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What Is Diabetes Type II?
Nearly 16 million people in the United States -- nearly one out of every 17 people -- have diabetes. And about 2,150 new cases are
diagnosed each day. Technically this disease is known as "diabetes mellitus," diabetes from the Greek for siphon, to describe the
excessive thirst and urination chracteristic of this condition, and mellitus from the Latin for honey -- diabetic urine is filled with sugar
and is sweet. Physicians and medical books use the term diabetes mellitus, but colloquially, this disease is simply called diabetes.
There are many types of diabetes, but the three most common are: type 1, type 2, and gestational diabetes. All of them are a little
different. But everyone with diabetes has one thing in common: Little or no ability to move sugar -- or glucose -- out of their blood into
their cells, where it is the body's primary fuel. Everyone has glucose in their blood, whether or not they have diabetes. This glucose comes
from food. When we eat, the digestive process breaks down carbohydrates into glucose, which is absorbed into the blood in the small
intestine. People who don't have diabetes rely on insulin, a hormone made in the pancreas, to move glucose from the blood into the body's
billions of cells. But people who have diabetes either don't produce insulin or can't efficiently use the insulin they produce. Without
insulin, they can't move glucose into their cells. Glucose accumulates in the blood -- a condition called hyperglycemia ("hyper" = too
much, "glycemia" = glucose in the blood).
Hyperglycemia causes intense thirst, the need to urinate frequently, blurred vision, fatigue, and other symptoms. Over time, high blood
glucose can cause very serious medical problems. These problems, diabetic complications, include: Heart disease, stroke, and blood
vessel (cardiovascular) diseases. Cardiovascular disease is by far the leading cause of death in the U.S., but compared with nondiabetics,
people with diabetes are at much higher risk. Kidney disease. This can also be fatal. Eye diseases. Diabetes is a leading cause of
blindness. Nervous system disorders. These may interfere with the ability to sense pain, and contribute to serious infections, particularly
in the feet and legs.
Adding up the total toll of diabetes complications, the disease is one of the nation's leading causes of death. But don't despair. All diabetes
complications can be largely prevented by practicing what is known as "tight control," keeping your blood glucose level as close to
normal as possible. This takes time and energy, but many diabetics do it successfully and live full lives without much trouble.
Scientists don't know exactly what causes diabetes, but it appears to result from a combination of genetics and environmental factors,
including viral infections, poor diet, and sedentary lifestyle. Currently, there is no cure for diabetes, but the good news is that the disease
can be managed. People with diabetes can live rich, happy lives
Type 2 or NonInsulin Dependent Diabetes Mellitus (NIDDM) What is it?
Ninety to ninety-five percent of people with diabetes have type 2 disease. Type 2 diabetics produce insulin, but the cells in their bodies
are "insulin resistant" -- they don't respond properly to the hormone, so glucose accumulates in their blood. Insulin resistance increases
as weight increases and physical activity decreases. Many people with type 2 diabetes have sedentary lifestyles, and are obese -- they
weigh at least 20 percent more than what's recommended for their height and build. Some people with type 2 diabetes must inject insulin,
but most can control the disease through a combination of weight loss, exercise, and prescription oral diabetes medication.
Risk factors Genetics. Like type 1 diabetes, type 2 disease also runs in families. Age. Most people diagnosed with type 2 are over 30
years old. Half of all new cases are aged 55 and older. Race/Ethnicity. Compared with whites and Asians, type 2 diabetes is more
common among Native Americans, African Americans, and Hispanics. Being overweight or obese. Insulin resistance increases with
weight. Sedentary lifestyle. Insulin resistance increases with lack of exercise. Women who have had gestational diabetes. Previous
gestational diabetes increases risk of type 2 diabetes years later. Women who have given birth to babies weighing 9 pounds or more.
What causes it?
Scientists are not certain, but like type 1 diabetes, type 2 disease also runs in families, which suggests some genetic component. In fact, a
genetic link seems even stronger in type 2 diabetes than in type 1. Scientists have not yet put their finger on a single gene that causes the
disease, but they are finding errors in several that may contribute to the disease. Researchers also suspect a genetic susceptibility to
obesity. Obesity is the single most important cause of type 2 diabetes. Definitions of obesity differ, but in general, you're obese if you
weigh at least 20 percent more than what's recommended for your height and build. Three-quarters of type 2 diabetics are overweight.
For reasons that remain unclear, carrying excess body fat somehow causes insulin resistance. That's why type 2 diabetes is usually treated
with diet and exercise. Dropping weight and gaining muscle helps the body use insulin more efficiently. Where you carry your weight is
as important as how much you carry. People who carry their fat above their hips ("apple shape") have a greater risk of developing type 2
diabetes than those who carry it on their hips ("pear shape").
Age also plays a role in type 2 diabetes. Half of all new diagnoses are in people over 55, and nearly 11 percent of Americans aged 65 to
74 have type 2 diabetes. However, it's not clear whether age, per se, is a cause of type 2 diabetes, or simply a reflection of the fact that
people tend to gain weight and become less physically active as they grow older.
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Blood Glucose Testing
The amount of glucose in your blood changes throughout the day. If your blood glucose level rises too high or falls too low, you could
develop some potentially serious complications. No matter which type of diabetes you have -- type 2 insulin-dependent, type 2 noninsulin-dependent, or gestational -- the single best way to manage your condition is to monitor the amount of glucose in your blood. Do it
at least once if not several times a day.
There are no magic formulas to tell you how your individual blood glucose level responds to food, insulin, exercise, illness and other
stress. Everyone is different. That's why you test -- to become more familiar with your individual blood glucose patterns. When you test
frequently and maintain normal glucose levels you feel a whole lot healthier and can do almost anything you want to do. Who Needs to
Test? Everyone who has diabetes should monitor their blood glucose levels by self-testing. If you have type 2 or gestational diabetes and
manage it with oral medication, or a diet-exercise plan, testing is still just as important. It will help you fine-tune the amount of
medication, food, and exercise you need. And as your blood glucose control improves, self-testing gives you positive feedback about
your progress toward the goal of diabetes self-management – tight blood glucose control, which minimizes risk of all the disease's
chronic complications.
How Often Should You Test?
We will suggest that to you .But remember: studies including the landmark Diabetes Control and Complications Trial have shown a
strong relationship between the number of daily self-tests and tight blood glucose control. The more often you test, the tighter your
control becomes.
In people with type 1 diabetes, blood glucose levels can fluctuate considerably during the day. If you're trying to keep your glucose as
close as possible to normal, then you need to test four or five times a day -- before each meal, before bedtime, and in the middle of the
night (around 3 a.m.) once a week.
But if you're on a less intensive self-testing schedule, one aimed largely at preventing high blood glucose (hyperglycemia) and its acute
complication (ketoacidosis), you may only need to test twice a day.
However, consider this: studies have shown that when self-monitoring drops to less than four tests a day, blood glucose control almost
always worsens, which increases risk of developing diabetes' serious complications. Whether you decide to test a lot or a little, diabetes
educators strongly urge everyone with diabetes type 1 at least to test before meals. It allows you to gauge how much insulin you need as
well as how much food you should eat to avoid hyper- and hypoglycemic reactions.
Compared with type 1 diabetics, people who have type 2 diabetes generally have more stable, less fluctuating blood glucose levels, and
don't need to self-test as often. But diabetes educators warn that type 2 diabetics can also have high blood glucose levels and still feel fine,
which left unnoticed can cause serious problems.
How often you test depends on how often you're willing to prick your finger, what your schedule permits, and how much you can afford
to spend on supplies. Sometimes you may not feel quite right and not know why. Checking your blood glucose may tell you what the
problem is. But be careful: some type 2 diabetics believe they can tell their blood glucose level by the way they feel, but studies have
shown that very few people can guess their glucose level accurately. When in doubt, test. When diet or activity levels change, or when
you're ill or under other stress, test more frequently.
When Should You Test?
We will usually suggest this to you. But if you are trying to fine-tune your glucose control, here are the best times to test:
Before meals Before bed One to two hours after meals At 2 a.m. or 3 a.m. at least once a week
Sometimes you should do extra tests: When you're sick If you suspect you may have low blood glucose Before you drive When you're
physically active If you wake up with high or low blood glucose levels When you change your insulin regimen, medication, diet, or
exercise After you've lost or gained weight When you're pregnant or thinking about getting pregnant When you're on intensive insulin
therapy When you have trouble recognizing the warning signs of hypoglycemia
How To Test
Most blood glucose monitors come with clear instructions on how to use them. However, you should have a certified diabetes educator
show you how to test your blood glucose level to make sure you're not making any mistakes. When done correctly, it's practically
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painless. If you don't know where to find a certified diabetes educator in your area, call the National Association of Diabetes Educators
at (800) 832-6874, and they'll refer you to someone.
What to Do With the Results
Every time you take a reading, write it down. In fact, you should write down everything that affects your blood glucose levels: what and
how much you eat, what kind of exercise you're getting, whether you've been sick or stressed out. Everything. Diabetes educators say that
keeping a diabetes diary like this will help you fine tune your glucose control and help your health team figure out what's wrong should
your glucose levels go haywire. The patterns in your blood glucose readings provide clues about your diabetes control. The only way to
see the patterns is to record the results. Sometimes you might find an unexpected high or low reading. Try to figure out why. Experiment.
Eat an extra piece of chicken or walk an extra mile and see what that does to your blood glucose level.
Sometimes self-monitoring can be frustrating. Your reading may be surprisingly high or low for no apparent reason. Keep testing. Keep
trying to make sense of your results. Trial and error -- and an extra helping of patience -- can help you achieve good control now and in
the years to come.
Products to Help Maintain Tight Control
To master your diabetes, you must become familiar with the supplies that help you keep your diabetes under control. The most
comprehensive guide to diabetes supplies is the ADA's Buyers Guide to Diabetes Supplies published every October in Diabetes Forecast
Magazine. The guide lists and describes every diabetes care tool in the market. To order a copy, call 1-800-232-6733.
Blood Glucose Meters and Test Strips
Blood glucose meters tell you how much glucose is in your blood. Armed with this information, you can fine-tune your
insulin,medication, diet, and exercise regimens to stay in tight control. There are many meters on the market. All of them use either color
or current to measure blood glucose levels:
Cost. Your blood glucose meter may be covered by your insurance company, but it may not. Check before you buy. In addition to the
price tag on the meter, check the cost of supplies that meter uses. Over time, the test strips and other equipment prove more costly than the
meter itself.
Ease of use. Some meters are easier to use than others. Some require a smaller drop of blood, have fewer buttons to push, or less time to
read your glucose level. Try several meters before you buy.
Accuracy. Make sure your glucose meter tells you exactly how much glucose you have in your blood. Test your meter's accuracy at least
once a month. Poor readings can occur if your meter is dirty, old, outdated, or has been stored in a harsh environment. Cleaning and
maintenance. No meter is indestructible. Some need more cleaning and maintenance than others.
Portability. All of today's meters weigh less than a pound and run on batteries, so they're all very portable.
Test time. All meters give quick results, usually in less than two minutes. However, you still might want to compare speeds of different
meters.
Lancets usually come with blood glucose kits. Most come with short and long lancet covers to allow for different degrees of penetration.
First-time users, children, and people with delicate skin should try a longer cover that prevents the lancet from penetrating too deeply.
People who have tougher skin or poor circulation should choose a shorter cover for deeper penetration.
Finger-stick devices have different methods for resetting them. Some require the user to manually push the lancet back into position.
Others do this automatically with the flip of a lever. The latter may be better for children or people with coordination problems.
Diet: How Does Carbohydrate Counting Work?
To understand how carb counting works, you have to understand how glucose gets into your blood in the first place. Let's say you just
devoured a juicy cheeseburger and washed it down a big vanilla milkshake. Most of this food will eventually end up in your blood as
glucose. But how much, when, and how fast?
Research shows that very little of the fat you eat is converted into glucose. Some of the protein you eat is converted into glucose,but very
slowly.By contrast, within an hour or so more than 90 percent of the carbohydrate you eat becomes glucose. This means that when you
test your blood one to two hours after a meal, most of the rise in blood glucose that you see comes from the carbohydrate you ate.
Carb counting assumes that if you know how much carbohydrate you eat, you can predict where your blood glucose level is headed. If
you eat a little carbohydrate, your blood sugar rises a little. If you eat a lot of carbohydrate, your blood sugar shoots up a lot.As you
probably already know, insulin balances glucose. So one way to control your blood glucose levels is to match insulin to carbohydrate.
This is exactly what carb counters do.
How To Get Started: To make carb counting work, you need to do three things:
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If you do not already, you will need to test your blood glucose several times a day and record your blood glucose (BG) levels before and
after every meal. You need to start measuring the amount of carbohydrate in your meals. You need to keep clear, accurate records of the
following: Times and results of your BG readings All food eaten (calculated in grams of carbohydrate) Time of meals and snacks Time,
type, and dose of insulin or oral medications Type, duration, and intensity of exercise Any additional influences on BG level, such as
illness, stress, and menstrual period.
At first, this is a hassle. But nothing worthwhile is ever easy. And in time, all this becomes habit. Keeping accurate records helps you
piece together exactly how your lifestyle affects your diabetes. And this, in turn, enables you to minimize the effects of diabetes on your
lifestyle.
Step 1: Make a Meal Plan
You should limit your total carbs to 224 gm for an 1800 Calorie Diet and 179 gm for a 1500 Calorie Diet. While what you eat is up to
you, you should try to eat the same amount of carbohydrate at each meal or snack whether you are on medication or not. When the
amount of carbohydrate you eat changes significantly, your blood sugar levels become harder to predict.
A word of warning: Carb counting gives you more freedom to choose what you eat, but if you concentrate only on how much
carbohydrate you're eating while ignoring fat and protein, you may gain weight. If you're trying to lose or maintain weight, you'll want to
limit the total number of calories you eat. You'll also want to watch your fat intake, especially saturated fat. Saturated fat is the stuff that
clogs your arteries, putting you at higher risk of a heart attack, by far the leading cause of death among diabetics. The less
saturated fat in your diet, the better. Also, dietitians recommend that you eat at least three to five servings of vegetables and two servings
of fruit each as part of your daily carbohydrate choices to maintain good nutrition.
Step 2: Measure the Carbs
Learn how many grams of carbohydrate are in the foods you eat. Exchange lists are a good place to start. They list the rough carbohydrate
content for specific measurements of foods. To obtain exchange lists, ask your dietitian, or call the American Diabetes Association, which
publishes several books on the subject.
The secret of carb counting is figuring out how much carbohydrate is in one portion of what you're eating. (Eventually you'll be adjusting
your insulin according to what you eat, so you'll need to learn to do this precisely.)
One way is to figure this out is to look at the exchange lists. On these lists a single portion is equal to 15 grams of carbohydrate, or one
carbohydrate choice. Another way is to look at the "Nutrition Facts" label on food packages. Nutritional labels list the number of grams
of carbohydrate in one serving of that food.
Then you will need to weigh or measure your food to see whether what you're eating is the same size as the serving listed on the package
or exchange list. If it's not, you'll have to figure out how much more or less carbohydrate you're eating. Remember: What you consider a
"serving" may not always equal what the food label or exchange list calls one serving. Be sure to calculate your carbohydrate according to
what you eat.
To measure your food, you need measuring cups, spoons, and a food scale. Measuring cups and spoons measure the volume of foods.
Scales measure the weight. Your dietitian can help you choose the equipment you need and teach you how to use it. It takes time, effort,
and practice to learn portion sizes. Sure, it's a hassle, but once you get used to gauging portion sizes, you'll be able to eyeball foods and
won't have to measure everything every time you eat. Usually it takes several weeks of measuring, recording, and calculating to become
comfortable with carb counting.
Once you've got lists of the carbohydrate content of various foods and you've practiced eyeballing portion sizes of a wide variety of
foods, you're ready to start calculating your own insulin-to-carbohydrate ratio.
References for Advanced Carb Counting
If you want to find out more about carb counting, or find a dietitian or a diabetes educator in your area, call:
The American Dietetic Association (800) 366-1655 www.eatright.org
The American Diabetes Association (800) 232-3472
www.diabetes.org
The American Association of Diabetes Educators (800) 832-6874 www.aadenet.org
Books :
American Diabetes Association Guide to Healthy Restaurant Eating. Hope Warshaw. American Diabetes Association, 1998.
Calories and Carbohydrates. 13th ed. Barbara Kraus. Penguin, 1993.
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Carbohydrate Guide to Brand Names & Basic Foods. Barbara Kraus. The New American Library, 1992.
Exchanges For All Occasions. Marion Franz. International Diabetes Center, Inc.,1993.
Exchange Lists For Meal Planning. American DiabetesAssociation, The American Dietetic Association, 1995.
Fast Food Facts. Marion Franz. International Diabetes Center, Inc., 1994.
Food Values of Portions Commonly Used. Jean Pennington. J.B. Lippincott Co.,1994.
The Complete Book of Food Counts. Corrine Netzer. DellPublishing. 1994.
Exchange Lists group foods based on their nutrient content and place them in different categories.
Today there are seven Exchange List categories: I. Starches List Includes: cereals, grains, pasta, breads, crackers, snacks,as well as
starchy vegetables such as beans and peas.Nutrient content:
carbohydrate: 15 grams protein: 3 grams fat: 0-1 grams calories: 80
Examples: Pasta (cooked).........................1/2 cup
II. Meat and Meat Substitutes List Includes: poultry, fish, shellfish, game, beef, pork, lamb, and cheese, tofu, tempeh, low-fat cheeses,
egg whites, and soy milk. Nutrient content: carbohydrate: 0 grams
protein 7 grams fat: 3-8 grams calories: 55-100Ex. Beef........1 oz
Oysters....6 medium
III. Fruit List Includes: fresh, frozen, canned, dried, and juice.Nutrient content carbohydrate: 15 grams
grams calories: 60Ex. Banana...1/2 banana Grapes.....15 grapes
IV. Dairy List Includes: most milk products. Nutrient content: carbohydrate: 12 grams protein: 8 grams
calories: 90-150 Ex.: Whole milk...1 cup Plain nonfat yogurt.....8 oz
protein: 0 grams fat: 0
fat: 0-5 grams
V. Vegetable List Includes: most vegetables from artichoke to zucchini -- but not the starchy vegetables: lentils, potatoes, corn, peas, and
squash. They are on the starch list instead. Nutrient content: carbohydrate: 5 grams protein: 2 grams fat: 0 grams calories: 25 Ex.
Artichoke..1/2 med. Tomato..1 large
VI. Fats List Includes: monounsaturated fats, polyunsaturated fats, and saturated fats -- based on the main type of fat any food contains.
fat: 5 grams carbohydrate 0 grams protein: 0 grams calories: 45
Examples: mayonnaise.............................1 tsp.
bacon.....................................1 slice
VII. Other Carbohydrates Includes: cakes, pies, puddings, granola bars, gelatin, etc. (contain more fats and sugars and less vitamin and
mineral content than the foods found in the other categories). Nutrient content:
carbohydrate: 15 grams fat: varies protein: varies calories: varies Ex ice cream..1/2 cup Brownie 2 in square
Think of exchanges within each list as trades. A food in any exchange list can be traded for another food in the same list, and can be
expected to have virtually the same effect on you. And despite what you may have heard elsewhere, size matters, at least when it comes
to food exchanges. The number of calories, carbohydrates, fats, and other nutrients listed for each exchange list only holds true if you eat
the amount specified next to each food on the list. So you must start getting used to weighing and measuring your food. At first this often
seems like a real chore. But if you measure your food diligently for a while -- a few weeks to a few months -- you should develop an eye
for portion sizes and won't need to take out your scale and measuring cups each time you want to fix yourself a snack.
Exchange List Breakfast 3 items (group II) 2 items (group I) 2 items (group VI) Lunch 4 items (group I) 2 items (group II)
1 item (group III) 1 item (group VI) Dinner 3 items (group I) 3 items (group II) 1 item (group III) 1 item (group V) 2 ite ms (group VI)
For example: Dinner you're allowed to pick three items from the starches list, three from the meat and meat substitutes list, one from the
fruit list, one from the vegetables list, and two from the fats list.
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