Diabetes

Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.

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    Strategies for Highs before Your Period

    • If you use insulin, gradually increase your dose. Work with your health care team to add small increments, so that insulin levels are higher the last few days of your cycle, when blood glucose levels normally rise. One to two addi­tional units of insulin may be all it takes. It will take a little trial and error to figure out the right dose for you. As soon as menstruation begins, estrogen and ­progesterone levels drop. When this happens, return to your usual dose of insulin to lower your risk of ­hypoglycemia.
    • Eat at regular intervals, when possible. This will keep your blood glucose levels from swinging too much. Large blood glucose swings could contribute to some of the emotional and physical symptoms of PMS, which may in turn make variations in blood glucose levels worse.
    • Try to avoid eating extra carbohydrates. Keep a handy ­supply of crunchy veggies—for example, celery, radishes, or cucumbers—and dip them in fat-free salsa.
    • Cut back on alcohol, chocolate, and caffeine. They can affect both your blood glucose levels and your mood.
    • Be especially careful about your sodium intake, which causes ­bloating. Use pepper, fresh or powdered garlic, lemon, cayenne pepper, or scallions to add some zing to food.
    • Try to be more physically active. Many women find that regular exercise diminishes mood swings, prevents excessive weight gain, and makes it easier to manage blood glucose levels.
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    You can find out for sure if you suspect that your blood glucose levels are affected by your menstrual cycle. Look at your daily blood glucose records over the past few months. Mark the date that your period started for each month. Do you see any pattern? Are your blood glucose levels higher or lower than normal during the week before your period? If you are not recording your blood glucose levels, now may be a good time to start.
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    At first, you think you’re just imagining it. You’re going along and everything seems fine. You’re in good spirits, eating well, getting regular workouts, and your blood glucose levels are on target most of the time. Then, for some unexplained reason, everything seems out of whack. Maybe your blood glucose levels are too high; maybe they’re too low. Then you check the calendar. Oh, yeah—it’s that time of the month.

    If you have trouble keeping your blood glucose levels on target just before your period starts, you are not alone. A survey of 200 women with type 1 diabetes showed that in the week before their periods, 27% had problems with higher-than-normal blood glucose levels and 12% had lower-than-normal blood glucose levels. Another study revealed that among women under the age of 45 who were hospitalized for diabetic ketoacidosis, half were within several days of starting their periods. A survey of more than 400 women revealed that nearly 70% experienced problems with blood glucose levels during their premenstrual period. The problem was more common among women who considered themselves to suffer from the moodiness associated with premenstrual ­syndrome (PMS).

    It’s difficult to pinpoint just how many women have problems with their blood glucose levels before menstruation. Many studies are based on surveys con­ducted after the fact and do not take physical activity and eating patterns into account.

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    Most women use intensive diabetes management during pregnancy to keep blood glucose levels close to normal. If that is your goal, you’ll need to be extra watchful for low blood glucose levels caused by exercise. Your glucose level can go very low very quickly. Monitoring is your way to watch out for hypoglycemia. Chances are that you’ll already be monitoring frequently during pregnancy. This can help you figure out how exercise affects your blood glucose and when your levels are starting to drop.

    • Monitor your blood glucose levels often—before, during, and after
             exercise.
    • Drink plenty of fluids before, during, and after exercise.
    • Warm up before and cool down after exercise.
    • Keep the strenuous part of your workout to no longer than 15
             minutes.
    • Keep your heart rate under 140 beats per minute while you
             exercise (about 23 beats per 10-second pulse count).
    • Keep your body temperature under 100°F. Ask your provider if hot
             tubs or steam rooms are safe.
    • Avoid exercises that involve lying on your back after your fourth
             month of pregnancy, straining or holding your breath, jerky
             movements, or quick changes in direction.
    • Stop exercising if you feel lightheaded, weak, or very out of
             breath.
    • Ask your obstetrician to show you how to feel your uterus for
             contractions during exercise. These contractions could be a
             sign you’re overdoing it.
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    AMarisa Moore, Nutrition & Dietetics, answered on behalf of Academy of Nutrition and Dietetics

    Two of three adults miss the mark on meeting the recommended daily intake for fruits and vegetables. So, this advice is not exclusive to people with or at risk for diabetes. 

    Fruits and vegetables offer many benefits that help prevent and control the risk factors associated with diabetes. Fruits and vegetables are a great source of potassium, which promotes healthy blood pressure levels. Citrus fruits, okra and beans have all been shown to lower cholesterol levels. Because they are low in calories, high in fiber and water, fruits and vegetables also help with weight loss. This is important since losing just 10% of excess body weight can lead to better blood sugar and blood pressure control. 

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    AJack Merendino, MD, Endocrinology Diabetes & Metabolism, answered on behalf of The Best Life
    If you have diabetes, you should call your doctor:

    If your sugars are above about 250 for more than twenty-four
           hours. If your ketones are high and won't come down after several hours
           of treatment. If you're losing weight. If you can't keep down fluids or are losing more fluids with vomiting
           or diarrhea than you can keep down. If you develop abdominal pain. If you notice a change in your breathing. If you have a high fever that won't come down. If you or a family member find that you are confused or sleepy and
           difficult to awaken. These all may be signs of DKA or HHS. If you can't reach your doctor and your situation is not getting better, you may have to call 911 or have someone take you to a hospital emergency room. Diabetes that's badly out of control is a medical emergency. It's a problem that's easy to treat in its early stages, but more difficult to manage and sometimes even fatal if allowed to go on.
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    AJanis Jibrin, MS, RD, Nutrition & Dietetics, answered on behalf of The Best Life
    Supplements can cause real damage if they are taken improperly; some can have adverse effects with long-term or high-dosage use; and many can react with your diabetes medications. At best, they can be a royal waste of money. If you do decide to use supplements, we cannot emphasize strongly enough how important it is to always run your plan by your health care practitioner.
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    A Stacy Wiegman, PharmD, Pharmacy, answered
    There is some evidence that vinegar may keep blood sugar levels from rising as high as they normally would after a meal, especially after a high-carbohydrate meal. This has been determined through preliminary research, however, so there are no official recommendations about the use of vinegar to control blood sugar. Consider vinegar a good seasoning to add to your meal, which may have a little extra benefit in terms of blood sugar control.
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    AJanis Jibrin, MS, RD, Nutrition & Dietetics, answered on behalf of The Best Life
    Deficiencies in the minerals chromium and magnesium as well as potassium and possibly zinc may worsen your blood sugar control. You may have heard that supplementing with chromium or magnesium will improve your condition, but at this point the American Diabetes Association does not recommend supplementing with any of the minerals mentioned above. However, you may need to supplement if tests prove you are deficient. Blood tests can detect if you're low in potassium or magnesium, but it's harder to test for chromium and zinc.
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    AJanis Jibrin, MS, RD, Nutrition & Dietetics, answered on behalf of The Best Life
    Legumes are beans, such as black beans and lentils, which come dried or canned. Legumes have a very low glycemic index (GI), probably because of their fiber and because they contain resistant starch. As with grains, the more intact the bean, the lower the GI. So a side dish of whole, cooked black beans would have a lower GI than a puréed black bean dip, which would have a much lower GI than bean flour.

    Legumes are rich in B vitamins and in minerals associated with improved diabetes management: calcium, magnesium, and zinc. They've been shown to lower low-density lipoprotein (LDL) cholesterol; this might be their soluble fiber at work (beans have a mix of soluble and insoluble fiber).

    All legumes -- black, kidney, pinto, white, cannelloni, garbanzo, adzuki, lentils, soy, pink -- are supernutritious, so pick your favorites! Save some money by cooking them from scratch (lentils have the shortest cooking time). If you buy them canned, look for those with no salt added (EdenFoods has a wide variety) or with no more than 120 mg sodium per half cup, such as Goya low-sodium. You'll find edamame in the frozen food section, both with the shell (which you don't eat) or shelled. Toss them into salads and stir fries or serve marinated as a side dish.