Diabetes mellitus is a chronic, progressive disease characterized by either a deficiency of insulin or the decreased ability of the body to use insulin. It can be a devastating disease, both physically and financially, if people do not know how to recognize and treat complications and conditions. In 2015, the CDC reported:
Diabetes affects over 30 million people in the United States
- 84 million people in the US have prediabetes, 33% of the population
- Over 7 million people with diabetes are undiagnosed
- 23 million adult in the US aged 65 or older are living with diabetes
- It is the seventh leading cause of death in the US
- Death risk among people with diabetes is about 50% higher than that of non-diabetics of similar age
- Medical expense are more than two times higher than for people without diabetes
The word "diabetes" describes more than one condition: Type 1 and Type 2. Type 2 diabetes is more prevalent than Type 1, most likely due to lifestyle choices as we age. Complications of the condition include hypoglycemia, hypertension, heart disease and stroke, vision problems, kidney, nervous system and periodontal disease, amputations, depression, susceptibility to infection, functional decline and diabetic coma.
According to the American Diabetes Association, prediabetes affects millions of people each year. People with prediabetes have a blood glucose measurement higher than normal but not high enough to be diagnosed with diabetes.
Prediabetes is often asymptomatic and is usually found by testing for diabetes. Blood testing should be ordered when there are multiple risk factors or any of the classic symptoms, such as polyuria (an abnormal production of urine), polydipsia (an abnormally high thirst), polyphagia (high levels of hunger), and unexplained weight loss.
How Does Insulin Work?
Insulin controls the body's ability to metabolize carbohydrates and move glucose from the bloodstream into cells for use as energy. Diabetes is categorized in to Type 1 and Type 2 diabetes based on how the insulin is produced and handled in the body.
In addition to Type 1 and Type 2 diabetes, the American Diabetes Association has identified two other clinical classes of diabetes: gestational. and "other." Gestational diabetes occurs during pregnancy. Other types of diabetes may result from genetic disorders, pancreatic disease. or adverse drug reaction.
Type 1 Diabetes
Type 1 diabetes, Insulin Dependent Diabetes Mellitus (IDDM), or juvenile-onset diabetes is an inherited disease. It has an autoimmune component that is characterized by little or no insulin production. The body develops antibodies that destroy or disable the cells in the pancreas responsible for producing insulin. According to the ADA, only 5% of people with diabetes have Type 1. It typically occurs in children or young adults.
Risk factors for Type 1 diabetes include a family history and the presence of beta cell antibodies in the blood.
Type 2 Diabetes
Type 2 diabetes, also known as adult-onset or non-insulin dependent diabetes mellitus (NIDDM), is believed to have a strong genetic link. It is generally diagnosed in middle aged and older adults. While not everyone with Type 2 diabetes is overweight, obesity and lack of physical activity are closely associated with this form.
In Type 2 diabetes, insulin secretion is impaired and body tissues are less sensitive to it. This causes less glucose to move into the cells, resulting in higher blood glucose (BG) levels. For this reason, Type 2 Diabetics must monitor their blood glucose levels with diabetes testing monitors and strips.
These risk factors include a family history of diabetes, obesity, coronary artery disease, hypertension, and chronic dyslipidemia. Ethnicity can also put a person at higher risk, for example African American, Hispanic, Native American, Asian and Pacific Islander descendants tend to be more prone to this disease.
Managing Risk Factors
Studies have shown that long term, intensive interventions aimed at multiple risk factors in people with Type 2 diabetes resulted in a 50% lower risk of cardiovascular events.
The value of addressing A1C, blood pressure, and LDL cholesterol-known as the "ABCs" of diabetic care-is both critical and effective. Monitor you A1C level and blood pressure with A1C test kits and blood pressure monitors.
- A: A1C should be maintained at <6.5%, if appropriate
- Plasma blood glucose measurements include the following:
- Before meal blood glucose reading of 70-130 mg/dl
- Peak meal blood glucose of less than 180 mg/dl (usually 1 to 2 hours after the start of a meal)
- B: Blood pressure should be less than 130/80 mmHg
- Strictly controlling blood pressure significantly reduces the risk for diabetes-related deaths, stroke, heart failure, microvascular disease, retinopathy progression, and deteriorating vision
- The ADA recommends blood pressure levels of less than 130/80 for people with diabetes, as long as it can be achieved safely
- C: Cholesterol-Lipid Profile (mg/dl) should be maintained at:
- LDL: <100 (for those with CVD <70)
- HDL: >40 for men and >50 for women
- Triglycerides: <150
- Cholesterol: <200
Controlling lipids reduces the risk of cardiovascular disease. Studies using statin medications have clearly shown that low-density lipoprotein (LDL) cholesterol reduction therapy can reduce the risk of cardiovascular disease in people with diabetes.
According to the Centers for Disease Control (2015), smokers are 30-40% more likely to develop Type 2 diabetes, and have increased problems regulating insulin doses and controlling their disease. It also more than doubles the risk for cardiovascular disease in people with diabetes. Therefore, quitting smoking is essential to reducing risk factors and can greatly reduce the risk of premature death.
People with diabetes will need to make lifestyle changes to reduce their risks for stroke, heart disease, and long term complications. Management of cholesterol and blood pressure, as well as reduction in weight will help in achieving good glycemic control.
A healthy eating plan is the first step. Diabetic diet management has changed over the years and modern diabetic diet therapy rarely uses total calories and "do not eat" lists anymore. Instead, individuals following diabetic diets are encouraged to practice portion control, reduce fat and sodium, and to avoid low-fiber complex carbohydrates and simple sugars.
Using a healthy eating plan with naturally rich nutrients, low calories and fat, that emphasizes non-starchy vegetables, whole grains, and fruits is part of a good diabetic diet and would also be considered an excellent eating plan for most anyone. The goal of this diet is to control blood glucose levels, fat, and cholesterol, and to reduce excess weight.
Controlling portion sizes, carbohydrate intake, and limiting fat, cholesterol, and sodium is essential to healthy eating for diabetics-and everyone else.
Food to Include
The ADA has recommended a list of diabetic "superfoods”. These include beans such as black, pinto, and kidney, dark, green leafy vegetables, fish such as salmon, citrus fruits, sweet potatoes, berries, tomatoes, whole grains, nuts, fish, fat-free milk and yogurt.
Starches (complex carbohydrates) and sugars (simple carbohydrates) are broken down into blood glucose during digestion. Healthier carbohydrates, for example vegetables, legumes such as beans, lentils, and peas, low-fat dairy products, and fruits, are a necessary part of a healthy diet.
The parts of plant foods that can't be absorbed or digested are the dietary fibers. Fiber helps control blood sugar levels and can decrease the risk of heart disease. Foods with high fiber levels are nuts, whole wheat flour, vegetables, fruits, and legumes like peas, lentils, and beans.
Fish are good alternatives for high-fat meats. Cod, halibut, and tuna are lower in saturated fats and cholesterol than poultry and meat. While other fish, such as mackerel, herring, and salmon, are rich with omega-3 fatty acids that promote healthy hearts through decreasing blood fats called triglycerides.
Proteins are helpful in maintaining blood glucose control throughout the day. Foods high in protein include fish, lean chicken, low-fat cheese, beans, peanut butter, eggs, and nuts.
Polyunsaturated and monounsaturated fats can help lower cholesterol levels. Foods containing these fats include almonds, olives, canola, olive and peanut oils, avocados, walnuts and pecans. However, since all fats are high in calories, these should be eaten in moderation.
People with diabetes should have no more than 300mg of cholesterol daily. Cholesterol can be found in high-fat animal proteins and dairy products, shellfish, egg yolks, liver, and other organ meats.
Food to Avoid
Increased risk of heart disease and stroke are associated with diabetes due to the fact that it can accelerate the development of hardened and clogged arteries. Foods with saturated fats, trans fats, cholesterol, and sodium can work against heart health. People with diabetes should avoid simple carbohydrates without any nutritional value such as candy, soda, cake, and other sweets.
Saturated fats increase the level of cholesterol in the blood and are often high in calories. Animal proteins, such as pork, poultry with skin, butter, and cheese, as well as high-fat dairy products, contain saturated fats.
There are two types of trans fats; naturally occurring and artificial (or trans fatty acids). Artificial trans fats are found in processed foods and are labeled as partially hydrogenated oils. They raise your bad cholesterol (LDL) and lower your good cholesterol (HDL). These fats are common in fried foods, baked goods, stick margarines, processed snacks, and shortening. Avoidance of these fats is recommended and replacement with monounsaturated and polyunsaturated fats, if possible, is recommended.
Exercise can contribute to loss of excess weight, glycemic control, lower lipid levels, and reduced risk for complications from diabetes especially when combined with a healthy diet.
Adults with diabetes should get at least 150 minutes per week of moderate-intensity aerobic physical activity. If physically possible, an additional 75 to 90 minutes per week of vigorous aerobic exercise is recommended. Activity time can be spread out over each day.
Exercise affects diabetes by lowering blood glucose levels and the body responds by seeking replacement energy. When a person follows a carbohydrate- and portion-controlled diet, the body is forced to use stored fat for some of this energy, resulting in weight loss.
Sometimes people will experience a drop in blood sugar during or after exercise so it is important to monitor levels, take precautions, and be prepared to treat hypoglycemia. Some trial and error is to be expected and you may find that, depending on the day and level of exercise, medications may need to be adjusted frequently until a regular routine has been achieved. If there are changes to an exercise plan, there is a good chance there will need to be a change in medication management.
Important Things to Remember
There are so many aspects to managing diabetes and it can be overwhelming for the person and their family members or caregivers. However, knowledge can empower you to take control of your health and enable them to live a longer, healthier life with diabetes. A healthy diet and routine exercise are the number one treatment in maintaining good glycemic control.
*The ExpressMed team are not medical professionals. The information contained on this page is meant for educational purposes only.