Diabetes Cookbook For Canadians For Dummies. Cynthia Payne

steady weight, or, when necessary, gain weight; and how best to adjust your diet in order to achieve whatever weight change you require (if any).

      ✔ Adjust your diet to accommodate your exercise program, travel schedule, sleeping in, shift work, and other factors.

      ✔ Find great recipes; indeed some dietitians are so expert at cooking they even co-write entire books on this subject.. like this book!

      

A good dietitian will not ask you to follow a regimented, unrealistic, unpleasant diet. A good dietitian will help you find a culturally appropriate, tasty, interesting, nutritious, and varied eating program. Not happy with the diet you’ve been asked to follow? Let your dietitian know; he or she’ll be glad to have the opportunity to modify your diet to better suit your needs.

Finding a registered dietitian

      These are a few ways you can find a registered dietitian to assist you:

      ✔ Call your local diabetes education centre (DEC). Most diabetes education centres allow self-referral, but if the one local to you doesn’t, then ask your doctor to refer you. The cost of the services provided by dietitians working out of a DEC are typically covered by the hospital or other health care facility where they are located, so you will not have to pay.

      ✔ Contact a private registered dietitian. You can find the name of a registered dietitian local to you in your phone book or online at http://dietitians.ca. Also your doctor can likely recommend one to you. Remember, it is a registered dietitian you want to see. Expect to pay a charge for the services provided by a private dietitian; however, if you have private insurance, your insurer may cover some or all of these costs.

      ✔ If your family physician works in a clinic setting, ask whether the clinic has a registered dietitian on staff. If so, you can book an appointment to see that clinic’s dietitian.

      Exercise and Blood Glucose

      Exercise has a powerful effect in controlling blood glucose. Indeed, if you’ve been sedentary and your blood glucose control hasn’t been very good, you’ll likely find yourself very impressed by how much your newfound exercise program helps bring your blood glucose down. This effect is made all the greater when coupled with nutrition therapy and weight loss. (Exercise also helps control blood pressure and cholesterol, lowers the risk of heart disease, and makes one feel generally better. Not too shabby, eh?) Cardiovascular (cardio) exercise causes your muscles to use oxygen and your heart to speed up and beat more forcefully. As the name suggests, cardiovascular exercise works – and benefits – the heart (hence the term cardio) and circulation (vascular). Examples of cardiovascular exercise are walking, running, and skating.

      The Canadian Diabetes Association recommends you perform cardiovascular exercise for at least 150 minutes per week, spreading it out over a minimum of three days of the week. Also, you should avoid going more than two days in a row without performing cardiovascular exercise.

      Resistance exercise uses muscular strength to move a weight or to work against a resistance. If you lift weights or exercise with weight machines, you’re performing resistance exercise. This type of exercise improves muscle strength and, as shown by pioneering Canadian research undertaken by Dr. Ron Sigal, also helps control blood glucose levels.

      The Canadian Diabetes Association recommends that you perform resistance training at least two times per week (and preferably three times per week), starting with one set of 10 to 15 repetitions using a moderate weight, and gradually progressing toward a goal of three sets of eight repetitions three times per week using a heavier weight.

      

Before you take up a new exercise program, be sure to first speak to your physician. He or she will need to ensure you are sufficiently healthy to perform the activity. Also, exercise can affect your blood glucose levels both while you’re performing the activity and afterward, so you’ll need to keep a close eye on them to see how they respond to your activities. Be sure to keep a fast-acting carbohydrate (as we discuss earlier) with you in case you develop hypoglycemia during or after your exercise.

      Taking Oral Medications to Help Control Your Blood Glucose

      If you have type 2 diabetes, taking oral medication or insulin to control your blood glucose should always be considered complementary to lifestyle therapy (including healthy eating, regular exercise, and weight control).

      

These are the classes of oral medications (and the generic names of the drugs within the classes) used to control blood glucose in people living with type 2 diabetes:

      ✔ Alpha-glucosidase inhibitors (acarbose) work by slowing down the rate of absorption of glucose into the body from the intestine.

      ✔ Biguanides (metformin) lower blood glucose primarily by reducing how much glucose the liver makes.

      ✔ DPP-4 inhibitors (linagliptin, sitagliptin, saxagliptin) work by reducing how much glucose the liver makes and by stimulating the pancreas to make more insulin.

      ✔ Meglitinides (repaglinide, nateglinide) work by stimulating the pancreas to make more insulin.

      ✔ Sulfonylureas (gliclazide, glimepiride, glyburide) work by stimulating the pancreas to make more insulin.

      ✔ SGLT-2 inhibitors (canaglifozin) work by allowing greater amounts of glucose to pass through the kidneys and be excreted from the body in the urine.

      ✔ Thiazolidinediones (pioglitazone, rosiglitazone) work primarily by helping glucose move from the blood into fat and muscle cells.

      

Of the various oral medications available, metformin is the preferred initial drug for most people.

      GLP-1 analogues (exenatide, liraglutide) have similar properties to DPP-4 inhibitors, but have the additional benefit of facilitating weight loss. GLP-1 analogues, however, are given by injection; they are not taken orally.

      Using Insulin to Help Control Your Blood Glucose

      As many Canadians know – and proudly declare – insulin was discovered in Canada. (Want to learn more about the amazing story behind the discovery of insulin? We highly recommend reading the superb book The Discovery of Insulin, by Michael Bliss, University of Chicago Press.)

      All people with type 1 diabetes require insulin therapy from the time of diagnosis. Many people with type 2 diabetes, given a sufficiently long time living with the condition, will also require insulin therapy because the pancreas in a person with type 2 diabetes gradually loses its ability to make insulin.

      Insulin is given by a painless injection with a tiny needle into the abdominal wall, arms, legs, or buttocks. It is most easily administered using a pen device. Pens are small, convenient, portable, and available for free from pharmacies and diabetes education centres.

Looking at the types of insulin

      A variety of different types of insulin therapy are available, each with its own specific properties. Combinations of different types of insulin are also available.

      The various insulins can be grouped into three main categories:

      ✔ Rapid-acting and short-acting insulins are given before meals and prevent the carbohydrates you ingest from making your blood glucose levels rise excessively. The trade names for the available rapid-acting insulins are Apidra, Humalog, and NovoRapid.

      ✔ Intermediate and long-acting insulins are given to prevent your blood glucose level from rising too high between meals and, especially, overnight. The only intermediate-acting insulin used in Canada is called NPH. The trade names for the available long-acting insulins are Lantus and Levemir. Lantus and Levemir have a main advantage over NPH insulin in that they are far less likely to cause hypoglycemia.

      ✔ Premixed