Screening For and Treating Long-Term Diabetes Problems

    People with diabetes should have regular exams to help find and treat long-term diabetes problems. All long-term diabetes problems have effective treatments.

   The long-term problems that occur in people with diabetes can usually be prevented or delayed if they are found and treated at an early stage. For example, kidney disease can be slowed or prevented by controlling high blood pressure and high blood sugar and by taking special medicines. Severe eye disease can be managed by laser surgery. Problems of circulation in the legs, heart or brain can be improved by treatments that may or may not involve surgery. These examples show that it is important for people with diabetes to be treated for diabetes problems at any stage of the disease to prevent the problems from getting worse.

   All people with diabetes should be examined by their health care providers for the problems that can occur with diabetes. Regular exams by a health care provider can help find problems at a time when they can be treated and managed successfully. You should have your feet, eyes and kidneys checked on a regular basis. Other tests may also be needed.  

  You should work with your health care provider to make healthy lifestyle choices to help control and manage your diabetes. Eating to control blood sugar and blood fat levels, taking prescribed diabetes medicine, getting regular physical activity, and getting regular foot and eye exams are all important for good health and to help control diabetes.

What can a physically active lifestyle do for me?

      Physical activity also plays an important part in preventing type 2 diabetes. A major Government study, the Diabetes Prevention Program (DPP), showed that modest weight loss of 5 to 7 percent—for example, 10 to 15 pounds for a 200-pound person—can delay and possibly prevent type 2 diabetes. People in the study used diet and exercise to lose weight.

                           Research has shown that physical activity can

lower your blood glucose and your blood pressure
lower your bad cholesterol and raise your good cholesterol
improve your body’s ability to use insulin
lower your risk for heart disease and stroke
keep your heart and bones strong
keep your joints flexible
lower your risk of falling
help you lose weight
reduce your body fat
give you more energy
reduce your stress levels

The Diabetes Food Pyramid: Fruit

Questions about fruit keep coming up. Will fruit juice increase blood glucose levels more quickly than a piece of fruit? Should you avoid fruit in the morning because your blood glucose might be higher than at other times in the day? Is it better to eat fruit with meals rather than snacks?
All carbohydrates, whether rice, potatoes or fruit juice, raise blood glucose about the same. In general, an equal amount of carbohydrate (15 grams) such as 1/2 cup grapefruit juice or 4 slices of Melba toast, should raise blood glucose at about the same speed and about the same amount.
However, that varies based on several factors -- whether you eat a piece of fruit after a high-fat meal or sip fruit juice on an empty stomach, what your blood glucose is when you eat the fruit, whether the fruit is cooked or raw, how much diabetes medication you have in your body, etc.
Also, people have individual differences. So, your challenge is to find out how fruit works in your body. Does eating fruit in the morning make it more difficult to keep your blood glucose controlled through the day? Does one particular kind of fruit send your blood glucose soaring? Or does a piece of fruit as an afternoon snack give you just enough carbohydrate

The Diabetes Food Pyramid: Vegetables

When it comes to vegetables, people with diabetes, should eat at least three servings a day. Vegetables are healthy, chock full of vitamins and minerals, and some give you much needed fiber. The best part: vegetables are naturally low in calories -- if you are careful not to top them with butter, sour cream, cream soups, or cheese sauces.
Remember, non-starchy vegetables such as spinach, broccoli, lettuce, greens, carrots, chilies, peppers and tomatoes (those in this food group) do contain a small amount of carbohydrate -- 5 grams per serving.
Easy ways to eat your vegetables:
• Keep frozen and canned vegetables on hand to know you always have vegetables at the ready.
• Make double and triple portions; at a serving one day and have one ready-to-go for the next.
• Blanch (quick cook and chill) a head of broccoli or cauliflower, break it into pieces, place in a plastic container and have a ready supply for the week, hot or cold.
• Keep a bag of pre-cut or baby carrots around -- grab a handful as a snack, pack them with lunch, throw them into stew, or microwave for a quick vegetable.
• Microwave or sauté onions and peppers to put more vegetables into a tomato sauce.
• Toss extra sautéed vegetables on a frozen pizza.
• Make a big salad to last a few days, store in the refrigerator in a plastic container.
• Add vegetables into sandwiches -- not just the old lettuce and tomato, try alfalfa sprouts, sliced red onion, sliced cucumbers, sliced yellow squash or zucchini, red peppers, or leftover grilled vegetables.
• Add vegetables to an omelette or scrambled eggs -- sauté onions, peppers, mushrooms, tomatoes and add some fresh herbs.
• Drink tomato juice, V-8 or Bloody Mary mix as a vegetable.
• In a tomato sauce, cut the amount of meat you use in half, and add more vegetables -- onions, peppers, mushrooms, eggplant, zucchini or others.

The Diabetes Food Pyramid: Starches

The message today: Eat more starches! It is healthiest for everyone to eat more whole grains, beans, and starchy vegetables such as peas, corn, potatoes and winter squash. Starches are good for you because they have very little fat, saturated fat, or cholesterol. They are packed with vitamins, minerals, and fiber. Yes, foods with carbohydrate -- starches, vegetables, fruits, and dairy products -- will raise your blood glucose more quickly than meats and fats, but they are the healthiest foods for you. Your doctor may need to adjust your medications when you eat more carbohydrates. You may need to increase your activity level or try spacing carbohydrates throughout the day.
On average Americans eat around 40-45% of our calories as carbohydrate. This is a moderate amount of carbohydrate, not high. Currently some controversy about carbohydrates is raging due to a few new diet books. These books encourage a low carbohydrate, high protein and moderate fat intake. These diets are not in synch with the American Diabetes Association nutrition recommendations, which are based on years of research and clinical experience. In addition, these trendy diets are hard to follow year after year.
A way to see how carbohydrates affect your blood glucose is to monitor your blood 1&1/2 to 2 hours after meals. Checking your blood glucose at this point tells you how high your blood glucose went from the carbohydrates you ate. For good diabetes control, keep your after-meal blood glucose levels at 180 or below.
Easy ways to eat more whole grains, beans and starchy vegetables:
• In a meatloaf or meatball recipe, substitute some grain, such as oatmeal, bulgur or brown rice, for some of the meat.
• Add noodles, peas, or beans to a vegetable soup.
• Prepare a hearty bean or pea soup. Eat some and divide the rest into individual portions; store the soup in the freezer for a quick meal.
• When you're cooking grains, make enough for extra servings. Then toss them on salads, into soups or casseroles, or reheat them as leftovers.
• Eat whole grain cold cereal as a snack and pack the small boxes for snacks on the run.
• Open a can of garbanzo beans (chickpeas) or kidney beans and add them to a salad, tomato sauce or a three bean salad.
• Treat yourself to great tasting whole grain bread with meals, for a snack or as the main course at breakfast.
• Add crunch to a salad or casserole with fat-free tortilla or potato chips.
• Have pretzels or light (in fat) popcorn for a snack.
• Buy breads with at least 2 to 3 grams of fiber and hot and cold cereals with at least 4 grams of fiber per serving

Using the Diabetes Food Pyramid:

The First Step
For most people, a great first step to healthier eating habits is to make a few simple changes. Perhaps you decide to eat more fruits and vegetables and to go lighter on the meats and sweets. If you make these changes and stick to them, pat yourself on the back. Before you make more changes, make sure you maintain the ones you have made. When you are ready, decide on the next change. Keep it easy to accomplish.
As you continue to change your eating habits to manage your diabetes, the diabetes food pyramid can help you and your whole family eat healthier. Here are some more healthy eating tips:
• Eat a wide variety of foods every day. Try new foods. Eating a wide variety of foods, even from the same food group, helps you get all the nutrients to be in good health. For example, within the fruit group, bananas are a good source of potassium and oranges are a good source of vitamin C.

• Be physically active every day. Try to accumulate 30 minutes of physical activity each day. Start slowly, by taking the stairs and walking more, or doing more yard work.

• Eat high-fiber foods such as fruits, vegetables, whole grains and beans. These are the foods you should primarily eat. They provide lots of vitamins, minerals, and fiber, yet they provide the least concentrated sources of calories.

• Use less added fat. It is well known that eating many foods that are high in fat, particularly ones with too much saturated fat and dietary cholesterol, can contribute to the development of clogged and narrowed arteries. This can lead to heart disease and people with diabetes are at an even greater risk for developing heart disease.

• Use less added sugar. Sugary foods, like jelly beans and regular soft drinks, and sweets, like ice cream and cookies, are not healthy for anyone. They provide a bunch of calories with little or no nutrients. Yet sugary foods and sweets are enjoyable to eat. Strike a balance -- practice moderation.

• Use less added salt and sodium. Americans eat more salt and sodium than they need. Most of the sodium we eat comes from processed foods like cold cuts, prepared foods, canned soups, and pickles. To keep your salt and sodium intake moderate, shake the salt shaker lightly and use more fresh and unprocessed foods.

• If you choose to drink alcohol, limit the amount and drink it with food. Check with your health care professional about an amount that's safe for you.
Next Step ... Learn More

Using the Diabetes Food Pyramid

The Diabetes Food Pyramid has six sections for food groups. These sections vary in size. The largest group -- grains, beans, and starchy vegetables -- is on the bottom. This means that you should eat more servings of grains, beans, and starchy vegetables than of any of the other foods. The smallest group -- fats, sweets, and alcohol -- is at the top of the pyramid. This tells you to eat very few servings from these food groups.
Eat servings from all the food groups other than the fats, sweets, and alcohol, every day. Eat the recommended number of servings on the pyramid within each food group. The exact number of servings you need depends on your diabetes goals, calorie and nutrition needs, your lifestyle, and the foods you like to eat. Divide the number of servings you should eat among the meals and snacks you eat each day. The Diabetes Food Pyramid makes it easier to remember what to eat. For a healthy meal plan that is based on your individual needs, you should work with a registered dietitian (RD) with expertise in diabetes management.

Key to Success

To individualize your medications and meal plan, all the members of your health care team need as much information about you as possible. Be sure to give each of them the following information:
• Your concerns about, or difficulties with, diabetes.
• Your cultural or religious practices.
• Your other medications, supplements, home remedies, or herbs.
• Your favorite foods.
• Your eating habits (timing of meals, how often you eat out, who does the shopping and cooking) and
• Your friends or family members who can help you.

Diabetic Meal Plan Systems

There are two main meal planning systems, exchange lists and carbohydrate counting. With your health care team, you will decide which system best meets your needs. You might be able to use a combination of systems for greater flexibility.
The exchange lists group foods into three categories:
• Carbohydrates (including lists of starches, fruits, vegetables, milk, and other carbohydrates such as dessert type foods).
• Meat and meat substitutes, and
• Fats
Within any one of the categories a food can be exchanged with another. The amount of energy provided by a specified serving size of the food is essentially the same. You choose from the different categories to design a plan for your meals and snacks.
With carbohydrate counting, the focus is on the amount of carbohydrates in the foods that you choose to eat. Your insulin or oral medication must be matched to the foods you eat. Your meal plan will tell you how many carbohydrate choices you can eat and when you can eat them. The carbohydrate can come from any type of food containing carbohydrates. In the beginning, this system will require that you to test your blood sugar several times a day, as well as weigh and measure your food.

Consult a Dietitian

In addition to your doctor, a key member of your health care team will be a dietitian. A dietitian is a nutrition expert who has passed a national credentialing exam. They can use the title Registered Dietitian (R.D.), or in some states Licensed Dietitian (L.D.). Some dietitians take an additional exam for the credential of Certified Diabetes Educator (C.D.E.). Regardless of whether a dietitian is a C.D.E., it is important for you to choose one experienced with diabetic meal planning. They will need to work with your doctor to assist you in fine-tuning your medications, meals and exercise requirements. They also will be able to assist you with reading food labels, and providing cooking and grocery shopping tips. If you have not seen a dietitian, request a referral or contact the American Dietetic Association at (800) 366 -1655.

Nutrition and Diabetes

NUTRITION IS ESSENTIAL
As you have read in the article on diabetes in this website, aggressive management of your blood sugar (glucose) is essential to prevent further complications of the disease such as blindness, amputations and kidney disease. While diabetes often requires insulin or oral medication for proper control, it is important to remember that proper nutrition is also equally critical in diabetes care. You will not be able to achieve good control of your diabetes without making changes in your diet!
Nutritional management, in the form of a meal plan designed especially for you, will help you to maintain blood glucose levels as close to normal as possible, and maintain or lose weight.
Like many people, you may not have had much success with dieting in the past and you may feel apprehensive about the need to be on a meal plan for essentially the rest of your life. You can improve your chances of succeeding by having a team of health care professionals design a plan that fits your lifestyle. Also, the meal plan may not seem so overwhelming once you realize that the general dietary recommendations for diabetics are very similar to what is recommended for all Americans. The following chart illustrates this.