Diabetes Basics: Management and treatment

Type 2 diabetes occurs two-three times more often in overweight people - particularly those who are inactive. Obesity causes the body cells to resist insulin and the resultant build up of glucose leads to diabetic symptoms. Weight loss, coupled with a healthy diet and good exercise often corrects this condition in Type 2 diabetes. By reducing weight, the need for oral antidiabetic drugs can also be prevented or their dosage lessened. Within several weeks, your body cells can lose their resistance and become sensitive once again to the effects of insulin. Insulin and blood glucose levels may normalize, and diabetes symptoms may disappear.

Weight control is also important for people with Type 1 diabetes as it contributes to a generally healthy lifestyle and longevity.

Using a food and exercise diary is an excellent way to keep on target with recommended diet and activity goals.

Whether you have Type 1 or Type 2 diabetes, good diet is essential for effective management. Drinking plenty of water and eating a wide variety of foods that provide a good balance of healthy fats, protein, carbohydrate, and fiber is recommended.

Actual food quantities, as well as when you eat, are also vital to blood-glucose control. Your dietitian can individualize a diet plan to suit your food preferences, lifestyle and health status. Here are a few hints on foods, eating patterns and carbohydrate distribution to keep in mind:  

Foods

• Eat foods rich in antioxidant vitamins C, E and beta-carotene (such as non-starchy vegetables and modified amounts of fresh fruit) as well as omega-3 fats (flax seeds/oil, salmon, tuna, sardines), magnesium (dark green leafy vegetables, whole grains, nuts/seeds, beans) and chromium (wheat germ, brewers yeast, liver). These foods may help to prevent long-term complications of diabetes, such as damage to small blood vessels and nerves.
  
• Choose wholegrain breads, cereals and pasta, and eat plenty of fresh fruits, vegetables, nuts, seeds, and legumes. These foods contain more fiber and slow the release of glucose into your blood after a meal.
  
• Limit foods that are high in added sugars. Small amounts of sugar as part of a meal may occasionally be okay, but you should discuss this with your dietitian. Artificial sweeteners may be an option.
  
• For circulation and heart health, limit foods that are high in saturated fat and cholesterol.

 Eating Patterns

• Don't skip meals. If you take insulin or an oral hypoglycemic agent, regular meals are important.
• If on insulin, eat meals at the same time each day and eat a similar amount of food at each meal. This allows for a steady release and usage of insulin.
• Leave an interval of about 30 minutes between an insulin injection and breakfast.
• Eat smaller amounts of food more frequently for steadier, more even blood glucose levels.

Carbohydrate Distribution

• An even carbohydrate distribution is very important in order to make best use of available insulin and to prevent extreme fluctuations in blood glucose levels.
• Ask your doctor or dietitian to help you determine the level of calories and carbohydrate most appropriate to your weight, medication, and activity. Use regular blood glucose checks to provide feedback.

For people with Type 1 diabetes, exercise can help to both stabilize blood glucose over a long period of time and to prevent diseases that people with diabetes are more prone to, such as heart disease. Low impact exercise, such as walking, is usually recommended for people with Type 1 diabetes as high impact exercise can be strenuous on the feet and legs , which can cause circulation problems. It is very important for those with Type 1 diabetes to consult with a health professional and monitor blood-glucose levels carefully when embarking on an exercise program.

Exercise is a highly important and effective form of treatment for Type 2 diabetes. Muscular contraction as a result of exercise helps to transport glucose into the cells and improve insulin sensitivity. As well as treating symptoms, exercise also helps to prevent other health risks associated with diabetes.

To properly manage diabetes, it is essential to monitor blood glucose throughout the day, both at home and at work, and to keep a log of results. Daily monitoring of your blood glucose will help you become familiar with your blood glucose patterns in relation to diet, exercise and medication. It will also allow you to spot an abnormal level before it becomes extreme.  

Blood glucose is checked using a small amount of blood drawn from the body. This is then read by a blood-glucose meter. Urine tests can also be used to check for blood glucose, but they are not as effective and should only be used when blood testing is impossible. To help stabilize blood glucose, keep the following tips in mind:

• Keep to a recommended daily eating pattern for good blood glucose control. Three meals and three snacks is best for people with Type 1 diabetes. Three meals at regular times is best for those with Type 2 diabetes, especially if overweight.

• Maintain an even carbohydrate distribution. For more information click on the article link to 'Carbohydrates and Diabetes: Breaking it down' at the bottom of the page.

• Keep a healthy weight. This does not mean you have to lose a lot of weight - you will begin to benefit with even a modest weight loss of only 5-10 percent of your body mass, combined with regular exercise.

• Control your diet. Know what and when you will eat. Seek referral to a dietitian for expert advice.

• Don't skip prescribed insulin or oral medication. If on insulin, know what action to take if hypoglycemia (low blood glucose) occurs.

• Have regular checkups with your physician.

• You can also measure your average blood-glucose levels over a 2-3 month period by using the A1C test. For more information click on the article link to 'Hemoglobin Never Forgets: Managing your diabetes with the A1C test' at the bottom of the page.

Insulin is used to keep blood glucose as close to a normal level as possible. People with Type 1 diabetes must take insulin as their bodies do not produce it naturally. Some people with Type 2 diabetes also take insulin to help their bodies use glucose.

Insulin comes in many forms – there are more than twenty types of insulin sold in the United States – and can be delivered using syringe, pump, or pen. Insulin therapy depends on many factors and should be worked out according to your existing health and lifestyle. Your health care team will help you to work out an effective insulin routine.

Meal planning for blood glucose control, weight loss, and exercise are always the first treatments used for people with Type 2 diabetes. In some cases, however, insulin or diabetes pills are also used to help lower blood glucose levels. If you are diagnosed with Type 2 diabetes, your doctor will advise you about medications.

Having diabetes doesn’t stop you going traveling, getting pregnant, or getting sick! However, you need to be aware of how to handle your diabetes in relation to these special circumstances. 

When you get sick and you have diabetes, your blood glucose levels can get very high. When the body releases hormones to fight diseases, these hormones also raise blood sugar levels and interfere with the blood sugar-lowering effects of insulin. Make sure you have a prepared plan for sick days that includes when to call your doctor, how often to measure blood sugar, what medicines to take, and how to eat. In general:

• Drink at least 8 oz of water an hour to prevent dehydration.
• Always continue to take your medications even if you are throwing up.
• If you have Type 2 diabetes check blood glucose levels at least four times a day. If blood sugar is higher than 300 you may need to measure ketones as well. For those with Type 1 diabetes you may need to take these measurements every four hours.
• Stick to your normal meal plan if you can. Replace regular foods with things like gelatin, crackers, soups and applesauce, or drink liquids that contain carbohydrates. Aim for 50g of carbohydrate every 3-4 hours.
• Do not exercise when you are sick. Exercising when you are sick can make blood glucose levels fluctuate dramatically and slow healing down.
• Always check the label of over-the-counter medicines such as cough medicine to check for sugar content.
• Get a yearly flu shot.

If you go traveling you can make your trip safer and more enjoyable by some simple planning ahead.

• Before a long trip, take a medical exam to assess how well your diabetes is under control.
• Take a letter from your doctor with you explaining your condition and how it is treated. Also take a prescription for insulin or diabetes pills in case of emergency. Make sure the prescription is valid where you are traveling.
• Wear a medical ID bracelet or necklace that shows you have diabetes.
• Pack at least twice as much medication and blood-testing supplies as you think you will need. If you are flying, always take at least half of this as carry-on luggage.
• Take a snack pack with you at all times. Pack it with foods you may not be able to get immediately including some form of sugar for treating low blood glucose.

If you want to get pregnant it is important to plan ahead and stay very focused on your overall health. Keeping blood glucose under control is essential to the good health of you and your baby, both before and during pregnancy. If you plan to have a baby:

• Keep a very strict watch on glucose levels. If these are not under control there is a risk of birth defects. During the first six weeks of pregnancy when the baby’s organs are forming, you may not even know you are pregnant. For this reason, good blood sugar control before you get pregnant is crucial. Plan for your pregnancy and try to have your blood sugar under control for 3-6 months before getting pregnant. 
• Make sure you see a doctor who knows how to take care of pregnant women with diabetes.
• Have your eyes and kidneys checked as pregnancy can lead to complications in these areas.
• As with any woman who is pregnant, do not smoke, drink alcohol, or use harmful drugs. These directly affect your baby.
• Continue to work with your health care team to maintain good blood glucose levels, regular exercise, and a healthy diet.
• Be aware that your insulin needs may change when you become pregnant.

When managing diabetes it's important to remember that you don't have to do it alone. Professionals are trained to help you, and friends and family are there to support you. If you are diagnosed with diabetes, make sure you tell those close to you about it and establish a good partnership with your doctor, dietitian, nurse practitioner, and pharmacist.

For more help, advice, and information you can also:

• See your doctor and ask him or her about local diabetes groups that you can get involved in.
• Find a diabetes educator that you can discuss issues with. Click on the Diabetes Educator link below to find one in your local area.
• Contact a dietitian to advise you on foods and meal plans. Click on the Eatright.org link below to find one in your local area.
• Click on the American Diabetes Association website link below.

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Please note: This article is for informational purposes only and is not intended to replace professional medical advice. Please see your doctor immediately if any of the following occurs:

• Your blood glucose level is consistently high or low even though you are taking your insulin/medications correctly.
• Your symptoms worsen
• You get chest pain, vision problems, sweatiness or numbness