Diabetes

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Diabetes

Who'd think you can be too sweet? Well, it's possible. If you have diabetes, all that extra sugar (or glucose) floating around in your bloodstream can lead to trouble--nerve damage, vision loss, infections, poor circulation, kidney and heart problems, you name it. That's why it's so important to get blood sugar down to a normal level.

Normally the food we eat is converted into glucose and used or stored by the body with little problem. Circulating insulin hormone stimulates the uptake of sugar by the body's cells. But with diabetes, something goes awry. The pancreas, which is the organ responsible for producing insulin, becomes irresponsible. It either stops producing the hormone completely (Type I diabetes) or else produces too much, which leads to insulin resistance (Type II diabetes). Either way, concentration of sugar in the blood shoots sky-high.

People with Type I, or insulin-dependent, diabetes need daily insulin injections. Those with Type II, or non-insulin-dependent, diabetes--the most common form of the disease--usually don't need insulin injections. But 25 percent of them take drugs to improve sugar metabolism.

Treating Type II diabetes with drugs does reduce blood sugar, it's true. But in many cases, doctors are electing to treat Type II patients with diet and exercise. They find that this lifestyle approach does more than just reduce blood sugar.

"It does a lot more," says James Barnard, Ph.D., professor of physiological science at the University of California, Los Angeles, and consultant to the Pritikin Longevity Center in Santa Monica. "The same regimen that puts diabetes on hold has a favorable impact on high cholesterol, high blood pressure and obesity." Those three, along with high blood sugar, are what doctors call the deadly quartet.

Here's what doctors are recommending to treat diabetes with diet and exercise. To determine what's appropriate for your individual situation, it's important that you check with your doctor before making changes.

Peel off some pounds. Most people with Type II diabetes are 30 to 60 pounds overweight, and for them, losing weight is often the only thing they have to do to get their diabetes under control, Dr. Barnard says. Several studies point out that it's not necessary to reach your normal weight to see a big drop in blood glucose, he adds. "Ten pounds may make a difference."

But don't go to extremes. Fad diets, fasting and skipping meals don't work. Decreasing dietary fat is the best approach if you're overweight. One way is to decrease total fat to no more than 50 grams daily, says Christine Beebe, R.D., director of the diabetes program at St. James Hospital in Chicago Heights, Illinois, and chairman of the Council on Nutritional Science and Metabolism for the American Diabetes Association.

Get moving. "Spend 45 minutes to one hour taking a good brisk walk every day," Dr. Barnard says. "It helps normalize body weight, and it helps correct insulin resistance, which is the main problem in Type II diabetes."

Stay regular as clockwork. "If you take insulin or insulin-stimulating drugs, as some people with Type II diabetes do, exercising at the same time three to six days a week for the same amount of time can be helpful," says Beebe. "That makes it easier to control your blood sugar."

If you don't exercise every day, pay particular attention on the days that you do. "You may need to cut your insulin dose 30 to 50 percent," Beebe says.

Change flab to firm. Muscle building and weight training can play an important role in diabetes control. "Having more muscle and less fat improves insulin sensitivity, so less insulin is needed to respond to sugar in the blood," says Bruce W. Craig, Ph.D., associate director of exercise science at Ball State University in Muncie, Indiana. "It means people with diabetes may be able to reduce their insulin intake and still handle the sugar in their blood--their glucose--effectively." Once you get your doctor's okay, join a health club that has weight-training equipment. Ask the club for professional instruction before you begin.

Cut the fat. At the Pritikin Longevity Center, the diet is carefully designed to cut out fat. Meals at the center are super low in fat, with less than 10 percent of calories from fat, 10 to 15 percent from protein and 75 to 80 percent from carbohydrates (such as veggies and fruits). What does that look like on your plate? Grains and beans, vegetables, fruits, nonfat milk and an occasional piece of fish or fowl. The good part is that except for the meat, you get to eat as much as you want. Adds Dr. Barnard: "Any reduction in fat is going to help your diabetes and your overall health."

When to See the Doctor If you have diabetes, you should work closely with your doctor, because regular checkups are a must. So if you're planning to start exercising, or if you want to change your diet, its important that your doctor be involved from the start. And because diet and exercise can have an immediate and profound impact on glucose metabolism and insulin levels, if you're taking insulin or insulin-stimulating drugs, your doctor should advise you regarding your dosage. "People may need to reduce their dosage within a day or two of starting to exercise to avoid low blood sugar," according to James Barnard, Ph.D., professor of physiological science at the University of California, Los Angeles, and consultant to the Pritikin Longevity Center in Santa Monica.

And cut the sugar. "This is becoming a real problem, because many low-fat or fat-free foods now on the market have a lot of refined sugar added to make them taste good. People with diabetes need to avoid most refined sugar," according to Dr. Barnard. "It really causes problems for them." His advice: Skip the sugar and satisfy your sweet tooth with fruit. Read the labels and buy low-fat foods sweetened with artificial sweeteners.

Be especially particular about breakfast. "There's some evidence that those with diabetes have a harder time with carbohydrates in the morning, when insulin resistance is greatest," Beebe says. Reducing carbohydrates and adding protein might be your best bet. Try skim milk and oatmeal, for example, or an occasional poached egg with a slice of whole wheat toast, or cottage cheese and crackers. Check your blood glucose before lunch to see how you're doing. The next day you can adjust your food intake further, if necessary.

Treat booze like fat. Alcohol is high in empty calories. "We recommend that people keep their alcohol consumption down to fewer than three drinks a week," Dr. Barnard says.

Chrome-plate your diet. Make sure you're getting enough chromium, a trace mineral that helps normalize blood sugar levels--high or low (it gives insulin a boost). In fact, in some cases, chromium may help prevent Type II diabetes.

Studies show that the typical American does not get nearly enough chromium in his diet, even when calorie intake is fairly high, says Richard A. Anderson, Ph.D., a biochemist at the U.S. Department of Agriculture Human Nutrition Research Center in Beltsville, Maryland. "Regardless of how you cut the cards, you're not getting enough chromium in your diet," he says. "Even diets designed by dietitians don't provide nearly enough chromium."

His suggestion: Take a chromium supplement in addition to a balanced multivitamin/mineral supplement. "In our studies, we use 200 micrograms a day, and that works very well," says Dr. Anderson. But check with your doctor before taking any supplemental dose.

Honor the East when you eat. Laboratory tests show that cinnamon and turmeric (the golden spice used in curry dishes) triple the ability of insulin to metabolize glucose, says Dr. Anderson. "There's a long history of spices being used in the treatment of diabetes, especially in India, Pakistan and China," he says. If cooking is your thing, get a couple of oriental cookbooks that have tasty recipes using these spices. And look for curry dishes when you dine out.