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IN THIS CHAPTER

❯❯ Understanding how carb choices, portions, and timing affect your health

❯❯ Getting started with carb control and advancing your carb-counting skills

❯❯ Living well with diabetes through self-management education

Diabetes is a disorder that is largely self-managed. You are the one making the daily decisions that affect your health outcomes. That’s a significant responsibility! The thought of taking on diabetes may seem overwhelming, but you can do it.

There’s a learning curve, of course. Being successful at any skill, sport, task, or job takes effort, training, patience, and support. Think about a preschool child who picks up his parent’s paperback novel and stares blankly at the foreign squiggles on the page, wondering how anyone could possibly read it. We’ve each been that child and faced that same challenge. We still encounter words that we don’t recognize from time to time, but we can look them up.

Learning about diabetes is similar. First you tackle the basics, and then you build on that foundation. Learning to manage your own diabetes requires diabetes self-management education. This book is designed to be your companion text in the learning process. The goal is to build knowledge (especially about counting carbs) and foster the skills needed for successful self-management. This chapter introduces you to the world of diabetes and carb counting.

Getting Up to Speed on Diabetes Basics

Diabetes is a condition of abnormal blood-glucose regulation. Lack of insulin (type 1 diabetes) or ineffective insulin (type 2 diabetes) both lead to elevated blood-glucose levels and a diagnosis of diabetes.

Diabetes and diet are intimately intertwined. It’s impossible to talk about managing diabetes without discussing food in great detail. Blood-glucose levels are influenced by what you eat, how much you eat, and when you eat. The goal is to eat healthy foods, properly portioned, at appropriate times. The following sections introduce the basics of managing diabetes.

Checking out concerning trends in the diabetes epidemic

Nearly 30 million Americans are living with diabetes. Type 2 diabetes accounts for roughly 95 percent of cases. Over 86 million American adults have prediabetes, a condition where blood-glucose levels are above normal but not yet high enough to be classified as diabetes.

The best way to turn that trend around is to improve dietary choices, lose weight if you are overweight, and exercise regularly. Prediabetes can progress to type 2 diabetes, but lifestyle changes cut the risk by up to 58 percent. If you already have diabetes, eating right and exercising comprise the foundation of treatment.

Improving outcomes and preventing complications

I don’t plan to list scary statistics on how many people with diabetes have developed complications. Fear isn’t a good motivator. Hope is. In this book, I focus on how to better manage diabetes to help prevent complications. Keep in mind that when people developed diabetes many years ago, they simply did not have the resources, knowledge, tools, medications, and technologies needed to adequately manage their disease. Those tools are available now: blood-glucose monitors, insulin and other medications, insulin-delivery options, and knowledge. The roles of diet and exercise in managing diabetes are understood. Multiple studies from around the globe provide a hopeful message, which is taking care of your diabetes has a big payoff: your improved health.

While the onset of type 1 diabetes is more obvious, type 2 diabetes can go undiagnosed for many years. Screening is critically important and may alert you to your risk long before diabetes develops. Chapter 2 sorts through the types of diabetes, delineates risk factors, and explains diagnostic criteria.

You should take diabetes seriously. Uncontrolled diabetes may lead to complications. For example, elevated blood-glucose levels over time can damage blood vessels and tissues. People with diabetes are twice as likely to suffer a heart attack or stroke. Your eyes, kidneys, feet, and nerves are all vulnerable to the damages inflicted by persistently elevated glucose levels.

If you currently have complications, talk to your diabetes specialist for appropriate treatment. Request a referral to a registered dietitian if treating your complication has a dietary component. Two examples: Kidney disease may impose restrictions on dietary sodium, potassium, phosphorus, fluid, and possibly protein. Treating gastroparesis (nerve damage that alters the digestive system) involves dietary modifications to improve digestion and absorption of food. When diet becomes part of the treatment for a disease, it’s referred to as medical nutrition therapy. A registered dietitian is a trained medical professional who can help you learn to make dietary changes that support the treatment of diabetes, heart disease, lipid problems, hypertension, and more.

A landmark study called the Diabetes Control and Complication Trial (DCCT 1983–1993) followed 1,441 people with type 1 diabetes for ten years. Results showed definitively that improving blood-glucose control reduces the risks of developing complications. The results were astounding: 76 percent reduction in eye disease, 50 percent reduction in kidney disease, and 60 percent reduction in nerve disease. The United Kingdom Prospective Diabetes Study (UKPDS 1977–1997) focused on people with type 2 diabetes. With 5,102 study participants, it was shown conclusively that both blood-glucose control and blood-pressure control are important in reducing complications.

Building your diabetes team

Your diabetes team starts with you. You are the team captain, and you get to pick who will be there to assist you on your diabetes management journey:

❯❯ Your primary care provider manages your overall healthcare needs. Look for one who has experience with diabetes.

❯❯ If you have type 1 diabetes or your type 2 diabetes is not under adequate control, your general practitioner may refer you to an endocrinologist, a doctor who specializes in diabetes.

❯❯ You may also benefit from the expertise of a diabetes nurse educator (RN or NP), who can teach you how to monitor your glucose levels, keep and review blood-glucose records, properly administer insulin, handle travel and sick days, and more. In addition, a registered dietitian (RD or RDN) can help you plan balanced meals, teach you to read Nutrition Facts labels and count carbs, and provide dietary advice to help you achieve weight goals, manage blood pressure, improve cardiovascular health, understand the impact of alcohol, treat hypoglycemia, and more.

❯❯ A certified diabetes educator (CDE) is a healthcare provider who has advanced training in diabetes management and has passed a comprehensive national exam. To maintain the CDE status, the healthcare professional must complete 75 hours of continuing education in the field of diabetes every five years.

❯❯ Also on the roster to join your team are an eye doctor (either an ophthalmologist or an optometrist), a dentist, and a pharmacist.

❯❯ At times you may choose to see a mental-health specialist: a counselor, social worker, psychologist, or psychiatrist.

❯❯ Should you need them, a podiatrist is available for foot care and an exercise physiologist or physical therapist can guide your physical fitness plan.

❯❯ Don’t forget your loved ones, family, and friends. Enlist the support and help of the important people in your life. People want to help; just let them know how best to assist you.

Staying up to date with advances in diabetes care

Diabetes specialists (like those listed in the preceding section) stay up to date on the latest advancements in the field of diabetes. Capitalize on their knowledge; stay up to date with your medical appointments and healthcare screenings. Having a few reputable diabetes management books (like this one!) on your home bookshelf is also helpful. Read and reread the sections most pertinent to you.

Keep in mind that not everything you read online is factual. Chapter 25 links you to reputable websites for gathering sound information.

Examining the Carb-Glucose Connection

This book offers in-depth info about the nutrients in food and how nutrients are used in the body. Carbohydrates, proteins, and fats are macronutrients. We need them in relatively large amounts as compared to micronutrients, such as vitamins and minerals, which are required in smaller amounts. Here’s what they do:

❯❯ Carbohydrates provide glucose, the body’s primary fuel.

❯❯ Proteins contribute amino acids for building and repairing tissues and cells.

❯❯ Fats provide fatty acids, assist in the absorption of fat-soluble vitamins and, along with glucose, are used for energy.

❯❯ Vitamins and minerals are essential nutrients required for hundreds of jobs throughout the body. To obtain the full complement of vitamins and minerals needed for health, choose a wide variety of wholesome foods.

Chapter 4 focuses on carbohydrates because carbs have the most profound effect on blood glucose, also known as blood sugar. There, you get a behind-the-scenes tour of carbs’ journey through the body. You find out how carbohydrate foods are digested, turn into glucose, and are absorbed into the bloodstream. You also track the glucose through the system and discover why insulin, “the key to the cell,” is required for proper fuel usage.

Glucose is so critical for human function that the body stockpiles glucose in the muscles and the liver. The storage form of glucose is glycogen. Glycogen reserves can be tapped into when the body is running low on glucose. If glycogen reserves become depleted, the liver will make glucose from scratch (but it may cost you a little muscle tissue … because you can’t make something from nothing).

Diabetes interrupts the delicate balance of glucose regulation. Managing dietary carbohydrate intake is one of the most important lessons when learning to self-manage your diabetes. It’s not only the amount and timing of the carbohydrate (see Chapters 6 and 8); it’s also the quality of the carbohydrate and what it’s mixed with (see Chapters 10, 11, and 12). In the bigger picture, carbs must be balanced with medications and exercise. Table 1-1 lists the most significant variables affecting blood-glucose levels for people with diabetes.

TABLE 1-1 Variables Affecting Blood-Glucose Regulation

Diabetes imposes the need to understand how to juggle carbs, exercise, and medications, but it can be done, as you find out in Chapters 6 and 14. No one has perfect blood-glucose control, so set realistic expectations. Use a blood-glucose monitor (see Chapter 23) and have A1C levels checked regularly. You and your healthcare team can use glucose data to make adjustments to your self-care regimen. If your medications put you at risk for low blood glucose, find out more about preventing, recognizing, and treating hypoglycemia in Chapter 15.

Nutritional needs and diabetes management strategies change and evolve through all ages and stages of life. Chapter 17 provides specific tips for managing diabetes in childhood, during pregnancy, and into the golden years.

Getting Acquainted with Carbs

Carbs have been getting a bad rap lately. Many people are swept up in the notion that carbs are fattening or carbs are bad. Perhaps the pendulum has swung too far, causing some diets to be too low in carbs and excessive in protein or fat. The human body has basic needs, and glucose is one of them. Carbohydrates provide glucose, which is the preferred fuel source for the brain, nervous system, and muscles. For the sake of your health, it’s important to find a happy medium … a little carb equilibrium.

What all carbs have in common is their chemical make-up. Simple carbohydrates and complex carbohydrates are made out of the same basic building blocks: sugar molecules. Chapter 3 boils it down into super simple chemistry concepts; a preview is just ahead. In this section I also talk about the nutrients in carbs and other food groups.

Carbohydrate foods do more than just contribute simple or complex carbs; they provide vitamins, minerals, and good taste too!

Introducing the so-called simple carbs

Imagine a pile of Legos. Lego blocks can exist separately or be snapped together in pairs. Those would represent the “simple” carbohydrates, which are single or double sugar molecules. The sugars in fruit are single sugars, while lactose, the sugar in milk, is a double sugar molecule. White sugar, brown sugar, honey, and syrups are simple carbohydrates too, but they don’t offer the same health benefits as fruit, milk, and yogurt. Spoon for spoon, most sugars and syrups have similar amounts of carb. Agave nectar is a natural carb-containing sweetener that has less impact on blood-glucose levels if used in moderation.

Desserts that contain sugar alcohol can claim to be “sugar free,” but they typically have as many carbs and calories as their sugar-containing counterparts. Chapter 12 sorts through the many sugars and alternative sweetening agents, and separates fact from fiction when it comes to carb-free sugar substitutes.

Catching up on complex carbs

Consider again the Lego analogy introduced in the preceding section. If you connect many Lego pieces together, you can build complicated structures. The same thing is true of starches; starches are complex carbs that are made out of many sugar molecules. Fiber is also considered a complex carb, but it doesn’t digest. Chapters 3 and 16 fill you in further on fiber facts.

Noting the nutrition in carb food groups

Carbohydrates are found in many healthy, nutrient-packed foods, including grains, legumes, whole-grain breads, starches, milk, yogurt, fruits, and vegetables. Beware of sweets and desserts, though. They are usually high in sugar (and oftentimes fat) and don’t offer much in terms of nutrition. Desserts and processed snack foods can contribute to weight gain and health problems if eaten in excess. Chapter 13 shows best-bet options in all food groups and even helps you figure out how to have a little dessert when you have diabetes; the key is moderation.

The term “carb” encompasses many foods, and not all carb foods are alike. Healthy carbs shouldn’t be condemned like junk-food carbs. Guilt by association isn’t fair. Give carbs a break and enjoy wholesome carb-containing foods in appropriate portions. Chapter 5 reviews carb-intake targets and reflects on established dietary guidelines.

Fruit is packed with nutrition, but you can’t ignore that it’s a simple sugar and that too much of a good thing isn’t good anymore. Fruits should be enjoyed in smaller serving sizes and one portion at a time. Chapter 11 specifically addresses fruit juice and sugary soft drinks and makes a convincing case against consuming your carbs in liquid form.

A balanced diet includes an appropriate amount of carbohydrate, protein, and fat and adequate intakes of all key vitamins and minerals. Some vitamins and minerals are found across a wide array of food choices, while other nutrients are unique to specific foods. Cutting out entire food groups cuts the nutrition in those groups. For example, vegetarians need to focus on getting adequate intakes of protein and iron. In addition, vegans must seek out vitamin B12 and calcium. When people try to avoid carbs, all kinds of nutrition red flags go up.

While focusing on carbohydrate is important, don’t lose track of the overall quality of your diet. Learn to make choices that are good for your heart, weight, and health. Check out Chapter 13 for more information about eating for health and happiness.

Acknowledging that staying healthy isn’t just about carbs

Diabetes requires that you control carbohydrates, but that isn’t the whole story. Keeping healthy means eating smart for your weight and heart (see Chapter 16); learning to identify the perfect proteins and the heart-healthiest fats and oils (see Chapter 13); and putting together balanced meals (see Chapter 8 and Part 5). A balanced diet not only assures nutritional needs are met, but blood glucose is also easier to control when meals have appropriate amounts of carbohydrate, protein, and fat.

Physical fitness plays an essential role in overall health. While exercise is encouraged for everyone, there are diabetes-related considerations and safety tips to be aware of (check out Chapter 14).

Making the Case for Carb Counting: To Count or Not to Count?

Whether you loosely manage your carbs or strictly count them depends on your situation. Carb counting is the gold standard if you have type 1 diabetes, but people with type 2 diabetes also stand to benefit from knowing how to count carbs. Establishing carb budgets and adhering to those budgets is one method of managing blood-glucose levels while simultaneously controlling calories and managing weight.

Counting carbs with type 1 diabetes: An essential tool

When you count carbs accurately, you know exactly how much glucose is going to end up in your bloodstream. Insulin doses can be adjusted to cover that amount of carb. People with type 1 diabetes don’t make any of their own insulin. If insulin doses are based on carbohydrate intakes, counting carbs as precisely as possible is really important. It takes a little extra time initially, but with experience it gets easier and quicker. Label reading and carb-counting fundamentals are covered in Chapters 7 and 8. See Chapter 9 to add Internet tools to your carb-counting tool chest. For a deeper understanding of the dietary variables that affect blood-glucose readings, check out Chapter 10, and to find out how to line up insulin timing with digestion timing, see Chapter 6.

THE EFFECTS OF CARB COUNTING WITH TYPE 1 DIABETES

Coral took one unit of rapid-acting insulin for every 15 grams of carbohydrate. She hadn’t been completely satisfied with the results. Sometimes her blood-glucose levels were higher or lower than expected. Upon close inspection we identified several issues:

• She was putting in effort but had gaps in her accuracy. She never counted the carbs in nonstarchy vegetables, such as green beans and broccoli. Coral was diagnosed at age 9, and at that time she didn’t really eat many vegetables, so her diabetes team told her family that vegetables were “free.”

• Another issue: No one had ever told her to subtract the fiber from the total carbohydrate when reading food labels. She’s now 28 years old and eating lots of vegetables and whole grains. After nearly 20 years of diabetes, she felt a measuring cup wasn’t needed. What she had been calling “one cup” of rice had gradually grown in size. She was easily having 1⅓ to 1½ cups, thinking it was just a cup. Inaccuracies in carb counting meant she wasn’t getting the right doses of insulin.

After our visit she went home, implemented the tips, and returned for follow-up three months later. Her blood-glucose levels had improved and were more predictable, so she felt safer and more confident. We explored how to further hone accuracy with a food scale, and we identified apps and online resources to count the carbs in mixed dishes and ethnic foods.

Gaining tighter control over blood-glucose levels with type 2 diabetes

Type 2 diabetes is characterized by insulin resistance. The body has insulin, but the insulin doesn’t work as well as it should. For better blood-glucose control, strive to spread carbohydrate intake between three meals and perhaps one or two small snacks per day. Chapter 22 offers snack ideas.

People who skip breakfast or lunch often end up eating too much in the evening. Big meals with lots of carbohydrate can derail glucose control. There are several ways to set portion limits. The plate model puts perspective on portioning and is a simple visual tool. The carb portioning and counting fundamentals covered in Chapter 8 aren’t reserved for people on insulin. Carb counting is an option for anyone who wants to accurately control carb portions.

Sticking with consistent carb counts when you’re on set insulin doses

Do you check your blood-glucose level at mealtime and then refer to an insulin chart to determine what your dose should be? That insulin dosing method is called sliding-scale insulin. The dose goes up incrementally for higher blood-glucose readings. Some individuals are on set insulin doses at mealtimes. In other words, the dose of insulin is the same from one day to the next regardless of blood-glucose levels.

The problem with sliding-scale insulin dosing and set insulin dosing is that they don’t take into consideration what you are planning to eat. The carbs in the pending meal will determine how much more glucose enters the bloodstream. Consider a low-carb salad for lunch one day and a burrito the next day. The two meals contain very different amounts of carbohydrate, but sliding-scale or set insulin dosing doesn’t take that carb variability into consideration. These insulin dosing plans require mealtime carb intakes to be consistent from one day to the next.

Establish mealtime carb targets (with the help of Chapters 5 and 6). You can vary your food choices daily but keep the carb amounts consistent. Sample menus for breakfast, lunch, and dinner with set carb amounts are found in Chapters 19, 20, and 21.

Set insulin dosing and sliding-scale insulin dosing aren’t ideal for type 1 diabetes but may suffice for some people with type 2 diabetes. Talk to your healthcare providers to determine a safe and effective insulin dosing plan for you.

Managing weight with carb counting and portion precision

Counting carbs and eating appropriate amounts at meals and snacks helps with weight control. When you adhere to budgeted amounts of carbs at mealtimes and snacks, you are automatically putting a cap on portion sizes for fruit, bread, grains, starches, cereals, milk, yogurt, sweets, and many other items. Controlling carb portions helps with blood-glucose control and weight management. Here are some pointers:

❯❯ Use the Exchange Lists in Appendix A to choose lean proteins and limit mealtime protein portions to the size of the palm of your hand.

❯❯ Choose lower-fat cooking methods and limit added fats.

❯❯ Eat plenty of vegetables and salads.

The benefits are cumulative. Controlling portions helps with weight loss; losing weight improves insulin action; better-working insulin improves blood-glucose control; and controlling diabetes and weight lowers your risk of heart disease! For more tips on eating smart for your weight and heart, see Chapter 16.

EXPLORING THE GLYCEMIC INDEX

The glycemic index (GI) is a tool to measure how individual foods are expected to impact blood-glucose levels. The basic concept may be used in addition to carb counting and other carb management strategies. It’s true that not all carb foods affect blood glucose in the same manner, which is why pizza isn’t used to treat hypoglycemia. Liquids move through the stomach quickly, so the sugars in juice and soda show up in the bloodstream in a matter of minutes. That’s just what you need if you’re trying to treat hypoglycemia. Juice isn’t what you need if blood-glucose levels are already running high.

Instead of deferring to a chart to choose from low, medium, or high GI foods, it pays to get to the bottom of why foods behave the way they do (check out Chapter 10). With a solid grasp of the concepts, you can make food choices work in your favor. For example, whole grains and legumes have fiber and a lower glycemic index than white refined grains and breads. Meals that contain fiber and balanced amounts of carbohydrate, protein, and fat produce a blunter blood-glucose rise and more stability in blood-glucose levels.

Regulating Carb Intakes

The human body relies on glucose to fuel many functions. The biggest user of this essential fuel is the brain. The minimum recommended intake for carbohydrate is 130 grams of carb per day, whether you are 1, 10, or 100 years old. Who says and why? The National Institutes of Health establish nutrient intake guidelines. The guidelines on carbohydrate intake assure adequacy for vital functions and baseline needs. Actual intake should be assessed individually, as discussed in the following sections.

Figuring out how much carb you need

Glucose is an important fuel for the human body. You can’t live without it. The brain requires a steady supply of glucose around the clock and lifelong. Glucose is the preferred fuel source for muscles and other tissues. Foods supply glucose and other nutrients.

Carbohydrate requirements depend on age, gender, height, weight, and level of physical activity. Use Chapter 5 to assess your body mass index (BMI) and weight status. Estimate your daily caloric needs. Choose a daily carbohydrate budget based on calorie goals and personal preference.

Timing your carb intake

There’s something to be said about proper meal spacing. If meals are too close together, blood-glucose levels can climb. If meals are too far apart, appetite can overtake willpower and make portion control difficult. Going to bed on a full stomach can lead to elevated glucose levels overnight and into the next day. Try having dinner at least three hours before going to bed. Eat three main meals four to six hours apart. Tuck in a snack if needed to curb appetite or to supply energy for exercise. Determine how to divvy up the carbs among meals and snacks to regulate appetite and blood-glucose levels in Chapter 6.

Matching insulin timing to digestion timing takes a bit more finesse. It’s critical to understand onset, peak, and duration profiles for the insulins you use. Chapter 6 reviews insulin action times. Chapter 10 looks at the variables that affect digestion timing. Some foods digest quickly (liquids, simple sugars, and refined grains), while others digest more slowly (whole grains, foods with fiber, and meals higher in protein and fat).

Counting Carbs Successfully

Make use of the many carb-counting resources available to you. The following sections introduce food labels, food lists, menus, brochures, apps, websites, and more.

Looking at the label lingo

Nutrition details are clearly marked on packaged foods. Look for the Nutrition Facts food label. First, identify the serving size. The calories, total carbohydrate, fiber, and everything else on the label refers to “one serving,” not necessarily the whole package. Did you know that fiber isn’t digestible so you can subtract it from the total carbohydrates to get a more accurate carb count?

Tune in to Chapter 7 to sharpen your supermarket savvy and find out all about food labels. You can even take a sneak peek at the new look; the food label is undergoing a makeover.

Gathering carb-counting resources

Some of the most nutritious foods are harvested, not manufactured. Don’t let the lack of a label keep you from reaching for wholesome foods. You can still closely estimate carbohydrate counts in fruits, vegetables, legumes, and grains with food composition lists (see Chapter 8 and Appendix A). The Exchange List concept groups foods by macronutrient composition; the items on a list have similar amounts of carbohydrate, protein, and fat. Every item on the fruit list, for example, identifies a portion size that equals 15 grams of carbohydrate: A small apple or orange, 17 grapes, 1 cup of cantaloupe or raspberries, or ½ banana all provide the same amount of carbohydrate. Variety isn’t only the spice of life; it’s also a great way to assure you get a wide array of important nutrients.

Measuring cups are essential for accuracy. Cooking from scratch? No problem! Chapter 8 also walks you through figuring out how to calculate carbs in your homemade recipes. Add tools to your carb-counting tool chest by tapping into online resources (flip to Chapter 9).

Increasing carb-counting accuracy

With type 1 diabetes, insulin doses must be carefully matched to carbohydrate intakes. Once you’ve mastered carb counting 101 (food labels and carb-counting lists), you’re ready for more advanced carb-counting strategies.

A food scale can verify exact carb counts on numerous foods, including fruits. By weighing foods occasionally, you’ll hone your ability to accurately estimate carbs in the future. Chapter 8 provides a list identifying the number of grams of carb per ounce of fruit. Weighing nails the carb counts in baked potatoes or a chunk of French bread.

Apps and web-based food databases offer nutrition facts on ethnic foods and combination foods, including pizza and lasagna. Chapter 9 describes how to combine the technologies: your food scale and a food database or app. Weigh your food item – a tamale, for example – and then plug the weight of your tamale into the food database to get an exact carb count on the item you’re about to eat. There is no need to do this for every food every time, but it sure helps to improve your ability to guestimate more accurately in the future.

Living Well with Diabetes: The Seven Pillars of Diabetes Management

Eating for health and happiness and reaping the rewards of fitness should be a lifelong commitment through all ages and stages of life. The following sections cover these and the other pillars of diabetes management.

We are all responsible for what we think, what we say, and what we do.

Eating a healthy diet

Food should be a positive part of creating and maintaining health, and it should be something to enjoy and savor too! Chapter 13 provides pointers for choosing the foods that promote health and wellness: colorful fruits and vegetables, whole grains, legumes, nuts, lean proteins, fish, vegetarian protein alternatives, heart-healthy fats, and dairy foods (or nondairy substitutes).

If you eat wholesome foods in appropriate portions, you’ll have the right recipe for health. This book provides you with a deeper understanding of how food choices affect your diabetes, weight, blood pressure, cholesterol, and cardiovascular health.

If you have celiac disease or gluten intolerance, it’s time to go gluten-free all the way. Chapter 18 provides details.

GIVING THOUGHT TO GOING GLUTEN-FREE

Gluten is a protein found in wheat, rye, and barley. Celiac disease inflicts intestinal damage if gluten-containing foods are consumed. The treatment is strict, lifelong avoidance of all sources of gluten, no matter how minute. Exposure to even a crumb can damage the linings of the intestine, impair nutrient absorption, and cause numerous diseases related to vitamin and mineral deficiencies.

People with type 1 diabetes have an increased risk of celiac disease because both diseases are autoimmune disorders. Whether you’re avoiding gluten because of celiac disease, wheat allergy, gluten sensitivity, or preference, Chapter 18 provides the information you need to get started.

Staying fit with exercise

Exercise has long been recognized as a foundation therapy in the treatment of type 2 diabetes. If you have prediabetes, exercise coupled with moderate weight loss has been shown to prevent or delay the onset of type 2 diabetes.

Everyone can cash in on multiple health benefits related to physical fitness. Exercise helps with weight control, improves blood pressure and cholesterol, strengthens bones and improves circulation, relieves stress, and improves sleep. No one comes back from an exercise session saying, “I wish I hadn’t done that!” On the contrary, most people feel better and actually think, “I’m so glad I did that! I’ll have to do that more often!”

If you aren’t currently engaged in regular exercise, start by building more activity into your usual day. Don’t sit for hours on end. Get up and move around. You can decide whether you move for one minute or for ten minutes. The first step is simply taking the first step. Walk while talking on your mobile phone. Do leg lifts and use hand weights while watching television. Put on some music and dance in your living room. Join an exercise class or a water aerobics group. Chapter 14 can help you get off on the right foot with fitness. The chapter also provides guidelines for building a safe exercise regimen.

Taking your medication

People with type 1 diabetes rely on insulin for life. Prior to 1921 when insulin was first discovered and made available for use, type 1 diabetes was a fatal disease. Insulin is essential for transporting glucose (fuel) into cells. Chapter 6 explains the importance of matching insulin doses with carbohydrate intakes. Take all insulin doses as prescribed. Insulin omission can lead to diabetic ketoacidosis, which is a potentially life-threatening condition. Look at the physiology behind the process in Chapter 4.

Insulin isn’t just for treating type 1 diabetes; many people with type 2 diabetes use insulin to manage their diabetes. Type 2 diabetes is a state of insulin resistance and oftentimes a concurrent deficiency in insulin production. When diet and exercise fail to adequately control glucose levels, medications are required. There are several classes of diabetes medications. Some stimulate insulin production, while others improve the way insulin works. Medications can decrease the amount of glucose released by the liver, increase the amount of glucose excreted in the urine, or delay the digestion of glucose. Whether it takes one medication or multiple medications, the goal is blood-glucose control because that’s how you prevent complications.

Some people struggle with medication adherence. It may be due to the number of medications prescribed or the dosing schedule. Pill caddies that separate morning and evening doses assist with remembering meds. Another reason for missing meds is simply a lack of perceived benefit. Many people with diabetes feel fine. Feeling good is important, but knowing your ABCs is important. That means know your A1C, Blood pressure, and Cholesterol results. Those numbers are a window into what is happening in your body.

There is no denying that well-controlled diabetes and cardiovascular health have big payoffs. If you wait until you feel bad before you decide to adhere to the medication regimen prescribed, you might wait too long. Discuss any side effects with your provider. Your doctor can decide whether a different dose or a different medication would be more appropriate.

Monitoring your blood-glucose levels

Home blood-glucose monitors are amazing little machines. Apply a tiny droplet of blood, and within five seconds, you know the result. Glucose meters have been available for home use only since the 1980s. In the scope of things, that’s a relatively short period of time. Prior to glucose monitoring, people with diabetes checked their urine glucose levels, which was a grossly inaccurate way to attempt to evaluate blood-glucose levels. Back in the diabetes “dark ages,” people didn’t have the tools and technologies to safely manage diabetes, so some people developed complications.

Monitoring your blood glucose and knowing how to respond to those numbers can greatly reduce the risks of diabetes-related complications. Ask your healthcare provider how often you should check and what your targets are. Keep records and share the results with your diabetes team. Diabetes management decisions are based on glucose results. When your numbers aren’t in target ranges, don’t get discouraged. There’s no such thing as good numbers or bad numbers. All numbers are useful. Managing diabetes is somewhat like solving a puzzle; each and every piece of the puzzle is important.

Chapter 23 provides tips on glucose monitoring and takes a look at another glucose measurement, A1C, which provides information on your average glucose control for the previous three-month period.

Managing stress

Most people encounter stressful situations from time to time. Finding healthy ways to cope with stress before small problems fester, grow, and get out of hand is important. If stress goes unchecked, it can contribute to anxiety, low mood, a feeling of hopelessness, or depression. Chronic conditions such as diabetes can contribute to stress and may have an additive effect to life’s other challenges. Talking about it helps. Confide in friends, family, support groups, and your diabetes healthcare team.

Physical activity is a wonderful outlet. Exercise increases natural chemicals that improve mood. Hobbies, arts, crafts, volunteer work, and faith-based gatherings are other positive ways to relieve pressure and boost mood. When you’re feeling blue, think about some of your favorite people and your best memories. Keep the self-talk in your head positive. Don’t focus on your shortcomings; recount your successes instead.

If you can’t shake the funk and the stress is preventing you from taking care of yourself, seek the help of a mental-health specialist.

Discovering how to problem-solve

Part of diabetes self-management is understanding how to assess a situation and decide the best course of action. Understanding cause and effect allows you to make adjustments to steer outcomes in the direction you desire. When something goes awry, reflect carefully on the chain of events that led up to the issue. If you can decipher the cause, you can formulate a solution. Over time you gain experience, which makes it easier to predict outcomes and make adjustments to your diabetes care. Your diabetes team can help you learn how to make informed decisions. There will still be things that happen unexpectedly from time to time because that’s just how life is. You can’t plan for all scenarios, but you can be prepared for most.

Problem-solving means reflecting and trying to figure out why things didn’t go as planned. Formulate a new plan or make adjustments to the old plan. Execute your plan, pay attention, and see whether things improve.

Reducing risk with healthy behaviors and regular medical checkups

Taking care of your diabetes is an investment in your future health and quality of life. Diabetes complications are preventable. Follow these guidelines:

❯❯ Eat right and exercise.

❯❯ Don’t smoke. Smokers are more likely to develop serious diabetes-related complications.

❯❯ Limit alcohol. Alcohol can cause profound hypoglycemia for some people with diabetes (see Chapter 11).

❯❯ Stay up to date on medical visits and health screenings.

❯❯ Get a handle on hypertension. High blood pressure increases the risk of health problems because it can damage small and large blood vessels.

❯❯ Have the necessary bloodwork needed to monitor diabetes, heart health, and other medical conditions.

❯❯ See your doctor regularly (every three months or as your doctor advises).

❯❯ Get your flu shot and have your eyes and kidneys checked annually.

❯❯ Keeping healthy will keep you happy, so show your smile to your dentist at least every six months.