What is Diabetes?
Diabetes is a condition in which the body cannot properly use sugar as energy. When we eat carbohydrates, they are broken down in the small intestine to simple sugars, one of which is glucose. People without diabetes automatically maintain normal levels of blood glucose, because the pancreas secretes insulin into the blood stream when blood glucose levels rise. The insulin allows the glucose to move from the bloodstream, where it cannot be used, into the body's cells, where it may be used as energy. People with diabetes do not have enough insulin to do the job of moving the glucose from the blood stream into the cells of the body. As a result, they have too much glucose in their blood. This high level of blood sugar can be measured, and this is one way that physicians can diagnose diabetes.
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How does the body maintain normal glucose levels?
When glucose levels rise, the pancreas automatically secretes more insulin to move the excess glucose into cells. When the glucose levels fall, the pancreas decreases its output of insulin levels. This is similar to the thermostat in your house. First, you set the thermostat to the goal temperature you would like to achieve. If the temperature in the room is lower than you set it, the heater will turn itself on and produce more heat. When the temperature rises above the goal level, the heater will turn itself off, allowing the temperature to fall back to the goal level. The thermostat turns the heater off and on to maintain a desired temperature. In this analogy, the blood glucose level is the thermostat, and the insulin-producing pancreas is the heater. For people with diabetes, it is as if their "heater" is broken. No matter how high the blood glucose level gets, the pancreas is unable to secrete enough insulin to bring it down to normal. Consequently, the blood glucose level continues to rise, but most of that glucose can not be used as energy.
Why are good sugar levels important?
High blood glucose levels may cause symptoms such increased thirst, excessive urination, fatigue, weight loss, and blurry vision. In the long run, the high sugars may increase the risk of heart attacks, strokes, kidney failure, permanent visual impairment or blindness, and problems with feet that may lead to amputation. The risk of these complications may be decreased with good sugar control.
How can I find out what level is appropriate?
You should work with your health care provider to determine the levels that are appropriate for you, and set those levels as your goal. Your health care provider may advise you to test your sugars to see if you are at your goal. If you are not at goal, your health care provider may recommend some changes in medication and/or lifestyle to reduce the risk of the long-term complications described above.
There are two ways to measure your blood glucose level. First, you may get a machine and monitor your own sugar at different times of the day. The second way of measuring your blood glucose level is a test called a hemoglobin A1C, which can be thought of as a three-month average of your blood sugars. Ask your health care provider if you have had one of these tests, find out your number, and see if your have reached the target goal. If not, discuss with your health care provider changes that will help you reach your goals.
Are there any general tips to help me reach my goals?
The tips below are to provide general information and are not to be used to treat individual patients. Please consult with your health care provider before implementing any of them. Feel free to show him or her this article as well as the website (listed below).
1) Work with your health care provider and make sure you understand all the instructions given and feel able to implement them when you get home. If you do not feel comfortable with any of the instructions, inform him/her at the time of your office visit.
2) Know your sugars and keep them charted. It is impossible to control numbers if you do not know what they are. If you are not checking your blood sugars now, ask your health care provider if "home glucose monitoring" is appropriate for you. If your sugars are at goal sometimes and not at others, try to figure out why and what changes can be made. Bring a copy of your log to your health care provider. He/She will be in a better position to help if you provide this data.
3) The hemoglobin A1C is a 3-month average sugar measurement. If the sugars are consistently at good levels, your health care provider will probably be very satisfied. If a good average is achieved with many high and low sugars, he will probably want to make changes to lower the variation in your sugar level.
4) If the sugar is not at the established goal, the first place you should look is diet. If you are gaining weight inappropriately, you may need to make adjustments. If the sugar is too high after meals, you may be consuming too many carbohydrates. Keep a log of your diet as well as the sugars and bring this into your health care provider. Many people improve their control by changing their diet. In addition to discussing this with your health care provider or a nutritionist, realize that your diet is your responsibility. You will need sufficient cooking skills, knowledge about food labels, and the desire to implement this knowledge consistently. I have found many people with diabetes are unable to implement their knowledge because they lack the desire or ability to cook. Please consult our website (listed below) as well as other sources to learn basic cooking skills as well as how to read food labels.
5) Find out your appropriate weight and set that as an important target. A proper diet involves proper portion sizes as well as proper foods. Watch your weight, and if it increases, review your diet with your health care provider. If he or she feels the foods are all appropriate, you may want to consider decreasing your portion size. You may need a scale to learn the appropriate portion sizes for you.
6) Ignore marketing hype and look at the nutrition labels on all foods. Even if a food is marked "appropriate for diabetes" or "no sugar added," you must still pay attention to portion size!
7) Try to be consistent with your diet. If you only follow a diet 5 days a week, you will have a very difficult time losing or maintaining your weight at normal levels as well as controlling your sugar.
8) If your health care provider directs you to restrict sodium (Na), green leafy vegetables, or other elements, you will have to follow this advice in addition to limiting carbohydrates.
9) Exercise is extremely important. Ask your health care provider what is appropriate for you, and schedule it as part of your daily routine.
10) Consider having a family member or friend understand your target goals for weight and blood sugar and hold you accountable for your lifestyle. Usually, a spouse or significant other is not an appropriate choice to fill this role. Perhaps you have a friend with diabetes, and you can hold each other accountable for implementing the recommendations of your health care providers.
Dr. Sybil Kramer is a board-certified endocrinologist who has been in medical practice for over 30 years.
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If you would like additional information and to view our cooking videos, please visit our website at diabeticsurvivalkit.com
I hope you found this information helpful.
Thank you,
Dr. Sybil Kramer
Dr. Sybil Kramer, Board-Certified Endocrinologist
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