It's a tricky balancing act - using diabetes medications to keep blood sugar at just the right level.
You're coasting along, trying to "eat right," when suddenly you're confronted with a crisis -- sharing a very large pizza. It's so difficult turning away from pizza -- yet you face the inevitable blood sugar spike, with your diabetes drugs faltering under the carb load. If you're taking insulin, the mealtime dosage will need lots of attention.
There's also the weight gain issue: Too many calories pack on the pounds, which worsens blood sugar control.
It's serious business, keeping blood sugar and diabetes under control. There are too many health complications at stake to take it lightly. Over time, those blood sugar spikes take a toll on all your major organs and nerves throughout your body. It's nothing to take lightly. But good blood sugar control can prevent the worst complications of diabetes.
In recent years, new drugs that treat diabetes and various types of insulin have helped improve the management of diabetes and greatly improve blood sugar control. Some medication used to treat diabetes help drop weight and reduce blood cholesterol levels. But they can't do the work alone, diabetes experts say.
Lifestyle changes are essential -- a healthy diet, regular exercise, and weight loss -- in letting diabetes medications do their job, says David Nathan, MD, chief of the Diabetes Center at Massachusetts General Hospital and a professor of medicine at Harvard Medical School.
"If you have type 2 diabetes, your pancreas is still trying to release insulin," Nathan explains. "But if you have a rapid rise in blood sugar, it just can't keep up with the demand. With diabetes medicines, it's the same thing. They will work better if you don't challenge the pancreas -- if you don't have spikes in blood sugar."
- You've got to watch your diet.
- Exercise regularly and maintain a normal weight.
- Test blood sugar often as recommended by your doctor.
- Follow your doctor's instructions when taking your diabetes medications.
There's no getting around it, if you want to live a good, long life.
Diabetes Diet Avoids Blood Sugar Spikes
A number of factors influence blood sugar levels after meals, but carbohydrates have the biggest impact, so watching what you eat is essential. You must learn to make wise food choices that won't cause blood sugar spikes -- yet indulge in an occasional pizza slice.
A dietitian or diabetes educator can help you line up a game plan for meals, says Roberta Anding, RD, a diabetes educator at Texas Children's Hospital in Houston. She is also a spokesperson for the American Dietetic Association.
After all, not all carbs are created equal. "A scoop of white rice is different from a scoop of brown rice," Anding tells WebMD. "The calories may be the same, but they act differently when digested."
Processed "white foods" -- white bread, white rice, cakes and cookies (made with white flour) -- are digested quickly, which causes sharp spikes in blood sugar. Even an apple -- highly nutritious and high in fiber in its natural form -- is done a disservice in processing. When an apple is made into applesauce or apple juice, it loses its fiber content.
"You see remarkable differences in the effect on blood sugar levels," Nathan explains. "The more processed the fruit, the faster the glucose level goes up -- and the higher it goes up. Getting more high-fiber carbohydrates in your diet will naturally slow the absorption rate, and will help the pancreas keep up with the insulin demand."
What are high-fiber carbohydrates? Everything your mother ever advised: vegetables, fruits, whole-grain breads, and cereals. Every colorful fruit and vegetable in your grocery's produce section -- broccoli, spinach, red bell peppers, fruits and berries of all types. Oatmeal is another great source of fiber!
Weight Gain vs. Diabetes Drugs
Weight gain poses its own problems for people with diabetes. The fight against weight gain has always been tough, as many older diabetes drugs may cause weight gain -- which further interferes with blood sugar control.
"The heavier you get, the more you're fighting a losing battle," Nathan tells WebMD. "If you're gaining weight, diabetes medications won't work as well, so you need more of the medicines -- which only makes your weight go up more."
Drugs like Byetta, Metformin, Symlin, and Victoza have made weight control a bit easier. These drugs stimulate the body's natural insulin-producing capability, plus patients may experience a decrease in appetite leading to weight loss.
Diabetes specialists typically prescribe these diabetes medications in combination with older diabetes drugs to get optimal blood sugar control. "It helps minimize the difficulties of dieting. ... People can restrict calories, exercise more, have more positive results in losing weight," says Anne Peters, MD, director of the clinical diabetes programs at the University of Southern California and author of the book Conquering Diabetes.
Lose the Weight, Take Less Diabetes Medication
Lifestyle is key to keeping weight off -- and to controlling diabetes in the long run. "There's no way around it, and it's hard work, but you have to address it. You don't have to get skinny, but you do have to lose weight," says Anding.
In fact, research shows that losing just 10% to 15% of body weight -- dropping 20 or 30 pounds, if you weigh 200 -- can have a marked improvement on diabetes control.
These lifestyle changes help preserve the body's insulin-producing function, explains Hermes Florez, MD, director of the Diabetes Prevention Program at the University of Miami Miller School of Medicine. "With weight loss, patients are able to nearly get off insulin. Some patients are able to come off insulin completely."
An NIH-funded clinical trial, the Diabetes Prevention Program, helped show the positive effects of healthy lifestyle changes. A significant number of patients in the study were able to reduce their diabetes risk with a healthy diet and regular exercise like brisk walking -- about 150 minutes a week.
In the early stages of diabetes, weight loss can also help reduce the dosage of diabetes medications you're taking, Peters tells WebMD. "I can't guarantee you will get completely off pills if you lose weight. But it's likely you will need less medicine. It depends on where you are in the disease process, because diabetes gets worse over the years."
Diabetes Diet and Insulin: Better Mealtime Control
Sticking with your diabetes diet makes it easier to calculate mealtime insulin. With new forms of insulin -- including small "pens" to give injections -- even taking your insulin is hassle-free. If you're out with friends, no one needs to know you're doing it.
Today's very rapid-acting insulin can be given with a meal or immediately afterward. "You need to make sure you eat within 10 minutes of taking insulin. These insulins act very quickly, so if you don't eat right away you'll have a low blood sugar reaction. The insulin will start working before food is absorbed," Nathan explains.
Insulin pens are nothing like the needles and insulin vials used in the past. The pens are small, and operate like fountain pens with cartridges -- an easy way to give yourself an injection to keep blood sugar under control.
Insulin pumps are another advance -- delivering a constant, computerized trickle of rapid-acting insulin into your bloodstream. At mealtime, you calculate the extra insulin dose you need to match carbs in the meal.
"A patient with an insulin pump often ends up needing less insulin overall," Peters tells WebMD. "It allows us to fine-tune insulin doses, so there's more flexibility and success in general. But to do it right, the patient needs a dietitian and diabetes educator. It takes a lot of education."
Diabetes Diet and Exercise Basics
Be sure to tell your doctor if you're starting a diet and exercise plan. "We can adjust insulin doses for your exercise," Peters tells WebMD. "Let's say you get an insulin shot beforebreakfast, but you're going to start exercising afterbreakfast. I might have you take half the dose before breakfast, so you're not too low while you exercise."
The mantra from diabetes experts:
Eat healthy: Get plenty of vegetables, fruits, whole grains, lean protein, and low-fat dairy.
Focus on fiber: Eat "real food," not processed food. Spinach, broccoli, and other colorful veggies should be staples. Feast on berries -- they're highly nutritious, high-fiber, and won't really affect your blood sugar despite their sweetness. Choose brown rice, whole-wheat tortillas, whole-grain bread, oatmeal. If you buy canned fruits or veggies, read labels closely to make sure there's no added sodium or sugar.
Curb the sweets: Ice cream, cookies, candy, and cake should be special-occasion treats only. They contain too much fat, sugar and calories. If you indulge, make sure you keep track in your total carb count.
Watch portions: Your meal plan is your guide. Excess calories only cause trouble -- blood sugar spikes and weight gain. Stop eating so much!
Exercise: Get your feet checked by a doctor, to ensure that you don't have injuries or signs of infection. People with diabetes are prone to foot problems caused by nerve damage, which can become very serious. Then get walking -- 20 to 40 minutes a day. Walk briskly to get maximum benefit!