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SECTION ONE

Diabetes, Nutrition, and Healthy Eating Basics

Chapter 1

A Few Bits and Bites about Diabetes

What You’ll Learn:

• what diabetes is and how it affects your body and why you’ll want to track your levels over time

• the target goals for blood glucose, blood lipids, and blood pressure— yourABCs

• how pre-diabetes (being at high risk for type 2) can progress to type 2 diabetes and what you can do to slow down this process

• the benefits of weight loss and physical activity to your short- and long-term health •

What Is Diabetes?

Before you dig in to learn about healthier eating, take a few minutes to learn more about diabetes and what you can do to slow down the progress of this disease. If you have diabetes, your body has difficulty converting the food you eat into energy you can use.

After you eat, your body breaks down some of the food into glucose, or sugar, which is the basic fuel for all the cells in your body. Insulin, a hormone produced by the beta cells in the pancreas, helps take the glucose from your blood to the cells. When you have pre-diabetes or type 2 diabetes, two things are going wrong with this process. First, your body is unable to keep up with the demand for large amounts of insulin. Very often this is because you are carrying around excess weight. Second, because your body has become resistant to the insulin your pancreas does make, you are not able to efficiently use the insulin you make. You have both insufficient insulin production and insulin resistance-key features of pre-diabetes and type 2 diabetes. The result is that glucose builds up in your blood, instead of getting into your cells via insulin to be used for energy. Over the years, high blood glucose levels can damage your kidneys, eyes, and nerves.

Managing your diabetes means working to keep your blood glucose levels as close to normal as possible. Unfortunately, people with diabetes, and particularly type 2 diabetes, also often have high blood pressure and unhealthy blood lipid levels: HDL (good) cholesterol is too low, triglycerides are too high, and LDL (bad) cholesterol is too high. These problems are caused by excessive weight and insulin resistance.

It’s the combination of high blood glucose levels, high blood pressure, and abnormal lipid levels that can cause the more serious complications of diabetes, including heart and blood vessel diseases. People with diabetes are six times more likely to have a heart attack and four times more like to have a stroke than people without diabetes. Heart and bloodvessel diseases are the leading causes of medical problems and death for people with diabetes. Enough bad news, the good news is that just a small amount of weight loss can improve all of these problems.

Many people need to take medications to manage blood glucose, blood pressure, and abnormal lipids to stay on target. Achieving these ABC goals can help keep you healthy for years to come.

Know Your ABCs

The three targets of effective diabetes management are known as the ABCs:

The American Diabetes Association recommends ABC goals for people with diabetes. Your health care provider can help you decide which goals are right for you.

Pre-diabetes (High Risk) and Type 2 Diabetes

About 57 million people in the United States have “pre-diabetes,” a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. (Pre-diabetes can also be considered being at high risk for diabetes.)

In the last decade, research has given health care providers a better understanding of how pre-diabetes can progress into type 2 diabetes if left untreated. Read about how pre-diabetes and type 2 can happen and how you can prevent or delay it if you are at high risk (see Progression from Normal Blood Glucose to Pre-Diabetes and Type 2 chart).

Here’s what happens progressively:

• Excess weight and inactivity initiate the problem. Excess adipose tissue (fat) releases markers of chronic inflammation into the bloodstream.

• Inflammation causes insulin resistance to escalate. Inflammation inhibits the action of insulin made in the pancreas, so your body is not able to use your insulin effectively, and also has a greater demand for it. This can damage your body’s tissues, yet you will likely be unaware that it is happening. ’

• With inflammation and insulin resistance the body powers up the beta cells to put out more insulin. Larger amounts of insulin are put out into the bloodstream to work on keeping blood glucose normal. This is when blood pressure starts to rise and blood lipids become abnormal.

• Insulin production from beta cells begins to dwindle. Blood glucose levels slowly start to rise above normal. Initially, blood glucose levels after meals tend to be higher before fasting levels.

• Blood glucose climbs slowly. The beta cells slowly become exhausted and can’t make enough insulin to keep blood glucose at normal levels. This is when blood glucose levels rise and the A1C level rises high enough to put you at high risk for diabetes. This subtle process can take 10 years or more for adults. Research shows it may happen more quickly in children and adolescents.

• The pancreas can no longer keep up with the body’s demand for insulin. The blood glucose rises to levels that are diagnostic for diabetes. Interestingly, at diagnosis people have already lost between 50 and 80% of their beta cells. At this point many people usually need to start taking a blood glucose-lowering medication, often metformin.

• Over time the ability to make insulin continues to dwindle and insulin resistance continues. To keep blood glucose levels in target ranges, you’ll need to progress your blood glucose-lowering medication. Eventually many people who live long enough with type 2 will need to take insulin by injection.

*People with pre-diabetes or early-onset type 2 diabetes may have anormal fasting plasma glucose level but a higher than normal level 2 hours after eating.

**A diagnosis of diabetes must be confirmed on a subsequent day by measuring fasting blood glucose, blood glucose levels 2 hours after eating, or casual (anytime) blood glucose.

Pre-diabetes (High Risk of Type 2 Diabetes): What You Can Do?

A large study started in the late 1990s called the Diabetes Prevention Program (DPP) showed that people at risk for type 2 diabetes who lost a small amount of weight (5-7% or about 10-20 pounds) and became more physically active, could prevent or delay the development of type 2 diabetes. Study participants were active for 150 minutes a week (30 minutes a day five days a week). People lost weight and kept it off for the three years of the initial study by eating fewer calories, less fat, and smaller portions of food. The participants experienced other benefits of weight loss, such as lowered blood pressure, improved blood lipids, and a reduction in medicines needed to control these conditions.

The DPPOS (Outcome Study), which is following people in the DPP, shows that it’s best to focus on keeping off these few pounds by eating healthy and being physically active. Losing weight and keeping weight off is challenging enough. This study showed that support—from diabetes educators, health care providers, a weight control group, or friends—can be critical to your success. For this reason, think about finding a local or online support network to help you with your efforts long term.

QUICK TIP

Key medical benefits from weight loss happen with the first 10 to 15 pounds you lose. There is no need to get down to an unrealistically low weight to enjoy these benefits. The key is to keep this small amount of weight off for good.

A Diagnosis of Type 2 Diabetes

You may be diagnosed with type 2 diabetes just after your blood glucose level crosses the threshold, or it may be years before you discover that your blood glucose is high enough to be diagnosed as diabetes. In addition, you may be carrying around extra pounds. These factors and others will influence how you and your health care provider will treat your diabetes.

Keep in mind that the care of type 2 diabetes has changed a great deal over the past few years. That’s because more has been learned about the progressive changes noted above. Recent research indicates that you can slow down the progression of type 2 diabetes—and reduce the chances of heart and blood vessel complications—by keeping your glucose levels on target day to day and year to year. For this reason current ADA recommendations suggest that you start taking one of several blood glucose-lowering medications as soon as you are diagnosed with type 2 diabetes. This doesn’t negate the importance of losing some weight and becoming more physically active. These actions can help increase your insulin sensitivity and, along with the medication, improve your ABCs.

If your health care provider suggests blood glucose-lowering medication, don’t fight it. Normal or near-normal blood glucose levels will help keep you healthy. As time goes on, don’t fight taking more medication or adding a new one to keep your blood glucose under control (see Know Your ABCs). If your health care provider suggests taking insulin to achieve glucose control, try not to fight this or put it off for too long. With thinner, sharper needles, convenient pens or pumps, and newer insulins, taking insulin is easier than ever before.

Key Features of a Diabetes Treatment Plan

Regardless of the medications you use over the years to manage your glucose levels, blood lipids, and blood pressure, research shows that there are three other key features for a solid treatment plan for diabetes. These are:

• healthy eating

• achieving and maintaining a healthy weight

• being physically active.

You can start to take charge of your plan by reading this book and deciding which changes you can make to live a healthier life with diabetes.