All About Diabetes
There are 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.
In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform.
With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.
In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.
Major Types of Diabetes
Type 1 DiabetesResults from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.
Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life.
Finding out you have diabetes is scary. But don't panic. Type 1 diabetes is serious, but people with diabetes can live long, healthy, happy lives.
Type 2 DiabetesResults from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes. Type 2 diabetes is the most common form of diabetes.
In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells.
When glucose builds up in the blood instead of going into cells, it can cause two problems:
- Right away, your cells may be starved for energy.
- Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.
Gestational DiabetesGestational diabetes affects about 4% of all pregnant women - about 135,000 cases in the United States each year.
Pre-DiabetesPre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 54 million Americans who have pre-diabetes, in addition to the 20.8 million with diabetes.
Before people develop type 2 diabetes, they almost always have "pre-diabetes" -- blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 54 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.
There is a lot you can do yourself to know your risks for pre-diabetes and to take action to prevent diabetes if you have, or are at risk for, pre-diabetes. The American Diabetes Association has a wealth of resources for people with diabetes. People with pre-diabetes can expect to benefit from much of the same advice for good nutrition and physical activity.
Pre-diabetes is a serious medical condition that can be treated. The good news is that the recently completed Diabetes Prevention Program study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range.
While the DPP also showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes.
The American Diabetes Association is developing materials that will help people understand their risks for pre-diabetes and what they can do to halt the progression to diabetes and even to, "turn back the clock" In the meantime, ADA has a wealth of resources for people with diabetes or at risk for diabetes that can be of use to people interested in pre-diabetes.
Making Healthy Food ChoicesKnowing what to eat can be confusing. Everywhere you turn, there is news about what is or isn't good for you. Some basic principles have weathered the fad diets, and have stood the test of time. Here are a few tips on making healthful food choices for you and your entire family.
- Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals
- Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce.
- Include dried beans (like kidney or pinto beans) and lentils into your meals.
- Include fish in your meals 2-3 times a week.
- Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey.
- Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese.
- Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks.
- Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats.
- Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream.
- Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.
Frequently Asked Questions about Nutrition
- Why do I need to see a dietitian? Registered dietitians (RDs) have training and expertise in how the body uses food. RDs who understand diabetes can teach you how the food you eat changes your blood glucose level and how to coordinate your diabetes medications and eating. Do you know how many calories you should eat each day? How to cut down on the fat in your meals? How to make eating time more interesting? An RD can help you learn the answers to these, and lots of other questions. Your dietitian will work with you to create a healthy eating plan that includes your favorite foods.
- Can I eat foods with sugar in them? For almost every person with diabetes, the answer is yes! Eating a piece of cake made with sugar will raise your blood glucose level. So will eating corn on the cob, a tomato sandwich, or lima beans. The truth is that sugar has gotten a bad reputation. People with diabetes can and do eat sugar. In your body, it becomes glucose, but so do the other foods mentioned above. With sugary foods, the rule is moderation. Eat too much, and 1) you'll send your blood glucose level up higher than you expected; 2) you'll fill up but without the nutrients that come with vegetables and grains; and 3) you'll gain weight. So, don't pass up a slice of birthday cake. Instead, eat a little less bread or potato, and replace it with the cake. Taking a brisk walk to burn some calories is also always helpful.
- Why does losing weight help my diabetes? Weight loss helps people with diabetes in two important ways. First, it lowers insulin resistance. This allows your natural insulin (in people with type 2 diabetes) to do a better job lowering blood glucose levels. If you take a diabetes medicine, losing weight lowers blood glucose and may allow you to reduce the amount you're taking, or quit taking it altogether. Second, it improves blood fat and blood pressure levels. People with diabetes are about twice as likely to get cardiovascular disease as most people. Lowering blood fats and blood pressure is a way to reduce that risk.
- How can I cut the fat in my diet? Here are some beginning hints. See a dietitian for more advice. Stir-fry foods in tiny amounts of oil and lots of seasonings. Choose nonfat or low-fat selections, such as nonfat or 1% milk or low-fat cheese. Keep portion sizes on target. Avoid fried foods -- bake, grill, broil, or roast vegetables and meat instead.
- Are some fats better than others? Yes. Unsaturated fats are the healthiest for your body. This includes both monounsaturated and polyunsaturated fats. You can find these "healthy fats" in foods like nuts, vegetable oils, olives and avocados. The fats to cut back on are the saturated and trans fats. Saturated fats are found in full-fat dairy products like ice cream, half and half, sour cream, cheese, and meats, chicken skin, bacon and lard. Trans fats are found in margarines and shortening as well as many processed packaged foods and sweets. Trying to cut back on how much saturated and trans fat you eat is important to help reduce your risk of heart attack and stroke.
- What foods can I eat a lot of? Forget about eating with abandon. The key to healthy living is moderation. Air-popped popcorn may be low in fat, but it still has calories. And calories count. If you can control the portion sizes of the food you eat, you will be able to eat a wider variety of foods, including your favorites, and still keep your blood sugar in your target range.
- What can I do if I overeat over the holidays? Put on your walking shoes and head for the pavement. Being more active helps lower your blood sugar, blood pressure and cholesterol. Physical activity uses up extra sugar in your blood and helps your insulin work better.
- Can I use low calorie sweeteners? Low calorie sweeteners are safe for everyone except people with phenylketonuria, who should not use aspartame. Calorie-free sweeteners like aspartame, saccharin, sucralose and acesulfame-K won't increase your blood glucose level. The sugar alcohols -- xylitol, mannitol, and sorbitol -- have some calories and do slightly increase your blood glucose level. Eating too much of any of these can cause gas and diarrhea.
- How much weight should I lose each week? Limiting your weight loss to 1/2 to 1 pound a week will keep you healthy, and let you enjoy the foods you love in small amounts. A slow steady weight loss is the key to keeping lost weight off.
- Can I drink alcohol? Yes, in moderation. Moderation is defined as two drinks a day for men and one drink a day for women. A drink is a 5-ounce glass of wine, a 12-ounce light beer, or 1-1/2 ounces of 80-proof distilled spirits. Make sure that your medications don't require avoiding alcohol, and get your doctor's okay.
- Isn't glucose control easier if I eat the same things every day? Probably, but this method of blood glucose control isn't very nutritious, not to mention boring. One of the keys to nutrition is eating a variety of foods each day. By checking your blood glucose two hours after starting to eat a meal, you can learn how different foods affect you. Over time, you will be able to predict how foods, and combinations of foods, affect your blood glucose level.
- What vitamins will help my diabetes? If you have a vitamin or mineral deficiency, it could be causing problems with your glucose control. For instance, one study found that taking the trace element chromium improved glucose control in subjects who had a chromium deficiency. More studies need to be done. If you choose a variety of fruits, vegetables, grains, and meat each day, and keep your blood sugar close to your target range, you probably don't need to take vitamin supplements because of diabetes.
- Are there herbs that will help my diabetes? Many herbs supposedly have glucose-lowering effects, but there are not enough data on any herb to recommend it for use in people with diabetes. Herbs are not considered food by the Food and Drug Administration and are not tested for quality or content. Therefore, products can be promoted as helping health conditions without having to show evidence of this. Discuss the herbal dietary supplements with your doctor or dietitian before trying them. They may interact poorly with your diabetes medication.
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