How to Live with Type 2 Diabetes

A new study suggests people with type 2 diabetes aren’t getting basic information that would help them better manage the disease.

July 20, 2009

The fiber in fresh vegetables makes them a must-have if you have type II diabetes.

RODALE NEWS, EMMAUS, PA—Type 2 diabetes rates are exploding in this country, with nearly 23 million people suffering from the disease in the United States alone. By 2050, an estimated 48 million will live with the condition in the U.S. Despite the rising number of cases, a new study finds that many people with the condition are not following recommendations that can lead to weight loss and better management of the disease. A big part of the problem is that doctors aren’t giving patients the information they need, says American Dietetic Association spokeswoman and Certified Diabetes Educator Constance Brown-Riggs, RD.


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THE DETAILS: The study’s researchers looked at data from the National Health and Nutrition Examination Surveys done between 1988 and 2004, and found that people with type 2 diabetes aged 45 to 64 increased both the total calories and the amount of carbohydrates they consumed in a day. None of the age groups in the surveys cut calories during that time period, but the people who fell in that 45- to 64-year-old age group actually ate about 350 more calories a day, including about a 15 percent increase in their carbohydrate intake. That’s contrary to standard advice for people with type II diabetes, who should be reducing their calorie intake by 500-1,000 a day if they’re overweight. The study appeared in this month’s Journal of the American Dietetic Association.

WHAT IT MEANS: If you want to manage your diabetes, a healthy diet is absolutely key. But people with type 2 diabetes are often confused about their condition, believing common myths like “type 2 diabetes isn’t that serious,” explains Brown-Riggs. But indeed, it is. The disease can lead to kidney and heart disease, stroke, blindness, and depression.

Here’s a commonsense guide to managing type 2 diabetes:

• Make your doctor give it to you straight. Believe it or not, many people leave the doctor’s office without even knowing they’ve just been diagnosed with type 2 diabetes. “Doctors really need to take more time in explaining the diagnosis and what’s going on,” says Brown-Riggs. “Oftentimes, they won’t even say the word diabetes, but say, ‘Your sugar’s elevated, just stay away from sugar,’” he says.

• Talk to a nutritionist. More than ever before, health insurance covers consultations with registered dieticians (RDs). Look for one with the Certified Diabetes Educator certification. A dietician will fill in the gaps that your doctor missed, explaining what happens in your body when you eat, and help developing individualized blood glucose control plans. (If you have to pay out-of-pocket, it costs about $150 to $250 for the initial consultation.)

• Know it’s not all or nothing. Having type 2 diabetes doesn’t mean you should cut all carbs out of your diet. In fact, avoiding carbs might actually make you gain weight, as another story today explains. Everyone is different, but generally, people shouldn’t dip below 120 gram of carbohydrates a day; try not to exceed 60 grams of carbs per meal, and keep it to 15 to 20 grams for two daily snacks. Try to monitor your carbs at each meal; don’t wait until dinner and load up on all 130 grams. Remember to factor beverages into your carb monitoring, too. For comparison, 1 large order of McDonald’s fries has 60 grams if carbs, as does 2 slices of fresh turkey breast (2 carbs) on 2 pieces whole wheat bread (24 grams) plus a medium apple (24 grams) covered in 2 tablespoons natural peanut butter (7 grams), and a 2-cup salad of green leaf lettuce (2 carbs) with red wine vinegar and olive oil dressing (less than a carb).

• Befriend fiber. Fiber is crucial for managing diabetes because it slows down the digestion process, preventing a dangerous spike in blood sugar. The idea is to you’re your blood sugar level steady and avoid mealtime explosions. Brown-Riggs says diabetics should have three to four high-fiber carb choices per meal. Here are some meal suggestions:

Breakfast: ¾ cup whole grain cereal, ½ cup milk, 1 slice whole grain toast with scrambled egg whites

Snack: Whole grain crackers with a little natural peanut butter

Lunch: Sandwich on whole grain bread, with sliced turkey breast, tomatoes, and mustard; piece of fresh fruit; unsweetened iced tea

Dinner: Use the plate method. Half of the plate should consist of leafy green vegetables, broccoli, or asparagus. Break the other half into two quarters. Fill one spot with lean beef, chicken, or fish, and the other with a starch, such as brown rice, whole grain pasta, or potatoes. (If you can’t give up white rice, make sure you add another high-fiber food, such as beans, to your meal to slow down digestion.)

• Swap juice for fruit. Some people can drink four ounces of juice at breakfast and not experience a blood sugar spike, but others do. Those people could try eating an orange instead, because the actual fruit contains more fiber that will put the stops on a big sugar spike.

• Squeeze in exercise for better glucose control. Brisk walking for a half hour a day, five days a week, can do wonders for your blood sugar, and is an important factor in handling type 2 diabetes. Pick an exercise you’ll enjoy, not loathe, or even look for something new and exciting. A study published last month in the Journal of Alternative and Complementary Medicine found that diabetics who attended twice-weekly tai chi programs had significantly better fasting glucose readings, quality of life, social functioning, mental health, and vitality than the group who skipped many of the classes.

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