Basic Rules for Coping with Diabetes
Although most of us tend to view a diagnosis of cancer as a death sentence, diabetes is usually regarded as just another chronic modern-day malady. But, millions of people with diabetes face the risk of multiple complications, including heart disease, blindness, kidney failure and irreversible damage to their nervous system. Many have to undergo limb amputations as the disease messes with their circulation. Sadly, diabetes is not the minor ailment many of us believe. In fact, the complications associated with diabetes are so common that they are the leading cause of adult blindness, kidney failure and limb amputations.
Carbohydrates, Sugars, Glucose and Insulin
Carbohydrates in our diet are our main source of energy. They come in two forms: starches and sugars. Starchy foods include bread, cereals, pasta, rice, potatoes, etc.; among the sugars are honey, table sugar (sucrose) and molasses. Other sugars can be found in a variety of foods, including fruits (fructose) and milk and dairy products (lactose).
Our digestive system breaks down starches and most sugars into glucose, the form of sugar that is used as fuel by our cells. The glucose is absorbed into the bloodstream and carried to all the body’s organs and tissues to power their functions. When glucose blood levels drop too low, the organs, especially the brain, start to malfunction. If there is too much glucose in the blood, there are serious consequences too. Here comes insulin into play. Insulin is a substance secreted into the bloodstream by the pancreas. Its role is to assure the body of a steady supply of fuel by assisting in the transfer of glucose from the bloodstream to the cells.
Diabetes: Where It All Begins
In one of the two possible scenarios the pancreas fails to do its job, producing little if any insulin. This condition is called ‘insulin-dependent diabetes’ and it usually affects children and young adults. In ‘non-insulin-dependent diabetes’ the pancreas continues producing insulin but the body either needs more than it can produce or does not respond properly to the available supply. This condition is called insulin resistance and it typically occurs in the middle-aged and elderly.
As a result, blood sugar levels increase as glucose is absorbed into the bloodstream and there is no or too little insulin to speed it into the cells. Since the body’s cells lack the necessary fuel, the energy level declines, resulting in the tired feeling that often characterizes diabetes. Subsequently, as unused glucose builds up, it begins to spill out of the bloodstream into the urine. Faced with a high concentration of glucose, the kidneys draw extra fluid from the body to dilute the urine. But, this only makes matters worse, leading to serious dehydration. That is why diabetes is marked by intense thirst and excessive urination. As the situation continues, a series of biochemical processes takes over, causing a dangerous acid condition which can potentially lead to coma and death.
What Causes Diabetes
Type 1 diabetes (insulin-dependent diabetes) is considered to be caused by an autoimmune reaction in which the body mistakes insulin-producing beta cells in the pancreas for foreign proteins and destroys them as if they were an invading bacteria or virus. However, we do not know yet why this happens or what triggers this reaction.
One theory proposes an intriguing explanation for this reaction, linking allergy to cow’s milk with type 1 diabetes. Studies show that insulin dependent diabetes is more common in children who drink large amounts of milk whereas breastfed infants, who begin drinking cow’s milk later in childhood, are less likely to develop the disease. There is a growing body of evidence suggesting that diabetes-prone animals and humans have high levels of antibodies to the proteins in cow’s milk. These antibodies may cross-react with the proteins found in the insulin-producing cells of the pancreas. This could mean that drinking cow’s milk triggers a series of events that generate the autoantibodies responsible for damaging the pancreas.
When it comes to type 2 diabetes, genetics and lifestyle are thought to be the major factors causing the insulin resistance responsible for the disease. As for lifestyle, overeating and obesity are the chief contributing factor as 80-90% of type 2 diabetics are obese. Researchers suggest that the fat cells of an overweight individual are not as sensitive to the insulin as they should be. That prevents cells from absorbing sugar.
In the past, type 2 diabetes typically emerged when a person was in their 40s while serious complications did not develop until their 60s or 70s. Now, with obesity among young population reaching epidemic proportions, experts fear that by the time affected teens reach their early 30s, they will face the same threat of kidney failure, amputations, blindness and heart attacks that their parents escaped until their senior years.
Treatment Options for Diabetes
Both types of diabetes are treated with exercise and diabetic diet. In addition to that type 1 diabetes must be also treated with insulin whereas type 2 requires weight reduction and, if lifestyle changes fail to control elevated blood glucose levels, oral medications must be used. If oral medications are insufficient, some patients with type 2 diabetes will also need to take insulin. Regular blood-sugar monitoring is a necessary component of any diabetic treatment.
Good nutrition and healthy weight are the cornerstones of treatment for all diabetics. As a rule of thumb, anyone who is trying to shed extra weight can expect to lose about a pound a week (half a kilogram) by reducing their daily food intake by 500 calories. However, caloric intake should not drop below 1,500 calories for men and 1,200 calories for women. Anything less than that could leave you with deficiencies of many vital vitamins and minerals.
How you divide up these calories depends upon your treatment goals and any complications you may have. If you are overweight, but otherwise healthy, you should get about 20% of your calories from protein, less than 30% from fat and about 50% from ‘healthy’ carbohydrates such as whole grains, legumes, fruits and vegetables.
Dietary fiber, heart-healthy fish rich in omega-3 fatty acids, such as sardines, tuna, salmon, mackerel and bluefish, as well as monounsaturated and polyunsaturated fats found in peanuts, almonds, pecans, walnuts, avocados, olives and olive oil, canola and peanut oil, play an especially important role in a diabetic diet, as demonstrated by a growing number of studies.
Sugar-sensitive diabetics have to limit foods that quickly enter their bloodstream, such as honey, table sugar, candy and molasses. They may also need to cut down on certain types of fruit or eat it at the end of a meal whereas some diabetics may need to avoid fruit juices altogether because of their almost instantaneous impact on blood sugar.
Diabetic diet should also help to control abnormal levels of fats in your blood, a common problem among diabetics. In practical terms, that means limiting your intake of saturated and trans fats and cholesterol-rich foods as well as salty meals. Among the worst offenders are processed meats, fatty cuts of pork and beef, egg yolks, cheese, whole milk and baked goods made with palm and coconut oils.
It takes a great deal of experimentation and blood-sugar self-monitoring to tell which foods work best for you. The only sure-fire way to create a diet plan that keeps your blood glucose at near normal levels is by testing your blood sugar regularly both before and one to two hours after meals. Once you learn how various foods affect these readings, you can adjust the timing and components of your meals.
Diabetes and Alcohol
Moderate alcohol consumption should not cause any health problems in most diabetics, assuming their blood glucose levels are under control and provided they drink alcohol with a meal and are not suffering from pancreatitis, gastritis, certain forms of kidney and heart disease, neuropathy and frequent bouts of low blood sugar. Moderate drinking means no more than two drinks a day for men and one for women (a drink is defined as a can of beer, a glass of wine or one shot of 80-proof hard liquor).
Do Diabetics Need Nutritional Supplements?
There is no simple answer to this question. Some studies have shown that if you have a deficiency of chromium, your body may have a harder time handling sugar because this trace element is known to enhance the action of insulin. However, chromium deficiency may be more of a problem among the elderly and the poor than among other diabetics. Good dietary sources of chromium include whole grain products, meat, brewer’s yeast, broccoli, grape fruit and cheese. But, experts caution that patients with diabetes should discuss chromium supplementation with their doctor before they begin taking it.
There is more evidence to suggest that some diabetics may benefit from extra intake of magnesium. Studies show that a lack of magnesium may contribute to insulin resistance, making it harder for the body’s cells to take up sugar. Many experts now recommend increased consumption of major food sources of magnesium, such as whole grains, green leafy vegetables and nuts to lower the risk of diabetes. Pregnant women, patients with congestive heart failure and people taking digoxin, diuretics or aminoglycosides (antibiotics such as streptomycin, gentamicin or tobramycin) are at increased risk for magnesium deficiency. Once again, you should talk with your doctor before considering a magnesium supplement. The fact is that high doses of this mineral can be harmful for those with abnormal kidney function which happens to be a common problem in patients with diabetes.
For patients taking diuretics, potassium supplementation may become necessary. However, you should ask your doctor before taking extra potassium since, in some situations, you may actually need less rather than more of this mineral. Potassium-restricted diets are sometimes recommended to diabetics with kidney problems which cause the body to hold too much potassium leading to hyperkalemia. Patients taking ACE inhibitors (blood-pressure lowering drugs) are also in danger of hyperkalemia and should limit their intake of potassium.
Zinc is yet another mineral which may be beneficial in the treatment of diabetes. For example, zinc supplements may help to heal diabetic leg ulcers. In addition, some studies have shown that the levels of zinc in a diabetic’s blood are typically lower than normal.
Sugar Substitutes and Diabetes
Although diabetics do not need to substitute sugar with artificial sweeteners, there are so many of these products with conflicting claims about their value that you may want to review their advantages and risks. The sweeteners, such as mannitol, sorbitol and xylitol (so-called sugar alcohols), contain calories and, therefore, need to be counted toward your carbohydrate allowance. The good news is that they do not increase blood glucose levels as much as sucrose and most other dietary sugars. Their most common side effect is diarrhea.
The advantage of sweeteners, such as saccharin and aspartame, is that they do not add calories to your diet and they do not affect blood glucose levels. Although some complaints exist that they may cause side effects such as headaches, depression, anxiety, insomnia, irritability, dizziness, abdominal pain, diarrhea or rash, scientific studies have failed to verify any of these claims beyond a reasonable doubt.
Why Exercise Is Key to Tackling Diabetes
Although adjusting the diet is an essential part of any treatment for diabetes, it will not be too effective without sufficient physical activity. Exercise can help lower your blood glucose levels by increasing insulin sensitivity of your cells and by increasing the number of calories your body burns. Aerobic exercise is considered to be most effective because it has the greatest impact on overall blood sugar control. It is recommended to exercise at least three days a week for at least twenty minutes a day. Regular exercise also happens to be an indispensable part of any weight loss program and it allows you to be a little more liberal when it comes to your diet.
Since diabetes can be accompanied by so many health complications, your doctor will have to determine whether there are any signs of heart, kidney, eye or nerve disease. If there are, you may need to modify the type, intensity and duration of your exercise. For example, diabetics with eye disease need to avoid exercises that may raise their blood pressure, which could further damage their eyes.
Diabetes is clearly a more complex and, therefore, more dangerous problem than many of us imagine it to be. However, if ignored, it can cause serious, even life-threatening consequences. But, if you watch your glucose levels and your weight, follow a generally healthy diet, exercise regularly and take medications as prescribed, you can significantly reduce the risk of possible complications of the disease.
Where to Find More Information: American Diabetes Association