Diabetes and Carb Counting For Dummies. Shafer Sherri

people with diabetes have developed complications. Fear isn’t a good motivator. Hope is. In this book, I focus on how to better manage diabetes to help prevent complications. Keep in mind that when people developed diabetes many years ago, they simply did not have the resources, knowledge, tools, medications, and technologies needed to adequately manage their disease. Those tools are available now: blood-glucose monitors, insulin and other medications, insulin-delivery options, and knowledge. The roles of diet and exercise in managing diabetes are understood. Multiple studies from around the globe provide a hopeful message, which is taking care of your diabetes has a big payoff: your improved health.

      

While the onset of type 1 diabetes is more obvious, type 2 diabetes can go undiagnosed for many years. Screening is critically important and may alert you to your risk long before diabetes develops. Chapter 2 sorts through the types of diabetes, delineates risk factors, and explains diagnostic criteria.

      You should take diabetes seriously. Uncontrolled diabetes may lead to complications. For example, elevated blood-glucose levels over time can damage blood vessels and tissues. People with diabetes are twice as likely to suffer a heart attack or stroke. Your eyes, kidneys, feet, and nerves are all vulnerable to the damages inflicted by persistently elevated glucose levels.

      

If you currently have complications, talk to your diabetes specialist for appropriate treatment. Request a referral to a registered dietitian if treating your complication has a dietary component. Two examples: Kidney disease may impose restrictions on dietary sodium, potassium, phosphorus, fluid, and possibly protein. Treating gastroparesis (nerve damage that alters the digestive system) involves dietary modifications to improve digestion and absorption of food. When diet becomes part of the treatment for a disease, it’s referred to as medical nutrition therapy. A registered dietitian is a trained medical professional who can help you learn to make dietary changes that support the treatment of diabetes, heart disease, lipid problems, hypertension, and more.

      

A landmark study called the Diabetes Control and Complication Trial (DCCT 1983–1993) followed 1,441 people with type 1 diabetes for ten years. Results showed definitively that improving blood-glucose control reduces the risks of developing complications. The results were astounding: 76 percent reduction in eye disease, 50 percent reduction in kidney disease, and 60 percent reduction in nerve disease. The United Kingdom Prospective Diabetes Study (UKPDS 1977–1997) focused on people with type 2 diabetes. With 5,102 study participants, it was shown conclusively that both blood-glucose control and blood-pressure control are important in reducing complications.

       Building your diabetes team

      Your diabetes team starts with you. You are the team captain, and you get to pick who will be there to assist you on your diabetes management journey:

      ❯❯ Your primary care provider manages your overall healthcare needs. Look for one who has experience with diabetes.

      ❯❯ If you have type 1 diabetes or your type 2 diabetes is not under adequate control, your general practitioner may refer you to an endocrinologist, a doctor who specializes in diabetes.

      ❯❯ You may also benefit from the expertise of a diabetes nurse educator (RN or NP), who can teach you how to monitor your glucose levels, keep and review blood-glucose records, properly administer insulin, handle travel and sick days, and more. In addition, a registered dietitian (RD or RDN) can help you plan balanced meals, teach you to read Nutrition Facts labels and count carbs, and provide dietary advice to help you achieve weight goals, manage blood pressure, improve cardiovascular health, understand the impact of alcohol, treat hypoglycemia, and more.

      ❯❯ A certified diabetes educator (CDE) is a healthcare provider who has advanced training in diabetes management and has passed a comprehensive national exam. To maintain the CDE status, the healthcare professional must complete 75 hours of continuing education in the field of diabetes every five years.

      ❯❯ Also on the roster to join your team are an eye doctor (either an ophthalmologist or an optometrist), a dentist, and a pharmacist.

      ❯❯ At times you may choose to see a mental-health specialist: a counselor, social worker, psychologist, or psychiatrist.

      ❯❯ Should you need them, a podiatrist is available for foot care and an exercise physiologist or physical therapist can guide your physical fitness plan.

      ❯❯

Don’t forget your loved ones, family, and friends. Enlist the support and help of the important people in your life. People want to help; just let them know how best to assist you.

       Staying up to date with advances in diabetes care

      Diabetes specialists (like those listed in the preceding section) stay up to date on the latest advancements in the field of diabetes. Capitalize on their knowledge; stay up to date with your medical appointments and healthcare screenings. Having a few reputable diabetes management books (like this one!) on your home bookshelf is also helpful. Read and reread the sections most pertinent to you.

      

Keep in mind that not everything you read online is factual. Chapter 25 links you to reputable websites for gathering sound information.

Examining the Carb-Glucose Connection

      This book offers in-depth info about the nutrients in food and how nutrients are used in the body. Carbohydrates, proteins, and fats are macronutrients. We need them in relatively large amounts as compared to micronutrients, such as vitamins and minerals, which are required in smaller amounts. Here’s what they do:

      ❯❯ Carbohydrates provide glucose, the body’s primary fuel.

      ❯❯ Proteins contribute amino acids for building and repairing tissues and cells.

      ❯❯ Fats provide fatty acids, assist in the absorption of fat-soluble vitamins and, along with glucose, are used for energy.

      ❯❯ Vitamins and minerals are essential nutrients required for hundreds of jobs throughout the body. To obtain the full complement of vitamins and minerals needed for health, choose a wide variety of wholesome foods.

      Chapter 4 focuses on carbohydrates because carbs have the most profound effect on blood glucose, also known as blood sugar. There, you get a behind-the-scenes tour of carbs’ journey through the body. You find out how carbohydrate foods are digested, turn into glucose, and are absorbed into the bloodstream. You also track the glucose through the system and discover why insulin, “the key to the cell,” is required for proper fuel usage.

      Glucose is so critical for human function that the body stockpiles glucose in the muscles and the liver. The storage form of glucose is glycogen. Glycogen reserves can be tapped into when the body is running low on glucose. If glycogen reserves become depleted, the liver will make glucose from scratch (but it may cost you a little muscle tissue … because you can’t make something from nothing).

Diabetes interrupts the delicate balance of glucose regulation. Managing dietary carbohydrate intake is one of the most important lessons when learning to self-manage your diabetes. It’s not only the amount and timing of the carbohydrate (see Chapters 6 and 8); it’s also the quality of the carbohydrate and what it’s mixed with (see Chapters 10, 11, and 12). In the bigger picture, carbs must be balanced with medications and exercise. Table 1-1 lists the most significant variables affecting blood-glucose levels for people with diabetes.