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FIVE. Treatments for Diabetes

What should I eat and what should I avoid? Please be specific!

Who should take pills and who should take insulin?

Are there any medications prescribed for other conditions that can improve or worsen my diabetes?

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Is diet and exercise management alone really effective for diabetes?

Diet and exercise are in fact the most effective treatments of all for most forms of type 2 diabetes, but are not primary measures for management of type 1 diabetes. In type 1 diabetes, profound insulin deficiency necessitates that insulin treatment is the principal form of treatment. Nevertheless, attention to diet and exercise can provide benefits in diabetes control and general health in patients with type 1 diabetes and should be included in the comprehensive treatment plan.

In the case of type 2 diabetes, the reason that diet and exercise are so effective is because lack of exercise and weight gain are the most significant causes of the disease and reversal of these issues can essentially reverse the problem of development of diabetes. Figure 3 (Question 11) shows the increasing likelihood of developing diabetes with increasing weight and this is discussed in Question 11. However, if one loses weight, one is able to travel back down the slope of diabetes to a large extent. Reduction in weight can reduce or even eliminate the need for medications in many patients, even those who have been on insulin injections for several years. The most striking example of this is bariatric surgery, which has been shown to reverse diabetes and to do so for several years, being effective as long as weight reduction is maintained. This is further discussed in Question 5.

Exercise works by making the body more sensitive to the actions of insulin and also by using up stored energy in the exercising muscles. The muscles then replace this energy by pulling in glucose and other sources of energy from the bloodstream. While this process can occur to some extent without insulin and in the absence of exercise, it occurs much more efficiently when the muscles are conditioned through regular exercise and normal levels of insulin are present. In addition, exercise helps to prevent recurrence of weight gain after successful attempts at reduction through diet. However, the longer diabetes has been present, the less effective diet and exercise are likely to be as treatment, although they are virtually always beneficial to some extent. Unfortunately, however, as we all know, there are many factors working against our ability to succeed in managing diabetes with diet and exercise in modern society. Longstanding success with diet and exercise alone is therefore the exception rather than the rule.

The longer diabetes has been present, the less effective diet and exercise are likely to be as treatment.

What should I eat and what should I avoid? Please be specific!

It depends. Nutrient needs are based on a number of different factors. Weight and coexisting conditions like high cholesterol and high blood pressure are important in determining an appropriate meal plan. Most people with type 2 diabetes need to treat all of these conditions.

Sugars and starches are primarily responsible for high blood sugar after a meal. These include fruit, juice, milk, soda, desserts, beans, peas, bread, pasta, rice, potatoes, and corn. A moderate restriction of these types of carbohydrates will help control after-meal blood sugar. However, restricting these foods too much may also be harmful, so it is important to seek professional guidance when choosing an appropriate carbohydrate amount. Avoiding fried foods and fatty meats (ground meat, sausage, bacon, bologna, hot dogs) and choosing healthier cooking oils, like canola and olive oil instead of shortening, lard, and butter, will help control your cholesterol levels and may assist with weight loss.

If high blood pressure is a concern, then sodium restriction and weight loss may be helpful. Eliminating canned and jarred items (unless they are low sodium) and reducing added salt can help lower your blood pressure. Using fresh or frozen foods is a much better choice when reducing your sodium intake.

When attempting weight loss, smaller portions of high calorie density foods like processed meats, fats, and refined sugars are important. Increasing portions of low calorie foods like vegetables can make you feel full and therefore less likely to munch on foods that are not as healthy. As with any weight loss program it is recommended that you talk to your doctor before starting an exercise program.

An ideal meal for someone with typical type 2 diabetes who is accustomed to consuming about 2000 calories per day and who is interested in weight loss includes:

Fiber

>10 g/meal

Sodium

<650 mg

Carbohydrate

~45 g/meal

Fat

<20 g/meal

Saturated Fat

<5 g/meal

Cholesterol

<60 mg

Protein

35 g/meal (28 g = 1 oz)

Following these guidelines should produce the recommended 1-pound-per-week weight loss. Please note, however, that all dietary changes should be reviewed by your healthcare provider in regards to your particular health status. Those who have advanced kidney problems may need to decrease portions of protein.

To determine if you are meeting these recommendations you must look at the food label. All of this information can be found there.

 
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