Diabetes Recommendations and Considerations

Recommendations

❑ Opinions may differ as to the optimal ratio of dietary carbohydrates, proteins, and fats for prevention and treatment of diabetes. However, it is safe to say that carbohydrates trigger the release of insulin. As more carbohydrates are consumed, more insulin is produced. The current epidemic of obesity and diabetes in the United States indicates that we are asking our bodies to bum the wrong fuel—refined carbohydrates in this case. It has been suggested by Dr. Gerald Reaven of Stanford University School of Medicine that a diet consisting of 45 percent carbohydrates, 40 percent “good” (polyunsaturated) fats, and 15 percent protein will benefit individuals with diabetes.
❑ Ina study published in the Journal of the American Medical Asssociation, those with diabetes who adopted a healthy diet that included adequate protein (about 20 to 30 percent), fats—mainly from polyunsaturated fats (about 30 percent), and carbohydrates (40 to 50 percent) from fruits and non-starchy vegetables, and ate a limited amount of whole grains, starchy vegetables, and pasta had less ill effects from the disease as evidenced by a reduction in hemoglobin A1c. Those who followed a diet rich in high-glycemic-load foods such as white and brown rice, baked potatoes, and breads did not get this benefit.


❑ Eat a low-fat, high-fiber diet including plenty of raw fruits and vegetables as well as fresh vegetable juices. This reduces the need for insulin and also lowers the level of fats in the blood. Fiber helps to reduce blood sugar surges. For snacks, eat oat or rice bran crackers with nut butter or cheese. Legumes, root vegetables, and whole grains are also good. Remember to regulate your complex carbohydrate intake.
❑ The types of carbohydrates consumed are at least as important as the total carbohydrate loading. High-glycemic foods such as white rice, white flour products, starchy vegetables, and many processed foods are quickly converted into blood sugar during digestion, causing insulin levels to go up. Carbohydrates found in low-glycemic foods such as asparagus, broccoli, cabbage, green beans, and low-starch vegetables and fruits are converted into blood sugar more slowly, which only gradually raises insulin levels. Avoiding “white foods” might be best.
❑ For those who are trying to lose weight, following a low-carbohydrate diet appears to be safe and effective in patients with type 2 diabetes. In one study, those who followed a diet that contained 20 percent of the total calories from carbohydrates lost about 16 pounds and reduced their hemoglobin A1c levels to 6.6 percent from 8.0 percent over a twenty-two-month period.
❑ Supplement your diet with spirulina. Spirulina helps to stabilize blood sugar levels. Other foods that help normalize blood sugar include berries, brewer’s yeast, dairy products (especially cheese), egg yolks, fish, garlic, kelp, sauerkraut, soybeans, and vegetables.

Caution: Brewer’s yeast can cause an allergic reaction in some individuals. Start with a small amount at first, and discontinue use if any allergic symptoms occur.

❑ Get your protein from vegetable sources, such as grains and legumes. Fish and low-fat dairy products are also acceptable sources of protein. Kidney function in people with type 2 diabetes seems to benefit from dietary soy protein. This protein also raises the level of “good” cholesterol.❑ Avoid saturated fats, trans fats, hydrogenated or partially hydrogenated oils, and simple sugars (except when necessary to balance an insulin reaction). While total fat intake doesn’t seem to change the risk of getting diabetes, the trans saturated fats and hydrogenated oils found in most fast foods can greatly increase the risk. Beneficial fats and oils include extra virgin olive oil, fish oil, almond oil and butter, avocados, nuts, and seed oils such as sesame, flax, sunflower, and pumpkin. Substituting polyunsaturated fats such as these and other vegetable oils also reduces cognitive decline in people with diabetes. Getting saturated and trans fats out of your diet is key to maintaining good brain function. Trans fats now are out of most of the American food supply—except for at some restaurants. To reduce your saturated fat intake, read labels and limit the amount of animal fat you consume.
❑ Eat more complex carbohydrates or reduce your insulin dosage before exercise. Exercise produces an insulinlike effect in the body. Talk to your doctor about the right approach for you.
❑ Do not take supplements containing large amounts of para-aminobenzoic acid (PABA), and avoid salt and white flour products. Consumption of these products results in an elevation of blood sugar.
❑ Do not take supplements containing the amino acid cysteine. It has the ability to break down the bonds of the hormone insulin and interferes with absorption of insulin by the cells.
❑ Do not take extremely large doses of vitamins B1 (thiamine) and C. Excessive amounts may inactivate insulin. These vitamins may, however, be taken in normal amounts.
❑ If symptoms of hyperglycemia develop, go to the emergency room of the nearest hospital. This is a potentially dangerous situation. Intravenous administration of proper fluids, electrolytes, and insulin may be required.
❑ Avoid taking large amounts of vitamin B3 (niacin). However, small amounts (50 to 100 milligrams daily), taken by mouth, may be beneficial.
❑ Chromium deficiency may be a key player in the type 2 diabetes problem. In addition, chromium may help improve body composition—that is, the ratio of fat to muscle.
Chromium is not generally available in plant foods, as plants have no requirement for it and thus do not concentrate it. Brewer’s yeast, beer, whole grains, cheese, broccoli, and meat are good dietary sources, but not all are good choices for people with diabetes. Inorganic forms of chromium are poorly absorbed. Chromium picolinate is an effective organic form that is readily available as a supplement.

Caution: Brewer’s yeast can cause an allergic reaction in some individuals. Start with a small amount at first, and discontinue use if any allergic symptoms occur.

❑ If you have a child with diabetes, be sure his or her teacher knows how to respond to the warning signs of hypoglycemia and hyperglycemia.
❑ If symptoms of hypoglycemia develop, immediately consume fruit juice, soda pop, or anything else that contains sugar. If that fails to help within twenty minutes, repeat this regimen. If the second treatment fails, or if you cannot ingest food, seek immediate medical attention and/or administer a glucagon injection. Anyone who has insulin-dependent diabetes should always carry a glucagon kit and know how to use it.
❑ Avoid tobacco in any form; it constricts the blood vessels and inhibits circulation. Keep your feet clean, dry, and warm, and wear only white cotton socks and well-fitting shoes. Lack of oxygen (because of poor circulation) and peripheral nerve damage (with loss of pain sensation) are major factors in the development of diabetic foot ulcers. Try to avoid injury, and take measures to improve the circulation in the feet and legs.
❑ Exercise regularly. Women who exercised at least once a week had a reduced risk of developing type 2 diabetes.
❑ Moderate coffee consumption (up to 4 cups a day) of either caffeinated or decaffeinated coffee reduces the risk of getting type 2 diabetes. These surprising results were obtained from over 88,000 women and published in the prestigious diabetes journal Diabetes Care. Coffee contains natural compounds besides caffeine that have been shown to improve glucose control in laboratory animals.

Considerations

❑ To compensate for the lack of insulin production, a person with type 1 diabetes must inject insulin on a daily basis. Injections are necessary because insulin cannot be absorbed from the gastrointestinal tract into the bloodstream if taken orally. Insulin pumps and pens (individual, disposable prefilled insulin syringes in the form of a pen) are also available for the delivery of insulin. Because the management of type 1 diabetes is such a complex challenge, it is imperative that a person with this condition have a good relationship with the physician prescribing the insulin. There are many insulin formulations on the U.S. market.
❑ Since 1982, most of the newly approved insulin preparations have been produced by inserting portions of DNA (recombinant DNA) into special lab-cultivated bacteria or yeast. This process allows the bacteria or yeast cells to produce complete human insulin. Recombinant human insulin has all but completely replaced animal-derived insulin, such as pork or beef insulin. Recently, insulin analogs have been produced that have a structure differing slightly from human insulin (usually by one or two amino acids). This changes the onset and peak of action times.
❑ Strict glucose control in type 1 diabetes also reduces the risk of atherosclerosis, according to a study reported in The New England Journal of Medicine. Intensive glucose control was found to greatly reduce damage to the eyes, nerves, and kidneys. Researchers also concluded that the tight control benefited the heart. Strict glucose control involves at least three insulin injections per day, or the use of an insulin pump, plus frequent self-monitoring. However, some newer studies have refuted these results. Ask a trained diabetologist or endocrinologist what the latest thinking is on the subject.
❑ The FDA has approved pramlintide (Symlin), a new drug for people with diabetes who cannot adequately control their blood glucose levels with insulin. It is intended to be used along with insulin to help lower blood glucose levels during the three hours after meals. Pramlintide must be kept separately from insulin and never mixed, nor should the same syringe be used to administer both, to prevent alteration of the activity of the insulin.
❑ Gastroparesis, which affects up to 75 percent of people with diabetes, causes bloating, loss of appetite, vomiting, and dehydration. With this condition, the flow of food from the stomach to the intestine is blocked or slowed. Because the timing of the digestive process is disrupted, this can complicate efforts to control blood sugar levels with medication. Researchers at Johns Hopkins University School of Medicine have found that sildenafil (Viagra) could be an effective remedy for the condition. Sildenafil appears to cause muscles in the digestive tract to relax.
❑ Caiapo, an extract of white sweet potatoes that is taken as a supplement in Japan, has been studied for its efficacy and tolerability. Dr. Bernard Ludvik of the University of Vienna Medical School found that subjects with type 2 diabetes experienced improvement in both blood sugar and cholesterol levels when taking caiapo. Subjects who took a placebo experienced no significant change. The research was published in the journal Diabetes Care.
❑ Cinnamon, a spice third only to pepper and mustard in popularity, may be a possible and pleasant treatment for diabetes. In a small study, taking 1 or 2 teaspoonfuls a day in capsule form was shown to lower blood sugar, triglycerides, and cholesterol. Some investigators have shown that people with diabetes who took 1, 3, or 6 grams a day of cinnamon reduced serum glucose, triglycerides, and the bad cholesterol (LDL). Mostly associated with pastry products, cinnamon is also an excellent spice for teas, meats, and vegetables, as well as fruits such as apples, bananas, and peaches. The continuous ingestion of table cinnamon is, however, probably not advisable due to the potential toxic buildup of certain cinnamon compounds.
❑ Do not take too much selenium. One study showed that taking 200 micrograms a day for 7.7 years resulted in a nearly threefold increase in the risk of type 2 diabetes.
❑ Taking 600 milligrams of chromium picolinate and 2 milligrams of biotin each day helped patients with poorly controlled diabetes improve glucose management and blood lipid measurements. Larger amounts of chromium picolinate (1,000 micrograms) helped attenuate weight gain and abdominal fat accumulation, while at the same time improving blood sugar control.
❑ In the Nurses’ Health Study, a study of over 80,000 women, higher zinc intake was associated with a slightly lower risk of developing type 2 diabetes. The lowest risk was associated with taking at least 18 milligrams a day of zinc.
❑ Cut back on soft drinks that contain sugar. That is the conclusion drawn by a study that appeared in the Journal of the American Medical Association. Women who drank more than one sugar-sweetened soft drink a day were found to be twice as likely to develop diabetes than those who did not. Even when other factors, such as weight, diet, and lifestyle differences, were factored in, researchers still found that the soft-drink group was 1.3 times more likely to develop the disease. It was hypothesized that in addition to the extra calories, the increase in risk might be attributable to the high amount of rapidly absorbed sugars that cause a dramatic rise in glucose and insulin. Neither diet soda nor fruit juice indicated a problem in the study, but sugared fruit punch showed results similar to the sugared soda.
❑ Cut back on soft drinks that contain artificial sweeteners. In a study of over 5,000 participants, those who drank one or more diet sodas a day had a 62 percent greater chance of developing diabetes. It is possible that the artificial sweetener increases the hedonistic desire for more sweet foods, or that incorporating diet sodas into one’s life is just an indication that the rest of the diet is unhealthy.
❑ Some newly diagnosed patients with diabetes benefited from a whole-system Ayurvedic protocol that included an herbal blend of neem, bitter gourd, blackberry, and Bael fruit coupled with an Ayurvedic diet and meditation. These patients experienced higher hemoglobin A1c levels, which showed better control of blood sugar levels over the six-month study.
❑ People with type 2 diabetes are less able than most people to perceive sweet tastes, and this may make it more difficult for them to lose weight. Because they do not recognize the sweet taste of substances, they often consume sugary products that they do not appreciate as sweet. If a person with type 2 diabetes attains a better understanding of food, exercises greater care in choosing foods, and reads food product labels carefully, he or she should be able to control the problem and avoid the need for treatment with drugs or insulin. Adhering to a low-glycemic-load diet may help control cravings, as it reduces hunger.
❑ A higher magnesium intake lowers the risk of getting type 2 diabetes. The journal Diabetes Care published a study in which overweight women who consumed large amounts of magnesium were 22 percent less likely to develop type 2 diabetes than women who consumed lower amounts. A diet rich in nuts, whole grains, and vegetables that are high in magnesium may be beneficial.
❑ Type 2 diabetes can be controlled by diet and exercise alone, but oral medications or injections of insulin can be added if regulating the diet does not work. Obesity is a major factor in type 2 diabetes, and a weight reduction program is often all that is required to control it.
❑ It was once thought that people with diabetes should avoid all sweetened foods. For weight control, this is still the case. However, research has shown that sugar—a simple carbohydrate—does not cause the greatest increase in blood glucose. Eating baked potatoes or some breakfast cereals causes a greater rise in blood sugar. Indeed, carrots raise blood sugar more than ice cream does. However, it is important to note that the extra vitamins and fiber in carrots probably make carrots a better choice for a diabetic than ice cream. Also, the amount of carrots consumed is usually not enough to cause concern. Carbohydrates are converted quickly into glucose in the body. It is on this principle that many high-protein, low-carbohydrate diets are based. It is essential, therefore, that people with diabetes measure their intake of both simple and complex carbohydrates—not simply those coming from sugar.
❑ Insulin inhalers are now in development. The dose is inhaled through the mouth into the lungs, and from there, the dry or dissolved insulin can easily be absorbed into the bloodstream. The benefits to this method of ingestion, as compared with injection, are obvious. The drawbacks, however, are in accurately administering the correct dose in the correct form. The inhalers deliver only up to 10 percent of the drug into the lungs, making it more expensive because more insulin is needed. The size of the drug particles is also critical—if they are too small, the drug will bind together; if too large, the insulin will not be able to reach the lungs.
❑ A continuous glucose monitoring system, the CGMS® System Gold™, is available from Medtronic, Inc. It records blood glucose levels at five-minute intervals for periods up to three days. Data can be downloaded into a computer for review by a doctor. This device should be used along with traditional finger stick tests for calibration purposes.
❑ A needle management system, called the Q-103 Needle Management System, is available to remove certain hypodermic needles from insulin syringes and to store them safely for later disposal. The device holds as many as 5,000 needles, and is produced by QCare International LLC.
❑ The FDA recently approved a wristwatch-like glucose-monitoring device for use by children and adolescents. The device, called the GlucoWatch G2 Biographer, manufactured by Cygnus, Inc., was previously approved for use by adults. Fluid is extracted through the skin as the device is worn and the glucose level is measured and displayed. Up to six painless measurements per hour for a thirteen-hour period are possible. The device must be warmed up and calibrated using a finger stick.
❑ A wound dressing, called Apligraf, is available that helps heal diabetic foot ulcers, open foot sores that can lead to amputation. It is manufactured by Organogenesis, Inc.
❑ Research indicates that supplementation with the hormone dehydroepiandrosterone in the form of 7-keto DHEA may help prevent diabetes.
❑ Hypothyroidism may be a leading cause of diabetes. Well-known researcher and author Stephen Langer, M.D., has noticed that neuropathies, together with other diabetic complications, disappear when thyroid hormone is administered. Many complications of diabetes and hypothyroidism area result of clogged arteries, which prevent the blood from delivering nutrients and oxygen and carrying off waste and debris.
❑ Glycosylation—the binding of glucose and other sugars onto proteins in the blood, nerve cells, and lenses of eyes—may be responsible for many of the long-term effects of diabetes. Researchers at the University of Surrey’s School of Biological Sciences and the Academic Unit of Diabetes and Endocrinology of London’s Whittington Hospital have shown that vitamin C may inhibit this destructive process. They say that if glycosylation is part of the normal aging process, taking vitamin C supplements may slow it.
❑ Magnet therapy helps some people with diabetes in coping with foot pain associated with the disorder.
❑ A woman with diabetes who wants to become pregnant should watch her blood sugar levels long before she plans to conceive. The fetus has the greatest chance of developing birth defects during the first five to eight weeks of pregnancy, before most women know they are pregnant. It usually takes a few months to get the blood sugar under proper control; if a woman begins to monitor her blood sugar level the day she conceives, damage may already be done by the time it is under control. Pregnant women are routinely checked during pregnancy for gestational diabetes. This disorder usually resolves after giving birth. However, many women who have gestational diabetes will develop type 2 diabetes later in life.
❑ Retinopathy (damage to the retina) from diabetes is the leading cause of blindness in the United States. The incidence of blindness from diabetic retinopathy has dropped with the use of laser surgery. However, persons with untreated diabetes are said to be twenty-five times more at risk for blindness than the general population. The Diabetes Control and Complications Trial (DCCT), a ten-year study which ended in June 1993, showed that improved blood glucose control among type 1 patients prevents or delays diabetic retinopathy. Therapy that keeps blood sugar levels as close to normal as possible reduced damage to the eyes by 76 percent. Persons with diabetes should get annual retinal examinations to check on their condition.
❑ Diabetic nephropathy (damage to the kidneys caused by diabetes) is quite common, but is becoming less so as people recognize the necessity of maintaining a stable blood sugar level. It is important to monitor kidney function periodically. Treating high blood pressure is important. Diabetic neuropathy (damage to the nerves caused by diabetes) usually affects the peripheral nerves, such as those in the feet, hands, and legs. Symptoms include numbness, tingling, and pain. Amitriptyline and desipramine, common antidepressant drugs, have proved to be successful in the treatment of this condition. They work by increasing levels of the neurochemical that carries messages between cells, thus increasing sensation. Autonomic neuropathy may lead, among other complaints, to a buildup of gastric juices in the stomach. Too much stomach acid can cause nausea and diarrhea, but the condition can be relieved by either antibiotic treatment or by eating smaller, low-fat meals. For men, neuropathy or circulatory problems can lead to erectile dysfunction (ED). Sildenafil (Viagra) and tadalafil (Cialis) may be able to alleviate this problem. Your physician will probably want to do a stress test before prescribing this drug.
❑ In one study, large amounts of niacin raised blood sugar levels in people with non-insulin-dependent diabetes by as much as 16 percent. Over time, this could cause dependence on insulin or medication. Niacin can also cause the level of uric acid in the blood to rise, indicating probable kidney dysfunction and an increased risk of gout. However, niacinamide, a form of niacin, slows down the destruction and enhances the regeneration of the insulin-producing beta cells in the pancreas, and therefore may be helpful for those with type 1 diabetes.
❑ Elevated glucose levels in the lens of the eye can result in the accumulation of substances called polyols, whose presence can ultimately cause damage to the lens. High polyol concentrations resulting from high glucose levels can persist even if glucose levels subsequently return to normal. Flavonoids, such as quercetin, help to inhibit the accumulation of polyols.
❑ Diabetes and high blood pressure often go hand in hand, and both can lead to kidney disease. In one recent study, hypertensive diabetics who took drugs called angiotensin converting enzyme (ACE) inhibitors cut their risk of developing serious kidney disease in half.
❑ Coronary artery disease is common in people with diabetes. Women with diabetes are particularly at risk. A sixteen-year study published in Circulation: Journal of the American Heart Association by Frank B. Hu, M.D., lead author and associate professor of nutrition and epidemiology at the Harvard School of Public Health, indicates that women with type 2 diabetes who consumed fish five or more times a week had a 64 percent reduction in coronary heart disease and a 52 percent reduction in total mortality compared with women who ate fish less than once a month. This was attributed to the higher consumption of omega-3 fatty acids associated with this diet. Concerns with environmental toxins found in fresh fish point to fish oil supplements as an acceptable substitute for the actual consumption of fish. Dr. Hu did not study supplements specifically, but did not rule out their theoretical use as substitutes. It is probable that the consumption of omega-3 fatty acids would have the same effect on men.
❑ Researchers at the University of Colorado Health Sciences Center found that smokers who have diabetes are two to three times more likely than their nonsmoking counterparts to develop kidney damage, often leading to the need for dialysis or a transplant. Smoking constricts blood vessels. In people with diabetes, this helps to push large protein molecules out of the vessels and into the kidneys. That can eventually lead to kidney failure.
❑ Rosiglitazone (Avandia) is a drug sometimes prescribed for type 2 diabetes. This drug controls blood sugar by adjusting the sensitivity of fat and muscle tissue to the insulin in the body. Rosiglitazone may cause fluid retention (a condition where the body keeps excess fluid), which may lead to or worsen congestive heart failure.
❑ People with diabetes who experience the pain associated with nerve damage (diabetic peripheral neuropathy) have a new treatment option—the first FDA-approved drug for managing the burning, tingling, and numbing sensations in the extremities that mark this condition. The drug, duloxetine (Cymbalta), was approved in September 2004 for treating the condition, the most common complication of diabetes. In clinical trials, people treated with Cymbalta reported less pain than those given a placebo. Treated with Cymbalta, 58 percent of the people reported at least a 30 percent sustained reduction in pain. Only 34 percent of the people treated with a placebo reported sustained pain reduction. Most commonly reported side effects included nausea, dry mouth, constipation, and diarrhea. In a few cases, patients experienced dizziness and hot flashes.
❑ On days having high levels of airborne particulates, such as dust and soot, people with diabetes are twice as likely to be hospitalized for cardiovascular problems. Exposure to these particles may affect heart rate and increase inflammation in the heart. This places diabetics with cardiovascular problems at a greater risk. If you have diabetes, check air quality levels and stay indoors during periods of risk.
❑ Many nutrients recommended for people with diabetes are available in combination supplements. One company that produces a line of specialty supplements for people with diabetes is Progressive Research Labs of Austin, Texas.
❑ It is vital for people who have diabetes to take care of their feet. Nerve damage can lead to lack of sensation in the feet, and once the skin is broken, sores there may not heal. Treatments for diabetic foot problems include becaplermin (Regranex), a topical gel that encourages tissue growth in the wound, and Dermagraft. Dermagraft is a skin substitute used to help wound closure associated with diabetic foot ulcers. It helps replace and rebuild damaged tissue.
❑ People with diabetes should be vigilant about blood fat and cholesterol levels. Optimum cholesterol levels are LDL (“bad cholesterol”), less than 130; HDL (“good cholesterol”), 60 or above; triglycerides, 150 or under. Your doctor may set different levels for you if you are diagnosed with diabetes.