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Learn about carbohydrate counting and portion sizes. A key to many diabetes management plans is learning how to count carbohydrates. Carbohydrates often have the biggest impact on your blood sugar levels. For people taking mealtime insulin, it's important to know the amount of carbohydrates in your food, so you get the proper insulin dose.
Avoid sugar-sweetened beverages. Sugar-sweetened beverages tend to be high in calories and offer little nutrition. And because they cause blood sugar to rise quickly, it's best to avoid these types of drinks if you have diabetes.
Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also helps your body use insulin more efficiently.
Insulin and other diabetes medications are designed to lower your blood sugar levels when diet and exercise alone aren't sufficient for managing diabetes. But the effectiveness of these medications depends on the timing and size of the dose. Medications you take for conditions other than diabetes also can affect your blood sugar levels.
When you're sick, your body produces stress-related hormones that help your body fight the illness, but they also can raise your blood sugar level. Changes in your appetite and normal activity also may complicate diabetes management.
Stick to your diabetes meal plan. If you can, eating as usual will help you control your blood sugar levels. Keep a supply of foods that are easy on your stomach, such as gelatin, crackers, soups and applesauce.
Get your doctor's OK to drink alcohol. Alcohol can aggravate diabetes complications, such as nerve damage and eye disease. But if your diabetes is under control and your doctor agrees, an occasional alcoholic drink is fine.
If you're stressed, the hormones your body produces in response to prolonged stress may cause a rise in your blood sugar level. Additionally, it may be harder to closely follow your usual diabetes management routine if you're under a lot of extra pressure.
Vegetarian and vegan diets offer significant benefits for diabetes management. In observational studies, individuals following vegetarian diets are about half as likely to develop diabetes, compared with non-vegetarians. In clinical trials in individuals with type 2 diabetes, low-fat vegan diets improve glycemic control to a greater extent than conventional diabetes diets. Although this effect is primarily attributable to greater weight loss, evidence also suggests that reduced intake of saturated fats and high-glycemic-index foods, increased intake of dietary fiber and vegetable protein, reduced intramyocellular lipid concentrations, and decreased iron stores mediate the influence of plant-based diets on glycemia. Vegetarian and vegan diets also improve plasma lipid concentrations and have been shown to reverse atherosclerosis progression. In clinical studies, the reported acceptability of vegetarian and vegan diets is comparable to other therapeutic regimens. The presently available literature indicates that vegetarian and vegan diets present potential advantages for the management of type 2 diabetes.
The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed.
About 38 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them have type 2 diabetes. Type 2 diabetes most often develops in people over age 45, but more and more children, teens, and young adults are also developing it.
Unlike many health conditions, diabetes is managed mostly by you, with support from your health care team (including your primary care doctor, foot doctor, dentist, eye doctor, registered dietitian nutritionist, diabetes educator, and pharmacist), family, and other important people in your life. Managing diabetes can be challenging, but everything you do to improve your health is worth it!
Stress is a part of life, but it can make managing diabetes harder, including managing your blood sugar levels and dealing with daily diabetes care. Regular physical activity, getting enough sleep, and relaxation exercises can help. Talk to your doctor and diabetes educator about these and other ways you can manage stress.
Diabetes self-management training teaches you to cope with and manage your diabetes. The program may include tips for eating healthy and being active, monitoring blood glucose (blood sugar), taking prescription drugs, and reducing risks. Some patients may also be eligible for medical nutrition therapy training.
There is considerable benefit of tight glucose control in patients with type 1 diabetes mellitus. Tight blood glucose control dramatically decreases the incidence of microvascular and macrovascular complications. Although glycemic goals should be individualized, most nonpregnant adults should strive for an A1C level less than 7%. Greater frequency of glucose monitoring and continuous glucose monitoring are both associated with lower A1C levels. The choice to monitor glucose levels via multiple daily capillary blood samples or continuous glucose monitoring is based on cost and patient preference. Intensive insulin treatment is recommended with a combination of multiple mealtime bolus and basal injections or with continuous insulin infusion through an insulin pump. The option to administer insulin with multiple daily injections vs. a pump should be individualized. Adjunctive medical therapy is under investigation but is not currently recommended. All patients with type 1 diabetes should participate in diabetes self-management education and develop individualized premeal insulin bolus plans under the guidance of a dietitian, if possible. Blood pressure and lipid control are important to prevent cardiovascular disease events. Patients with type 1 diabetes should have sick-day plans and be able to identify warning signs of hypoglycemia and diabetic ketoacidosis. Advances in diabetes care, including the bionic pancreas and the closed-loop system of glucose monitoring with an automated insulin pump, may have a significant effect on type 1 diabetes care in the years ahead.
A well-designed double-blind randomized controlled trial of adults with type 1 diabetes who were taking metformin did not show significant improvement in glycemic control. The potential cardiovascular disease benefit remains under investigation.
Tight glycemic control remains the standard of care for most patients with type 1 diabetes. The American Diabetes Association recommends an A1C goal of less than 7% for non-pregnant adults (Table 1).6 Despite the benefits of lower A1C levels, goals should be personalized to account for individual preference, history of severe hypoglycemia, older age, and frailty. Higher glycemic targets for older adults or those with functional impairments, multiple comorbidities, or limited life expectancy are advisable.7
There is a strong association between more frequent self-monitoring of blood glucose and lower A1C levels.8 The conventional approach, practiced by approximately 83% of patients with type 1 diabetes, is to monitor glucose levels via capillary blood testing.9 Testing is advised before meals, before exercise, before bedtime, occasionally postprandially, and anytime hypoglycemia is perceived.6 Although the optimal number of daily tests should be individualized, using these indications corresponds to six to 10 tests per day.
The newer practice of continuous glucose monitoring, used by approximately 17% of persons with type 1 diabetes, can also achieve tight glycemic control.9 With this method, a sensor inserted into the subcutaneous tissue measures interstitial glucose levels in real time and transmits them to a receiving device and monitor (Figure 1). The effectiveness of continuous glucose monitoring devices depends on adherence and does not completely eliminate the need for capillary testing, which is still required for device calibration and to confirm abnormal levels.
Compared with conventional self-monitoring, continuous glucose monitoring has been associated with improved glycemic control.10 One randomized controlled trial demonstrated a reduction in A1C levels from approximately 7.6% to 7.1% over six months in persons 25 years or older with type 1 diabetes who used continuous glucose monitoring, compared with traditional self-monitoring of blood glucose at least four times daily.11 Data do not show a definitive reduction in overall severe hypoglycemic events, but continuous glucose monitoring alarm features and trend alerts can notify patients and caregivers to expeditiously administer treatment.12 The significant increase in cost associated with continuous glucose monitoring needs to be considered when an individual is choosing between glucose monitoring approaches.13
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