More modern history of the diabetic diet may begin with Frederick Madison Allen and Elliott Joslin, who, in the early 20th century, before insulin was discovered, recommended that people with diabetes eat only a low-calorie and nearly zero-carbohydrate diet to prevent ketoacidosis from killing them. While this approach could extend life by a limited period, patients developed a variety of other medical problems.
Insulin can’t be taken orally to lower blood sugar because stomach enzymes interfere with insulin’s action. Often insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like a large ink pen.
The first thing to understand when it comes to treating diabetes is your blood glucose level, which is the amount of glucose in the blood. Glucose is a sugar that comes from the foods we eat and also is formed and stored inside the body. It’s the main source of energy for the cells of the body, and is carried to each cell through the blood. Glucose gets into the cells with the help of the hormone insulin.
It’s only natural that certain weight loss books and programs appeal to some people more than others. Different plans might work better for different people, and finding what fit best is an individual choice. Whether you love to cook from scratch, the microwave is your best friend, you’re looking for a complete overhaul, or want to take small steps, there’s a diet plan that can help you succeed. We help you explore five diverse approaches to losing weight while maintaining a diabetes-appropriate diet.
Fig. 8.2 outlines these options, as well as recommendations for further intensification, if needed, to achieve glycemic goals. If a patient is still above the A1C target on premixed insulin twice daily, consider switching to premixed analog insulin three times daily (70/30 aspart mix, 75/25 or 50/50 lispro mix). In general, three times daily premixed analog insulins have been found to be noninferior to basal-bolus regimens with similar rates of hypoglycemia (62). If a patient is still above the A1C target on basal insulin plus single injection of rapid-acting insulin before the largest meal, advance to a basal-bolus regimen with ≥2 injections of rapid-acting insulin before meals. Consider switching patients from one regimen to another (i.e., premixed analog insulin three times daily to basal-bolus regimen or vice-versa) if A1C targets are not being met and/or depending on other patient considerations (60,61). Metformin should be continued in patients on combination injectable insulin therapy, if not contraindicated and if tolerated, for further glycemic benefits.
Glyburide/metformin (Glucovance), rosiglitazone/metformin (Avandamet), glipizide/metformin (Metaglip), pioglitazone/metformin (Actoplusmet), and metformin/sitagliptin (Janumet) are five relatively new combination pills on the market to treat type 2 diabetes.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. There are no signs or symptoms of insulin resistance. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use.
Gestational diabetes is different from type 1 and type 2 diabetes because it’s specific to pregnant women. Gestational diabetes occurs in approximately 9.2 percent of pregnancies. The hormones of pregnancy interfere with the way insulin works. This causes the body to make more of it. However, for some women, this still isn’t enough insulin, and they develop gestational diabetes.
Diabetes mellitus (DM). Merck Manual Professional Version. http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm. Accessed Nov. 9, 2015.
Joanne M. Gallivan, RD, director of the National Diabetes Education Program at the National Institutes of Health, has this kitchen tip: “Garlic has been shown to have many healthful benefits, including lowering the risk for many cancers. But the way you treat it while preparing a dish can enhance its cancer-fighting properties. A recent study showed that letting garlic rest for about 10 minutes before it is used in cooking may enhance its cancer-fighting benefits. Chopping or crushing garlic helps to produce the active compounds that give it the distinct smell and healthful sulfide compounds. But heating it immediately after it is chopped inactivates the cancer-fighting properties.”
Diet plays an important role in fighting diabetes. Drop your carb intake (bread, pasta, rice). Ensure at least half your meal comes from veggies. Get plenty of fruit in every day. Have good quality fats (grass-fed butter and ghee, avocados). Get moving through the day. Go for a brisk walk or jog for at least 30-45 minutes daily. Or play your favorite game.
According to About.com, a half-cup serving of firm tofu contains 10 grams of protein, 5 grams of fat, and only 2 grams of carbohydrates. In addition to tofu, a number of soy products like tempeh and miso contain a lot of protein and few carbs.
Similarly, adults with diabetes are also two to five times more likely than those without diabetes to develop cataracts. Cataracts forms when the eye’s clear lens becomes cloudy, which blocks normal light from entering. Due to poor blood flow and nerve damage, diabetics are also more likely to develop cataracts at a younger age and have them progress faster.
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. You should be evaluated by your physician before starting an exercise program.
Jump up ^ “Diabetic foods – Joint statement on ‘diabetic foods’ from the Food Standards Agency and Diabetes UK”. Positional statements. Diabetes UK. July 2002. Archived from the original on 2006-11-28. Retrieved 2006-10-22.
In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.
Studies in type 1 patients have shown that in intensively treated patients, diabetic eye disease decreased by 76%, kidney disease decreased by 54%, and nerve disease decreased by 60%. More recently the EDIC trial has shown that type 1 diabetes is also associated with increased heart disease, similar to type 2 diabetes. However, the price for aggressive blood sugar control is a two to three fold increase in the incidence of abnormally low blood sugar levels (caused by the diabetes medications). For this reason, tight control of diabetes to achieve glucose levels between 70 to120 mg/dl is not recommended for children under 13 years of age, patients with severe recurrent hypoglycemia, patients unaware of their hypoglycemia, and patients with far advanced diabetes complications. To achieve optimal glucose control without an undue risk of abnormally lowering blood sugar levels, patients with type 1 diabetes must monitor their blood glucose at least four times a day and administer insulin at least three times per day. In patients with type 2 diabetes, aggressive blood sugar control has similar beneficial effects on the eyes, kidneys, nerves and blood vessels.
As you’ll learn in this health topic, hypoglycemia, or low blood sugar, occurs when the level of sugar or glucose in the blood drops too low to fuel the body. Hypoglycemia is not a disease but a condition that results from a variety of causes.
Two glitazones are available: pioglitazone and rosiglitazone. These drugs can have the side effects of weight gain or swelling and are associated with increased risks of heart disease and stroke, bladder cancer and fractures.
Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.
Please Note: This meal plan is controlled for calories, carbohydrates, fiber, saturated fat and sodium. If you are concerned about any nutrient in particular, speak with your care provider and a registered dietitian about altering this plan to best suit your individual health needs.
To this end, treatment programs such as the Cognitive Behavioural Therapy – Adherence and Depression program (CBT-AD) have been developed to target the psychological mechanisms underpinning adherence. By working on increasing motivation and challenging maladaptive illness perceptions, programs such as CBT-AD aim to enhance self-efficacy and improve diabetes-related distress and one’s overall quality of life.
Sometimes medications — such as metformin (Glucophage, Glumetza, others) — also are an option if you’re at high risk of diabetes, including when your prediabetes is worsening or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.