Diabetes

Diabetes

New Choices for Balancing Blood Sugar

Diagnosed with diabetes at age 30, Sandra Panchak had more or less resigned herself to a lifetime of daily insulin injections when she heard about an alternative.

Like other women with diabetes, Panchak has trouble using glucose, the simple sugar that is the body's primary energy source.

Normally, your digestive system breaks carbohydrates such as pasta, fruit, cookies and vegetables into glucose and channels the sugar into the bloodstream. This prompts your pancreas, a gland behind your stomach, to secrete insulin. A hormone, insulin ferries the sugar into cells throughout your body, where it's used for fuel.

If you have diabetes, however, glucose can't get into your cells. Either your pancreas doesn't produce enough insulin or your cells resist insulin's attempts to usher in the sugar, or both. Uncontrolled, this cellular glucose embargo can lead to serious, and sometimes fatal, complications. Sugar can build up in your bloodstream, damaging your blood vessels, nerves, eyes and kidneys. Blood vessel damage that accompanies diabetes can impair circulation, delaying wound healing and increasing risk of infection. Diabetes also raises your risk of heart disease and stroke.

NEW HOPE FOR A STUBBORN PROBLEM

Some women with diabetes can get by with oral medication that stimulates insulin secretion. But others, like Panchak, need daily injections of synthetic insulin to keep blood sugar levels within the normal range. "Normal" is 80 to 115 milligrams of glucose per deciliter of blood.

Initially, Panchak's doctor told her that she might be able to manage her diabetes with oral medication--if she lost weight. Overweight is a key contributor to diabetes. Despite her best efforts, though, Panchak never lost enough weight to make a difference.

"I tried dieting, but it didn't work, so I went straight to using insulin," says Panchak, 53, who lives in Washington, D.C. "I'd almost given up hope of getting off insulin, when I had an opportunity to try an alternative approach."

Panchak learned that researchers at nearby Georgetown University were looking for volunteers to test the effectiveness of a vegetarian diet in the treatment of diabetes. With her doctor's blessing, Sandra signed up for the study. Just three months after she started the diet, Panchak's blood sugar levels were well under control and her doctor lowered her insulin dose.

"By the end of the study, I'd lost 17 pounds, and since then I've lost another five," says Panchak, who continues to eat low-fat vegetarian fare. "My doctor says that if I continue to lose extra weight, I may be able to stop using insulin and rely on oral medication alone. Before, that was out of the question."

A vegetarian diet is just one alternative that can help women manage diabetes, says Jill Sanders, a naturopathic physician practicing in Portland, Oregon. "There are a lot of things you can do that can help."

But first, you need to know where you stand.

HAVE YOU HAD YOUR BLOOD SUGAR CHECKED?

Diabetes is extremely common. One in 20 Americans, many of them women, have the disorder. Unfortunately, roughly half don't know that they do, says Philip Cryer, M.D., endocrinologist, researcher and professor at Washington University School of Medicine in St. Louis and president of the American Diabetes Association. "The problem is, complications can arise even before a women is diagnosed," he adds.

Warning signs include frequent urination and excessive thirst, unexplained weight loss and repeated vaginal infections. Don't ignore these symptoms. Ask your doctor to test your blood sugar levels, says Dr. Cryer. A fasting blood glucose test can usually tell you whether or not you have diabetes. (You'll be asked to go without food overnight and then have your blood tested in the morning before you eat or drink anything.) If this test is normal but symptoms persist, measuring blood glucose levels after swallowing glucose can identify impaired glucose tolerance, a condition that can lead to diabetes.

There are two basic types of diabetes, known as Type I and Type II. With Type I (insulin-dependent) diabetes, which usually develops during childhood, your body can't use glucose because the pancreas makes little or no insulin. If you have Type I diabetes, you'll need daily insulin injections to keep your blood sugar levels in a safe range.

With Type II (non-insulin-dependent) diabetes, which develops in adulthood, your body makes some insulin, but your cells resist it, interfering with insulin's ability to lower blood sugar. If, like Panchak, you have Type II, or what used to be called adult-onset diabetes, you may need to inject insulin or take oral medication.

No one knows exactly what causes diabetes, says Dr. Cryer. Type I seems to be result of a glitch in which immune cells destroy the cells that manufacture insulin. Some research indicates that this wanton destruction may sometimes be triggered by a virus. Type I also seems to run in families.

Besides being overweight, a family history of diabetes also increases your risk that you will develop Type II diabetes. During pregnancy, some women develop gestational diabetes, a temporary but dangerous form of Type II diabetes. If that happens, you're more likely to develop Type II later in life. And for reasons that aren't entirely clear, African-American, Hispanic and some Native American women also run higher risks of Type II diabetes, Dr. Cryer says.

YOU'RE IN CONTROL

Studies suggest that the best way to prevent diabetes may be to drop excess weight, improve your diet and exercise regularly. That's also the best way to control your blood sugar levels and limit complications associated with diabetes if you already have Type I or II. If you have Type I and take steps to control it, you may be able to get by using less insulin. If you have Type II, you may be able to get by with less medication, or none, says Dr. Cryer.

Professional health organizations such as the American Diabetes Association offer advice on how to change your diet and work exercise into your life. But some alternative practitioners offer additional ways to manage and prevent diabetes, like switching to a vegetarian diet, taking vitamin or mineral supplements or trying certain herbs. Research suggests that vegetarianism and other alternatives get good results.

Before you modify your diet or activity level or start taking supplements or herbs, however, be sure to check with your doctor, says Dr. Sanders. And if you have gestational diabetes, your obstetrician should monitor your progress throughout your pregnancy. If lifestyle changes aren't enough to bring your blood sugar levels under control, she may prescribe insulin injections until the danger passes.

No matter what type of diabetes you have, trying alternative treatments may change your need for insulin and medication. But never stop taking insulin or medication or adjust the dosages without your doctors consent, says Dr. Cryer.

FOOD THERAPY: INSULIN-FRIENDLY
EATING PLANS

As a rule, a high-fiber, low-fat diet that helps you lose weight will improve blood glucose levels and help control Type II diabetes, explains Christine Beebe, R.D., president-elect of health care and education for the American Diabetes Association and director of the Health and Wellness Center at St. James Hospital in Chicago Heights, Illinois. High-fiber, low-fat diets fill you up before you overeat. So you eat less and lose weight, which keeps blood glucose levels comfortably normal.

Another key to blood glucose control is spacing out the carbohydrate-rich foods that you eat during the day since carbohydrates raise blood glucose levels more than fat or protein, says Beebe. If you take insulin, it may mean adjusting your dose to keep your blood glucose on an even keel. So a high-fiber, low-fat diet that assists in weight loss is a good choice whether you're trying to prevent or control diabetes. But specific high-fiber, low-fat diets may be particularly beneficial. Here are your best bets.

Try the vegetarian route. In the Georgetown study, men and women with Type II diabetes saw their blood sugar control improve and their weight drop significantly after they switched to a totally vegetarian diet, free of meat and dairy food. Like most vegetarian diets, the Georgetown diet was high in fiber and low in fat and included adequate, but not excessive, protein.

Because vegetarian diets usually don't contain as much protein as diets that include meat or dairy foods, they may have an edge over other high-fiber, low-fat diets, says Andrew Nicholson, M.D., the researcher who headed the Georgetown study and the director of preventive medicine for the Physicians' Committee for Responsible Medicine, in Washington, D.C.

Extra protein can overburden your kidneys, the organs responsible for ridding your body of excess protein. If you have diabetes, your kidneys are already vulnerable. (Doctors aren't sure why, but diabetes damages the kidneys.) In the Georgetown study, volunteers excreted less protein in their urine after switching to a vegetarian diet, which suggests that the diet helped protect their kidneys from damage, says Dr. Nicholson. (For information on following a vegetarian diet, see page 286.)

Try the Ornish approach. The Ornish diet--a low-fat vegetarian diet designed by Dean Ornish, M.D., cardiologist, assistant clinical professor of medicine at the University of California in San Francisco and director of the Preventive Medicine Research Institute in Sausalito, California--offers another dietary alternative. (To follow the Ornish diet, see page 132.)

Consider the Pritikin diet. If you're not ready to do without meat, you might consider the Pritikin diet. Developed in the 1970s by an engineer named Nathan Pritikin, this diet allows a modest 3½ ounces of animal protein per day and only 10 percent of calories from fat, with generous portions of high-fiber grains, vegetables and fruits.

Like the Ornish diet, the Pritikin diet seems to help control diabetes. In a University of California, Los Angeles, study of more than 600 women and men with diabetes, 71 percent of those taking oral hypoglycemic drugs and 39 percent of those using insulin were able to stop taking medications after switching to the Pritikin diet and starting an exercise program. (For more information on the Pritikin Diet, see page 137.)

Cruise the Mediterranean. Some men and women with diabetes do well on a diet that's slightly higher in fat, provided that the fat is consumed in the form of monounsaturated fat, like olive oil. Unlike animal fats, which are largely saturated, olive oil is composed primarily of monounsaturated fat.

In a study at the University of Texas Southwestern Medical Center at Dallas, ten men with diabetes needed 13 percent less insulin after they started following a Mediterranean-style diet typical of Italy, Greece and Spain. The diet included lots of whole grains, vegetables, fruits, legumes like white beans--and olive oil. The diet got 50 percent of calories from fat.

That's far more fat than the 10 percent supplied by the Ornish or Pritikin diets, says Abhimanyu Garg, M.D., associate professor of internal medicine at the center and the study's chief researcher. He speculates that the individuals in this study needed less insulin because they ate fewer carbohydrates while on the diet. In other words, the calories that came from olive oil took the place of calories that would have otherwise come from carbohydrates. The results imply that men and women alike can benefit from a Mediterranean diet.

"People with diabetes are less able to metabolize carbohydrates than those who don't have diabetes," explains Dr. Garg. "So, if you reduce carbohydrate intake by replacing carbohydrates with monounsaturated fat, that improves diabetes control."

Not only were the individuals in the study better able to control their blood sugar levels, but their low-density lipoprotein (LDL) cholesterol levels dropped, too. Saturated fat such as butter and lard will raise levels of LDL cholesterol, contributing to heart disease.

In contrast, monounsaturated fat such as olive oil lowers blood levels of LDL cholesterol--a significant benefit to people with diabetes, who are at higher risk for heart disease. (For information on following the Mediterranean diet, see page 159.)

Cook with onions and garlic. Some research suggests that onions and garlic--members of the lily family--may lower insulin resistance and help control blood sugar. When researchers at the University of Kerala, India, treated diabetic rats with an active compound isolated from garlic, their blood sugar levels stayed under control. These researchers believe that onions may have a similar benefit.

To enjoy these benefits, add garlic to sauces, soups and stews, says Dr. Sanders. Sprinkle sliced onions on salads and use them in sandwiches, soups, stews and casseroles.

HERBAL HELPERS

A number of herbs can help prevent and control diabetes, Dr. Sanders says. Try incorporating some of them into your diet.

Benefit from ginseng. In a Finnish study, people with non-insulin-dependent (Type II) diabetes had more stable blood sugar levels when they took on a daily basis 200 milligrams of ginseng, a fleshy root widely used for its medicinal properties. Look for ginseng (Panax ginseng or Panax quinquefolius) in health food stores.

Get gymnema. The leaves of this woody plant, which grows in the tropical forests of central and southern India, seem to help control blood glucose levels, says Dr. Sanders. She recommends 400 milligrams of gymnema (Gymnema sylvestre) a day. This herb is available as an extract made from the leaves. You may have to shop around to find it or special order it through health food stores.

Add bilberry and ginkgo. A relative of blueberry, bilberry (Vaccinium myrtillus) may help improve your circulation and, if you have diabetes, lower your risk of eye damage, says Dr. Sanders. The same goes for ginkgo (Ginkgo biloba), a tree native to China. You can find both bilberry and ginkgo in freeze-dried or tincture form at health food stores. Follow the manufacturer's directions.

VITAMINS AND MINERALS OFFER PROTECTION

Research suggests that women with diabetes may be falling short in certain vitamins and minerals that can help ward off some of the complications associated with the disorder. To avoid deficiency, include these in your diet.

Add some C. "Vitamin C can help prevent the damage to blood vessels that accompanies diabetes," says Dr. Sanders. She recommends at least 1,000 milligrams of vitamin C a day. Take 500 milligrams in the morning and another 500 milligrams at night.

Get extra E. In an Italian study, daily doses of vitamin E helped people with Type II diabetes make better use of insulin. Dr. Sanders recommends 400 international units of vitamin E every day.

Check out chromium. In a U.S. Department of Agriculture (USDA) study, people with Type II diabetes had more stable blood sugar levels when they took supplemental chromium. Some USDA research suggests that the mineral may help prevent diabetes. Dr. Sanders recommends 200 micrograms. (People with diabetes who take chromium should be under medical supervision since their insulin dosage may need to be reduced as blood sugar drops.)

EXERCISE: TRAINING THE PANCREAS TO BEHAVE

Whether you have Type I, Type II or gestational diabetes, regular exercise can help keep your blood sugar levels in the normal range.

Exercise seems to make all your cells more sensitive to insulin and allow more glucose to enter. Regular exercise also helps control your weight, which reduces insulin resistance, says Dr. Cryer. Consequently, exercise can help control diabetes and possibly prevent Type II diabetes in the first place.

Aim for a half-hour workout. Shoot for at least 20 minutes of
moderately intense physical activity, such as jogging, brisk walking or swimming, three or four times a week, says Dr. Cryer.

"Start slow if you've been inactive," says Dr. Sanders. "Do as little as five minutes of exercise a day for the first couple of weeks. Then add ten minutes a week. Walking, swimming and low-impact aerobics are good choices for beginners," she says.

Have fun. Pick an activity you like, adds Dr. Sanders. If you enjoy your exercise routine, you're more likely to stick with it.

Adjust accordingly. If you have diabetes, remember to use your home blood glucose meter to test your blood sugar before and after exercising, Dr. Sanders says. This way you will be able to anticipate a drop in blood sugar and adjust your medication or food intake.

Blood sugar levels that are too low can cause symptoms of hypoglycemia, or low blood sugar, says Dr. Cryer. These symptoms include confusion, shakiness and, in extreme cases, unconsciousness and coma.

Map out a plan with your doctor. Like insulin and medication, exercise will make your blood sugar levels drop. To keep sugar levels within the safe range, then, you need to strike a balance among eating, exercising and taking either insulin or oral medication. If you step up your exercise regimen, you may need to cut back on insulin or your medication. You may also need to eat occasional snacks before, during or after exercise to keep your blood sugar in a safe range, says Dr. Cryer.

Be kind to your hard-working feet. If you have diabetes, you may not feel pain in your feet, due to nerve damage. Untended sores and cuts can get badly infected, and unchecked infections can destroy skin and blood vessels, says Dr. Cryer. So check your feet for sores every day, especially on days you don't exercise. If you find a sore, see your doctor. If the sore is infected, she may prescribe an antibiotic.

BETTER BLOOD SUGAR WITH BIOFEEDBACK

Stress triggers the release of adrenaline and other hormones that interfere with your body's blood sugar control mechanisms, raising or lowering blood sugar levels. But stress-fighting techniques like biofeedback, which teaches you to control your body's response to stressful events, can even your blood sugar levels out again, when used with your medication, says Angele McGrady, Ph.D., professor of psychiatry and physiology at the Medical College of Ohio in Toledo and past president of the Association for Applied Psychophysiology and Biofeedback, based in Wheatridge, Colorado.

In a study headed by Dr. McGrady, men and women with Type I diabetes who used biofeedback to relax were able to lower their blood glucose levels. In another study, biofeedback also enabled people with diabetes to increase circulation to their feet. (For information on where to find a health professional trained in biofeedback, see page 65.)