Articles about Diabetes

Living Your Best Life with Diabetes

Good Nutrition & its Effects on Blood Glucose
By: Molly Boll
Published June 17, 2008

Food is the fuel and energy source for our bodies. Food cannot be used for energy until the body changes it into a simple sugar called "glucose." Our blood carries glucose (blood sugar) to every cell throughout the body. Without glucose, cells do not have the energy to work.

Glucose needs help to get inside each of the cells in our body. The helper that carries glucose inside the cells is called insulin, which is made by the pancreas. For a person with diabetes, food is changed into glucose just as it is in those without diabetes. For those with Type I Diabetes, however, the body does not generate a sufficient amount of insulin to control the glucose level. For those with Type II Diabetes, the body does not respond correctly to insulin (insulin resistance), and does not allow it to carry glucose into the cells. In both cases, the glucose that is not able to get into the cells builds up in the blood. This causes high blood sugar, which can lead to diabetic complications.

Good nutrition entails eating a variety of different foods in combinations that provide both necessary nutrients and good blood sugar control. Good nutrition also means limiting your fat and cholesterol intake.

Food contains nutrients and energy. The nutrients in our food supply form the building blocks of the body. Food also contains energy, which is measured in calories. Calories come from carbohydrates, proteins, fats, and alcohol. The following is a quick summary of the different types of food and how they affect the blood glucose in our bodies.

Carbohydrates are the body's main source of energy, and can be found in the starches in breads, cereals, and most vegetables, and in the sugars found in fruits and milk. Complex carbohydrates should be a big part of your meals and snacks. Vegetables, lentils and legumes, beans and peas, whole grain unprocessed breads, cereals, rice and pasta are all examples of complex carbohydrates. These tend to slowly raise blood glucose, and contain a variety of vitamins and minerals as well as fiber. The sugar that is found in candy, cake, pie, jam, jelly and honey is also a carbohydrate. One hundred percent of the carbohydrates that we digest are broken down into the energy packet glucose. This happens quickly, from five minutes to three hours.

Fiber is a type of carbohydrate that is not used for energy. It does not raise blood sugar because the body cannot digest it and break it down into glucose. Insoluble fiber is useful for promoting regularity and feeding the good bacteria in the gut; it may decrease your risk of colon cancer. Examples of insoluble fiber are whole-wheat products, vegetables such as broccoli, Brussels sprouts, carrots, corn, and spinach. It is interesting to note that soluble fiber sources form gels and slow down absorption of sugars into the blood. Good sources of soluble fiber are oats, beans, fruits, and vegetables such as asparagus, green beans, cabbage, and celery.

The American Diabetes Association suggests that diabetics eat 20 - 35 grams of fiber per day. The average American adult, however, eats only 10 - 15 grams daily. To help you determine where and how much fiber is in your food choices, please note the following average amounts of fiber per serving:

Proteins are used to build and repair the body. Proteins are found in meats, fish, poultry, cheese, milk, eggs, and nuts. Proteins also break down into energy. Fifty to sixty percent of the protein we consume breaks down into glucose. This process happens slowly, over three to six hours.

Fats pack a large number of calories, and therefore energy, in a small bundle. Foods that contain fats are oils, margarine, butter, meat, and salad dressings. Use fats sparingly if you are trying to lose weight or if your blood fats are high. The body will store the majority of fat and will only break it down to smaller energy packets for use in emergencies. Only ten percent of the fat we consume raises our blood sugar directly, over a period of eight to ten hours. Fat is a form of stored energy that is broken down at a later time; it is the preferred source of fuel for muscles at rest. Which fats are healthier for you? Margarine is preferable to butter, but olive oil is the healthiest choice of the three.

Alcohol has calories, but little nutritional value. It is interesting to note that alcohol actually lowers blood sugar levels. It is suggested that people with diabetes snack while drinking to ensure that their blood sugars do not go too low. They should also limit their intake to one drink.

Since nutrition is a key component to managing one's blood sugar, it is important to learn to put together healthy meals from the various food groups. The food pyramid offers an easy approach to healthy eating. This guide shows that healthy meals and snacks should contain lots of carbohydrates that are also rich in vitamins, minerals, and fiber (lentils, legumes, vegetables, and yogurt, for example). All carbohydrates become glucose in blood within five minutes to three hours after they are eaten. These foods have a significant effect on blood glucose. The best ones to choose are those that are full of nutrients instead of those that just offer empty calories (soda, cakes, and candy, for example). You should eat antioxidant-rich vegetables that are high on the glycemic index scale, such as spinach, broccoli, yellow squash, and tomatoes.

Healthy eating also means avoiding foods that are high in fat and cholesterol. These foods have been linked to atherosclerosis, the fatty build-up inside blood vessel walls. This can lead to heart disease or stroke. People with diabetes have a two to three times greater risk of getting atherosclerosis. Therefore, when choosing proteins and fats in your diet, opt for lean cuts of meat, and eat more fish, chicken, and turkey (without the skin). Use nonfat milk or low fat milk products. Limit fried foods, gravies, cream sauces, butter, and margarine.

Logically, the key to maintaining your weight is watching the amount of food you eat. For good diabetes control, you must be consistent from day to day. Plan your day to be sure that you eat the right foods, in the right portions, at about the same times every day. Here are several examples of what constitutes a serving size:

In addition to eating healthily, it is crucial to stay hydrated by drinking plenty of water. Start your day out with an eight-ounce glass of water, and continue to drink water throughout the day. Water dilutes the blood and therefore has some degree of influence on lowering your blood sugars.

As with all things in life, use the concept of BALANCE in choosing your meal plans. Eat a variety of foods that give a balance of carbohydrates and protein. One easy approach is to take your dinner plate and have one-fourth of it filled with proteins, one-fourth filled with a starch such as brown rice or a small potato, and one-half of the plate filled with vegetables (preferably the colorful ones as discussed above).

Mix garbanzos, pepper, green onions, and cilantro in a large bowl. In a small bowl, combine the lemon juice, vinegar, garlic, ginger, cumin, salt, pepper flakes, and olive oil. Pour the liquid dressing over the vegetables and toss to coat. Cover the salad and refrigerate overnight.

Heat oil in a pan over medium heat. Add the carrot, and let it cook for one minute. Add the soy sauce, peanut butter, and water, followed by the broccoli and chicken. Stir-fry for about four minutes until the colors are bright and the aroma is nice. Make sure the bottom does not brown while cooking; add a bit more water as the pan dries. (Serves one; approximately 400 calories; 16 g carbs; 43 g protein, 19 g fat)

Since nutrition is such a vast subject, we will be continuing this healthy diet discussion in the next 'Living with Diabetes' article, where we will discuss the glycemic index, carb counting, sweeteners, and controlling your eating habits, to name a few topics.

Please email me at mollyboll@verizon.net with any and all questions about your diabetes and I will attempt to get back to you. If I do not know the answer to your question, I will obtain an answer from a healthcare provider.

CONTINUING GOOD LUCK WITH YOUR DIABETES MANAGEMENT. REMEMBER - YOU CAN DO IT!!! YES, YOU CAN DO IT!!!

Diabetes is a serious, lifelong condition that touches every part of your life. If you've recently been diagnosed with diabetes, you should know that living with this disease is not easy. It's going to take hard work and discipline to manage your diabetes.

But, the good news is that it can be done! You can enjoy a good life while having diabetes. There are a lot of things you can do to protect your health from this disease. By taking charge of your diabetes today, you can live a more healthy life in the years to come.

I would like to start by giving you a quick glance at my struggles with diabetes. As I look back to when I was first diagnosed some 27 years ago, I realize today the extent of my denial at that time. I did not even take my diabetes medications for the first two years after diagnosis. I thought I was invincible, and I felt fantastic! I had a college education and a very interesting and demanding career in the Alaskan seafood industry. Now, how could I have this disease called DIABETES? People who have diseases are sick, and I was not sick!

Little did I know at that time that my blood glucose levels were working hard on my internal organs to eventually cause many health complications. Fortunately, my mother steered me to one of the top endocrinologists in the United States, Dr. Irl Hirsch of the University of Washington Medical Center-Diabetes Clinic.

Over the years, and with Dr. Hirsch's help, I have slowly learned how to manage this disease. It has been an ongoing process, and one in which I sometimes succeed and other times fail. But the important thing is that when I do fail, I pick myself up and start all over again in this process of managing my diabetes.

Yes, approximately 60% of people living with diabetes have denied having this disease at one time or another. Yet, diabetes is a disease that seldom goes away. It is always with us. We have to consistently monitor our blood glucose levels, take our medications, and watch our diets. You are certainly not alone if you find yourself denying that you have this disease. But it is vitally important for you to acknowledge that you have diabetes, and to be willing to pick yourself up and continue on your self-management program for good diabetes control.

It is paramount to understand that YOU, AND ONLY YOU, are in control of your diabetes; but you can manage this disease with the help of a strong team. I like to explain this by way of a triangle and a ship. You are the captain of your ship at the top of the triangle; your doctor is the chief engineer at the lower left point; and your nutritionist is the first mate at the lower right point of the triangle.

You ultimately run the ship, while your doctor is your chief advisor and your nutritionist gives you the fuel to run your ship. It takes a TEAM effort to manage your diabetes. So, the first thing to do is to find a well-qualified internal medicine doctor who is familiar with diabetes, or an endocrinologist, as well as a diabetic nutritionist.

Now that you have this concept of a ship to help you with your diabetes control, your ship must have a destination. Ultimately, this destination is a full and healthy life where your diabetes is well under control. Here are some suggestions to get you started on your journey to your "diabetes destination."

Assemble your diabetes medical team. It is important to find the right physician for your diabetes visits, whether that is an endocrinologist or an internal medicine doctor. After you find the doctor that's the right fit for you, be sure to ask him or her for the names of recommended diabetic nutritionists, eye doctors, and foot doctors.

Enroll in a diabetes class. It is highly suggested that you enroll in a diabetes class to learn more about your disease. Knowledge is a powerful tool in diabetes self-management. You will also meet a supportive network of people who are facing the same challenges that you are.

Test your blood sugar. I've found this to be the absolute most important tool. How can you possibly manage this disease if you do not know the levels of your blood glucose? Your diabetes educator can teach you how to use one of the many blood glucose meters available, and your doctor can tell you how often to test. You might be instructed to take a fasting test before your breakfast and then one or two more tests before lunch or dinner. Bring your blood glucose machine with you to your doctor's visits so that he or she can see trends in your readings.

Lose weight. Diabetes and heart disease go hand in hand with excess weight. Obesity strains your heart, raises your blood pressure, and raises your LDL (bad) cholesterol and triglyceride (blood fat) levels. It lowers HDL (good) cholesterol. Even losing ten pounds can help to decrease your heart disease risks by lowering blood pressure, insulin resistance, and body fat.

Be physically active. Regular exercise helps to lower blood glucose levels and lower insulin resistance. This means your body can use its own insulin more effectively. Walking, swimming, and biking are excellent forms of exercise.

Eat a healthy and balanced diet. Have your diabetic nutritionist assist you in putting together a good meal plan for your particular diabetes. One essential component of this plan is that you eat all of the food groups daily. We will be discussing healthy eating for those with diabetes in our next article, with recipes included.

Take your medications as prescribed by your doctor. You must follow your doctor's recommendations about your diabetic medications. It is essential to blood glucose management that your medications are taken daily as per the instructions of your doctor.

The (A) stands for a Glycosylated hemoglobin test (A1C). The A1C test measures the amount of sugar that attaches to protein in your red blood cells. Your red blood cells live for about two to three months, so this test shows your average blood sugar levels during that time. The greater the amount of sugar in your blood and the longer it remains high, the more sugar that will attach to those red blood cells. It is suggested you have this test done at least every three to six months. The American College of Endocrinology (ACE) recommends a target A1C of less than 6.5%. To give you an example of what the A1C indicates in terms of blood sugar, if your A1C is 6, then your average blood sugar would be 135 mg/dl; if your A1C is 7, then your average blood sugar would be 170 mg/dl; and if your A1C is 9, then your average blood sugar would be 240 mg/dl. The ACE recommends the following goals:

A word of caution here: these levels apply to most people, but your individual levels may be higher or lower. Your healthcare team will help you set the blood sugar target range that is best for you. It is also suggested that you try to keep your blood sugar levels similar on a daily basis. Research has shown that "variable" blood sugar levels can cause diabetic complications.

The (B) stands for blood pressure. It is said that people with diabetes are as much as three times more likely to have high blood pressure than people without diabetes. For this reason, people with diabetes are at a greater risk for heart disease. High blood pressure increases your risk for heart disease and stroke, and is also a factor in diabetic kidney disease, and eye and nerve problems. About 71% of people with diabetes have high blood pressure/hypertension. There are two numbers associated with blood pressure levels: the systolic (the bigger number) which measures the pressure as your heart beats and pushes blood into the blood vessels; and the diastolic (the smaller number), which measures the pressure when your heart rests between beats. The American Diabetes Association recommends that your blood pressure be no more than 130 for systolic and 80 for diastolic. If you have high blood pressure, you can make a number of lifestyle changes to lower your numbers. Quitting smoking, exercising at least four times per week, lowering your sodium intake, and adopting a weight-loss program if you are overweight can help to lower your blood pressure. Many people also need medication to get their blood pressure into the target range. These could include ACE inhibitors, angiotension receptor blockers (ARBs), beta-blockers, or diuretics.

The (C) stands for Cholesterol. If your LDL (bad) cholesterol is higher than 100 mg/dl., your HDL (good) cholesterol is lower than 40 mg/dl., and your triglycerides (blood fat) are higher than 200 mg/dl., then you are at greater risk for cardiovascular disease, diabetes, and insulin resistance. To keep cholesterol within healthy limits, eat a diet low in saturated fat and low in cholesterol.

In summary, whether you have been recently diagnosed or you have had diabetes for years, but do not feel in control of the disease, it is highly suggested that you: get your diabetes health team together; register for a diabetes education class; test your blood sugars daily; begin a weight loss program if needed; stop smoking; exercise consistently; eat a healthy and balanced diet, take your medications as prescribed; and know the ABC's of diabetes.

Our next diabetes article will focus entirely on exercise and good nutrition, and will include some delicious recipes that complement a healthy diabetic diet.

If you have any questions about diabetes, please feel free to email me at mollyboll@verizon.net and I will attempt to answer all of your questions.

GOOD LUCK WITH YOUR DIABETES SELF-MANAGEMENT PROGRAM! AND REMEMBER, "YOU CAN DO IT!"

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