weightloss tips).
Too rapid weight loss rarely works in the long run and is potentially dangerous if undertaken without a doctor's advice. Sometimes, a doctor will, in fact, prescribe a very-low-calorie diet to initiate weight loss, but only for a very short period of time. Generally, the best approach is to lose weight gradually with a low-fat, lower-calorie, nutritionally balanced diet combined with increased activity. Avoid the use of over-the-counter appetite suppressants that contain phenyipropanolamine (PPA).
Many experts believe that a Type II diabetic may more easily achieve normal blood sugar levels by not overloading with too much food at one time. Three smaller meals a day breakfast, lunch, and dinner plus two or three snack-type meals in between is easier for the diabetic person's insulin to handle. Just be sure that you don't overshoot your calorie limit, however," advises Lebovitz.
Get a firm foothold.
Neuropathy damage to the nerves, is a common problem for diabetics. It occurs most often in the feet and legs, and its signs include repeated burning, pain, or numbness. "Neuropathy can be dangerous if it causes a loss of feeling, because then even a minor foot injury may go undiscovered leading to serious infection, gangrene, and even amputation of the limb, says Joseph C. DAmico. D.P.M., a podiatrist in private practice in New York. Diabetics, therefore, need to be diligent about foot care. (See Foot Notes for Diabetics").
Be a sport.
Regular exercise provides many benefits. It tones up the heart and other muscles, strengthens bones, lowers blood pressure, strength-ens the respiratory system, helps raise HDL (good cholesterol), gives a sense of well-being, decreases tension, aids in weight control, enhances work capacity, and confers a sense of achievement. For those with diabetes, says Laufer, exercise bestows additional benefits. It promotes the movement of sugar from the bloodstream into cells, where it is burned for energy,
and it improves the cells ability to respond to insulin, thus decreasing their need for the hormone.
Not all exercises are for every diabetic person. If blood sugar is high, exercise will lower it; if it's low, exercise will lower it further. Those on medication must work with a doctor to make necessary adjustments. Because of the potential for neuropathy, diabetics need to protect the nerve endings in the feet and so may need to avoid high-impact activities such as jogging. Another consideration is that diabetics are particularly sensitive to dehydration.
Also, intense exercise could endanger capillaries in the eyes already weakened by diabetes, leading to rupture, vision problems. and even blindness. So you will need to choose your exercise program carefully with the aid of your doctor. And especially if you are over 40 years old, you will need to undergo a general medical examination, including a cardiovascular screening test and exercise test, before proceeding with your exercise program.
Once your doctor gives you the go-ahead to begin a program of regular exercise, you need to set up realistic goals in order to avoid too-high or too-low blood sugar levels and other problems that could result from doing too much too soon. Someone who has not spent much time engaged in physical activity who is also overweight should not be thinking in terms of running races advises Laufer.
Swimming, bicycle riding, and brisk walking are all recommended. Indeed, walking is the one activity that all medical experts agree is ideal for a diabetic patient. The average Type II diabetic patient is over 50, overweight, and underactive, says Laufer. Walking is a kinder, gentler activity for such individuals. Remember, however, that the positive effects of exercise last for only a day or two, so your goal should be to exercise at least every other day.
Watch your mouth.
Diabetics must be extra careful about their teeth. Good dental hygiene is important for everyone, says Andrew Baron. D.D.S.. a dentist and clinical associate professor at Lenox Hill Hospital in New York. "Because they are at increased risk for infection, diabetics should be super cautious about preventing tooth decay and periodontal disease. Keep a supply of toothbrushes so you won't have to deal with old, worn brushing aids. Brush and floss without fail after every meal and before bedtime. And see your dentist regularly for checkups and cleaning.
Check your dentures.
Ill-fitting dentures or permanent bridgework cause frustration for anyone who has to live with them. For a diabetic, the consequences go far beyond annoyance. "Dentures that move around in your mouth can cause sores that don't heal", cautions Baron. It's a shame to suffer with such problems, especially when they are so easily remedied by a dentist.". If you notice sore spots in your mouth or find that your dentures are moving or slipping, see you're dentist to have the problem corrected.
How do you psych yourself up for a game that has no time-outs and that never ends? That's the question diabetics face every day. One way is to learn all you can about your illness so that you can better control it. Diabetics are constantly learning and relearning lifestyle changes and behavior adjustments. It's like studying for a master's degree in diabetes and, in this case, there is no graduation and no vacation, says Laufer.
Its a given that even in a diabetic whose disease appears to be totally under control, there will be occasional rapid and even violent swings in blood sugar levels, brought on by emotional or physical stresses, meals, medications, or even the time of day. But if they are anticipated and accepted, these episodes can be viewed as simply a bump in the road rather than a major detour.
Do something nice for yourself.
While it's important to learn as much as you can about your diabetes and stay with your treatment regimen, you also need to keep things in perspective. It is a rare individual who takes time to stop and smell the roses, as it were, notes Laufer. This is especially true for diabetics, who often get so caught up in their disease that it is difficult for them to focus on other, more-positive aspects of life. Make a list of all the things you would like to do if you had the time and then make the time to do at least some of them. Obviously, finishing a box of chocolates should not appear on this list. While staring into space may be an ideal uplifter for one person, and napping the afternoon away does the same for another, straightening out a messy closet may do the trick for a third.
Do something nice for someone else.
It's hard to think of your own problems when you are engaged in making another person's life more pleasant. In any city or town in the country, there are those who are less well-off, with more severe problems. You can call your local hospital or library to inquire about volunteers, says Laufer. Or you can knock on the door of an elderly, housebound neighbor who might appreciate a visit".
Hypoglycemia: The Disease that Isn't
After eating a mealor going too long without oneare you tired? Lightheaded? Dizzy? A little bit anxious? You may be among the thousands of people who have been told or who have convinced themselves that they have low blood sugar, or hypoglycemiaand who are wrong.
Hypoglycemia, also called sugar blues", was a condition that appeared some years ago and was supposedly caused by eating excess sugar, which led to very high glucose levels followed by very low levels. More likely, says John Buse, M D., Ph. D., the symptoms were caused by skipping meals, lack of sleep, or tension.
But hypoglycemia does, indeed, exist. Doctors have determined that there are two basic types. One, called fasting hypoglycemia, occurs after missing one or more meals and develops slowly as the blood sugar gradually drops lower and lower. It commonly produces central nervous system symptoms, and its causes can be serious underlying disorders, such as tumors that produce insulin. Type I diabetics who take too much insulin for the amount of food they eat may experience the symptoms of fasting hypoglycemia.
The second type, reactive hypoglycemia, occurs about two to four hours after eating, especially if the meals are high in carbohydrates. The usual symptoms include shakiness, weakness, sweating, rapid heartbeat, and faintness, which indicate that the body is reacting to a sudden blood sugar drop by producing adrenaline, cortisol, and glucagonhormones that aim to bring blood sugar back to normal.
People in the early stages of diabetes may rarely have this type of hypoglycemia, but it is more common after extensive abdominal surgery or other surgery.
Choose One from Column A...
These recommendations should be considered ground rules for a Type II diabetic. Diets must be adjusted to meet individual needs, so be sure to discuss your diet with your doctor before making and changes.
Raise carbohydrate intake to more than half of total calories. Every gram of carbohydrate provides four calories.
Keep protein intake to 12 to 20 percent of total calories. A gram of protein provides four calories as well.
Lower fat intake to less than 30 percent of total calories and make every effort to substitute polyunsaturated fat or monounsaturated fat for saturated fat. Each gram of fat provides nine calories, so go easy!
Maintain cholesterol intake at less than 300 milligrams a day. Less saturated fat in the diet will automatically lead to reduced cholesterol.
Include fiber in the diet; it should be part of as many meals as possible.
INTERNATIONAL DIABETES FEDERATION
THE DIABETES EDUCATION STUDY GROUP