First, lets' deal with some simple definitions that we use here at Diabetic-Lifestyle on a regular basis and that you will hear at your doctor's office, in articles on diabetes, and just in conversation.
What is type 1 diabetes? This is the type of diabetes that used to be called juvenile diabetes or insulin dependent diabetes. It results from our body's inability to make insulin-the hormone that allows glucose in and out of cells to fuel them. Glucose is the end product of the metabolism of the food that we eat. It gives us energy and allows us to function normally throughout the day. Before you were diagnosed with diabetes, you will remember how tired you were and how much weight you lost. This is a result of that loss of insulin in the body so the body no longer functions normally. You will also note that when you begin to take insulin, you will become less dehydrated and will begin to regain that excessive weight loss. The tell tale symptoms of diabetes will fade away, like impaired sight, fatigue, poor healing etc.
What is type 2 diabetes? I know some of you know all of this, but remember when you were just diagnosed? We get many e-mails from newly diagnosed diabetics who really don't know what they have and why. Type 2 diabetes used to be called non-insulin dependent diabetes. Of course, we all know that many type 2 diabetic patients take insulin, so this is probably not a good medical way to describe it. Type 2 diabetes is a result of insulin resistance (condition in which the body fails to make enough or properly use insulin it makes), combined with relative insulin deficiency. Often type 2 diabetes can be controlled through losing weight, improved nutrition, and exercise alone, but many people may need oral medications and/or insulin to control their diabetes. Look in the 'what's hot' index for the article we have which describes the types of medication that are used to control diabetes.
How is diabetes diagnosed? The ADA suggests that all people over 45 be tested for diabetes and, if they test normal, then be retested every 3 years. People from high risk ethnic groups should be tested routinely as should people with high risk medical conditions. You will be diagnosed with diabetes if you register a fasting blood glucose level over 126 mg/dl, if your casual glucose is equal to or above 200 mg/dl, or plasma glucose is equal to or above 200 mg/dl during an oral glucose tolerance test.
It's time to get down and dirty about diabetes questions for the newly diagnosed. The most often asked questions we get are all about food. Just from looking at the above two questions, you will understand that what we print here will be general in nature, but should point you in the right direction and give you enough information to return to your physician and health care team with a packet of questions that you need to have answered. Over and over we at Diabetic-Lifestyle share with you that you need to be an expert about this disease so that you can care for yourself on a 24/7 basis, because this is a 365 day a year type of process.
Meal Planning:
The first thing people think of when you say diabetes is that you will have to give up anything with sugar in it for the rest of your life. The concept of carbohydrate metabolism and therefore carbohydrate counting has evolved over the past years, so this is no longer the case. What you do need to do as soon as you are diagnosed is to meet with a dietitian or diabetes educator who specializes in meal planning. The "whys" of this are simple. If you need to lose weight, this is the person who will know how. If you need to gain weight, this is the person to see, and if you want to maintain weight, the answer is the same. Every person's meal plan should be different depending on their ethnic backgrounds, work conditions, other medical conditions etc. You may be taught how to count carbohydrate grams or use diabetic exchanges, all of which are just weights of food which your insulin or medication will need to cover. Your meal plan will include the number of meals you eat per day (some people do better on many small meals, others eat regular meals and snacks as needed), how many calories you need to eat, how to include special foods for special days, how to dine out, guidelines for low cholesterol and lower fat intake, how you actually add some sugar to your recipes, how to include that glass of wine with meals, and finally how to become a savvy food shopper and read labels for your health. If you want to see some examples of Meal Plans, look at our welcome page in the yellow box on the right.
Self monitoring of blood glucose levels: Why is it important to prick your finger or arm and test your blood? We all know that having a high blood glucose level over time can lead to serious complications throughout our bodies. People with diabetes suffer high rates of cardiovascular disease, kidney disease, neuropathy, digestive disease, skin and teeth disease, muscular problems, diabetic retinopathy and more. If you haven't heard about the DCCT (Diabetes Control and Complication Trial) and the British UKPDS (UK Prospective Diabetes Study), you certainly will as you talk about diabetes and read about it in books, medical journals and on the net. Both studies have ended the argument about the benefits of lowering glucose levels in diabetes. The goal today is decisively glucose control.
What do you need to know about blood glucose control? When you sit down with your physician or diabetes educator, ask just what goals you need to set for yourself and how they can help you help yourself. At the end of this section, we'll list the medical goals that are common out there, so you can take them to your medical appointment. Anytime you have a new diagnosis, you may feel confused about the everyday stuff. Monitoring your blood glucose level has become an easy prospect compared to 20 years ago. My first glucometer was the size of a novel, and each time I had to recalibrate it for the first few months I had to ask my druggist to help. Today, I can carry my meter in a pocket when I exercise or travel. My first meter took 2 minutes to register; today there are ones that take just a few seconds. Like any new skill, it will take a few times to master the programming, etc., but here you are using a computer so a meter will be child's play. You will need to have a schedule for taking your blood sugar levels. This schedule will help you and your health care team to understand how your levels vary according to certain foods, stress, exercise, etc. and then to modify your medications or activities. Storage of medications and insulin as well as monitoring supplies always comes up in questions. If you take insulin you will need to know what your insulin should look like and how to store it safely. Finally, the team should help educate you on interpreting blood glucose levels and then making decisions on how to treat them. This includes how to treat both high and low blood levels, and will depend on what medication, if any, that you are taking or the type of insulin you use. One last proviso and that is to keep the manual that comes with your meter. You'll be surprised how long those batteries last and how soon we all forget how to program another gadget around the house.
Here is that chart we promised about blood glucose levels. You'll note that we give you levels for both non-diabetic and diabetic people.
| For non-diabetic people |
| Before Breakfast (fasting) | <110 |
| Before Lunch | <110 |
| Two Hours after Meals | <140 |
| Bedtime | <120 |
| HbA1c | < 6% |
| For People with Diabetes |
| Before Breakfast (fasting) | 90-130 |
| Before Lunch | 90-130 |
| Two hours after meals | < 160 |
| Bedtime | 110-150 |
| HbA1c | =7% |
Use of insulin or oral medications:
There are many families of medications which work in different parts of your body so it's important to ask how and where the medication you are prescribed works. You will also want to ask about any side effects. Ask your doctor to run a drug-drug interaction with the other medications you take to make sure there are no interactions that can cause you problems. If you take insulin, make sure you know the type, the half life, and how long it takes to kick in. Your health care team will tell you about timing and schedule for your medication or insulin injections. Ask someone to write it down. As you monitor your glucose, these may have to change and/or you may forget. If you take insulin, have someone teach you how to go through that process including drawing insulin, injecting and site rotation, or if you opt for a pump make sure you are thoroughly educated. Make sure you can contact someone for help if you need it. I can tell you that when I came home with my pump I had to call the manufacturer because the doctor's office had closed and I was frightened, knowing that the pump was not functioning as I thought it should. Two calls later and I was fine. As I said before, learning about new gadgets with little computers inside can be scary until you get the hang of it, and sometimes the educator, as was mine, was anxious to get home on a Friday afternoon. Sometimes we all make mistakes; we miss a pill or give ourselves the wrong amount of insulin. Ask how to correct these mistakes.
Next month we will continue with our Newly Diagnosed Article. Again, just e-mail if you have questions. We'll do our best to answer your questions.
BSP
