Living with Diabetes

Resources

Introduction

The term “diabetes” is often used collectively to refer to several forms of the condition in which high blood sugar features as the central issue. Sugar is always present in the blood. As the body breaks down the foods we eat, glucose is produced and our bodies, in turn, use it for energy.

Chronic high blood sugar levels, however, are dangerous and occur either because the body does not produce enough insulin to control glucose levels, or because the body is not reacting appropriately to the insulin that is present and being produced.

Types of Diabetes and Risk Factors

Prediabetes
Prediabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Although not everyone with prediabetes will develop type 2 diabetes, many people will.

It is important to know if you have prediabetes, because research has shown that some long-term complications associated with diabetes – such as heart disease and nerve damage – may begin during prediabetes.

Like type 2 diabetes, prediabetes can occur without you knowing it, so being aware of your risks and being tested are important. This is especially true if you have prediabetes as part of the “metabolic syndrome”, meaning you also have high blood pressure, high levels of low-density lipoprotein cholesterol (LDL, the “lousy” cholesterol) and a tendency toward abdominal obesity.

Type 2 Diabetes
Type 2 diabetes is a disease in which your pancreas does not produce enough insulin, or your body does not properly use the insulin it makes. As with type 1 diabetes, if you have type 2 diabetes, glucose builds up in your blood instead of being used for energy. Over time, high blood glucose levels can cause complications such as blindness, heart disease, kidney problems, nerve damage and erectile dysfunction. Fortunately, good diabetes care and management can prevent or delay the onset of these complications.1

For more information on risk factors, complications, how to lower your risk of developing diabetes if prediabetes is diagnosed, insulin therapy, managing your diabetes, and getting support, we invite you to visit the Canadian Diabetes Association website.

Controlling Diabetes

If you control your diabetes, it can help you feel better and stay healthy. Keeping your blood glucose levels close to normal lowers your chances of having problems with your eyes, heart, kidneys and nerves. To control your diabetes, you need to know your blood glucose numbers and your target goals. Your primary health care professional will discuss this with you and support you in the process until it all becomes routine.

Diabetes Myths & Misconceptions

There’s a lot of misinformation floating around that just isn’t accurate and can lead to a distorted view about outcomes and about how to manage your diabetes. The American Diabetes Association published the ten most common myths and misconceptions about diabetes after testing the common knowledge of the general public. Here are two of the more important ones you should know about:

Myth: Eating too much sugar causes diabetes.
Fact: No, it does not. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors. Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories, whether from sugar or from fat, can contribute to weight gain. If you have a history of diabetes in your family, eating a healthy meal plan and regular exercise are recommended to manage your weight.

Myth: If you are overweight or obese, you will eventually develop type 2 diabetes.
Fact: Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role. Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor for type 2 diabetes. Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight.

Questions You Can Ask Your Doctor

As a newly diagnosed diabetic, there are a few things you’ll want to ask your doctor but they may not occur to you all at once. Use this checklist to make sure you get all the answers.Here are a few sample questions:

How can I control my diabetes?
How often should I check my blood glucose?
What levels are too high or too low for me?
What is the correct way for me to check my levels?
Are there any local classes to help me learn more about how to control my diabetes?

Identifying & Treating Long-Term Diabetes Problems

It’s a good idea to keep in regular contact with your doctor. As time goes on, new health concerns can crop up. Your doctor will want to keep on top of symptoms so that he/she can order tests to ascertain the extent of any damage that might be happening. Typical checks on each visit include blood pressure, weight review, and a foot check. Annually, your health care professional will look at things such as:

A lipid profile
Dilated eye examination and comprehensive foot examination
Physical examination specifically targeted toward identifying nerve damage
Serum creatinine and urinalysis for protein, microalbumin, albumin-to-creatinine ration to detect kidney disease.

Diabetes To-Do List

Diabetes can damage the nerves in your body. It is very common for diabetics to have problems with their feet. This is caused by diabetic neuropathy, a condition which makes it less likely for you to feel pressure on your skin or an injury to your foot. If left too long, infection or long-term damage may set in. Protect your feet as best you can with the best quality, sturdy footwear you can afford.

Make Plans Now to Take Care of Your Feet for Your Lifetime

Now is the time to take good care of your feet so you can avoid more serious problems down the road, especially if you have loss of feeling in your feet, changes in the shape of your feet or foot ulcers or sores that do not heal. Here are a few suggestions to get you started:

You may have serious foot problems but feel no pain. For instance, you may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes. Foot injuries like these can lead to more serious problems. Check your feet for cuts, sores, red spots, swelling, and infected toenails every day at the same time you so don’t forget.
Wash your feet in warm, not hot, water. Do not soak your feet because your skin will get dry afterwards. Before bathing or showering, test the water to make sure it is not too hot. You can use a thermometer (90F to 95F is safe) or your elbow. Dry your feet well. Be sure to dry between your toes. Use talcum powder or cornstarch to keep the skin between your toes dry.
Rub a thin coat of lotion, cream, or petroleum jelly on the tops and bottoms of your feet. Do not put lotion or cream between your toes because this might cause an infection. Put lotion on the tops and bottoms of your feet.

Checking Blood Glucose Levels

Checking your blood glucose levels will help you control your diabetes. It will also help you and your doctor or health care team to make changes to your treatment plan. You can check your own blood glucose to see what your levels are. Food, medicines, physical activity, sickness, or stress can affect your levels.

How Do I Check My Blood Glucose Levels?
You use a blood glucose meter and a lancet (a tool to get a drop of blood) to check your own blood glucose levels. You do not have to go to the doctor’s office to do it. Use the lancet to get a drop of blood and the meter will use the drop of blood to give you a number. This is your blood glucose level.

There are many types of meters. Some meters are made for people who have trouble with their eyes. Some take blood samples from the finger or other parts of the body. Each meter works differently. Be sure to read the papers that come with your meter. Ask your doctor, pharmacist, diabetes educator, or other health care team member to show you the right way to use your meter.

Diabetes & Nutrition

One of the most important parts of your life is now going to be an eating plan that encompasses when and what you eat. Actually, it’s no different than what any other individual should be doing, it’s just that now, it’s more crucial to your overall health.

Your eating plan will help you focus on timing; times of the day to eat and how much time elapses between your meals and snacks. This helps you get a good grip on controlling your blood glucose levels. The other side of this plan will include which types of foods to choose, and how much of them you should have, again, to maintain optimum blood glucose levels.

The following information is all geared toward helping you bring your nutrition into alignment with your goals.

Reverse Prediabetes with Nutrition
Now more prevalently referred to as prediabetes, prediabetes is also referred to as metabolic syndrome, Syndrome X, or insulin-resistance syndrome and generally results from eating too many sugars and simple carbohydrates (candy bars, desserts, bread, pizza, pasta, soft drinks). These foods are rapidly broken down by the body, leading to a surge in blood sugar levels, followed by a rush of insulin. But after years of dealing with high insulin levels, the body can become resistant to it. That’s when both blood sugar and insulin levels stay elevated, leading to a diagnosis of prediabetes or diabetes. The main symptoms of prediabetes include abdominal obesity, high blood pressure, high levels of triglyceride (a type of fat in the blood), low levels of HDL, and high levels of blood sugar or insulin.

You can reverse your risk of prediabetes by focusing on your eating habits, supplements, and physical activity.
Your best bet is to use the one-third, two-thirds rule; one third of your plate should be a quality, lean source of protein, the other two thirds should consist of vegetables and whole grains (lentils, legumes, barley, etc.). As for timing of meals and snacks, it’s best to work with your primary health care provider to create a customized schedule.

What is the Diabetes Food Pyramid?
The Diabetes Food Pyramid is a general guide of what and how much to eat each day. The pyramid is divided into six groups. You should eat more foods from the largest group at the base of the pyramid and less from the smaller groups at the top of the pyramid. As always, check with your primary health care provider for the best information designed especially for your situation.

Serving Suggestions:

Grains, Beans, Starchy Vegetables, 6 or more per day.
Fruits, 3-4 per day.
Vegetables, 3-5 per day.
Milk, 2-3 per day.
Meats & other proteins, 2-3 per day.
Fats, Sweets, and Alcohol, limited quantities only.

Recipe and Meal Planner Guide
To create a healthy new lifestyle, start with an eating plan that helps manage and control your diabetes. Strive to have this plan replace some of the less-than-healthy choices you may be making now, and in their place, include more vegetables, fruits, lean protein, and grains.
To create a healthy meal plan, you should consider the following:

Eat a variety of foods as recommended in the Diabetes Food Pyramid to get a balanced intake of the nutrients your body needs – carbohydrates, proteins, fats, vitamins, and minerals.
Make changes gradually because it takes time to accomplish lasting goals.
Reduce the amount of fat you eat by choosing fewer high-fat foods and cooking with less fat.
Eat more fiber by eating at least 5 servings of fruits and vegetables every day.
Eat fewer foods that are high in sugar like fruit juices, fruit-flavored drinks, sodas, and tea or coffee sweetened with sugar.
Use less salt in cooking and at the table. Eat fewer foods that are high in salt, like canned and packaged soups, pickles, and processed meats.
Eat smaller portions and never skip meals.
Learn about the right serving sizes for you.
Learn how to read food labels.
Limit use of alcohol.

Many dishes/recipes are made up of several types of foods. Therefore, they do not fit in one specific group.

Food Exchanges
A Food Exchange Reference is one of the most important parts of a diabetic meal plan. Think of an exchange list as more of a guideline to portion control. Exchange lists offer you the opportunity to create variety in your meal plans while ensuring you meet nutritional and glucose level targets. As well, an exchange list is very handy to have until you’re in the swing of your new nutritional routine. What do they look like? Well, here’s an example of what you might find on a Starches Exchange List. (remember, it’s more about portion control).

Examples of Exchange Lists

Starches – Did you know that one serving (exchange) of a starchy food usually contains 15 grams of carbohydrate, 3 grams of protein and 0 to 1 gram of fat? This adds up to about 80 calories. Starches in the given amounts on this list equal one exchange. To protect your heart and blood vessels, try to avoid added fats, such as butter and sour cream.

What Is A “Free” Food?

Just what is a free food? In the diabetes world, “free food” refers to any food that has less than 20 calories and 5 grams or less of carbohydrate per serving. Everyone loves foods that don’t count whether you are managing diabetes or trying to lose weight. The key here is the serving size. As a guideline, you can eat 3 servings of free foods per day. If you eat more than 3 servings (or eat all 3 servings at one time), then you will need to count the calories and carbohydrate as part of your meal plan to stay on track.

Examples of “free” snacks include 1 piece of hard candy, 5 baby carrots, 1/4 cup of blueberries, 1/2 ounce of fat-free cheese, 10 goldfish-style crackers, 1 cup light popcorn, salad greens are not limited – eat as much as you want without counting them.

Examples of “free” condiments include 2 slices sweet pickles or 1 Tbsp pickle relish, 1 Tbsp freshly grated Parmesan cheese, 2 Tbsp yogurt, 1 Tbsp honey mustard, ketchup or soy sauce, 2 tsp barbecue sauce or sweet and sour sauce, 1 Tbsp fat-free cream cheese, 1 Tbsp fat-free mayonnaise or salad dressing.

All of the seasonings such as garlic, herbs, vinegar, lemon juice, and hot pepper sauce are not limited. They are truly free so use them liberally to spice up your food. Using fresh ingredients to make your own salsa or chutneys is a great way to sneak in extra vegetables while keeping the sodium lower.

Diet, Diabetes & the Glycemic Index

Maintaining normal blood glucose (BG) levels is the aim of every diabetic. In most cases, this can be achieved through diet, accompanied by other factors such as exercise. The Glycemic Index provides diabetics with a great resource for understanding which foods can help, and which foods will hinder, their attempts at controlling roller-coastering BG levels.

The Glycemic Index rates foods according to how quickly a food is converted into sugar in the blood and how quickly glucose levels in the blood return to acceptable levels. Each food is assigned a score. The higher the score, the more you want to avoid eating large amounts of this food. The index itself is divided into three categories: Foods rating 0-55 are considered low glycemic foods, foods rating 55-70 are considered medium glycemic foods and foods rating over 70 are considered high glycemic foods.

How does a low, medium or high glycemic food act in the body? High glycemic foods are digested and absorbed more quickly leading to a speedy rise in BG. Eating an overabundance of foods categorized as “high” is called a high glycemic load (HGL). Unfortunately, HGL’s also cause the “spike” in BG that we’ve all heard about that results in a “crash” within hours of eating high glycemic foods and in diabetics, more serious complications can occur.

Does this mean you stay away from nutritious foods ranked high on the index? No. It simply means you take their rank into consideration in combination with the rest of the foods on your diet and adjust your intake of them accordingly.

Luckily, foods ranked higher on the index are generally foods you should keep to a minimum in your diet anyway (refined starches and sugars). Most legumes and whole grains are medium glycemic index foods and most fruits and vegetable are low glycemic index foods. For example, the glycemic rank of an avocado is so negligible that most indexes don’t even mention them.

Remember, everything in moderation! There are no foods you should avoid unless the health professionals you are working with have told you to steer clear. What you need to do is be very aware of your daily intakes. There is also a “preparation and combination factor”. Eating a raw apple suggests a certain index score. However, as soon as you prepare this apple with other foods, and possibly add refined sugar, the benefits of the apple being ranked as low are lost.

The glycemic index is not the ultimate tool to use to design your diet. It is only a guideline for your reference and there are still many ongoing global studies looking at the effects of foods and how your body converts them into glucose. The American Dietetic Association recommends that diabetics track grams of carbohydrates rather than adherence to the glycemic index. Have a look at some examples of food exchanges that can help you create a healthy eating plan.

Go Ahead, Eat Out!
Sometimes, the most relaxing thing you can do is to avoid the kitchen and have a nice meal away from home. But worries can creep up about sticking to your meal plan adding stress right back into your life. There are several tried and true ways to stay on track to feel energized and relaxed after enjoying a meal out.

Check out the menu ahead of time. Many restaurants now have menus posted to their websites so you can plan in advance what will best suit your taste buds for the evening.
Plan to have a broth-based soup or salad to start your meal. Ask for salad dressing on the side and use it sparingly.
If the bread basket is tempting, ask for them to leave it in the kitchen.
Stick to your normal portion sizes – plan to take any extra home for lunch or dinner the next day.
If you are saving room for dessert, make sure you save your carbs…skip the rolls and other starchy foods with your meal. And don’t forget to split the dessert with your dining companions.

Easy Steps to Increase Physical Activity

Get a Step Counter
Every step counts! Some advocates recommend reaching for a total of 10,000 steps a day but that number can seem daunting to the beginner. Start by wearing a step counter for a day or two and recording your number of steps. Then, day by day, slowly increase the number of steps you take. You might try:

Parking a little farther away from work each week.

Taking the stairs up at least one floor and take the elevator the rest of the way.
Walk around your block once a day.

If walking hurts your knees, try exercising sitting down or swimming.

Albumin.
Water-soluble protein found in most animal tissues. Determination of the types and levels of albumin in blood, urine, and other body tissues and fluids is the basis of many diagnostic tests. The presence of albumin in the urine usually indicates kidney disease.
– Barron’s Medical Guides, Dictionary of Medical Terms, Fourth Edition

Creatinine.
(pronounced kree-at-n-en) breakdown product of phosphocreatine, an energy source for muscle contraction.
– Barron’s Medical Guides, Dictionary of Medical Terms, Fourth Edition

Diabetic neuropathy.
Nerve injuries caused by decreased blood flow and high blood sugar levels.
– MedlinePlus, A service of the U.S. National Library of Medicine, National Institutes of Health

Glucose.
Simple sugar that is the major energy source in the body.
– Barron’s Medical Guides, Dictionary of Medical Terms, Fourth Edition

Insulin.
1. hormone secreted by the beta cells of the islets of Langerhans of the pancreas; it regulates the metabolism of glucose and, secondarily, intermediary processes in the metabolism of carbohydrates and fats. Inadequate insulin levels lead to too-high glucose levels and other disturbances of metabolism, often associated with diabetes mellitus. 2. drug made from the natural hormones and used to treat diabetes mellitus.
– Barron’s Medical Guides, Dictionary of Medical Terms, Fourth Edition

For more information visit The Canadian Diabetes Association Website – www.diabetes.ca

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