How to Manage Diabetes

By Guest Blogger Robin Amylon

November is American Diabetes Month. Diabetes is a serious disease that can lead to potential life-threatening complications. It is the leading cause of kidney failure, non-traumatic lower-limb amputations, and new cases of blindness among adults in the U.S. Diabetes is also a major cause of heart disease and stroke and is the seventh leading cause of death in the United States. In the past twenty-five years the number of people with diabetes has tripled. There are now 25.8 million Americans who have diabetes and 7 million don’t even know they have it. An additional 79 million have pre-diabetes, a condition that comes before type 2 diabetes, (the most prevalent type of diabetes). 10.9 million, or 26.9% of those aged 65 and older have diabetes. Individuals with diabetes can live long, healthy lives as long as they keep their blood sugar levels under control. It’s those that don’t keep their blood sugar levels within an acceptable range that experience complications associated with the disease. Over time, high blood glucose (sugar) levels can damage blood vessels and cause heart disease, kidney disease, blindness and nerve damage. These complications can be avoided if diabetes is detected early on and you take the proper measures to keep your blood sugar under control. This is why it is so important to have your blood sugar checked regularly. In order to prevent these complications it is also important to:

• Have your blood pressure checked every 3 months and your cholesterol checked at least once a year.
• Check your feet regularly and avoid walking barefoot. Have your doctor check your feet for signs of nerve disease and for deformities and lesions every visit.
• Have your urine checked for protein at least once a year.
• See an eye doctor regularly to check for signs of eye problems.

These complications are not an inevitable part of diabetes but are a consequence of poor blood sugar control. There are three major ways you can prevent these issues from occurring.

Monitor and Control Your Blood Sugar

Your doctor can review with you what your goal ranges should be. In order to help your doctor see how well you have been controlling your blood sugar you should

• Check your blood sugar 2-4 times/day
• Record your results, along with the times you last ate, exercised and took medications.
• Bring these results to your doctor on your next visit.

Consume a Healthy Diet

A common misconception that many individuals with diabetes have is they cannot eat any carbohydrates. This is not true. Carbohydrates contain glucose which is your body’s main source of energy, so you need to include them in your diet. It’s the type and amount of carbohydrates that you need to be mindful of. Foods that contain carbohydrates are:

• Grains: rice, potatoes, pasta, bread, legumes, couscous, quinoa, millet, barley, etc.
• Fruit
• Dairy products: milk and yogurt
• Starchy vegetables: corn and peas

To keep blood sugars under control, carbohydrates should only make up about one quarter of your plate. When choosing carbohydrates it is important to choose whole grains rather than processed/refined grains. Whole grains contain fiber which can help better control blood sugar levels. Fiber is also good for your heart and keeping your bowels regular. Examples of whole grains include:

• Whole wheat bread
• Oatmeal
• Brown rice
• Baked potato with the skin
• Whole wheat pasta

It is also important to consume carbohydrates with a source of protein. Another quarter of your plate should consist of protein. The protein will help to slow the absorption of the sugar consumed and help better control your blood sugar. It will also help you to feel full and satisfied so you don’t feel you need to eat more carbohydrates. Good sources of protein include:

• Chicken
• Fish
• Turkey
• Lean cuts of beef
• Tofu
• Eggs
• Nut butters like peanut butter
• Cheese

The other half of your plate should consist of vegetables. Vegetables are very low in carbohydrates but high in fiber and rich in vitamins, minerals and phytochemicals that are important for your health. You can eat as many vegetables as you want. The amount of carbohydrates you can have at each meal will vary depending on your medication regimen, how well your blood sugars are controlled and your individual nutritional needs. Your doctor and a registered dietitian can help you figure out exactly how much you should be eating. Processed foods and sweets should be limited in the diet as these foods are high in sugar and have no nutritional value. Sweetened beverages such as juice, soda, iced tea and fruit punch should be avoided as well. Even juice that is all natural and has no sugar added to it should be avoided. As I stated earlier, fruit has sugar in it. Having one serving of fruit is fine but how many oranges do you think it takes to make one cup of orange juice? Even if there is no sugar added to the juice you are still drinking the amount of sugar in approximately 3-5 oranges combined. This could be about 45-75 grams of sugar which is really high. Plus, when you drink the juice of the fruit you are missing out on the fiber the natural fruit has that can help to slow the absorption of the sugar. Because of this it is always best to eat the whole fruit and drink water instead.

Participate in Regular Physical Activity

As we all know exercise has many health benefits. Specifically to diabetes it lowers blood sugar. One minute of exercise can lower your blood glucose level by 1 to 1.5 points. It also helps insulin work more efficiently. Insulin is a hormone produced by your pancreas that lowers your blood sugar levels by helping glucose to enter your cells to be used it for energy. Exercise also lowers blood pressure and cholesterol, helps improve weight management, lowers your risk for heart disease and stroke, strengthens your heart, muscles and bones, decreases body fat and increases muscle mass, improves blood circulation, reduces stress and improves self-esteem and keeps your body and joints flexible Since exercise lowers your blood sugar, there are some things individuals with diabetes need to do before starting an exercise program.

• Have a medical checkup and find out what activities are safe for you
• Review the symptoms of hypoglycemia (low blood sugar) and know how to treat it (see below)
• Keep snacks handy during activity
• Wear well-fitting shoes
• Make sure you are properly hydrated
• Check your blood sugar before participating in any physical activity.
  • If your blood sugar is below 100 mg/dl, eat carbohydrates prior to exercising
  • If blood sugar is > 250 mg/dl avoid strenuous exercise and if it is > 300 mg/dl avoid all types of physical activity

Be Aware of Hypoglycemia

Symptoms of Hypoglycemia include:

• Shaking
• Sweating
• Anxiety
• Hunger
• Dizziness
• Fast heartbeat
• Impaired vision
• Weakness, fatigue
• Headache
• Feeling irritable

How to Treat Hypoglycemia:

• If you feel any of the symptoms mentioned above, test your blood glucose levels. If you can’t test your blood sugar levels, consume a food item containing 15 grams of carbohydrates such as:
  • cup (4oz) of apple juice
  • 10 jelly beans 5-6 hard candies
  • 3 packets of sugar
  • 3 glucose tablets (check label)
  • NOTE: Avoid using candy bars, chocolate or ice-cream to treat hypoglycemia. These foods won’t raise your blood sugar fast enough because of their fat content.
• Rest for 15 minutes
• Test your blood glucose levels
  • Target blood glucose level: 80 to 120 mg/dl
  • High blood glucose level: > 140 mg/dl
  • Low blood glucose level: < 70 mg/dl
• If your blood glucose level is within normal range (80 to 120mg/dl) skip to step 5. If your blood glucose level is still low (< 70mg/dl), repeat steps 1, 2 and 3. If your blood glucose level continues to be low (< 70 mg/dl) after the second treatment CALL 911 IMMEDIATELY!!!!!!
• Eat a light snack such as a peanut butter or meat sandwich and glass of milk, to avoid recurrent hypoglycemia.

How to Prevent Hypoglycemia:

• Eat all meals and snacks at the same time every day
• Don’t skip meals
• Never take insulin or your pills without eating a meal/snack and take your medication as prescribed by your doctor
• Carry a few pieces of hard candy/glucose tablets with you all the time
• Bring snacks with you if you know you’ll be out for the whole day
• Eat an extra snack if you are planning to exercise
• If you are eating out, inject your insulin or take your pills after you get to the restaurant in case your meal is delayed
• Check your blood glucose levels often. (At least 3 times a day or follow the instructions by your physician)
• Avoid drinking alcoholic beverages or at least drink alcohol in moderation with a meal/snack
• Get to know how you feel when your blood glucose is low so that you’ll be able to treat hypoglycemia right away
• Make sure your family and friends know how to help you with hypoglycemia treatment when it occurs

For further information on diabetes you can visit the following websites: www.diabetes.org and www.dlife.com. You can also contact the American Diabetes Association at 1-800-DIABETES (342-2383)

Robin Amylon is an NYC-based Nutritionist. She received her Bachelor of Science from Queens College in Nutrition and Exercise Science and is currently finishing a program at New York-Presbyterian Hospital to become a Dietitian.