If you're one of the nearly 24 million Americans living with type 2 diabetes, you know your body has difficulty using or producing insulin. What can you do to manage the disease? We asked Jill Crandall, MD, professor of clinical medicine and director of the diabetes clinical trials unit at Albert Einstein College of Medicine in New York City, to debunk some myths and help you learn to live well.
1. Does having type 2 diabetes mean you have to give up sugar completely?
Not really. It's a misconception that people with diabetes can never have a dish of ice cream. The diet we recommend for people with diabetes really isn't very different from the diet we recommend for everybody.
For most people, eating balanced meals of protein, carbohydrates, and modest amounts of unsaturated fat is the best approach. Large carb meals (pasta, bread, potatoes, rice) and concentrated sweets (fruit, fruit juice, cake) raise blood sugar, so it's best to eat those foods in moderation.
The plate method is often helpful: Think of dividing your dinner plate into three sections. Half the plate should be vegetables or salad, a fourth should be protein (for instance, meat or fish), and a fourth should be starch (such as rice or pasta, preferably whole grain).
We all know junk food like candy and donuts is not good for anybody. Junk food is especially problematic for people with diabetes because it tends to be high in carbohydrates and excess calories. But we try to stay away from saying there are certain things you can never have, because sometimes the idea of deprivation just makes foods all the more appealing.
If you know you want to have that piece of cake at the end of dinner, then don't eat any bread with dinner, or have a very small portion of rice.
2. Is it better to eat frequently throughout the day?
Some people find frequent, small meals work for them -- they don't get too hungry, and their bodies can handle smaller amounts of carbs better. But others find they end up gaining weight this way -- the frequent meals may not be that small. However, skipping meals is probably not a good idea because people get hungry, then can't control their next meal very well.
Keeping a food diary, along with testing blood sugar before and after meals, is a good way to see the effect of particular foods on blood sugar level. The immediate feedback can be helpful.
And pay attention to portion sizes. Food labels are useful (they provide information about carbohydrate content as well as total calories), but the portion sizes they list are often unrealistically small (how many people eat half a muffin?). Although weighing food servings can be annoying, it might help train your eyes as to what a "6-ounce serving" of something really looks like.
3. How do stress and sleep affect diabetes management?
There's emerging evidence that people who are chronically sleep-deprived tend to eat more and gain weight, so sleep can be important for diabetes management. There is definitely a biological connection between stress and managing diabetes, too. [The levels of] stress hormones like cortisol and epinephrine go up when people are stressed, and we know those hormones tend to elevate blood sugar.
It's also difficult for people to focus on managing their diabetes when they're distracted by work problems, family issues, or other kinds of stress.
Many doctors' offices and hospitals have diabetes education programs that will help people develop skills for managing diabetes. Try stress reduction techniques, and don't forget that exercise is wonderful for helping to manage diabetes and can relieve stress, too.
4. Why do I need to exercise?
There's evidence that exercise can have profound effects on blood sugar control -- even if you don't lose weight. When you exercise, insulin's ability to help bring glucose into the cells improves. Aerobic exercise, like running on a treadmill, bicycling, or jogging as well as weight or resistance training can help control blood sugar. Some studies indicate that weight training may be even more effective than aerobic exercise, which is a bit surprising.
The key is to exercise on a regular basis: 30 minutes a day, at least five days a week. That recommendation comes from the Diabetes Prevention Program study, which was designed to see if we could prevent diabetes in people who are at high risk. The lifestyle intervention included a low-fat, reduced-calorie diet and 30 minutes a day of moderate-intensity physical activity -- mostly people did brisk walking. The intervention was very effective at reducing the rate of diabetes -- by 58% -- in people who were at high risk.
Check with your doctor before beginning an exercise program to find out which exercise is best for you, and whether you need to make changes to your medication.
5. Are there any promising treatments ahead for type 2 diabetes?
The most promising treatment is something that's gotten some play in the news recently, and that's bariatric or weight-loss surgery. It obviously can lead to dramatic weight loss, [and] in most cases reverses diabetes completely, which is an amazing thing. Even before people have lost any significant amount of weight, blood sugar levels often dramatically improve. It probably has to do with alteration of hormones that are secreted within the intestine, and factors that regulate appetite and energy expenditure.
Not everybody who is overweight or obese would want to have weight-loss surgery or would be appropriate for it. But what we're learning about how these procedures can radically change how the body handles calories and regulates appetite may lead to new insights that will result in other treatments.
Bonus Question: Is weight loss important if you have type 2 diabetes? Why?
Losing even a modest amount of weight can help you manage type 2 diabetes. That's really a No. 1 goal for just about everybody because most people with type 2 diabetes are overweight or obese. If you lose weight, your blood sugar control will be much better. Sometimes when people lose weight they don't even need any medication.
We don't want people to feel that unless they lose 50 pounds, [weight loss] won't help them. That's not true. A number of studies suggest that losing 15 or 20 pounds, or 7% of your body weight, can be helpful in improving blood sugar.
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