November is National Diabetes Awareness Month in the United States. Across the globe, World Diabetes Day is observed on November 14, the birthday of Dr. Frederick Banting, who in 1921 co-discovered insulin with the help of his colleague Dr. Charles Best. We owe a world of gratitude to these two pioneers in diabetes treatment. Before their discovery, no successful treatment existed.

According to The American Diabetes Association:

• Every 21 seconds, someone new is diagnosed with diabetes.
• 84 million have pre-diabetes in the U.S. and 30 million people have diabetes.
• Diabetes causes more deaths than breast cancer and AIDS combined.
• Diabetes is no longer a disease – it is an epidemic.

These are astonishing facts, but don’t let that discourage you. Understanding diabetes and adopting healthy lifestyle behaviors can help control and manage diabetes, and prevent or delay the onset of diabetes for those living with pre-diabetes.

What is Diabetes?

Diabetes is a metabolic disorder involving the pancreas, a small organ behind the stomach. In normal digestion, food is broken down into glucose and other simple sugars (our fuel) that enter the bloodstream. When this occurs, the pancreas releases insulin. Insulin goes to the cells and “opens” them allowing the glucose to leave the bloodstream by entering the cells.

Glucose is fuel to the body as gas is fuel to a car. To get the fuel (glucose) into the tank (the cells), access (taking the cap off the tank or opening the cells) must take place for the fuel to enter. Once fueled, the car will run efficiently as the body will have the energy it needs for daily activities. If glucose stays in the bloodstream, it is not in the cells to be used for energy.

Diabetes Risk Factors

A risk factor is something that can increase your chances of getting a disease. The more of the following risk factors that are present, the higher the risk of developing Type 2 diabetes.

• Being overweight or obese
• Not being physically active
• The presence of pre-diabetes
• Having heart or blood vessel disease
• Abnormal cholesterol or triglyceride levels
• Over the age of 45
• Family history of diabetes
• Ethnicity: African American, Hispanic or Latino, Asian, Native Hawaiian or Pacific Islander, Native American or Alaska Native
• History of gestational diabetes, a baby weighing more than 9 pounds or polycystic ovarian syndrome (PCOS)

Some of the above-referenced risk factors are modifiable because you can do something about them, such as smoking, being overweight, and physical inactivity. Other risk factors such as age, ethnicity, and family history are not modifiable.

Signs and Symptoms of Diabetes

Symptoms of diabetes are often overlooked or rationalized as something else. Feeling poorly usually prompts a visit to a healthcare provider to find out what is wrong. One or more of the following common symptoms may be present:

• Excessive thirst
• Frequent urination
• Increased hunger
• Unexplained weight loss
• Tiredness/fatigue
• Blurred vision
• Cuts/sores that do not heal
• Dry itchy skin
• Infections that keep coming back
• Numbness/tingling in hands or feet

It is also possible that none of these symptoms will be experienced in the presence of diabetes. Proper treatment can help most of these symptoms go away.

Diagnosing Diabetes

Diabetes is diagnosed through glucose and hemoglobin A1C blood tests. Elevation in these tests may result in a repeat of the tests to confirm the diagnosis of diabetes.

There could be many reasons for the presence of diabetes, some of which may include:

• The pancreas is not producing any insulin (Type 1 diabetes).
• The pancreas is producing less insulin than normal (Type 2 diabetes).
• The pancreas is overproducing insulin, but the cells are not “opening” for the insulin to enter (Type 2 diabetes).
• The liver is overproducing glucose at the wrong time.

Types of Diabetes

Healthcare providers look at blood glucose results as well as other factors such as weight and lifestyle to determine which type of diabetes is present.

• Type 1 diabetes: occurs in 5-10% of people with diabetes. In this type of diabetes, the pancreas has stopped producing insulin. This usually occurs in children and young adults under the age of 30. These individuals need insulin to stay alive and will always be on insulin.
• Type 2 diabetes: occurs in 90-95% of people with diabetes.
  • The pancreas is not producing enough insulin.
  • The pancreas is overproducing insulin, but it is unable to be used, this is called insulin resistance. Individuals who are overweight may have fat layers blocking the cells preventing the insulin from getting to the cell.
• Gestational Diabetes: occurs only during pregnancy due to hormonal changes
  • Glucose levels usually return to normal after delivery
  • Gestational Diabetes is a risk factor for type 2 diabetes.

How is Diabetes Treated?

Once a diagnosis of diabetes is confirmed, treatment will be recommended based on the glucose results. The goals of treatment are based on helping to:

• Maintain glucose within the optimal range
• Maintain optimal ranges in blood pressure and cholesterol
• Ensure the care plan is realistic and doable
• Prevent or delay other problems associated with diabetes

Frequently when people hear the word “diabetes”, they automatically think insulin is going to be prescribed. With all the new medications and treatments for diabetes today, that is seldom the case. You may have heard “once on insulin, always on insulin”. That is true in the case of Type 1 diabetes but not always true in Type 2 diabetes.

Lifestyle behaviors play a very important role in the management of diabetes. Notice how all of the following treatment scenarios include food and activity plans.

Food + Activity Plan

The foods eaten contribute to how high the glucose will rise as well as how quickly it will return to normal. A valued partner to the food plan, activity, plays an important role in glucose control by utilizing glucose for fuel, lowering the blood glucose for several hours. These lifestyle recommendations are included in every diabetes care plan and are the foundation of the treatment plan.

Food + Activity + Oral Medications

If changing food and activity habits are not enough to bring the glucose into the optimal range, oral medications may be added. There are many oral medications available today for a healthcare provider to choose from.

Food + Activity + Oral Medication + Non-insulin Injectable

If the addition of oral medication was not quite enough, the addition of an injectable non-insulin medication could be the next step. A non-insulin injectable is a very effective partner to oral medications before moving to insulin.

Food + Activity + Oral Medication (one or more) + Insulin (one or more)

Sometimes the pancreas produces insulin but needs a little extra help from an injection of insulin. About 14% of adults with Type 2 diabetes will need some insulin.

Food + Activity + Insulin (one or more )

When maximum doses of oral medications and combinations have been tried and the glucose is still elevated, a move to insulin is the best choice. Only about 14% of adults with Type 2 diabetes move to insulin alone as their treatment.

Creating a Healthy-Eating Plan

Eating healthy, well-balanced meals that are rich in vitamins and low in calories and fat are essential. Following the simple guidelines below can help control glucose better. The goal is to eat in a manner that healthy choices and healthy portions will:

1. Achieve optimal glucose control.
2. Achieve and maintain cholesterol, LDL and triglyceride levels in the optimal ranges.
3. Achieve and maintain a healthy weight.

The basic guidelines for eating healthy with diabetes include:

• Eating 3 meals a day, evenly spaced apart (meaning about every 4-5 hours).
• Eating about the same times daily. Our body likes routines. This will help the pancreas and medications work best if prescribed
• Eat about the same amount at each meal. Consistency is the key. This means that breakfast, lunch, and dinner should be about the same size daily. But all three meals do not need to be the same size.
• Don’t skip meals. Skipping meals can cause low blood sugar resulting in overeating, which may cause the glucose to spike.

Carbohydrates

Carbohydrates have a bad reputation these days, but they play a number of important roles in your body from providing vital nutrients to converting into glucose, which our body uses for energy. Choosing healthy carbs,  eating them in moderation and avoiding highly processed foods is most important.

And what about white foods? There are many white foods that provide nutrients—milk, cauliflower, and white potatoes provide potassium, Vitamin C and fiber. Look at the nutrient contribution rather than the color of the food. It is important for people with diabetes to keep the carbohydrate content of their meals consistent but not necessarily low.

The plate method or plate planner is a very easy way to portion foods for everyone, not just those with diabetes. With this method, half the plate is filled with vegetables, one-quarter with a lean protein source, and one-quarter with a starch source. The picture below will show how to do this using a 9” in diameter plate.

Adding healthy fat such as olive oil (to prepare the scallops), a low-fat dairy such as 1% or fat-free milk and fruit for dessert would complete this meal. This is a very simple, balanced meal that anyone can create. A registered dietitian is an excellent resource for more information on what to put on your plate.

Physical Activity

Physical activity and eating healthy are important parts of a healthy lifestyle whether you have diabetes or not. The basic recommendation for physical activity in the presence of diabetes is to move daily to help lower blood glucose! Don’t worry about your pace, it’s important to go slow if you are just starting out.

• Park farther away from your destination.
• Take the stairs when possible.
• Work in the garden.
• Walk during television commercials.
• Sit less by limiting screen time (TV, computer, phone).
• Take a walk after a meal.

Work your way up to adding weight training and cardiovascular exercises for the heart and lungs a workout. If you are thinking about starting an exercise program, always consult with your healthcare provider first.

Live your best, longest, and healthiest life by learning about diabetes, being open to making positive changes, and making those changes now for more good years^®.

Helpful online resources for getting started

American Diabetes Association
American Association of Diabetes Educators
American Heart Association
Academy of Nutrition and Dietetics
National Diabetes Education Program

Sources:

Hamilton, Lara. “What Is the Plate Method?” Diabetes Forecast, Nov. 2014, www.diabetesforecast.org/2015/adm/diabetes-plate-method/what-is-the-plate-method.html. Accessed 24 Oct. 2019.

Life with Diabetes. 3rd ed., American Diabetes Association, 2004.

“National Diabetes Statistic Report, 2014 Estimates of Diabetes and Its Burden in the United States.” National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation, Center for Disease Control, www.cdc.gov/diabetes/pdfs/data/ 2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf. Accessed 24 Oct.2019.

Type 2 Diabetes Basics. 5th ed., International Diabetes Center at Park Nicollet, 2017.