Dayle Hayes 2013-02-28 05:10:11
Learn what you need to know for your body and for your family about this increasingly prevalent medical condition. When you hear the word diabetes, what comes to mind? Super-strict sugar-free diets? Multiple blood tests and shots every day? Really scary stuff, like your diabetic uncle who went blind and had a foot amputated? Maybe you worry that you’ll get diabetes because half the people in your immediate family have it. Or perhaps, like many Americans, you pretend it doesn’t exist and pray that your doctor never mentions it during an office visit. Contemplating diabetes, or any type of medical condition, can be overwhelming. Take a deep breath and let’s walk through what you need to know, summarized into a few easy-to-understand lessons. This article has just one very important goal: to help you take better care of yourself. To meet that goal, this piece details the facts you need to help prevent diabetes for yourself (and your family) and offers the basic information you need to work with your healthcare provider, if you are ever diagnosed with diabetes. Diabetes 101 What we commonly call diabetes is actually a group of diseases rather than a single condition, in which blood sugar—also called blood glucose—is higher than normal. Blood sugars are high in diabetes for one of two reasons: ■ The body does not make enough insulin, a hormone produced by the pancreas that helps your body’s cells use glucose (sugar) for energy and other functions. ■ The body is not able to use insulin effectively. When insulin cannot get glucose into the cells, glucose builds up in the blood stream and you have diabetes. There are three common types of diabetes: type 1, type 2 and gestational. (Note: There also is a totally unrelated rare condition called diabetes insipidus, which relates to a specific kidney dysfunction.) Type 1 diabetes accounts for only 5% of cases of diabetes in adults today. It usually is first diagnosed in children or young adults. People with type 1 diabetes do not make enough insulin. There is no known cure for type 1 diabetes today, so people who have it must take insulin from an injection or a pump in order to survive. There is also no way to prevent type 1 diabetes, which typically has genetic origins, but may be caused by autoimmune or environmental factors, as well. Type 2 diabetes is the most common form of diabetes. Nearly 95% of all cases of diabetes are type 2. Several studies have shown that a combination of healthy eating and regular physical activity can help prevent, delay the onset of and treat type 2 diabetes. Some people diagnosed with type 2 may need regular insulin injections to treat their disease, while others may be prescribed oral medications (pills). There are several risk factors for type 2 diabetes: ■ Age: People are seven times more likely to have type 2 diabetes after the age of 65 than before age 40. ■ Race and ethnicity: Based on genetics, several ethnic groups experience much higher rates of types 2 diabetes, including African Americans, Hispanic Americans, Asian Americans, American Indians and Alaska Natives. ■ Family history: Whatever your race, there is a strong genetic component to both types 1 and 2 diabetes. If diabetes tends to run in your family, you are more likely to get it—especially if you are not taking good care of yourself. ■ Lifestyle: Being inactive, smoking and alcohol consumption all can increase your risk of diabetes. Being overweight and carrying lots of weight around your waist also can make it more likely that you will develop type 2 diabetes, especially as you get older. Gestational diabetes occurs only during pregnancy and is found in less than 10% of pregnant women. Gestational diabetes can cause serious problems for both mothers and babies during pregnancy and later. Studies show that children whose mothers had gestational diabetes are at higher risk for diabetes and obesity. Moms with gestational diabetes have a much greater chance for type 2 diabetes 10 to 20 years after pregnancy. On the Rise If you think that you’ve been hearing a lot more general talk about diabetes these days, you’re right! That’s because the number of Americans with diabetes has more than tripled since the 1990s. In 2010, the U.S. Centers for Disease Control and Prevention (CDC) estimated that as many as one in three U.S. adults could have diabetes by 2050, if current trends continue. That means that about one-third of adults could suffer the health problems— and the higher healthcare costs— related to type 2 diabetes. This increase explains why you are hearing so many diabetes prevention messages from federal, state and local health groups—and maybe your doctor—and why you now may be hearing about prediabetes. Prediabetes means that your blood sugar levels are higher than normal, but not (yet) high enough to meet the criteria for a type 2 diagnosis (and treatment). When you have prediabetes, you are at greater risk of developing type 2 diabetes, as well as heart disease and stroke. The good news is that going from prediabetes to diabetes is not inevitable; it is more like a warning signal. Studies show that you can prevent or delay the onset of type 2 diabetes by getting at least 150 minutes of moderate to vigorous physical activity per week (about 30 minutes a day five times per week). If you are overweight, losing as little as 5 to 7% of your body weight also can improve blood sugar levels. However, as most of us know, maintaining that weight loss over time is the tricky part! Understanding Your Test Scores From this point on, we’ll concentrate on prediabetes and type 2 diabetes, since they affect far more Americans than the other types. Check the resources listed in exclusive web content for this article at www.schoolnutrition.org/snmagazinebo nuscontent to learn more about type 1 diabetes and gestational diabetes. Testing for diabetes typically is included as part of a yearly or preventive medical exam with your healthcare provider. The American Diabetes Association (ADA) recommends screening for diabetes in the following cases: ■ Anyone with a BMI (body mass index) over 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome (PCOS); having delivered a baby who weighed more than 9 pounds; a history of diabetes in pregnancy; chronically high cholesterol levels; a history of heart disease; or having a close relative with diabetes. ■ Anyone over the age of 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter. Type 2 diabetes and prediabetes can be diagnosed with one of several blood tests. The following details can help you make sense of the different tests and their results on your own. Glycated hemoglobin (A1C) test. This blood test shows your average blood sugar level over the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, a protein in red blood cells. The higher your blood sugar levels have been, the higher your A1C tends to be. ■ Normal A1C levels are below 5.7%. ■ An A1C level between 5.7 and 6.4% suggests you have prediabetes. ■ An A1C level of 6.5% or higher on two separate tests indicates that you have type 2 diabetes. If the A1C test results aren’t consistent, if the test isn’t available or if you have certain conditions that might make the A1C test inaccurate, your healthcare provider may use certain tests to diagnose diabetes. Random blood sugar test. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/ dL) or higher suggests diabetes. Fasting blood sugar test. This is taken from a blood sample following an overnight fast. ■ Normal is below 100 mg/dL. ■ A fasting blood sugar level between 100 and 125 mg/dL is considered to indicate prediabetes. ■ If your fasting blood sugar is 126 mg/dL or higher on two separate tests, you meet the criteria for a diabetes diagnosis. Oral glucose tolerance test. In this test, a blood sample is taken after you fast for at least eight hours or overnight. Then you’ll drink a sugary solution, and your blood sugar level will be measured again after two hours. A normal blood sugar level is less than 140 mg/dL after two hours. A blood sugar level from 140 to 199 mg/dL is considered prediabetes. Dangers of Type 2 Diabetes Although this article rejects scare-tactic approaches, it is important to understand what having diabetes—especially untreated diabetes over several years—can do to your body. Frankly, the news is not good. In fact, diabetes negatively affects every system in the human body in one way or another. The basic problem is that high sugar (glucose) levels in the blood system can damage nerves and blood vessels, as well as major body organs like your kidneys and heart. However, this damage is not inevitable. Even if you or someone you love has been diagnosed with type 2 diabetes, you can reduce complications— by as much as 70%—simply by checking blood sugar levels frequently and taking steps to keep them within a normal range. This often is called “tight control,” which is now the standard for diabetes treatment in the United States. On the other hand, uncontrolled or untreated diabetes can lead to devastating health problems, because of damage inflicted on blood vessels and nerves. Heart and blood vessel disease, also known as atherosclerosis, is the most common long-term complication of uncontrolled diabetes. High blood sugar levels damage blood vessels by making the walls thicker. As a result, blood has a harder time getting through them. Diabetics are two to four times more likely to have a stroke or heart attack than those without the disease. Keeping blood sugar, blood cholesterol and blood pressure under control, maintaining a healthy weight and stopping smoking are among the most effective ways to reduce the risks of developing heart and blood vessel disease. About two-thirds of people with diabetes experience mild to severe diabetic neuropathy or nerve damage. In fact, one of the first symptoms of diabetes can be tingling, numbness or pain in some part of the body. This is an indication that nerves have been damaged in those areas. Diabetes neuropathy can be prevented or delayed by keeping blood sugars in the normal range as much as possible. Some common types of diabetic nerve damage follow: ■ Distal neuropathy, the most common diabetic neuropathy, affects the hands and feet. A lack of sensation and decreased blood flow in the feet can lead to serious problems. People with diabetes are at high risk for foot ulcers and infections. In severe cases, foot sores never heal, leading to gangrene (death and decay of tissue) and amputation. ■ Diabetic retinopathy causes damage to the small blood vessels in the eye. As many as 12,000 to 24,000 people with diabetes go blind every year due to this condition. People with diabetes are at higher risk of developing cataracts (loss of transparency in the lenses of the eyes) and glaucoma (excessive pressure of fluid in the eye). ■ Kidney disease is a very serious consequence of uncontrolled diabetes. An estimated 28,000 people with diabetes develop kidney failure each year due to nerve damage in their kidneys’ filtering system. When this happens, waste products are not removed from blood and patients must have regular dialysis or a kidney transplant to survive. In addition, when the nerves in the small intestine or rectum are damaged, stools may be passed without warning. If the nerves in the large intestine are damaged, constipation may result. Neuropathy of the bladder can lead to more frequent and difficult-to-treat urinary tract infections. And men with diabetes run a greater risk of developing impotence. Eat Your Way to Health The good news about type 2 diabetes is that it can be prevented, delayed and treated by the same things: smart food choices and an active lifestyle. Truly, it’s not any more complicated than that! The real key to managing diabetes is sticking to a realistic plan for healthy eating and daily physical activity. In fact, people with diabetes can follow the same guidelines that are the foundation for the new U.S. Department of Agriculture’s (USDA) meal patterns and HealthierUS School Challenge awards, as well as SNA’s STEPS Challenge (www.schoolnutrition. org/steps). All of these programs are based on the Dietary Guidelines for Americans, which are just right to help people prevent and manage type 2 diabetes. A smart eating plan for people with type 2 diabetes—sometimes called medical nutrition therapy (MNT)— means eating a variety of nutrient-rich foods in moderate amounts and sticking to regular mealtimes. According to the Mayo Clinic, “rather than a restrictive diet, MNT is a healthy eating plan that’s naturally rich in nutrients and low in fat and calories, with an emphasis on fruits, vegetables and whole grains. In fact, a diabetes diet is the best eating plan for most everyone.” If this sounds like MyPlate and the new nutrition standards for schools, that’s because it is! The meals that you are now serving to children can help them—and you—to develop lifelong eating habits that prevent type 2 diabetes. If you are diagnosed with diabetes or prediabetes, your healthcare provider likely will recommend an appointment with a registered dietitian (RD) to support and guide you toward realistic dietary changes that can help control blood sugar and maintain a healthy weight. This is especially important if you are prescribed insulin or any pills or medication to treat your diabetes. Meals, snacks and physical activity all need to be coordinated to keep blood sugar levels from rising too high or falling too low. Either one can lead to complications. In addition to meeting with an RD (or taking a class about smart food choices for people with diabetes), there are multiple ways to make healthy eating habits a way of life. Following are just a few examples of online tools and books that can help. Your healthcare provider also can point you toward local resources. ■ Tracking your eating habits can be an effective way to manage your blood glucose levels and keep them within a normal range. USDA’s Super Tracker tool (www. supertracker.usda.gov) is a free and easy way to track foods and physical activities online. ■ There are literally hundreds of books and cookbooks aimed at people with diabetes. Hope Warshaw, RD, CDE, the author of Diabetes Meal Planning Made Easy (www.hopewarshaw.com), has written many of the classics. Her website is a great resource for in-depth information about eating well with diabetes. ■ Similarly, a new book by Michelle May, MD, and Megrette Fletcher, MEd, RD, CDE, Eat What You Love, Love What You Eat With Diabetes, uses awareness and intention to help readers discover how eating and physical activity affect their blood sugar. It applies a four-part system to help people think, nourish, care and live with diabetes— without restriction or guilt and discover optimal health. Learn more details about this particular approach at www.diabete sandmindfuleating.com. Get Moving! Physical activity—which uses blood sugar for energy—is just as important as food choices in managing diabetes. In addition to all the usual benefits of an active lifestyle, research has shown that regular physical activity can help lower your blood glucose and improve your body’s ability to use insulin. Since activity also is effective at improving blood pressure and cholesterol levels, it is a great way to protect your blood vessels and nerves from the usual damage of diabetes. While being physically active is generally very good for people with diabetes, it is important to check with your healthcare provider first before beginning or altering an exercise program. It is essential to ask about your medicines—both prescription and over-the-counter—and whether you should change the amount you take before engaging in physical activity. If you have heart disease, kidney disease or eye or foot problems, find out which types of physical activity are safest and best for you. Once you have the “all clear” from a medical standpoint, decide which activities you enjoy most and set some goals. Some people do best in a structured class or club situation; if you go this route, always tell an instructor that you have diabetes. But others may do better walking or biking on their own. You can find lots of useful information about being active with diabetes on the CDC website (www.cdc. gov/diabetes/consumer/beactive.htm). Being Well-Informed Is Key If you to want to learn more about diabetes and taking good care of yourself, it’s easier than ever before to access the information and support that you need—in person, from books and online. Remember that your best source of information is your personal healthcare provider, who can review your blood tests and make specific recommendations for appropriate medications and treatment options. Your primary provider also can make a referral to an RD or certified diabetes educator (CDE) to help you develop personalized nutrition and fitness plans. These visits usually are covered by health insurance. Low-cost or free diabetes care also may be available through city, county or state health programs. Additionally, be sure to check out a list of valuable online resources at www.schoolnutrition.org/ snmagazinebonuscontent for additional tips, tools and support. Remember that knowledge is the first step to power. Stay engaged in your own health. Making sustainable changes in eating and exercise habits isn’t easy, but the consequences of failing to be your own best health advocate will be far more disruptive and unpleasant to incorporate into your life. Take the same passion and compassion you have for feeding children healthy, nutritious meals and give it to the person in the mirror, too! SNAPSHOT ■ There are three common types of diabetes: type 1, type 2 and gestational. ■ The number of Americans with diabetes has more than tripled since the 1990s. ■ You can work to lower your risk by taking steps to practice a healthy lifestyle. Myth: If you are overweight, you definitely will be diagnosed with type 2 diabetes at some point. Fact: While being overweight is a risk factor for type 2 diabetes, other risk factors—such as family history, ethnicity and age—also play a role. Most overweight people will never develop type 2 diabetes, and many people with type 2 diabetes are at normal weights. Myth: Diabetes is not that serious. Fact: Diabetes causes more deaths a year than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke. Myth: Insulin causes complications of diabetes. Fact: Insulin is a natural hormone, which has been used to treat diabetes for more than 90 years. It is probably one of the safest medications around. In fact, insulin helps control blood glucose, which in turn slows down or prevents the usual complications of diabetes. TRIED-AND-TRUE TENSION RELIEVERS Is stress a given in today’s busy world? Well, yes, to an extent, but life also offers you many simple ways to offset and relieve your stress load. The following tips can help to reduce your frantic pace just a bit, by saving time and focusing on yourself. Remember, every new positive step takes repetition to become a habit! Timely Timesavers ■ Are your mornings frantic because you’re paralyzed by the decision of what to wear? And then there’s the day’s lunch you still need to pack; trying to fit in a healthy breakfast; collecting needed items for the day ahead that are scattered across the house—and maybe doing this for your spouse and children in addition to yourself! Reduce the a.m. rush with some advance prep. How much can you get ready the previous afternoon or evening? For example, while cooking or cleaning up from dinner, pack lunches and pull out the non-perishable items for breakfast. Use a commercial break during your favorite television show to put the sports bag, dry cleaning or library books by the door. When prepping for bed, take a few minutes to get the morning’s clothes ready. What else can you do before resting your head at last? ■ Planning meals on the fly is a common source of stress. Instead, sit down with your family before the week starts and review the schedule of activities. Use that to rough out a plan for a week’s worth of dinners and schedule just one trip to the grocery store to get what you’ll need. ■ Do you scramble to buy birthday or holiday gifts for family and friends at the last minute? If you see the perfect gift for a loved one at some point throughout the year, snap it up and put it aside in an easy-to-find and -remember spot. Then, when gift-giving time comes, you’ll greatly reduce that frantic feeling. Similarly, consider purchasing—or making—several greeting cards at one time and filing them for the year ahead. ■ Identify a specific date each month that you will pick up regular prescriptions and replenish personal care items. Create a master list of such items (e.g. toothpaste, shampoo, mascara, toilet paper, etc.) and leave it on your computer or phone. The day before your scheduled errand day, use this list to do a quick inventory of what you need this month. This can dramatically reduce the repetition of urgent trips when running dangerously low on necessities. Myth: Having diabetes means that you have to give up all sweets and chocolate. Fact: People with diabetes can enjoy sweets and desserts, so long as they are eaten as part of a healthy meal plan and combined with regular physical activity. Desserts are no more “off-limits” to people with diabetes than to anyone else. The key to sweets is to enjoy smaller portions so you focus your meal on more nutrient-rich foods. BONUS WEB CONTENT For a detailed list of recommended diabetes resources, as well as other fascinating diabetes-related myths and facts, be sure to check out additional online-only content found at www.schoolnutrition.org/snmagazinebonuscontent. Dayle Hayes is a nutrition consultant and speaker based in Billings, Mont. She also maintains the School Meals That Rock Facebook page (www.facebook.com/SchoolMealsThatRock). You can reach her at EatWellatSchool@gmail.com. Photography by iStockphoto.com and Jupiter images TO YOUR CREDIT: For CEUs toward SNA certifi cation, complete the “To Your Credit” test on page 50.
Published by School Nutrition Association. View All Articles.
This page can be found at http://mydigimag.rrd.com/article/Diabetes+in+Depth/1330154/148692/article.html.