Diabetes Management

Insulin resistance

Type 2 diabetes is a metabolic disorder in which your
body can’t properly use or make enough insulin. Your pancreas produces
insulin, which transports glucose into the cells of your body. If you
don’t produce enough insulin or your cells are resistant to insulin,
the glucose levels rise in your blood stream, resulting in diabetes.

Why is it so bad to have an elevated
blood glucose?

At high levels, glucose is toxic to your blood vessels.
Diabetes is so devastating because it causes vascular disease to your
entire body. Blood vessels become narrowed, kinked and full of plaque.
Complications include:

  • Blindness due to retinal damage
  • Heart disease/failure due to coronary artery disease. If you
    have diabetes, you’re risk of having a heart attack is the same
    as a person who’s already had one.
  • Kidney failure due to damaged blood flow in the renal arteries
  • Pain and numbness in the legs due to damaged nerves.
  • Sexual dysfunction due to compromised blood flow in the genital
    area.

What can I do to decrease my risk of diabetic
complications?

The number one goal of treatment is to protect your
heart and vascular system as the leading cause of death from diabetes
is a heart attack. Goals of treatment involve lowering blood pressure,
cholesterol, weight, and blood sugar. The most important thing you can
do is to lower your insulin resistance (take the load off your pancreas)
by losing weight and exercising. Set a goal of lowering your BMI (Body
Mass Index) to <27. Go to www.americanheart.org
to calculate your BMI. If you smoke, get help to quit immediately.

Recommendations for meal planning

The goal of dietary treatment is to eat foods with a
low glycemic (sugar) index. In other words, you want to eat foods that
don’t raise blood sugar, which are foods that are metabolized more slowly.
The higher the fiber in a food, the lower the glycemic index. Foods
that have a low glycemic index include whole grains, nuts, legumes,
vegetables, fruits (in moderation), lean meats and dairy. Starchy and
sugary foods such as sweets, breads, tortillas, potatoes, corn, rice
and pasta are high glycemic foods. These starches are quickly converted
into glucose, raising blood sugar and causing increased work for your
pancreas. See your diabetes educator for more specific meal planning.
Check out the links below for nutritional and dietary planning.

Medications

Medications may be recommended if diet and weight loss
alone do not normalize your blood sugar. Many medications work to improve
the function of your pancreas and are usually well tolerated. Certain
medications can abruptly drop blood sugar levels, causing hypoglycemia.
If you develop hyppoglycemia (blood sugar <80) you may feel anxious,
nauseated, clammy, lightheaded or tired. Check your blood sugar if you
feel you may be having a hypoglycemic episode. If your blood sugar is
<80, then take 15 grams of carbohydrates (5 life savers or ½ cup of
juice). Wait 15 minutes, then recheck your blood sugar. You may repeat
the 15 grams of carbohydrates if your blood sugar does not rise to 80.
Notify your health care provider if you are developing hypoglycemia.
If your blood sugar has not been controlled for a while and you have
begun treatment you may feel like you are having hypoglycemia, even
though your blood sugar levels are not low. These episodes will resolve
as your body adjusts to having overall lower levels of glucose.

Health goals

To prevent diabetic complications you will need to control
your weight, blood pressure, cholesterol and blood sugar. See the chart
below. If you are using tobacco, you absolutely must stop as nicotine
dramatically increases vascular disease. Talk to your health care provider
about getting help for tobacco cessation.

 Goal My Value
Fasting blood sugar <110
Two hour post-prandial blood sugar (after eating) <140
HgbA1C (3 month average) <6.5
LDL Cholesterol <70
HDL Cholesterol >50
Triglycerides >150
Urine microalbumin (kidney function test) >20
Blood Pressure >130/80
Weight/BMI (Body Mass Index) <27
Eye exam by ophthalmologist Annual
Dental exam/cleaning to prevent
gingivitis
Every 6 months
Flu Shot Annual
Foot exam Annual
Exercise 30-60 minutes 5-7 times/week

Links

www.ndep.nih.gov

www.DiabetesAction.org