Foot problems are very common in people with diabetes and can lead to serious complications. This fact sheet provides basic information about how diabetes affects your feet and what you can do to keep your feet healthy. Contact the Canadian Diabetes Association for additional resources.
Diabetes and your feet
Diabetes affects the circulation and immune systems, which in turn impairs the body’s ability to heal itself. Over time, diabetes can damage sensory nerves (this is known as “neuropathy"), especially in the hands and feet. As a result, people with diabetes are less likely to feel a foot injury, such as a blister or cut. Unnoticed and untreated, even small foot injuries can quickly become infected, potentially leading to serious complications.
Daily foot care
As always, prevention is the best medicine. A good daily foot care regimen will help keep your feet healthy.
Start by assembling a foot care kit containing nail clippers, nail file, lotion, a pumice stone and a non-breakable hand mirror. Having everything you need in one place makes it easier to follow this foot care routine every day:
Wash your feet in warm (not hot) water, using a mild soap. Don’t soak your feet, as this can dry your skin.
While your feet are still wet, use a pumice stone to keep calluses under control.
Dry your feet carefully, especially between your toes.
Thoroughly check your feet and between your toes to make sure there are no cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or ask someone else to check them for you.
Clean cuts or scratches with mild soap and water, and cover with a dry dressing suitable for sensitive skin.
Trim your toenails straight across and file any sharp edges. Don’t cut the nails too short.
Apply an unperfumed lotion to your heels and soles. Wipe off excess lotion that is not absorbed. Don’t put lotion between your toes, as the excessive moisture can promote infection.
Wear fresh clean socks and well-fitting shoes every day. Whenever possible, wear white socks – if you have a cut or sore, the drainage will be easy to see.
Best advice
Do wear well-fitting shoes. They should be supportive, have low heels (less than 5 cm high) and should not rub or pinch. Shop at a reputable store with knowledgeable staff who can professional fit your shoes. Do wear socks at night if your feet get cold. Do elevate your feet when you are sitting. Do wiggle your toes and move your ankles around for a few minutes several times a day to improve blood flow in your feet and legs. Do exercise regularly to improve circulation. Do inspect your feet daily and in particular feel for skin temperature differences between your feet. Don’t wear high heels, pointed-toe shoes, sandals (open toe or open heel) or worn-out shoes. Don’t wear anything tight around your legs, such as tight socks or knee-highs. Don’t ever go barefoot, even indoors. Consider buying a pair of well-fitting shoes that are just for indoors. Don’t put hot water bottles or heating pads on your feet. Don’t cross your legs for long periods of time. Don’t smoke. Smoking decreases circulation and healing, and significantly increases the risks of amputation. Don’t have pedicures by non-healthcare professionals.
When to see your doctor
If you have any swelling, warmth, redness or pain in your legs or feet, see your doctor right away.
If you have any corns (thick or hard skin on toes), calluses (thick skin on bottom of feet), in-grown toenails, warts or slivers, have them treated by your doctor or a foot care specialist (such as a podiatrist, chiropodist or experienced foot care nurse). Do not try to treat them yourself.
Have your bare feet checked by your doctor at least once a year. In addition, ask your doctor to screen you for neuropathy and loss of circulation at least once a year.
Take your socks off at every diabetes-related visit to your doctor and ask him or her to inspect your feet.
Why is smoking so bad for people with diabetes?
Smoking is bad for everyone. It increases your risk for lung cancer, heart attack and stroke, and each year, 45,000 Canadians die of smoking-related illnesses. But people with diabetes face an even greater risk from smoking: just like high blood glucose levels, the noxious chemicals in cigarette smoke attack blood vessels, accelerating atherosclerosis (hardening of the arteries) and impairing the blood’s ability to carry oxygen to the tissues.
Together, the deadly combination of high blood glucose and smoking dramatically increase damage to the blood vessels that feed the heart, brain, eyes, kidneys and peripheral nerves, speeding up the long-term complications of diabetes. People with diabetes are already at increased risk for heart disease; however, if they smoke, they face three times the risk for heart attack of a person with diabetes who does not smoke.
Together, the deadly combination of high blood glucose and smoking dramatically increase damage to the blood vessels that feed the heart, brain, eyes, kidneys and peripheral nerves, speeding up the long-term complications of diabetes. People with diabetes are already at increased risk for heart disease; however, if they smoke, they face three times the risk for heart attack of a person with diabetes who does not smoke.
Nature's Diabetes Defense
herbs that contain powerful antioxidants can help reduce inflammation, which may lead to the development of type 2 diabetes and is also implicated in heart disease, kidney problems, and other life threatening conditions.
Discuss taking herbs with your doctor amd make sure to monitor your blood sugar levels regularly, when you factor herbs into your new active lifestyle and smart eating plan, you strengthen organ systems weakened by type 2 diabetes - and you just might be able to avoid taking blood sugar-lowering drugs. Here are some that show promise.
Cinnamon
This familiar spice not only reduces blood sugar, but also lowers cholesterol and triglycerides, and best of all, cinnamon is delicious sprinkled on oatmeal and other whole grain breakfast cereals. In a study conducted by the USDA's Beltsville Human Nutrition Research Center in Maryland, 30 women and men with type 2 diabetes dusted cinnamon on food. Their blood sugar dropped by 18 to 29%, total cholesterol by 7 to 27%, and their triglycerides plummeted 23 to 30% in just 40 days. "Effects of this magnitude could help prevent or alleviate diabetes-and its complications," says Richard Anderson, PhD, of the USDA's Human Nutrition Research Center. "I took about 1/2 teaspoon a day and after 3 months, my cholesterol dropped by 60 mg/dl."
Fennugreek
Fennugreek (Trigonella foenum-graecum) is a staple Ayurvedic medicine and is a spice found in curry blends. Its seeds, rich in fiber and protein, were used in ancient Chinese medicine to help people recover from illness. In studies, a fenugreek compound, called 4-hydroxy-isoleucine, stimulated pancreatic insulin production in rats, and fenugreek seed reduced fasting blood sugar levels. In other studies, people with diabetes who were given the herb handled glucose better in glucose tolerance tests. Finally, researchers found that people with type 2 diabetes who took fenugreek had reduced blood sugar levels after eating.
Gymnema
In Ayurveda, India's traditional medical system, gymnema (Gymnema sylvestre) is a widely used treatment for diabetes and obesity. Its Hindi name "gurmar" means "destroyer of sugar." The herb contains a compound called gymnenin, which lessens your ability to taste sweets, and also diminishes appetite for up to 90 minutes. Two long-term studies showed that the herb reduced fasting blood glucose in people with type 1 and type 2 diabetes.
Using Herbs Safely
Monitor blood sugar frequently. Discuss your plan with your doctor and don't use herbs if you are pregnant or nursing, unless an herbal practitioner recommends otherwise. Give it time to work - most herbs take at least 6 to 8 weeks to show full results.
Discuss taking herbs with your doctor amd make sure to monitor your blood sugar levels regularly, when you factor herbs into your new active lifestyle and smart eating plan, you strengthen organ systems weakened by type 2 diabetes - and you just might be able to avoid taking blood sugar-lowering drugs. Here are some that show promise.
Cinnamon
This familiar spice not only reduces blood sugar, but also lowers cholesterol and triglycerides, and best of all, cinnamon is delicious sprinkled on oatmeal and other whole grain breakfast cereals. In a study conducted by the USDA's Beltsville Human Nutrition Research Center in Maryland, 30 women and men with type 2 diabetes dusted cinnamon on food. Their blood sugar dropped by 18 to 29%, total cholesterol by 7 to 27%, and their triglycerides plummeted 23 to 30% in just 40 days. "Effects of this magnitude could help prevent or alleviate diabetes-and its complications," says Richard Anderson, PhD, of the USDA's Human Nutrition Research Center. "I took about 1/2 teaspoon a day and after 3 months, my cholesterol dropped by 60 mg/dl."
Fennugreek
Fennugreek (Trigonella foenum-graecum) is a staple Ayurvedic medicine and is a spice found in curry blends. Its seeds, rich in fiber and protein, were used in ancient Chinese medicine to help people recover from illness. In studies, a fenugreek compound, called 4-hydroxy-isoleucine, stimulated pancreatic insulin production in rats, and fenugreek seed reduced fasting blood sugar levels. In other studies, people with diabetes who were given the herb handled glucose better in glucose tolerance tests. Finally, researchers found that people with type 2 diabetes who took fenugreek had reduced blood sugar levels after eating.
Gymnema
In Ayurveda, India's traditional medical system, gymnema (Gymnema sylvestre) is a widely used treatment for diabetes and obesity. Its Hindi name "gurmar" means "destroyer of sugar." The herb contains a compound called gymnenin, which lessens your ability to taste sweets, and also diminishes appetite for up to 90 minutes. Two long-term studies showed that the herb reduced fasting blood glucose in people with type 1 and type 2 diabetes.
Using Herbs Safely
Monitor blood sugar frequently. Discuss your plan with your doctor and don't use herbs if you are pregnant or nursing, unless an herbal practitioner recommends otherwise. Give it time to work - most herbs take at least 6 to 8 weeks to show full results.
Healthy Eating & Physical Activity
Healthy eating, along with medicine if prescribed and regular physical activity, can help lower your blood sugar. Eating healthy is key to reducing your risk of health complications from diabetes.
Changing the way you eat can be hard. So make changes slowly. Start by adding high-fiber foods including fruits and vegetables. These fiber-rich foods may help stop spikes in blood sugar. Eat less meat and fewer sweets.
Regular physical activity can lower blood sugar by decreasing insulin resistance. It can also reduce your risk of heart disease and high blood pressure. Plus, it willhelp you manage your weight.Eating healthy and being active can help you manage your weight. If your doctor says you need to lose weight, do it slowly. Work together to come up with a meal plan that will help you lose about one pound a week. Even losing a little weight may lower your blood sugar level and make you feel better.
It’s hard to do everything right every day. Just try to do some things right each day. Take small steps toward creating a healthy meal plan and activities that you can enjoy.
Changing the way you eat can be hard. So make changes slowly. Start by adding high-fiber foods including fruits and vegetables. These fiber-rich foods may help stop spikes in blood sugar. Eat less meat and fewer sweets.
Regular physical activity can lower blood sugar by decreasing insulin resistance. It can also reduce your risk of heart disease and high blood pressure. Plus, it willhelp you manage your weight.Eating healthy and being active can help you manage your weight. If your doctor says you need to lose weight, do it slowly. Work together to come up with a meal plan that will help you lose about one pound a week. Even losing a little weight may lower your blood sugar level and make you feel better.
It’s hard to do everything right every day. Just try to do some things right each day. Take small steps toward creating a healthy meal plan and activities that you can enjoy.
First trial of plant-produced insulin takes place in UK
The world’s first trial of human insulin produced in plants is underway in the UK. It is hoped that this could be a new source of insulin which will help meet growing demand as diabetes prevalence increases.
A genetically modified variety of safflower that makes high concentrations of human insulin has been developed by SemBioSys, a Canadian biotechnology company. Safflower is currently a minor source of seed oil from which insulin can be easily extracted.
The trial will show whether human insulin derived from the safflower plant has the same effects on blood sugar levels as commercial human insulin, which is largely produced by cultures of genetically engineered bacteria in huge fermenters.
Thirty healthy volunteers are taking part in the trial, which if successful, will be extensively tested in people with diabetes.
The cost of producing insulin using ‘bio-pharming’ methods, which aim to produce a range of human molecules in genetically engineered plants, is 70 to 80 per cent lower than in bacterial fermenters say producer SemBioSys.
The plant produced insulin will need to undergo a demonstration of ‘bio-equivalence’ to prove that it is biologically identical to human insulin before seeking approval for sale from regulators such as the European Medicines Agency.
A genetically modified variety of safflower that makes high concentrations of human insulin has been developed by SemBioSys, a Canadian biotechnology company. Safflower is currently a minor source of seed oil from which insulin can be easily extracted.
The trial will show whether human insulin derived from the safflower plant has the same effects on blood sugar levels as commercial human insulin, which is largely produced by cultures of genetically engineered bacteria in huge fermenters.
Thirty healthy volunteers are taking part in the trial, which if successful, will be extensively tested in people with diabetes.
The cost of producing insulin using ‘bio-pharming’ methods, which aim to produce a range of human molecules in genetically engineered plants, is 70 to 80 per cent lower than in bacterial fermenters say producer SemBioSys.
The plant produced insulin will need to undergo a demonstration of ‘bio-equivalence’ to prove that it is biologically identical to human insulin before seeking approval for sale from regulators such as the European Medicines Agency.
estimated Average Glucose, eAG
The results of the A1C-Derived Average Glucose study (ADAG), published in Diabetes Care, have affirmed the existence of a linear relationship between A1C and average blood glucose levels.
In light of the study results, ADA is recommending the use of a new term in diabetes management, estimated average glucose, eAG. Health care providers can now report A1C results to patients using the same units (mg/dl or mmol/l) that patients see routinely in blood glucose measurements.
The relationship between A1C and eAG is described by the formula 28.7 X A1C – 46.7 = eAG.
In light of the study results, ADA is recommending the use of a new term in diabetes management, estimated average glucose, eAG. Health care providers can now report A1C results to patients using the same units (mg/dl or mmol/l) that patients see routinely in blood glucose measurements.
The relationship between A1C and eAG is described by the formula 28.7 X A1C – 46.7 = eAG.
Complications of Diabetes
I was told about all the problems my diabetes could cause, but nobody explained why. Had someone explained these things to me, I might have tried harder to do what I had been told to do. Complications from diabetes come on over time, and damage has often started before we realize something is wrong. The belief that "as long as I feel well I must be well" does not hold true for the complications of diabetes; they come on quietly.
Cardiovascular System
The heart actually has the largest blood vessels in the body so why is it damaged? First of all, it is the job of the heart to pump the thick, sticky blood through all the narrowed vessels in the body. That is like canoeing in Jell-O compared with canoeing in water. The heart also has many small vessels that feed and nourish it. When blood sugars are high, they do not get the circulation they need. So not only are we asking the heart to work twice as hard, we are depriving it of nutrition to give it strength. Cardiovascular Disease is the most common cause of death in people with diabetes. But there are support and therapy strategies that have been proven effective.
Nerve Damage and DiseaseAmputations and ulcers, especially in the feet, are more frequent in patients with poorly controlled diabetes. Decreased circulation to feet and legs leads to damage and loss of nerve function. The nerves lose their ability to sense pain, pressure, touch, or temperature correctly, which results in tingling and numbess of the feet and toes (fingers, too). This condition is called peripheral neuropathy.
Autonomic neuropathy occurs when there is nerve damage affecting the automatic processes in your body such as heart rate or sweating, so they do not work as they should. The stomach may not process food correctly. The heart rate or blood pressure does not speed up or slow down in response to exercise, exertion, rest, standing, or sitting. Autonomic neuropathy also contributes to the absence of chest pain with heart attack, and can cause sweating at inappropriate times or in specific areas, leaky bladder, pupils that do not constrict or dilate as needed, sexual dysfunction, and decreased ability to sense an infection or hypoglycemia.
If you already have numbness in your feet, is there any point to controlling blood sugars? Absolutely. Numbness and burning in the feet are signs that nerves have been damaged. Evidence has shown that nerves, when only damaged, can learn to trasmit messages through different pathways. If your feet are so completely numb that you cannot tell where they are because you cannot feel them, managing your blood sugars most likely will not get any sensation back. But it can prevent the numbness and nerve damage from spreading farther up your leg. And controlling your blood sugars will give your damanged nerves and your immune system a fighting chance to help your feet stay healthy.
Vision Problems
Retinopathy, macular edema, glaucoma, and cataracts are the more common eye disorders related to diabetes.
Eye disease is typically progressive, and there are usually no symptoms until damage has occurred. You may have 20/20 vision yet one day have complete vision loss due to a hemorrhage. This is the reason a yearly eye exam is so important. An eye doctor will be able to see the changes occurring before vision is at risk. Laser surgery can destroy the abnormal vessels in the eye and prevent their regrowth.
So What's The Good News?
Believe it or not, there is some good news. The whole process of long-term complications started with sticky red blood cells. The good news is that red blood cells only live two to three months. That means that in three months of keeping your blood sugar levels nearer to normal, you have a whole new set of unsticky red blood cells. This turnover eliminates the cops, slow cars, and semi-trucks from the freeway, and prevents further damage to the road. When blood sugar levels come down, the stickiness decreases on the walls of the arteries and veins, and triglycerides and cholesterol levels are reduced. So where lanes of traffic were closed, we now have open roads. Where damage has been done, we may not be able to repair it, but with improved control, we can prevent further complications and slow or stop the progress of any existing ones. Keeping blood sugars close to normal is the best way to prevent complications. Unlike genetics, age, or sex, it is the one component we have some control over.
Excerpt from: Mastering Your Diabetes (Before Diabetes Masters You)
Cardiovascular System
The heart actually has the largest blood vessels in the body so why is it damaged? First of all, it is the job of the heart to pump the thick, sticky blood through all the narrowed vessels in the body. That is like canoeing in Jell-O compared with canoeing in water. The heart also has many small vessels that feed and nourish it. When blood sugars are high, they do not get the circulation they need. So not only are we asking the heart to work twice as hard, we are depriving it of nutrition to give it strength. Cardiovascular Disease is the most common cause of death in people with diabetes. But there are support and therapy strategies that have been proven effective.
Nerve Damage and DiseaseAmputations and ulcers, especially in the feet, are more frequent in patients with poorly controlled diabetes. Decreased circulation to feet and legs leads to damage and loss of nerve function. The nerves lose their ability to sense pain, pressure, touch, or temperature correctly, which results in tingling and numbess of the feet and toes (fingers, too). This condition is called peripheral neuropathy.
Autonomic neuropathy occurs when there is nerve damage affecting the automatic processes in your body such as heart rate or sweating, so they do not work as they should. The stomach may not process food correctly. The heart rate or blood pressure does not speed up or slow down in response to exercise, exertion, rest, standing, or sitting. Autonomic neuropathy also contributes to the absence of chest pain with heart attack, and can cause sweating at inappropriate times or in specific areas, leaky bladder, pupils that do not constrict or dilate as needed, sexual dysfunction, and decreased ability to sense an infection or hypoglycemia.
If you already have numbness in your feet, is there any point to controlling blood sugars? Absolutely. Numbness and burning in the feet are signs that nerves have been damaged. Evidence has shown that nerves, when only damaged, can learn to trasmit messages through different pathways. If your feet are so completely numb that you cannot tell where they are because you cannot feel them, managing your blood sugars most likely will not get any sensation back. But it can prevent the numbness and nerve damage from spreading farther up your leg. And controlling your blood sugars will give your damanged nerves and your immune system a fighting chance to help your feet stay healthy.
Vision Problems
Retinopathy, macular edema, glaucoma, and cataracts are the more common eye disorders related to diabetes.
Eye disease is typically progressive, and there are usually no symptoms until damage has occurred. You may have 20/20 vision yet one day have complete vision loss due to a hemorrhage. This is the reason a yearly eye exam is so important. An eye doctor will be able to see the changes occurring before vision is at risk. Laser surgery can destroy the abnormal vessels in the eye and prevent their regrowth.
So What's The Good News?
Believe it or not, there is some good news. The whole process of long-term complications started with sticky red blood cells. The good news is that red blood cells only live two to three months. That means that in three months of keeping your blood sugar levels nearer to normal, you have a whole new set of unsticky red blood cells. This turnover eliminates the cops, slow cars, and semi-trucks from the freeway, and prevents further damage to the road. When blood sugar levels come down, the stickiness decreases on the walls of the arteries and veins, and triglycerides and cholesterol levels are reduced. So where lanes of traffic were closed, we now have open roads. Where damage has been done, we may not be able to repair it, but with improved control, we can prevent further complications and slow or stop the progress of any existing ones. Keeping blood sugars close to normal is the best way to prevent complications. Unlike genetics, age, or sex, it is the one component we have some control over.
Excerpt from: Mastering Your Diabetes (Before Diabetes Masters You)
Signs and Symptoms of Diabetes:
Frequent trips to the bathroom:
Are you visiting the bathroom much more lately? Does it seem like you urinate all day long? Urination becomes more frequent when there is too much glucose in the blood. If insulin is nonexistent or ineffective, the kidneys can't filter glucose back to the blood. They become overwhelmed and try to draw extra water out of the blood to dilute the glucose. This keeps your bladder full and it keeps you running to the bathroom.
Unquenchable Thirst:
If it feels like you can't get enough water and you're drinking much more than usual, it could be a sign of diabetes, especially if it seems to go hand in hand with frequent urination. If your body is pulling extra water out of your blood and you're running to the bathroom more, you will become dehydrated and feel the need to drink more to replace the water that you are losing.
Losing Weight Without Trying:
This symptom is more noticeable with Type 1 diabetes. In Type 1, the pancreas stops making insulin, possibly due to a viral attack on pancreas cells or because an autoimmune response makes the body attack the insulin producing cells. The body desperately looks for an energy source because the cells aren't getting glucose. It starts to break down muscle tissue and fat for energy. Type 2 happens gradually with increasing insulin resistance so weight loss is not as noticeable.
Weakness and Fatigue:
It's that bad boy glucose again. Glucose from the food we eat travels into the bloodstream where insulin is supposed to help it transition into the cells of our body. The cells use it to produce the energy we need to live. When the insulin isn't there or if the cells don't react to it anymore, then the glucose stays outside the cells in the bloodstream. The cells become energy starved and you feel tired and run down.
Tingling or Numbness in Your Hands, Legs or Feet:
This symptom is called neuropathy. It occurs gradually over time as consistently high glucose in the blood damages the nervous system, particularly in the extremities. Type 2 diabetes is a gradual onset, and people are often not aware that they have it. Therefore, blood sugar might have been high for more than a few years before a diagnosis is made. Nerve damage can creep up without our knowledge. Neuropathy can very often improve when tighter blood glucose control is achieved.
Other Signs and Symptoms That Can Occur:
Blurred vision, skin that is dry or itchy, frequent infections or cuts and bruises that take a long time to heal are also signs that something is amiss. Again, when these signs are associated with diabetes, they are the result of high glucose levels in the body. If you notice any of the above signs, schedule an appointment with your doctor. He or she will be able to tell you if you have reason to be concerned about a diagnosis of diabetes.
Are you visiting the bathroom much more lately? Does it seem like you urinate all day long? Urination becomes more frequent when there is too much glucose in the blood. If insulin is nonexistent or ineffective, the kidneys can't filter glucose back to the blood. They become overwhelmed and try to draw extra water out of the blood to dilute the glucose. This keeps your bladder full and it keeps you running to the bathroom.
Unquenchable Thirst:
If it feels like you can't get enough water and you're drinking much more than usual, it could be a sign of diabetes, especially if it seems to go hand in hand with frequent urination. If your body is pulling extra water out of your blood and you're running to the bathroom more, you will become dehydrated and feel the need to drink more to replace the water that you are losing.
Losing Weight Without Trying:
This symptom is more noticeable with Type 1 diabetes. In Type 1, the pancreas stops making insulin, possibly due to a viral attack on pancreas cells or because an autoimmune response makes the body attack the insulin producing cells. The body desperately looks for an energy source because the cells aren't getting glucose. It starts to break down muscle tissue and fat for energy. Type 2 happens gradually with increasing insulin resistance so weight loss is not as noticeable.
Weakness and Fatigue:
It's that bad boy glucose again. Glucose from the food we eat travels into the bloodstream where insulin is supposed to help it transition into the cells of our body. The cells use it to produce the energy we need to live. When the insulin isn't there or if the cells don't react to it anymore, then the glucose stays outside the cells in the bloodstream. The cells become energy starved and you feel tired and run down.
Tingling or Numbness in Your Hands, Legs or Feet:
This symptom is called neuropathy. It occurs gradually over time as consistently high glucose in the blood damages the nervous system, particularly in the extremities. Type 2 diabetes is a gradual onset, and people are often not aware that they have it. Therefore, blood sugar might have been high for more than a few years before a diagnosis is made. Nerve damage can creep up without our knowledge. Neuropathy can very often improve when tighter blood glucose control is achieved.
Other Signs and Symptoms That Can Occur:
Blurred vision, skin that is dry or itchy, frequent infections or cuts and bruises that take a long time to heal are also signs that something is amiss. Again, when these signs are associated with diabetes, they are the result of high glucose levels in the body. If you notice any of the above signs, schedule an appointment with your doctor. He or she will be able to tell you if you have reason to be concerned about a diagnosis of diabetes.
Chromium
Controls Hazardous Insulin: Chromium increases the power of insulin to process sugar, so you need less insulin to do the job, and blood levels drop. If chromium is low you need about ten times more insulin to process sugar, says Dr. Anderson. Thus, with adequate chromium, much less insulin circulates in the blood to attack artery walls, precipitating atherosclerosis, and possibly plunging you into adult-onset (Type II) diabetes. Be reactivating insulin, chromium alleviates some of the danger of "insulin resistance" that comes on with age. Chromium can even improve insulin resistance in diabetics, according to several studies. A daily 200 micrograms of chromium improved insulin resistance in 62 percent of women with Type II diabetes and 50 percent of men with the disorder within ten days, according to Israeli research.
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Controls Hazardous Insulin: Chromium increases the power of insulin to process sugar, so you need less insulin to do the job, and blood levels drop. If chromium is low you need about ten times more insulin to process sugar, says Dr. Anderson. Thus, with adequate chromium, much less insulin circulates in the blood to attack artery walls, precipitating atherosclerosis, and possibly plunging you into adult-onset (Type II) diabetes. Be reactivating insulin, chromium alleviates some of the danger of "insulin resistance" that comes on with age. Chromium can even improve insulin resistance in diabetics, according to several studies. A daily 200 micrograms of chromium improved insulin resistance in 62 percent of women with Type II diabetes and 50 percent of men with the disorder within ten days, according to Israeli research.
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Fish Oil Lowers Triglycerides
Fish Oil Lowers Triglycerides With Little or No Glycemic Effect in Type 2 Diabetics
The results of a meta-analysis of 18 trials conducted over a 10-year period show that fish oil supplementation for patients with type 2 diabetes lowers triglycerides but has no statistically significant effect on glycemic control (blood sugar).
"This study disproves the long-held belief that fish oil supplementation adversely affects glycemic control in patients with type 2 diabetes," Dr. Victor M. Montori told Reuters Health.
Dr. Montori, of the Mayo Clinic and Foundation, Rochester, Minnesota, and colleagues collected data on glycemic control and lipid levels in 823 patients with type 2 diabetes who took fish oil supplements in daily dosages ranging from 3 g to 18 g. Most patients, who were followed for a mean of 12 weeks, were men between 55 and 65 years of age who had had type 2 diabetes for between 5 and 10 years.
In the September issue of Diabetes Care, the researchers write that "fish oil supplementation did not result in any statistically or clinically significant increase in fasting glucose or glycosylated hemoglobin."
The main effect of fish oil supplementation was "the reduction of triglycerides by an average of 0.56 mmol/L," Dr. Montori told Reuters Health. Conversely, he reported a "small increase [0.21 mmol/L on average] in low-density lipoprotein cholesterol."
The increases in LDL cholesterol and reductions in triglycerides were "most marked in those trials that recruited hypertriglyceridemic subjects and used higher doses of fish oil," the researchers write. They note that triglycerides levels were reduced up to 4 mmol/L in patients with hypertriglyceridemia.
While the pooled data "was not able to elucidate the ideal dose of fish oil needed to achieve large reductions in triglycerides," Dr. Montori said, it suggests that "fish oil may be safe to add to the armamentarium of triglyceride-lowering medication" for people with diabetes.
Source: Reuters Health, October 2005
Fish Oil Lowers Triglycerides With Little or No Glycemic Effect in Type 2 Diabetics
The results of a meta-analysis of 18 trials conducted over a 10-year period show that fish oil supplementation for patients with type 2 diabetes lowers triglycerides but has no statistically significant effect on glycemic control (blood sugar).
"This study disproves the long-held belief that fish oil supplementation adversely affects glycemic control in patients with type 2 diabetes," Dr. Victor M. Montori told Reuters Health.
Dr. Montori, of the Mayo Clinic and Foundation, Rochester, Minnesota, and colleagues collected data on glycemic control and lipid levels in 823 patients with type 2 diabetes who took fish oil supplements in daily dosages ranging from 3 g to 18 g. Most patients, who were followed for a mean of 12 weeks, were men between 55 and 65 years of age who had had type 2 diabetes for between 5 and 10 years.
In the September issue of Diabetes Care, the researchers write that "fish oil supplementation did not result in any statistically or clinically significant increase in fasting glucose or glycosylated hemoglobin."
The main effect of fish oil supplementation was "the reduction of triglycerides by an average of 0.56 mmol/L," Dr. Montori told Reuters Health. Conversely, he reported a "small increase [0.21 mmol/L on average] in low-density lipoprotein cholesterol."
The increases in LDL cholesterol and reductions in triglycerides were "most marked in those trials that recruited hypertriglyceridemic subjects and used higher doses of fish oil," the researchers write. They note that triglycerides levels were reduced up to 4 mmol/L in patients with hypertriglyceridemia.
While the pooled data "was not able to elucidate the ideal dose of fish oil needed to achieve large reductions in triglycerides," Dr. Montori said, it suggests that "fish oil may be safe to add to the armamentarium of triglyceride-lowering medication" for people with diabetes.
Source: Reuters Health, October 2005
Water Is Key To Weight Loss And Good Health
Source: Jet Magazine
If you want to lose weight, drink more water each day and you'll chase the pounds away.
Water is crucial to any fitness or weight-loss regimen. When you exercise, water helps your body convert excess fat to energy and helps your kidneys flush out waste products from the extra fat and calories you burn.
Water also keeps your body from retaining excess fluid. When you don't drink enough water, your body, sensing the shortage, will retain as much water as it can. Retained water shows up as extra weight and can give you that bloated look. Drinking plenty of water combats water retention.
Water transports nutrients and oxygen to cells, aids in food digestion, regulates your body temperature, and removes toxins from your body, as well as prevents constipation, cushions your joints, protects organs and tissues and cools down the body.
If you're trying to cut back on calories, drinking water before and during each meal can help you eat less. Water takes up space in your stomach, leaving less room for extra food and making you feel full quicker so that you'll eat less.
Experts say you need about eight glasses of water a day--about 64 ounces--to keep your system running smoothly under normal conditions. But if you exercise, you'll need even more to replace the fluids you lose through perspiration.
Also, keep in mind high temperatures, low humidity, fevers brought on by illness, working outdoors, high altitudes, even certain medications can dehydrate your body. Depending on the conditions, it may be necessary to drink more than two quarts of water a day, and more frequently to keep your body healthy.
According to the American Medical Association, the best way to meet your daily water quota is by drinking plain water. But fruit juices, milk and caffeine-free drinks are also good sources.
Fruits and vegetables are other potent sources of the fluid your body needs, especially those that have high-water contents like lettuce, watermelon, broccoli and grapefruit.
Watch out for caffeinated and alcoholic beverages, however, since they can cause the body to lose water.
To get your daily dose of water, keep a water bottle nearby during the day and take regular water breaks. Drink a glass of water when you get up in the morning and one at bedtime, and have water with your meals instead of soda and coffee. Zest it up with a twist of lemon or lime, or try flavored waters to quench your thirst and help shed those pounds and inches.
Source: Jet Magazine
If you want to lose weight, drink more water each day and you'll chase the pounds away.
Water is crucial to any fitness or weight-loss regimen. When you exercise, water helps your body convert excess fat to energy and helps your kidneys flush out waste products from the extra fat and calories you burn.
Water also keeps your body from retaining excess fluid. When you don't drink enough water, your body, sensing the shortage, will retain as much water as it can. Retained water shows up as extra weight and can give you that bloated look. Drinking plenty of water combats water retention.
Water transports nutrients and oxygen to cells, aids in food digestion, regulates your body temperature, and removes toxins from your body, as well as prevents constipation, cushions your joints, protects organs and tissues and cools down the body.
If you're trying to cut back on calories, drinking water before and during each meal can help you eat less. Water takes up space in your stomach, leaving less room for extra food and making you feel full quicker so that you'll eat less.
Experts say you need about eight glasses of water a day--about 64 ounces--to keep your system running smoothly under normal conditions. But if you exercise, you'll need even more to replace the fluids you lose through perspiration.
Also, keep in mind high temperatures, low humidity, fevers brought on by illness, working outdoors, high altitudes, even certain medications can dehydrate your body. Depending on the conditions, it may be necessary to drink more than two quarts of water a day, and more frequently to keep your body healthy.
According to the American Medical Association, the best way to meet your daily water quota is by drinking plain water. But fruit juices, milk and caffeine-free drinks are also good sources.
Fruits and vegetables are other potent sources of the fluid your body needs, especially those that have high-water contents like lettuce, watermelon, broccoli and grapefruit.
Watch out for caffeinated and alcoholic beverages, however, since they can cause the body to lose water.
To get your daily dose of water, keep a water bottle nearby during the day and take regular water breaks. Drink a glass of water when you get up in the morning and one at bedtime, and have water with your meals instead of soda and coffee. Zest it up with a twist of lemon or lime, or try flavored waters to quench your thirst and help shed those pounds and inches.
Famous People with Diabetes
Actors/Directors
Jack Benny, '50s television host
Halle Berry
Wilford Brimley, of television and films, "Cocoon" and "The Firm"
Delta Burke, of television's "Designing Women"
James Cagney, producer, director and actor
Nell Carter, of the television show "Gimme a Break"
Dale Evans, actress, singer and wife of Roy Rogers
Stephen Furst, actor on the television shows "St. Elsewhere" and "Babylon 5"
Jackie Gleason, funny star of "The Honeymooners"
Gordon Jump, actor on "WKRP in Cincinnati"
Mabel King, actress who played Mama on "What's Happening"
Marcello Mastroianni, actor who appeared in 142 films
Jerry Mathers, actor of "Leave It To Beaver" fame
Mary Tyler Moore, actress and star of "The Mary Tyler Moore Show".
Richard Mulligan, actor on the television show "Empty Nest"
Minnie Pearl, entertainer, actress on the variety show "Hee Haw"
Aida Turturro, plays Tony's sister on the Sopranos
Ehster Rolle, actress on the TV Show "Good Times"
George C. Scott, Academy Award-winning actor
Jean Smart, actress on "Designing Women"
Kate Smith, singer, actress who sang "God Bless America"
Spencer Tracy, famous leading man of Hollywood movies
Mae West, actress
Jane Wyman, actress on "Falcon Crest"
Political Leaders
Rania Al-Abdullah, Queen of Jordan
Yuri Andropov, former premier of Soviet Union
Menachem Begin, Israeli prime minister
Lucille B. Chapman, a five-time Menominee Indian tribal chairwoman
James Farmer, civil rights pioneer
Mikhail Gorbachev, former Soviet premier
Janet Jagan, president of Guyana
Fiorello LaGuardia, New York mayor and the airport's namesake
Winnie Mandela, South African anti-apartheid leader
Gen. Augusto Pinochet, the infamous Chilean dictator
Anwar Sadat, Egyptian leader
Mike Huckabee, Republican Presidential Hopeful
Business Leaders
James Conkling, founder of The National Academy of Recording Arts and Sciences
Bill and John Davidson, heads of Harley Davidson motorcycles
Tom Foster, former head of Foster Poultry Farms
W.L. Gherra, of Payless Drugs
Howard Hughes, industrialist
Ray Kroc, founder of McDonald's fast food restaurants
Musicians
Nat Adderley, jazz trumpeter
Ray Anderson, jazz trombonist
Hoyt Axton, folksy baritone, songwriter and actor
Syd Barrett, of the rock group Pink Floyd
Johnny Cash, legendary country singer, known as "the man in black"
Carol Channing, Tony Award-winning singer/actress in "Hello Dolly"
Mark Collie, contemporary country star
David Crosby, member of The Byrds and Crosby, Stills, Nash & Young
Miles Davis, legendary jazz great
Freddy Fender, actor and country singer
Ella Fitzgerald, jazz vocalist
Mick Fleetwood, singer in rock band Fleetwood Mac
Jerry Garcia, lead singer of The Grateful Dead
Dizzy Gillespie, jazz trumpeter
Mahalia Jackson, singer
Waylon Jennings, country singer
B.B. King, rhythm and blues star
Patti LaBelle, pop singer
Peggy Lee, '50s songster
Tommy Lee, of heavy metal band Motley Crue
Andrew Lloyd Webber, Broadway composer
Meat Loaf, singer
Bret Michaels, lead singer of the rock group Poison
The Pump Girls
Elvis Presley
Brad Wilk, member of Rage Against the Machine and Audioslave
Scientists
Morris Braunstein, scientist
Thomas Edison, inventor
Albert Ellis, psychologist, rational emotive therapy
Cynthia Ice, developer of Lotus software
George Minot, first person with diabetes to receive Nobel Prize in medicine
Lois Jovanovic-Peterson, scientist, endocrinologist, author of "Diabetic Women"
Sports
Wasim Akram, Pakistani cricket star played from 1984-2002
Arthur Ashe, tennis legend
Walter Barnes, former Philadelphia Eagle turned actor
Ayden Byle, runner
Bobby Clarke, hockey player for the Philadelphia Flyers
Ty Cobb, baseball player for the Detroit Tigers
Scott Coleman, first man with diabetes to swim the English Channel
Buster Douglas, boxer
Kenny Duckett, football player for the New Orleans Saints
Chris Dudley, New York Knicks basketball player
Del Ennis, baseball player
Curt Frasier, hockey player for the Chicago Black Hawks
Bill Gullickson, pitcher for the Cincinnati Reds
Gary Hall, Olympic gold medalist in swimming
Jonathon Hayes, tight end for the Pittsburgh Steelers and Kansas City Chiefs
Catfish Hunter, pitcher for the Oakland A's and the New York Yankees
Jason Johnson, pitcher for the Baltimore Orioles
Billie Jean King, tennis player
Ed Kranepool, baseball player with the New York Mets
Kelli Kuehne, LPGA golfer who wears a pump on the golf course
Jay Leeuwenburg, offensive tackle for the Cincinnati Bengals
Calvin Muhammed, football player for the Washington Redskins
Steve Redgrave, 5-time Olympic gold medalist and type 1 diabetic
Jackie Robinson, baseball star who broke the color barrier in the Major Leagues
Sugar Ray Robinson, boxer
Ron Santo, third basemen for the Chicago Cubs
Art Shell, NFL player and coach
Michael Sinclair, defensive end for the Seattle Seahawks
Bill Talbert, hall of fame tennis player
Scott Verplank, a golfer on the PGA tour and a member of the recent Ryder Cup team for America, is a type 1 diabetic.
Jersey Joe Walcott, boxer
Wade Wilson, NFL quarterback
Bob Woolmer, cricket player and coach has type 2 diabetes
Writers/Reporters
Richard Bartlett, film
June Bierman, author of books on diabetes
Fran Carpentier, editor of Parade magazine
Sylvia Chase, ABC News Reporter
Ernest Hemingway - 20th Century Novelist. Born on July 21, 1899, Ernest Hemingway grew up to become one of the greatest novelist of the 20th century. He wrote such works as The Sun Also Rise, 1926; A Farewell to Arms, 1929; and For Whom the Bell Tolls, 1940 just to name a few. He also received the Nobel Prize for Literature in 1954.
Walt Kelly, animator and Disney founder
Bruce Andrew Peters, internationally published, award-winning photojournalist
Mario Puzo, author of "The Godfather"
Anne Rice, "Interview With a Vampire" author
H.G. Wells, writer, "The Invisible Man"
Sources: Angela Rose, Diabetes Digest, Diabetes Health Magazine
Actors/Directors
Jack Benny, '50s television host
Halle Berry
Wilford Brimley, of television and films, "Cocoon" and "The Firm"
Delta Burke, of television's "Designing Women"
James Cagney, producer, director and actor
Nell Carter, of the television show "Gimme a Break"
Dale Evans, actress, singer and wife of Roy Rogers
Stephen Furst, actor on the television shows "St. Elsewhere" and "Babylon 5"
Jackie Gleason, funny star of "The Honeymooners"
Gordon Jump, actor on "WKRP in Cincinnati"
Mabel King, actress who played Mama on "What's Happening"
Marcello Mastroianni, actor who appeared in 142 films
Jerry Mathers, actor of "Leave It To Beaver" fame
Mary Tyler Moore, actress and star of "The Mary Tyler Moore Show".
Richard Mulligan, actor on the television show "Empty Nest"
Minnie Pearl, entertainer, actress on the variety show "Hee Haw"
Aida Turturro, plays Tony's sister on the Sopranos
Ehster Rolle, actress on the TV Show "Good Times"
George C. Scott, Academy Award-winning actor
Jean Smart, actress on "Designing Women"
Kate Smith, singer, actress who sang "God Bless America"
Spencer Tracy, famous leading man of Hollywood movies
Mae West, actress
Jane Wyman, actress on "Falcon Crest"
Political Leaders
Rania Al-Abdullah, Queen of Jordan
Yuri Andropov, former premier of Soviet Union
Menachem Begin, Israeli prime minister
Lucille B. Chapman, a five-time Menominee Indian tribal chairwoman
James Farmer, civil rights pioneer
Mikhail Gorbachev, former Soviet premier
Janet Jagan, president of Guyana
Fiorello LaGuardia, New York mayor and the airport's namesake
Winnie Mandela, South African anti-apartheid leader
Gen. Augusto Pinochet, the infamous Chilean dictator
Anwar Sadat, Egyptian leader
Mike Huckabee, Republican Presidential Hopeful
Business Leaders
James Conkling, founder of The National Academy of Recording Arts and Sciences
Bill and John Davidson, heads of Harley Davidson motorcycles
Tom Foster, former head of Foster Poultry Farms
W.L. Gherra, of Payless Drugs
Howard Hughes, industrialist
Ray Kroc, founder of McDonald's fast food restaurants
Musicians
Nat Adderley, jazz trumpeter
Ray Anderson, jazz trombonist
Hoyt Axton, folksy baritone, songwriter and actor
Syd Barrett, of the rock group Pink Floyd
Johnny Cash, legendary country singer, known as "the man in black"
Carol Channing, Tony Award-winning singer/actress in "Hello Dolly"
Mark Collie, contemporary country star
David Crosby, member of The Byrds and Crosby, Stills, Nash & Young
Miles Davis, legendary jazz great
Freddy Fender, actor and country singer
Ella Fitzgerald, jazz vocalist
Mick Fleetwood, singer in rock band Fleetwood Mac
Jerry Garcia, lead singer of The Grateful Dead
Dizzy Gillespie, jazz trumpeter
Mahalia Jackson, singer
Waylon Jennings, country singer
B.B. King, rhythm and blues star
Patti LaBelle, pop singer
Peggy Lee, '50s songster
Tommy Lee, of heavy metal band Motley Crue
Andrew Lloyd Webber, Broadway composer
Meat Loaf, singer
Bret Michaels, lead singer of the rock group Poison
The Pump Girls
Elvis Presley
Brad Wilk, member of Rage Against the Machine and Audioslave
Scientists
Morris Braunstein, scientist
Thomas Edison, inventor
Albert Ellis, psychologist, rational emotive therapy
Cynthia Ice, developer of Lotus software
George Minot, first person with diabetes to receive Nobel Prize in medicine
Lois Jovanovic-Peterson, scientist, endocrinologist, author of "Diabetic Women"
Sports
Wasim Akram, Pakistani cricket star played from 1984-2002
Arthur Ashe, tennis legend
Walter Barnes, former Philadelphia Eagle turned actor
Ayden Byle, runner
Bobby Clarke, hockey player for the Philadelphia Flyers
Ty Cobb, baseball player for the Detroit Tigers
Scott Coleman, first man with diabetes to swim the English Channel
Buster Douglas, boxer
Kenny Duckett, football player for the New Orleans Saints
Chris Dudley, New York Knicks basketball player
Del Ennis, baseball player
Curt Frasier, hockey player for the Chicago Black Hawks
Bill Gullickson, pitcher for the Cincinnati Reds
Gary Hall, Olympic gold medalist in swimming
Jonathon Hayes, tight end for the Pittsburgh Steelers and Kansas City Chiefs
Catfish Hunter, pitcher for the Oakland A's and the New York Yankees
Jason Johnson, pitcher for the Baltimore Orioles
Billie Jean King, tennis player
Ed Kranepool, baseball player with the New York Mets
Kelli Kuehne, LPGA golfer who wears a pump on the golf course
Jay Leeuwenburg, offensive tackle for the Cincinnati Bengals
Calvin Muhammed, football player for the Washington Redskins
Steve Redgrave, 5-time Olympic gold medalist and type 1 diabetic
Jackie Robinson, baseball star who broke the color barrier in the Major Leagues
Sugar Ray Robinson, boxer
Ron Santo, third basemen for the Chicago Cubs
Art Shell, NFL player and coach
Michael Sinclair, defensive end for the Seattle Seahawks
Bill Talbert, hall of fame tennis player
Scott Verplank, a golfer on the PGA tour and a member of the recent Ryder Cup team for America, is a type 1 diabetic.
Jersey Joe Walcott, boxer
Wade Wilson, NFL quarterback
Bob Woolmer, cricket player and coach has type 2 diabetes
Writers/Reporters
Richard Bartlett, film
June Bierman, author of books on diabetes
Fran Carpentier, editor of Parade magazine
Sylvia Chase, ABC News Reporter
Ernest Hemingway - 20th Century Novelist. Born on July 21, 1899, Ernest Hemingway grew up to become one of the greatest novelist of the 20th century. He wrote such works as The Sun Also Rise, 1926; A Farewell to Arms, 1929; and For Whom the Bell Tolls, 1940 just to name a few. He also received the Nobel Prize for Literature in 1954.
Walt Kelly, animator and Disney founder
Bruce Andrew Peters, internationally published, award-winning photojournalist
Mario Puzo, author of "The Godfather"
Anne Rice, "Interview With a Vampire" author
H.G. Wells, writer, "The Invisible Man"
Sources: Angela Rose, Diabetes Digest, Diabetes Health Magazine
Eating Out with Diabetes
Having diabetes doesn’t deprive you of eating out. If you eat out regularly, you will need to pay close attention to food choices and serving sizes to manage your weight and diabetes.
Don’t limit your enjoyment by thinking you need to go to a special restaurant or eat special meals just because you have diabetes. You’ll soon discover that many restaurants serve foods that are suitable for healthy eating. Most will also value your patronage and are more than happy to help if you can’t find something suitable on the menu. Ask restaurant staff about the dish of your choice and the way it’s been cooked, and request simple changes if required.
Try to choose meals that:
Are lower in fat and particularly low in saturated fat
Contain breads, cereals (preferably wholegrain), vegetables (including legumes) and/or fruits
Do not have a large amount of sugar added.
Having diabetes doesn’t deprive you of eating out. If you eat out regularly, you will need to pay close attention to food choices and serving sizes to manage your weight and diabetes.
Don’t limit your enjoyment by thinking you need to go to a special restaurant or eat special meals just because you have diabetes. You’ll soon discover that many restaurants serve foods that are suitable for healthy eating. Most will also value your patronage and are more than happy to help if you can’t find something suitable on the menu. Ask restaurant staff about the dish of your choice and the way it’s been cooked, and request simple changes if required.
Try to choose meals that:
Are lower in fat and particularly low in saturated fat
Contain breads, cereals (preferably wholegrain), vegetables (including legumes) and/or fruits
Do not have a large amount of sugar added.
Glycaemic Index (GI)
The glycemic index or GI ranks carbohydrates according to their effect on blood glucose levels. The lower the GI, the slower the rise in blood glucose levels will be when the food is consumed. The effect may differ from person to person.
It is recommended that people with diabetes have moderate amounts of carbohydrate and include high fibre foods that also have a low GI (not all high fibre foods have a low GI).
Some research has shown that by eating a diet with a lower GI, people with diabetes can reduce their average blood glucose levels. This is important in reducing the risk of developing diabetes-related complications.
GI numbers are to be used as a guide only as individual foods do not have the same response in all people with diabetes.
Low GI foods are foods with a GI less than 55.
Intermediate GI foods are foods with a GI between 55 and 70.
High GI foods are foods with a GI greater than 70.
The recommendation is to eat more low and intermediate GI foods, not to exclude high GI foods.
The GI is only a small part of the healthy eating plan for people with diabetes.
For more information: visit the Glycemic Index and GI Database website.
It is recommended that people with diabetes have moderate amounts of carbohydrate and include high fibre foods that also have a low GI (not all high fibre foods have a low GI).
Some research has shown that by eating a diet with a lower GI, people with diabetes can reduce their average blood glucose levels. This is important in reducing the risk of developing diabetes-related complications.
GI numbers are to be used as a guide only as individual foods do not have the same response in all people with diabetes.
Low GI foods are foods with a GI less than 55.
Intermediate GI foods are foods with a GI between 55 and 70.
High GI foods are foods with a GI greater than 70.
The recommendation is to eat more low and intermediate GI foods, not to exclude high GI foods.
The GI is only a small part of the healthy eating plan for people with diabetes.
For more information: visit the Glycemic Index and GI Database website.
Nutrition
Good nutrition and healthy meal planning are vital components of diabetes management. Recognizing the challenges involved in nutrition and diabetes, the Canadian Diabetes Association offers a full breadth of resources and information, including guides, tools, resources and manuals. We provide specific information on special topics such as carbohydrate counting, alcohol, sugars and sweeteners, portion sizes, the Glycemic Index and more.
Just the Basics
This is the first resource, developed by the Implementation Subcommittee of the National Nutrition Committee to help diabetes educators, those affected by diabetes, and consumers to implement the Guidelines for the Nutritional Management of Diabetes Mellitus in the New Millennium which were released in 1999.
Portion Guide
This easy to use guide provides ways to estimate appropriate portion sizes when planning a meal.
Meal Planning Resource
Meal Planning for Healthy Eating, Diabetes Prevention and Management has been created to help you eat tasty and healthy meals that will promote good health and diabetes management. The manual contains information on a wide variety of topics, from eating out, to recipe makeovers, to physical activity
Healthy Lifestyle Resource
Lifestyle Choices for Diabetes Prevention and Management will provide information to help anyone improve his or her lifestyle. The goal of this manual is to promote good health and to assist in diabetes management.
Top 10 Tips for Tasty and Healthy Meals
Preparing food that both tastes good and is good for you is not a magic trick. A few simple meal planning and preparation tips will help you to produce healthy, delicious food that your family will love.
Fats
Which is better for you - butter or margarine? This question is frequently asked by people who visit a registered dietitian’s office. Often people describe hearing, viewing or reading a news report that one is a healthier option that the other. It almost seems that there’s a different recommendation weekly!
Fibre
With changing dietary fashions, the current emphasis on low-fat items - witness the vast array of ‘light’ and fat-reduced products lining supermarket shelves - has given dietary fibre a back seat.
Healthy Eating is in Store for You™
This is an educational program that supports the change in Canadian regulations for mandatory labelling of packaged foods with nutrition information.
Meal Planning Guide
New research and new medications have changed both diabetes management and diabetes education. The Association’s new meal planning guide, Beyond the Basics: Meal Planning for Diabetes Prevention and Management, is based on the Association’s clinical practice guidelines and current scientific evidence.
Carbohydrate Counting
Research shows that it is the total amount of carbohydrate, which matters most to blood glucose control. In other words, if today for supper you eat all your carbohydrate as pasta and tomorrow you eat carbohydrate as syrup and milk, it won’t likely affect your insulin needs and diabetes control as long as the two meals are fairly equal in total carbohydrate.
A Guide to Eating Out
We all love to have food prepared for us, whether it is take-out, fast foods or at a sit-down restaurant. We don’t have to cook or wash the dishes - it’s easy! It is possible to eat out often and still make healthy food choices; however, this can be a challenge.
Sweeteners
Are you worried about the calories in sweeteners like sugar and honey? Are sugar substitutes a better way to sweeten foods without the extra calories? Let’s consider the sweet choices available to people with diabetes, and how they fit as part of a healthy diet.
Functional Foods
The best way to manage your diabetes is by eating a healthy diet, being physically active, and taking medication as prescribed. You may wonder about adding a functional food to your regimen.
Good nutrition and healthy meal planning are vital components of diabetes management. Recognizing the challenges involved in nutrition and diabetes, the Canadian Diabetes Association offers a full breadth of resources and information, including guides, tools, resources and manuals. We provide specific information on special topics such as carbohydrate counting, alcohol, sugars and sweeteners, portion sizes, the Glycemic Index and more.
Just the Basics
This is the first resource, developed by the Implementation Subcommittee of the National Nutrition Committee to help diabetes educators, those affected by diabetes, and consumers to implement the Guidelines for the Nutritional Management of Diabetes Mellitus in the New Millennium which were released in 1999.
Portion Guide
This easy to use guide provides ways to estimate appropriate portion sizes when planning a meal.
Meal Planning Resource
Meal Planning for Healthy Eating, Diabetes Prevention and Management has been created to help you eat tasty and healthy meals that will promote good health and diabetes management. The manual contains information on a wide variety of topics, from eating out, to recipe makeovers, to physical activity
Healthy Lifestyle Resource
Lifestyle Choices for Diabetes Prevention and Management will provide information to help anyone improve his or her lifestyle. The goal of this manual is to promote good health and to assist in diabetes management.
Top 10 Tips for Tasty and Healthy Meals
Preparing food that both tastes good and is good for you is not a magic trick. A few simple meal planning and preparation tips will help you to produce healthy, delicious food that your family will love.
Fats
Which is better for you - butter or margarine? This question is frequently asked by people who visit a registered dietitian’s office. Often people describe hearing, viewing or reading a news report that one is a healthier option that the other. It almost seems that there’s a different recommendation weekly!
Fibre
With changing dietary fashions, the current emphasis on low-fat items - witness the vast array of ‘light’ and fat-reduced products lining supermarket shelves - has given dietary fibre a back seat.
Healthy Eating is in Store for You™
This is an educational program that supports the change in Canadian regulations for mandatory labelling of packaged foods with nutrition information.
Meal Planning Guide
New research and new medications have changed both diabetes management and diabetes education. The Association’s new meal planning guide, Beyond the Basics: Meal Planning for Diabetes Prevention and Management, is based on the Association’s clinical practice guidelines and current scientific evidence.
Carbohydrate Counting
Research shows that it is the total amount of carbohydrate, which matters most to blood glucose control. In other words, if today for supper you eat all your carbohydrate as pasta and tomorrow you eat carbohydrate as syrup and milk, it won’t likely affect your insulin needs and diabetes control as long as the two meals are fairly equal in total carbohydrate.
A Guide to Eating Out
We all love to have food prepared for us, whether it is take-out, fast foods or at a sit-down restaurant. We don’t have to cook or wash the dishes - it’s easy! It is possible to eat out often and still make healthy food choices; however, this can be a challenge.
Sweeteners
Are you worried about the calories in sweeteners like sugar and honey? Are sugar substitutes a better way to sweeten foods without the extra calories? Let’s consider the sweet choices available to people with diabetes, and how they fit as part of a healthy diet.
Functional Foods
The best way to manage your diabetes is by eating a healthy diet, being physically active, and taking medication as prescribed. You may wonder about adding a functional food to your regimen.
Sweet fruit drinks lead to diabetes
Sweetened fruit drinks are often marketed as a healthier alternative to non-diet soft drinks but are just as likely to cause weight gain and increase the risk of diabetes, researchers said on Monday.
"The public should be made aware that these drinks are not a healthy alternative to soft drinks with regard to risk of type 2 diabetes," Julie Palmer and colleagues at Boston University wrote in their report, published in the Archives of Internal Medicine.
Type 2 diabetes, the most common form of the disease, is closely linked to obesity and has become more common worldwide.
The findings came from a look at nearly 44,000 black women in the United States who were checked from 1995 through 2005.
Those who said they drank two or more non-diet soft drinks a day had a 24 percent increased risk for developing type 2 diabetes than those in the study who drank fewer than one regular soft drink per month, the research team said.
Women who drank two or more sweetened fruit drinks per day had a 31 percent increased risk compared to those who drank fewer than one such fruit drink a month. Diet soft drinks, grapefruit juice and orange juice were not linked to a higher diabetes risk, the researchers said.
While pure orange and grapefruit juices also contain sugars naturally, they may have a different metabolic effect or may be more likely to be consumed as part of a meal, the investigators said.
Soft drinks and sweetened juices are often consumed between meals and may lead to snacking, they said.
An earlier study involving thousands of white women also linked diabetes to both soft drinks and sweetened juices, the report said.
Another study in the same journal found that eating fruits and vegetables seems to ward off type 2 diabetes, perhaps by preventing obesity or providing protective nutrients, including antioxidants.
A third study found that a low-fat diet does not seem to change the risk of diabetes.
"The public should be made aware that these drinks are not a healthy alternative to soft drinks with regard to risk of type 2 diabetes," Julie Palmer and colleagues at Boston University wrote in their report, published in the Archives of Internal Medicine.
Type 2 diabetes, the most common form of the disease, is closely linked to obesity and has become more common worldwide.
The findings came from a look at nearly 44,000 black women in the United States who were checked from 1995 through 2005.
Those who said they drank two or more non-diet soft drinks a day had a 24 percent increased risk for developing type 2 diabetes than those in the study who drank fewer than one regular soft drink per month, the research team said.
Women who drank two or more sweetened fruit drinks per day had a 31 percent increased risk compared to those who drank fewer than one such fruit drink a month. Diet soft drinks, grapefruit juice and orange juice were not linked to a higher diabetes risk, the researchers said.
While pure orange and grapefruit juices also contain sugars naturally, they may have a different metabolic effect or may be more likely to be consumed as part of a meal, the investigators said.
Soft drinks and sweetened juices are often consumed between meals and may lead to snacking, they said.
An earlier study involving thousands of white women also linked diabetes to both soft drinks and sweetened juices, the report said.
Another study in the same journal found that eating fruits and vegetables seems to ward off type 2 diabetes, perhaps by preventing obesity or providing protective nutrients, including antioxidants.
A third study found that a low-fat diet does not seem to change the risk of diabetes.
What are the symptoms?
Signs and symptoms of diabetes include the following:
w Unusual thirst
w Frequent urination
w Weight change (gain or loss)
w Extreme fatigue or lack of energy
w Blurred vision
w Frequent or recurring infections
w Cuts and bruises that are slow to heal
w Tingling or numbness in the hands or feet
w Trouble getting or maintaining an erection
It is important to recognize, however, that many people who have type 2 diabetes may display no symptoms.
Signs and symptoms of diabetes include the following:
w Unusual thirst
w Frequent urination
w Weight change (gain or loss)
w Extreme fatigue or lack of energy
w Blurred vision
w Frequent or recurring infections
w Cuts and bruises that are slow to heal
w Tingling or numbness in the hands or feet
w Trouble getting or maintaining an erection
It is important to recognize, however, that many people who have type 2 diabetes may display no symptoms.
Diagnosis of diabetes
Fasting blood glucose
You must not eat or drink anything except water for at least eight hours before this test. A test result of 7.0 mmol/L or greater indicates diabetes.
OR
Casual blood glucose
This test may be done at any time, regardless of when you last ate. A test result of 11.0 mmol/L or greater, plus symptoms of diabetes, indicates diabetes.
OR
Oral glucose tolerance test
You will be given a special sweetened drink prior to this blood test. A test result of 11.1 mmol/L or greater taken two hours after having the sweet drink indicates diabetes.
Fasting blood glucose
You must not eat or drink anything except water for at least eight hours before this test. A test result of 7.0 mmol/L or greater indicates diabetes.
OR
Casual blood glucose
This test may be done at any time, regardless of when you last ate. A test result of 11.0 mmol/L or greater, plus symptoms of diabetes, indicates diabetes.
OR
Oral glucose tolerance test
You will be given a special sweetened drink prior to this blood test. A test result of 11.1 mmol/L or greater taken two hours after having the sweet drink indicates diabetes.
Just been Diagnosed with Diabetes?
When you’re diagnosed with diabetes it can be overwhelming. Your doctor will provide you with a lot of information and ask you a number of questions, including your eating patterns, weight history, blood pressure, medications you might be taking, whether you smoke or drink, any family history of heart disease and any treatments you have received for other health problems.
Don't be too alarmed by these questions your doctor isn’t prying. All of this information has a bearing on your diabetes and how to best manage it.
When you’re diagnosed with diabetes it can be overwhelming. Your doctor will provide you with a lot of information and ask you a number of questions, including your eating patterns, weight history, blood pressure, medications you might be taking, whether you smoke or drink, any family history of heart disease and any treatments you have received for other health problems.
Don't be too alarmed by these questions your doctor isn’t prying. All of this information has a bearing on your diabetes and how to best manage it.
Blood Sugar
Keeping your blood sugar levels as close to normal as possible through proper dietary changes, exercise, and/or medication and insulin therapy is the key to good diabetes control. Avoiding highs and lows will not only make you feel better, but will significantly reduce your risk of diabetes complications. The only way to make sure your blood sugar levels are in target range is to test frequently each day and to get regular A1c tests from your healthcare provider. The American Association of Clinical Endocrinologists (AACE)1 recommends the following general blood glucose testing goals for adults with type 1 and type 2 diabetes:
Preprandial* (fasting, or before a meal) - <110 mg/dl (6.1 mmol/l)
Two hours postprandial (after the start of a meal) - <140 mg/dl (7.8 mmol/l)
A1c (three month blood glucose average) – 6.5% or lower
Keeping your blood sugar levels as close to normal as possible through proper dietary changes, exercise, and/or medication and insulin therapy is the key to good diabetes control. Avoiding highs and lows will not only make you feel better, but will significantly reduce your risk of diabetes complications. The only way to make sure your blood sugar levels are in target range is to test frequently each day and to get regular A1c tests from your healthcare provider. The American Association of Clinical Endocrinologists (AACE)1 recommends the following general blood glucose testing goals for adults with type 1 and type 2 diabetes:
Preprandial* (fasting, or before a meal) - <110 mg/dl (6.1 mmol/l)
Two hours postprandial (after the start of a meal) - <140 mg/dl (7.8 mmol/l)
A1c (three month blood glucose average) – 6.5% or lower
Gestational Diabetes
Gestational diabetes (sometimes referred to as GDM) is diagnosed when higher than normal blood glucose levels first appear during pregnancy. From 3% to 8% of pregnant women will develop gestational diabetes around the 24th to 28th week of pregnancy. However, some may be earlier. While blood glucose levels usually return to normal after the birth of the baby, there is an increased risk for type 2 diabetes in the mother in the future. The risk of getting gestational diabetes increases with a family history of type 2 diabetes and you are overweight. Risk is also increased in those from an Aboriginal or an Indian, Vietnamese, Chinese, Middle Eastern background.
Gestational diabetes (sometimes referred to as GDM) is diagnosed when higher than normal blood glucose levels first appear during pregnancy. From 3% to 8% of pregnant women will develop gestational diabetes around the 24th to 28th week of pregnancy. However, some may be earlier. While blood glucose levels usually return to normal after the birth of the baby, there is an increased risk for type 2 diabetes in the mother in the future. The risk of getting gestational diabetes increases with a family history of type 2 diabetes and you are overweight. Risk is also increased in those from an Aboriginal or an Indian, Vietnamese, Chinese, Middle Eastern background.
DIABETES AND EXERCISE
Diabetes and Exercise
A regular exercise program has many benefits for everyone. These include:
• An improved sense of well-being
• Stress reduction
• Lower blood pressure
• Lower cholesterol and increased HDL cholesterol
• Improved muscle tone and reduced risk of falls
• Better sleep
• Weight loss and maintenance
• Maintenance of bone strength
• Less risk of heart disease
If you have diabetes, you will get all these benefits from exercise. In addition, regular exercise will improve your insulin sensitivity, and if you have type 2 diabetes, regular exercise will also improve your glucose control. However, there are a number of challenges to exercising safely if you have diabetes. The challenges include avoiding both high and low blood glucose levels during exercise, especially when you are on insulin, and how to exercise safely when you have complications of diabetes, especially neuropathy and heart disease.
Exercise has numerous benefits for people with diabetes, but it is not as simple as saying “go and exercise.” Before embarking on an exercise plan, visit your physician and diabetes educator and get guidance on how to exercise safely. If you have type 1 diabetes, you may need to adjust your insulin and your carbohydrate intake before, during, and after exercise. You will also need to monitor your glucose levels more frequently.
A regular exercise program has many benefits for everyone. These include:
• An improved sense of well-being
• Stress reduction
• Lower blood pressure
• Lower cholesterol and increased HDL cholesterol
• Improved muscle tone and reduced risk of falls
• Better sleep
• Weight loss and maintenance
• Maintenance of bone strength
• Less risk of heart disease
If you have diabetes, you will get all these benefits from exercise. In addition, regular exercise will improve your insulin sensitivity, and if you have type 2 diabetes, regular exercise will also improve your glucose control. However, there are a number of challenges to exercising safely if you have diabetes. The challenges include avoiding both high and low blood glucose levels during exercise, especially when you are on insulin, and how to exercise safely when you have complications of diabetes, especially neuropathy and heart disease.
Exercise has numerous benefits for people with diabetes, but it is not as simple as saying “go and exercise.” Before embarking on an exercise plan, visit your physician and diabetes educator and get guidance on how to exercise safely. If you have type 1 diabetes, you may need to adjust your insulin and your carbohydrate intake before, during, and after exercise. You will also need to monitor your glucose levels more frequently.
The World Diabetes Day campaign in 2008
The World Diabetes Day campaign in 2008 aims to:
Increase the number of children supported by the IDF Life for a Child Program.
Raise awareness of the warning signs of diabetes
Encourage initiatives to reduce diabetic ketoacidosis and distribute materials to support these initiatives.
Promote healthy lifestyles to help prevent type 2 diabetes in children.
Diabetes and children
Diabetes is one of the most common chronic diseases to affect children. It can strike children of any age, even toddlers and babies. If not detected early enough in a child, the disease can be fatal or result in serious brain damage. Yet diabetes in a child is often completely overlooked: it is often misdiagnosed as the flu or it is not diagnosed at all.
Every parent, school teacher, school nurse, doctor and anyone involved in the care of children should be familiar with the warning signs and alert to the diabetes threat.
Know the diabetes warning signs
Frequent urination
Excessive thirst
Increased hunger
Weight loss
Tiredness
Lack of interest and concentration
Blurred vision
Vomiting and stomach pain (often mistaken as the flu)
*In children with type 2 diabetes these symptoms may be mild or absent.
Type 1 and type 2 diabetes.
Diabetes is a chronic, potentially debilitating and often fatal disease. It occurs as a result of problems with the production and supply of the hormone insulin in the body. The body needs insulin to use the energy stored in food. When someone has diabetes they produce no or insufficient insulin (type 1 diabetes), or their body cannot use effectively the insulin they produce (type 2 diabetes).
Type 1 diabetes is an autoimmune disease that cannot be prevented. Globally it is the most common form of diabetes in children, affecting around 500,000 children under 15. However, as a result of increasing childhood obesity and sedentary lifestyles, type 2 diabetes is also increasing fast in children and adolescents. In some countries (e.g. Japan), type 2 diabetes has become the most common form of the disease in children.
Globally, there are close to 500,000 children under the age of 15 with type 1 diabetes.
Every day 200 children develop type 1 diabetes.
Every year, 70,000 children under the age of 15 develop type 1 diabetes.
Type 1 diabetes is increasing in children at a rate of 3% each year
Type 1 diabetes is increasing fastest in pre-school children, at rate of 5% per year.
Finland, Sweden and Norway have the highest incidence rates for type 1 diabetes in children.
Type 2 diabetes has been reported in children as young as eight and reports reveal that it now exists in children thought previously not to be at risk.In Native and Aboriginal communities in the United States, Canada and Australia at least one in 100 youth have diabetes. In some communities, it is one in every 25.
Over half of children with diabetes develop complications within 15 years.
Global studies have shown that type 2 diabetes can be prevented by enabling individuals to lose 7-10% of their body weight, and by increasing their physical activity to a modest level.
Type 2 diabetes in children is becoming a global public health issue with potentially serious outcomes.
Type 2 diabetes affects children in both developed and developing countries.
No Child Should Die of Diabetes
Diabetes is a deadly disease. Each year, almost 4 million people die from diabetes- related causes. Children, particularly in countries where there is limited access to diabetes care and supplies, die young.
Diabetic Ketoacidosis (DKA), a build-up of excess acids in the body as a result of uncontrolled diabetes, is the major cause of death in children with type 1 diabetes. With early diagnosis and access to care, the development of severe DKA should be preventable.
Insulin was discovered more than 85 years ago. Today children in many parts of the world still die because this essential drug is not available to them.
Children with diabetes should monitor their blood sugar regularly to help control their diabetes. This monitoring equipment is often unavailable or not affordable.
In Zambia, a child with type 1 diabetes can expect to live an average of 11 years. In Mali, the same child can expect to live for only 30 months. In Mozambique the child is likely to die within a year.
Increase the number of children supported by the IDF Life for a Child Program.
Raise awareness of the warning signs of diabetes
Encourage initiatives to reduce diabetic ketoacidosis and distribute materials to support these initiatives.
Promote healthy lifestyles to help prevent type 2 diabetes in children.
Diabetes and children
Diabetes is one of the most common chronic diseases to affect children. It can strike children of any age, even toddlers and babies. If not detected early enough in a child, the disease can be fatal or result in serious brain damage. Yet diabetes in a child is often completely overlooked: it is often misdiagnosed as the flu or it is not diagnosed at all.
Every parent, school teacher, school nurse, doctor and anyone involved in the care of children should be familiar with the warning signs and alert to the diabetes threat.
Know the diabetes warning signs
Frequent urination
Excessive thirst
Increased hunger
Weight loss
Tiredness
Lack of interest and concentration
Blurred vision
Vomiting and stomach pain (often mistaken as the flu)
*In children with type 2 diabetes these symptoms may be mild or absent.
Type 1 and type 2 diabetes.
Diabetes is a chronic, potentially debilitating and often fatal disease. It occurs as a result of problems with the production and supply of the hormone insulin in the body. The body needs insulin to use the energy stored in food. When someone has diabetes they produce no or insufficient insulin (type 1 diabetes), or their body cannot use effectively the insulin they produce (type 2 diabetes).
Type 1 diabetes is an autoimmune disease that cannot be prevented. Globally it is the most common form of diabetes in children, affecting around 500,000 children under 15. However, as a result of increasing childhood obesity and sedentary lifestyles, type 2 diabetes is also increasing fast in children and adolescents. In some countries (e.g. Japan), type 2 diabetes has become the most common form of the disease in children.
Globally, there are close to 500,000 children under the age of 15 with type 1 diabetes.
Every day 200 children develop type 1 diabetes.
Every year, 70,000 children under the age of 15 develop type 1 diabetes.
Type 1 diabetes is increasing in children at a rate of 3% each year
Type 1 diabetes is increasing fastest in pre-school children, at rate of 5% per year.
Finland, Sweden and Norway have the highest incidence rates for type 1 diabetes in children.
Type 2 diabetes has been reported in children as young as eight and reports reveal that it now exists in children thought previously not to be at risk.In Native and Aboriginal communities in the United States, Canada and Australia at least one in 100 youth have diabetes. In some communities, it is one in every 25.
Over half of children with diabetes develop complications within 15 years.
Global studies have shown that type 2 diabetes can be prevented by enabling individuals to lose 7-10% of their body weight, and by increasing their physical activity to a modest level.
Type 2 diabetes in children is becoming a global public health issue with potentially serious outcomes.
Type 2 diabetes affects children in both developed and developing countries.
No Child Should Die of Diabetes
Diabetes is a deadly disease. Each year, almost 4 million people die from diabetes- related causes. Children, particularly in countries where there is limited access to diabetes care and supplies, die young.
Diabetic Ketoacidosis (DKA), a build-up of excess acids in the body as a result of uncontrolled diabetes, is the major cause of death in children with type 1 diabetes. With early diagnosis and access to care, the development of severe DKA should be preventable.
Insulin was discovered more than 85 years ago. Today children in many parts of the world still die because this essential drug is not available to them.
Children with diabetes should monitor their blood sugar regularly to help control their diabetes. This monitoring equipment is often unavailable or not affordable.
In Zambia, a child with type 1 diabetes can expect to live an average of 11 years. In Mali, the same child can expect to live for only 30 months. In Mozambique the child is likely to die within a year.
WORLD DIABETES DAY
World Diabetes Day - November 14
World Diabetes Day (WDD) is the primary global awareness campaign of the diabetes world.
It was introduced in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in response to the alarming rise in diabetes around the world. In 2007, the United Nations marked the Day for the first time with the passage of the United Nations World Diabetes Day Resolution in December 2006, which made the existing World Diabetes Day an official United Nations World Health Day.
World Diabetes Day (WDD) is the primary global awareness campaign of the diabetes world.
It was introduced in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in response to the alarming rise in diabetes around the world. In 2007, the United Nations marked the Day for the first time with the passage of the United Nations World Diabetes Day Resolution in December 2006, which made the existing World Diabetes Day an official United Nations World Health Day.
DIABETES TYPE 1 & 2
Type 1 and 2 diabetes
Type 1 diabetes begins as an autoimmune disorder in which the insulin-producing cells of the pancreas are destroyed by the body's immune system explains Margherita T. Cantorna, PhD, of Penn State University. These pancreatic cells are the only cells in the body that produce insulin (which regulates blood sugar), so people with this form of diabetes must have insulin delivered by pump or injection. Type 1 diabetes usually strikes children and young adults, but disease onset can occur at any age. Risk factors for this disease may be genetic, autoimmune, or environmental.
Most people with Type 2 diabetes are insulin resistant, meaning that the body produces insulin, but cannot metabolize it efficiently. Type 2 diabetics are often diagnosed with metabolic syndrome - also called Syndrome X - which means they have three or more of the following five markers:
glucose intolerance
obesity
high blood pressure
elevated levels of cholesterol
elevated levels of triglycerides.
Type 2 diabetes is associated with older age, a family history of diabetes, impaired glucose metabolism, and obesity. Between 80 and 90 percent of people with this disease are obese, or 20 percent or more above their recommended weight.
Type 1 diabetes begins as an autoimmune disorder in which the insulin-producing cells of the pancreas are destroyed by the body's immune system explains Margherita T. Cantorna, PhD, of Penn State University. These pancreatic cells are the only cells in the body that produce insulin (which regulates blood sugar), so people with this form of diabetes must have insulin delivered by pump or injection. Type 1 diabetes usually strikes children and young adults, but disease onset can occur at any age. Risk factors for this disease may be genetic, autoimmune, or environmental.
Most people with Type 2 diabetes are insulin resistant, meaning that the body produces insulin, but cannot metabolize it efficiently. Type 2 diabetics are often diagnosed with metabolic syndrome - also called Syndrome X - which means they have three or more of the following five markers:
glucose intolerance
obesity
high blood pressure
elevated levels of cholesterol
elevated levels of triglycerides.
Type 2 diabetes is associated with older age, a family history of diabetes, impaired glucose metabolism, and obesity. Between 80 and 90 percent of people with this disease are obese, or 20 percent or more above their recommended weight.
DIABETIC KIDNEY DISEASE
Officially known as diabetic nephropathy, nephropathy is a type of kidney disease that leads to kidney failure. Nephropathy tends to develop in people who have had diabetes for 20 years or more. It used to be that a third of all people with type 1 diabetes developed nephropathy, but today's treatment methods and the emphasis on better blood-sugar control are shrinking that percentage. People with type 2 diabetes develop nephropathy infrequently.
How It Happens
To see why nephropathy would be a problem, let's look first at what the kidneys do. The kidneys are organs located near the waist. Inside the kidneys are small blood vessels, called glomeruli, that act as filters, removing wastes from the blood and discharging them through the urine. Useful products, such as protein and glucose, are not eliminated but are sent back into the bloodstream.
Nephropathy is the condition in which small arteries in the kidneys become hardened and the glomeruli become damaged, in much the same way that the small vessels of the eye become damaged during retinopathy. The kidneys ultimately fail in their job of filtering out wastes. People with kidney failure must go on dialysis (the use of a machine to filter blood) or have a kidney transplant; otherwise, lethal levels of wastes and toxins build up in their bodies.
Nephropathy is caused by high blood-sugar levels. Also, high blood pressure, arteriosclerosis, smoking, and high cholesterol increase the likelihood of kidney complications. Frequent urinary tract infections add to the problem because an infection can easily spread to the kidneys and damage them.
Recognizing the Signs
Early warning signs of nephropathy include problems emptying the bladder, blood in the urine, and urinary tract infections. The disease can be confirmed through simple urine and blood tests. Just as the kidneys lose their ability to discharge wastes, they also lose their ability to keep protein and glucose in circulation. Sugar and protein begin to show up in the urine tests in larger and larger amounts. Blood tests also detect high levels of urea nitrogen and creatinine, another indication of kidney damage.
Handling the Problem
To halt kidney damage before kidney failure occurs, the wisest step is to take urinary tract infections seriously. Remember: Infections can back up further into the urinary system and spread to the kidneys, impairing their function.If signs of developing kidney problems are detected, doctors often recommend a regimen of tight blood-sugar control and a low-protein diet to ease stress on the kidneys. Recent clinical studies suggest that use of the blood-pressure lowering drugs like enalapril may preserve kidney function.
How It Happens
To see why nephropathy would be a problem, let's look first at what the kidneys do. The kidneys are organs located near the waist. Inside the kidneys are small blood vessels, called glomeruli, that act as filters, removing wastes from the blood and discharging them through the urine. Useful products, such as protein and glucose, are not eliminated but are sent back into the bloodstream.
Nephropathy is the condition in which small arteries in the kidneys become hardened and the glomeruli become damaged, in much the same way that the small vessels of the eye become damaged during retinopathy. The kidneys ultimately fail in their job of filtering out wastes. People with kidney failure must go on dialysis (the use of a machine to filter blood) or have a kidney transplant; otherwise, lethal levels of wastes and toxins build up in their bodies.
Nephropathy is caused by high blood-sugar levels. Also, high blood pressure, arteriosclerosis, smoking, and high cholesterol increase the likelihood of kidney complications. Frequent urinary tract infections add to the problem because an infection can easily spread to the kidneys and damage them.
Recognizing the Signs
Early warning signs of nephropathy include problems emptying the bladder, blood in the urine, and urinary tract infections. The disease can be confirmed through simple urine and blood tests. Just as the kidneys lose their ability to discharge wastes, they also lose their ability to keep protein and glucose in circulation. Sugar and protein begin to show up in the urine tests in larger and larger amounts. Blood tests also detect high levels of urea nitrogen and creatinine, another indication of kidney damage.
Handling the Problem
To halt kidney damage before kidney failure occurs, the wisest step is to take urinary tract infections seriously. Remember: Infections can back up further into the urinary system and spread to the kidneys, impairing their function.If signs of developing kidney problems are detected, doctors often recommend a regimen of tight blood-sugar control and a low-protein diet to ease stress on the kidneys. Recent clinical studies suggest that use of the blood-pressure lowering drugs like enalapril may preserve kidney function.
WEIGHT LOSS -A LONG TERM GOAL
Weight-Loss -A LONG TERM GOAL
Anyone who's tried to lose weight can attest to the fact that it's easy for the best-laid dietary plans to go awry--at least temporarily. Not to worry. This is a long-term project, and occasional lapses are to be expected.
Controlling your calorie intake is the bedrock of all weight-loss plans. But how can you stay the course when food is abundant and the temptation to overindulge is strong? Start by making a few small adjustments to your dining and snackinghabits. For instance:
Keep food off the table. If you portion out servings on plates at the stove or kitchen counter and don't set food out on serving platters, you'll be less tempted to take more once your plate is empty.
Don't eat from packages. It's all too easy to lose track of how much food you've gobbled if you're nibbling straight from the box. Instead, portion out crackers, pretzels, and other snacks on a plate to give yourself a visible sense of what you're consuming.
Downsize your dishes. Smaller plates and bowls make portions appear larger.
Take it slow. It takes about 20 minutes for the brain's appetite-control center to register that there's food in the stomach. To wait it out, put down your fork between each bite and take small sips from your drink.
Work for your food. Eating foods that require some effort--peeling an orange, cracking open crabs, or cutting open a baked potato, for example--slows you down even more, giving food a chance to make you feel full.
Anyone who's tried to lose weight can attest to the fact that it's easy for the best-laid dietary plans to go awry--at least temporarily. Not to worry. This is a long-term project, and occasional lapses are to be expected.
Controlling your calorie intake is the bedrock of all weight-loss plans. But how can you stay the course when food is abundant and the temptation to overindulge is strong? Start by making a few small adjustments to your dining and snackinghabits. For instance:
Keep food off the table. If you portion out servings on plates at the stove or kitchen counter and don't set food out on serving platters, you'll be less tempted to take more once your plate is empty.
Don't eat from packages. It's all too easy to lose track of how much food you've gobbled if you're nibbling straight from the box. Instead, portion out crackers, pretzels, and other snacks on a plate to give yourself a visible sense of what you're consuming.
Downsize your dishes. Smaller plates and bowls make portions appear larger.
Take it slow. It takes about 20 minutes for the brain's appetite-control center to register that there's food in the stomach. To wait it out, put down your fork between each bite and take small sips from your drink.
Work for your food. Eating foods that require some effort--peeling an orange, cracking open crabs, or cutting open a baked potato, for example--slows you down even more, giving food a chance to make you feel full.
Weight Management for Type 2 Diabetes
Lifelong changes in eating habits, physical activity, and attitudes about food and weight are essential to weight management. Unfortunately, although many people can lose weight initially, it is very difficult to maintain weight loss. People with type 2 diabetes may have a particularly difficult time. Here are some general suggestions that may be helpful:
Start with realistic goals. When overweight people achieve even modest weight loss they reduce risk factors in the heart. Ideally, overweight patients should strive for 15% weight loss or better, particularly people with type 2 diabetes.
A regular exercise program is essential for maintaining weight loss. If there are no health prohibitions, choose one that is enjoyable. Check with a doctor about any health consideration. [For more information, see In-Depth Report #29: Exercise.]
Hunger pangs should not be taken as cues to eat. A stomach that has been stretched by large meals will continue to signal hunger for large amounts of food until its size reduces over time with smaller meals.
Be honest about how much you eat, and track calories carefully. Studies on weight control that depend on self-reporting of food intake frequently reveal that subjects badly misjudge how much they eat (typically underestimating high-calorie foods and overestimating low-calorie foods). In one study, even dietitians underreported their calorie intake by 10%. People who do not carefully note everything they eat tend to take in excessive calories when they believe they are dieting.
For patients who cannot lose weight with diet alone, effect weight-loss medications are now available, including sibutramine (Meridia) and orlistat (Xenical). Orlistat may have particular benefits for patients with type 2 diabetes. This drug may delay or even prevent the onset or progression of diabetes. It may also improve cholesterol levels, regardless of weight loss. Sibutramine is also helpful in weight loss but should not be used by patients with high blood pressure or kidney or liver problems.
Once a person has lost weight, maintenance is required. To maintain a healthy weight, make careful decisions about how many calories you consume in food and how many calories you expend through physical activity. Such thinking will eventually become automatic.
A procedure known as bariatric surgery has been very helpful in producing rapid weight loss and improving insulin and glucose levels in people with diabetes.
Start with realistic goals. When overweight people achieve even modest weight loss they reduce risk factors in the heart. Ideally, overweight patients should strive for 15% weight loss or better, particularly people with type 2 diabetes.
A regular exercise program is essential for maintaining weight loss. If there are no health prohibitions, choose one that is enjoyable. Check with a doctor about any health consideration. [For more information, see In-Depth Report #29: Exercise.]
Hunger pangs should not be taken as cues to eat. A stomach that has been stretched by large meals will continue to signal hunger for large amounts of food until its size reduces over time with smaller meals.
Be honest about how much you eat, and track calories carefully. Studies on weight control that depend on self-reporting of food intake frequently reveal that subjects badly misjudge how much they eat (typically underestimating high-calorie foods and overestimating low-calorie foods). In one study, even dietitians underreported their calorie intake by 10%. People who do not carefully note everything they eat tend to take in excessive calories when they believe they are dieting.
For patients who cannot lose weight with diet alone, effect weight-loss medications are now available, including sibutramine (Meridia) and orlistat (Xenical). Orlistat may have particular benefits for patients with type 2 diabetes. This drug may delay or even prevent the onset or progression of diabetes. It may also improve cholesterol levels, regardless of weight loss. Sibutramine is also helpful in weight loss but should not be used by patients with high blood pressure or kidney or liver problems.
Once a person has lost weight, maintenance is required. To maintain a healthy weight, make careful decisions about how many calories you consume in food and how many calories you expend through physical activity. Such thinking will eventually become automatic.
A procedure known as bariatric surgery has been very helpful in producing rapid weight loss and improving insulin and glucose levels in people with diabetes.
HYPOGLYCEMIA
Hypoglycemia
Hypoglycemia in patients with diabetes can be caused by several factors, some of which are listed below:
Too much or incorrectly timed insulin.
Too much exercise or incorrectly timed exercise.
Not enough food or insufficient amount of carbohydrates in food.
If blood glucose levels are low enough, the patient may become agitated, sweaty, and have many symptoms of sympathetic activation of the autonomic nervous system—they may experience feelings similar to dread and immobilized panic. Consciousness can be altered, or even lost, in extreme cases, leading to coma and/or seizures or even brain damage and death. Those experienced with their diabetes can often recognize the symptoms early on—all with diabetes should carry something sugary to eat or drink as these symptoms can be rapidly reduced if treated early enough. In the case of children, this can be a type of candy disliked by the patient, to prevent concerns about non-emergency use. Other ways of treating hypoglycemia include an intra muscular injection of glucagon, which causes the liver to convert its internal stores of glycogen to be released as glucose into the blood. This cannot be repeated until after the next meal, as once the liver glycogen stores have been mobilized they will no longer be available until replenished. Oral or intravenous dextrose can also be given. In most cases recovery is rapid and trouble free. Longstanding hypoglycemia may require hospital admission to allow supervised recovery and adjustment of diabetic medications.
Hypoglycemia in patients with diabetes can be caused by several factors, some of which are listed below:
Too much or incorrectly timed insulin.
Too much exercise or incorrectly timed exercise.
Not enough food or insufficient amount of carbohydrates in food.
If blood glucose levels are low enough, the patient may become agitated, sweaty, and have many symptoms of sympathetic activation of the autonomic nervous system—they may experience feelings similar to dread and immobilized panic. Consciousness can be altered, or even lost, in extreme cases, leading to coma and/or seizures or even brain damage and death. Those experienced with their diabetes can often recognize the symptoms early on—all with diabetes should carry something sugary to eat or drink as these symptoms can be rapidly reduced if treated early enough. In the case of children, this can be a type of candy disliked by the patient, to prevent concerns about non-emergency use. Other ways of treating hypoglycemia include an intra muscular injection of glucagon, which causes the liver to convert its internal stores of glycogen to be released as glucose into the blood. This cannot be repeated until after the next meal, as once the liver glycogen stores have been mobilized they will no longer be available until replenished. Oral or intravenous dextrose can also be given. In most cases recovery is rapid and trouble free. Longstanding hypoglycemia may require hospital admission to allow supervised recovery and adjustment of diabetic medications.
ARE YOU AT RISK FOR DIABETES
Are you at risk?
If you have diabetes it is best if it is diagnosed early. You can prevent many problems
with diabetes if you know about it early and take action to manage it.
If you find you have a high risk of developing diabetes but don't yet have it, you can take
action that may prevent you ever getting diabetes.
Find out if you have a high risk of having or developing diabetes.
You are at risk of developing Type 2 diabetes if you can tick two or more of these
risk factors:
Are European and over 40 years old
Are of Maori, Asian, Middle Eastern or Pacific Island descent and over 30 years old
Have diabetes in your family (grandparents, parents, brothers or sisters
Have high cholesterol or high blood pressure
Have had a large baby weighing more than 9lbs / 4kg
Have had gestational diabetes (diabetes during pregnancy)
Have been diagnosed as having Impaired Glucose Tolerance (IGT).
If you tick two or more, please see your doctor now – you may have diabetes.
And make the following changes to reduce your risk:
· Stay physically active and get regular daily exercise (walking is good)
· Eat healthy food
· Keep your weight in a healthy range.
If you have diabetes it is best if it is diagnosed early. You can prevent many problems
with diabetes if you know about it early and take action to manage it.
If you find you have a high risk of developing diabetes but don't yet have it, you can take
action that may prevent you ever getting diabetes.
Find out if you have a high risk of having or developing diabetes.
You are at risk of developing Type 2 diabetes if you can tick two or more of these
risk factors:
Are European and over 40 years old
Are of Maori, Asian, Middle Eastern or Pacific Island descent and over 30 years old
Have diabetes in your family (grandparents, parents, brothers or sisters
Have high cholesterol or high blood pressure
Have had a large baby weighing more than 9lbs / 4kg
Have had gestational diabetes (diabetes during pregnancy)
Have been diagnosed as having Impaired Glucose Tolerance (IGT).
If you tick two or more, please see your doctor now – you may have diabetes.
And make the following changes to reduce your risk:
· Stay physically active and get regular daily exercise (walking is good)
· Eat healthy food
· Keep your weight in a healthy range.
BMI
To assess the risk excess body weight may present to your health, your doctor or health
professional may want to measure your weight, height and/or your waist circumference.
Weight and height are used to calculate body mass index (BMI). Body mass index, waist
circumference and the presence of other risk factors help evaluate your overall health risk.
Waist circumference
· For women, waist circumference should be less than 90 cm
· For men, waist circumference should be less than 100 cm
Women Men
Less than 90 cm Less than 100 cm
Body mass index (BMI)
· Body mass index is calculated by dividing weight in kilograms by height in metres squared
BMI = Weight in kg/
(Height in metres) 2
professional may want to measure your weight, height and/or your waist circumference.
Weight and height are used to calculate body mass index (BMI). Body mass index, waist
circumference and the presence of other risk factors help evaluate your overall health risk.
Waist circumference
· For women, waist circumference should be less than 90 cm
· For men, waist circumference should be less than 100 cm
Women Men
Less than 90 cm Less than 100 cm
Body mass index (BMI)
· Body mass index is calculated by dividing weight in kilograms by height in metres squared
BMI = Weight in kg/
(Height in metres) 2
Did You Know?
Diabetes currently affects 246 million people worldwide and is expected to affect 380 million by 2025.
In 2007, the five countries with the largest numbers of people with diabetes are India (40.9 million), China (39.8 million), the United States (19.2 million), Russia (9.6 million) and Germany (7.4 million).
In 2007, the five countries with the highest diabetes prevalence in the adult population are Nauru (30.7%), United Arab Emirates (19.5%), Saudi Arabia (16.7%), Bahrain(15.2%), and Kuwait (14.4%).
By 2025, the largest increases in diabetes prevalence will take place in developing countries.
Each year a further 7 million people develop diabetes.
Each year 3.8 million deaths are attributable to diabetes. An even greater number die from cardiovascular disease made worse by diabetes-related lipid disorders and hypertension.
Every 10 seconds a person dies from diabetes-related causes.
Every 10 seconds two people develop diabetes.
Diabetes is the fourth leading cause of global death by disease.
At least 50% of all people with diabetes are unaware of their condition. In some countries this figure may reach 80%.
Up to 80% of type 2 diabetes is preventable by adopting a healthy diet and increasing physical activity.
Diabetes is the largest cause of kidney failure in developed countries and is responsible for huge dialysis costs.
Type 2 diabetes has become the most frequent condition in people with kidney failure in countries of the Western world. The reported incidence varies between 30% and 40% in countries such as Germany and the USA.
10% to 20% of people with diabetes die of renal failure.
It is estimated that more than 2.5 million people worldwide are affected by diabetic retinopathy.
Diabetic retinopathy is the leading cause of vision loss in adults of working age (20 to 65 years) in industrialized countries.
On average, people with type 2 diabetes will die 5-10 years before people without diabetes, mostly due to cardiovascular disease.
Cardiovascular disease is the major cause of death in diabetes, accounting for some 50% of all diabetes fatalities, and much disability.
People with type 2 diabetes are over twice as likely to have a heart attack or stroke as people who do not have diabetes. Indeed, people with type 2 diabetes are as likely to suffer a heart attack as people without diabetes who have already had a heart attack.
Source:
Diabetes Atlas, third edition, International Diabetes Federation, 2007.
In 2007, the five countries with the largest numbers of people with diabetes are India (40.9 million), China (39.8 million), the United States (19.2 million), Russia (9.6 million) and Germany (7.4 million).
In 2007, the five countries with the highest diabetes prevalence in the adult population are Nauru (30.7%), United Arab Emirates (19.5%), Saudi Arabia (16.7%), Bahrain(15.2%), and Kuwait (14.4%).
By 2025, the largest increases in diabetes prevalence will take place in developing countries.
Each year a further 7 million people develop diabetes.
Each year 3.8 million deaths are attributable to diabetes. An even greater number die from cardiovascular disease made worse by diabetes-related lipid disorders and hypertension.
Every 10 seconds a person dies from diabetes-related causes.
Every 10 seconds two people develop diabetes.
Diabetes is the fourth leading cause of global death by disease.
At least 50% of all people with diabetes are unaware of their condition. In some countries this figure may reach 80%.
Up to 80% of type 2 diabetes is preventable by adopting a healthy diet and increasing physical activity.
Diabetes is the largest cause of kidney failure in developed countries and is responsible for huge dialysis costs.
Type 2 diabetes has become the most frequent condition in people with kidney failure in countries of the Western world. The reported incidence varies between 30% and 40% in countries such as Germany and the USA.
10% to 20% of people with diabetes die of renal failure.
It is estimated that more than 2.5 million people worldwide are affected by diabetic retinopathy.
Diabetic retinopathy is the leading cause of vision loss in adults of working age (20 to 65 years) in industrialized countries.
On average, people with type 2 diabetes will die 5-10 years before people without diabetes, mostly due to cardiovascular disease.
Cardiovascular disease is the major cause of death in diabetes, accounting for some 50% of all diabetes fatalities, and much disability.
People with type 2 diabetes are over twice as likely to have a heart attack or stroke as people who do not have diabetes. Indeed, people with type 2 diabetes are as likely to suffer a heart attack as people without diabetes who have already had a heart attack.
Source:
Diabetes Atlas, third edition, International Diabetes Federation, 2007.
Healthy eating plan
A diet for the diabetic patient is one that could be followed by anyone who wants to adopt healthier eating habits. That is a diet that emphasizes vegetables, fruits and whole grains.
EATING GUIDE
§ Avoid irregular eating habits like over or under eating.
§ Establish a routine for eating meals and snacks at regular times every day
§ Choose the healthiest foods in the right amounts at each meal
A stricter plan may be need if you need to lose weight or you're taking diabetes medications or insulin.The diet has to be tailored based on your health goals, tastes and lifestyle.
Counting carbohydrates
Carbohydrate counting can be a helpful meal-planning tool.Eating the same amount of carbohydrates at each meal or snack will keep your blood sugar from going too high or too low throughout the day
The glycemic index can be used to select foods — especially carbohydrates. Foods with a high glycemic index are associated with greater increases in blood sugar than are foods with a low glycemic index.
Consistency and variety are key
Consistent eating habits can help you control your blood sugar levels. Every day try to eat about the same amount of food at about the same time. Include a variety of foods to help meet your nutritional goals.
Nutrient
Carbohydrates-65% of daily calories
Protein-15% of daily calories
Fats-20% of daily calories
Embracing your healthy-eating plan is the best way to keep your blood sugar under control and prevent diabetes complications. Get creative within the guidelines of your healthy-eating plan.Work out your own diet plan and include a variety of low glycemic index tasty foods.
Always remember-DIET FOR DIABETES IS A LONG TERM GOAL
EATING GUIDE
§ Avoid irregular eating habits like over or under eating.
§ Establish a routine for eating meals and snacks at regular times every day
§ Choose the healthiest foods in the right amounts at each meal
A stricter plan may be need if you need to lose weight or you're taking diabetes medications or insulin.The diet has to be tailored based on your health goals, tastes and lifestyle.
Counting carbohydrates
Carbohydrate counting can be a helpful meal-planning tool.Eating the same amount of carbohydrates at each meal or snack will keep your blood sugar from going too high or too low throughout the day
The glycemic index can be used to select foods — especially carbohydrates. Foods with a high glycemic index are associated with greater increases in blood sugar than are foods with a low glycemic index.
Consistency and variety are key
Consistent eating habits can help you control your blood sugar levels. Every day try to eat about the same amount of food at about the same time. Include a variety of foods to help meet your nutritional goals.
Nutrient
Carbohydrates-65% of daily calories
Protein-15% of daily calories
Fats-20% of daily calories
Embracing your healthy-eating plan is the best way to keep your blood sugar under control and prevent diabetes complications. Get creative within the guidelines of your healthy-eating plan.Work out your own diet plan and include a variety of low glycemic index tasty foods.
Always remember-DIET FOR DIABETES IS A LONG TERM GOAL
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