A Large Waist is a Risk Factor for Diabetes

Having a large waist is one of the biggest risk factors for developing diabetes. People who carry fat around their waist are also called “pear” shaped. Unlike “apple” shaped people who carry their fat throughout their body, pear shaped people carry their fat in the middle of the body, deep in the belly. This deep belly fat is linked to a number of problems including, insulin resistance, reduced insulin production, nonalcoholic fatty liver disease, cardiovascular damage, nerve damage, and diabetes. The risk of developing diabetes increases with waistlines over 35 inches for women and over 40 inches for men.

Fat deep in the belly puts extra stress on the organs it surrounds. Just one gram of excess fat around the pancreas is all it takes to overburden the organ. As the pancreas ramps up its insulin production to counteract the excess fat and sugar, beta cells are damaged. If not treated, the beta cells can become so damaged they are no longer able to make insulin leading to a lifelong dependence on insulin injections to manage blood glucose levels. Having excess fat around the liver will cause the organ to release excess glucose. This can lead to elevated blood glucose levels and eventually type 2 diabetes if not treated. Fat will also strain the liver and not allow it to remove toxins as well as it should, potentially leading to other problems.

One gram of fat does not seem like it would impact the body so significantly, but it does. Fortunately, if the excess fat around the belly is reduced, most damage to the organs and cardiovascular system can be reversed. In most cases, type 2 diabetes can even be cured! If you have a “spare tire” around your waist and are worried about developing diabetes, or already have, you should talk to your doctor about a weight loss plan. There are several options you should consider including bariatric surgery, extremely low caloric diets, and more moderate diet and exercise regimens.

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Calculating Carbohydrate Exchange Based on Nutritional Information

To utilize the carbohydrate exchange, first you and your doctor or dietitian need to set a daily caloric goal. A healthy diet consists of 45 to 65 percent of your caloric intake coming from carbohydrates. As an example we will use the normal suggested levels of a daily caloric intake of 1,200 recommended for women and 1,600 recommended for men. That would set the carbohydrate calorie levels at 540 to 780 for women and 720 to 1040 per day for men.

One gram of carbohydrates is equal to 4 calories, so you will need to divide the carbohydrate ranges by 4 to get how many grams of carbohydrates your daily intake allows. This will set the daily grams of carbohydrates between 135 to 195 for women and 180 to 260 for men.

Next, calculate the exchange rate of carbohydrates you are allowed a day. To do this divide the allowable grams of carbohydrates by 15 since 15 grams is considered one serving. For women this would be between 9 to 13 and for men it would be 12 to 17 carbohydrate exchanges.

Make sure you pay attention to serving sizes. Many food packages have multiple servings in one container. If you plan on eating the whole package you will need to multiply the carbohydrate grams by the number of servings. A package with 15 grams per serving and 2 servings would be equal to 30 grams of carbohydrates or 2 carbohydrate exchanges.

If nutritional information is not available then you can calculate carbohydrates based on weight. An ounce of uncooked spaghetti contains 7.5 grams of carbohydrates. So in a 2 ounce serving, there would be 15 grams of carbohydrates or 1 carbohydrate exchange.

Understanding how to use carbohydrate exchanges will allow you to better manage your blood sugar levels while still enjoying a diverse diet. There are several resources available as a reference for carbohydrate exchanges. There are quick reference on the internet, and the American Diabetes Association frequently publishes a book called Choose Your Foods that is for sale if you prefer to have the reference guide on hand.

 

Monogenic Diabetes

Monogenic diabetes is a lesser known form of diabetes that is often misdiagnosed as type 1 or type 2 diabetes. Monogenic diabetes occurs when there is a mutation of a single gene. There are around 30,000 individual genes in the body, and more than 20 genes are linked to diabetes. The most common forms of monogenic diabetes are neonatal diabetes and maturity onset diabetes of the young (MODY).

Neonatal diabetes (NDM) is a rare form of monogenic diabetes that occurs in the first 6 months of life. Approximately one in 100,000 to 500,000 live births will have neonatal diabetes. Often neonatal diabetes is misdiagnosed as type 1 diabetes, but type 1 diabetes typically occurs after the first 6 months of life. There are two types of neonatal diabetes, permanent neonatal diabetes (PNDM) and transient neonatal diabetes (TNDM). In TNDM the condition disappears during infancy and can reappear later in life. Many fetuses with NDM do not grow well in the womb and fail to gain weight and grow as rapidly as other infants. With appropriate diabetes therapy, growth and development can normalize.

MODY is diagnosed in 1-2% of people with diabetes. It is a highly inherited mutation, and typically patients present with a significant family history of diabetes. Frequently MODY diabetics have symptoms that are moderate or absent and are only diagnosed with diabetes after routine lab work. Younger healthier people are often misdiagnosed with type 1 diabetes, and overweight people are often misdiagnosed with type 2 diabetes. In cases where the person has a strong family history of diabetes, a genetic test will be performed to confirm MODY and the rest of the family should also be tested after a diagnosis.

Scientists are not sure why genetic mutations occur, but they do know that they can be either spontaneous or hereditary. Hereditary mutations are passed from parent to child and in this case they are not dependent on the sex of the parent. Spontaneous mutations occur during fetal development, and can become hereditary for the next generation.

Treatment for monogenic diabetes varies. Certain forms require no intervention as slightly elevated blood sugar levels are considered “normal” for the individual and will not lead to complications later. Many forms of monogenic diabetes are controlled with sulfonylureas or oral medication, and some will require insulin. Genetic testing can be done to determine what the best treatment for diabetes would be depending on the particular mutated gene.

Reversing Type 2 Diabetes

In 2011 a Newcastle University study examined 11 people with type 2 diabetes. Under close medical supervision, their caloric intake was limited to 800 calories per day for 8 weeks. 600 of those calories were from 3 Optifast shakes a day, and the remaining 200 were from non-starchy vegetables. When the 8 weeks was over, the participants were coached on portion control, healthy eating, and healthy exercise. After 3 months, 7 of the 11 people had been declared free of diabetes and no longer required medication.

This study came about after researchers noticed a pattern in diabetic patients after having gastric bypass surgery. In many of the patients, fasting blood sugar levels and insulin production returned to normal within 8 weeks of the surgery. After significant weight loss, the body was able to remove fat around the liver and pancreas. Just losing one gram of fat around the pancreas was all that was necessary to restore normal function to the organ. After blood sugar levels returned to normal the β-cells in the pancreas were able to heal and resume normal insulin production. Insulin resistance was also decreased, which meant the pancreas no longer had to work overtime to produce more insulin.

Not all diabetics are the same, and rapid weight loss may not reverse all diabetic conditions. Many people are unaware that there are 16 different types of diabetes. Type 2 diabetes brought on by excess fat around the pancreas and liver may be reversed by rapid weight loss. It is imperative that you discuss any changes in diet and exercise with your doctor to be sure that you are healthy enough for such a drastic cut in caloric intake.

Here is a chart of non-starchy vegetables and their caloric values. While going from a diet of over 2,500 calories to only 800 calories is an incredibly hard undertaking, choosing the right vegetables can be a big help. If you are only allowed 200 calories from food a day, you might as well get the most bang for your caloric buck. Most of the vegetables below are either raw or boiled with salt and drained.

A daily intake of only 200 calories could be:

A salad of 1/2 cup cucumbers, 1 celery stalk, 1/2 cup mushrooms, 2 cups salad greens, 1/2 cup tomatoes, and 2 tbl balsamic vinegar.

And a plate of cooked vegetables including 1 cup broccoli, 1/2 cup green beans, 1/2 cup mushrooms, 1/2 cup spaghetti squash, and 1 tbl of butter.

Decline in New Diagnoses of Diabetes

 

There are many potential factors that can be attributed to the decline in new diagnoses. For decades, overall health, eating habits, exercise, and obesity rates had been on the decline. Recently, however, there have been significant advances. Soda consumption has decreased by a quarter since 1990. Americans are increasing their exercise as well. In 2000, the CDC estimated that only 30% of the population was getting enough exercise. In 2013 that percentage rose to 55% of adults. Children are also seeing a significant increase. Caloric intake in adults and children have dropped by a small margin. This is considered to be a good step in the right direction, however to impact overall health, more needs to be done. Obesity rates, considered a major risk factor in diabetes, have remained flat. The hope is that with more education, all of these numbers will continue to improve.

Education is an important factor in diabetes prevention. Many schools, cities, states, and the Federal government have implemented education programs to teach people about the importance of living a healthy lifestyle. In some poor uneducated areas of the country, people do not have access to the health care that they need, and were simply never taught about it. Typically in poorer communities, things like nutrition, exercise, blood pressure, cholesterol, blood sugar, and diabetes were not even talked about. Awareness campaigns have been very successful at getting the information about these topics to everyone in the country. Those are not the only areas of education that need to be improved though. The level of education a person receives is also an important factor. Well educated people have seen the biggest drop in diabetes. People with a high school degree have see a slight decline in diabetes diagnoses, and people without a high school education have remained fairly stagnant.

The decrease in new diagnoses of diabetes is definitely a step in the right direction. Hopefully, with more education about the importance of diet, exercise, and overall health; the numbers of new diagnoses of diabetes will continue to decline.

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Managing Diabetes During the Holidays

The holidays can be a challenging time for managing diabetes. There are so many comfort foods that we love to eat around the holidays. Fighting the urge to gorge ourselves can be hard. But with a little prior planning and self control, you should be able to enjoy almost all of your favorites, in moderation of course.

Before you start cooking, consider any changes you can make to your favorite foods to make them more blood sugar friendly. Instead of mashed white potatoes, try substituting mashed cauliflower. Instead of putting marshmallows on top of your sweet potatoes, try just sprinkling some cinnamon on top.

There are so many non-starchy vegetable options available. Making a variety of vegetables can make your holiday meal and healthy, hearty, and beautiful. Some examples of non-starchy vegetables include: greens, mushrooms, asparagus, green beans, cauliflower, broccoli, peppers, zucchini, brussel sprouts, peas, eggplant, pumpkin, carrots, and many more. Just a selection of a few of these will add color, flavor, and variety to any holiday feast.

Focus on lean proteins. Turkey, chicken, pork roast, salmon, steak, lamb chops, and venison are all great options. They are all extremely versatile, and can be seasoned almost any way you prefer.

Before you get ready to make your plate, start with a plan. Break your plate down into fourths. Half of your plate should be filled with non-starchy vegetables. A quarter of your plate can have small portions of carbohydrates and your favorite comfort foods. The final quarter of your plate should consist of a lean protein.

Fortunately, most things in moderation are fine for a diabetic to eat. With so many diverse and delicious choices for both sides and meats, having a enough satisfying options at your celebration should be a piece of cake. Just remember to think about your options in advance, and hopefully you will be able to enjoy the celebrations without sacrificing your health!

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Common Skin Problems for Diabetics

Skin problems can be potentially serious for diabetics. In most cases, with early diagnosis, treatment, and proper blood glucose management skin problems can be controlled. Skin problems in diabetics can be linked to a number of causes. As with almost any complication of diabetes, prevention is paramount. Proper blood glucose management is both the preventative measure and the treatment for a number of these conditions. Here are a few examples of common skin problems diabetics may experience.

• Acanthosis nigricans is a darkening and thickening of the skin typically in the folds of the skin. The skin becomes tan or brown, might be raised, may look like warts, and feels velvety to the touch. Weight loss may improve the condition. Acanthosis nigricans is considered to be a precursor for diabetes, but it can also be caused by acromegaly and Cushing syndromes.
• Diabetic blisters may occur in people who have severe diabetes and diabetic neuropathy. Blisters that resemble burn blisters can occur on the hands, forearms, legs, and feet. The blisters are usually painless and can resolve on their own. Typically proper blood glucose management is the treatment.
• Diabetic dermopathy, also known as shin spots, is a result of damage to the blood vessels that supply the skin. Typically, a shiny round or oval lesion occurs on the front of the lower legs. It is normally not painful and will generally not require medical treatment.
• Disseminated granuloma annulare are ring or arc-shaped rashes on the skin. They range from skin colored to red or red-brown. These rashes occur most often on the fingers or ears, but they can also occur on the chest or abdomen. Typically medical treatment is not required, but a topical steroid may help.
• Digital sclerosis affects the skin on the fingers, hands, and toes. The skin becomes thick, waxy, and tight. The joints in the affected areas can also become stiff. Treatment includes proper blood glucose management. The use of lotions may help to soften the skin.
• Eruptive xanthomatosis is caused by uncontrolled blood sugar and triglyceride levels. With severe insulin resistance, it can be difficult for the body to remove fat from the blood. Firm, yellow, waxy pea-like bumps can appear on the skin. These are typically surrounded by red halos and are itchy. The bumps are typically found on the face and buttocks, but they can also form on the arms, legs, back, and any creases in the skin. When the level of fat in the blood is well controlled, the bumps should stop erupting.
• Itching is caused by a number or causes, diabetics however are more prone to poor blood flow caused by high blood sugar levels. Poor blood flow, typically in the lower legs and feet can starve skin of the nutrients it needs. If your skin is itchy, a lotion may help to keep the skin moist and prevent itching.
• Necrobiosis lipoidica diabeticorum is thought to be caused by changes in collagen and fat under the skin. The skin above the affected fat and collagen becomes thick and reddened. The lesions are often itchy and painful. They are typically found on the front of the lower legs. Treatment is typically not necessary unless the lesions break open.
• Scleredema diabeticorum is a rare skin problem that affects people with type 2 diabetes. It causes a thickening of the skin on the back and neck. Typically proper blood glucose management is the treatment. Using moisturizers may help to soften skin as well.
• Vitiligo normally affects people with Type 1 diabetes, though it does rarely affect people who have type 2 diabetes. With vitiligo, the cells in the body that make pigment are attacked. This typically affects coloration around the chest, abdomen, face, and eyes. Due to a loss of pigmentation, any areas affected should be covered with a sunscreen with an SPF of 30 or higher. Treatment for vitiligo may include topical steroids or micropigmentation (tattooing) the affected areas.

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Fiber Rich Foods Help Control Diabetes

Fiber is known as natures broom for a couple of reasons. There are two types of fiber, soluble and insoluble. Soluble fiber becomes sticky as it passes through the digestive tract which helps reduce the absorption of cholesterol. Insoluble fiber does not dissolve and promotes bowel regularity. Because fiber is a carbohydrate that cannot be digested, it makes you feel fuller longer and aids in better blood glucose regulation. This will also help you to lose weight. 20 to 35 grams of fiber are recommended a day to promote heart health, weight loss, better digestion, and blood glucose control. Here are 10 foods that are high in fiber that you should consider including in your diet:

• Artichoke – A medium steamed artichoke contains about 10 grams of fiber. It is also a great source of potassium, magnesium, vitamin C, and folate.
• Avocado – Avocados are a great source of fiber and omega-3 fats. One cup of avocado has 15 grams of fiber but it also has 368 calories and 34 grams of fat. So remember to eat avocado in moderation. Try to use it as a substitute for butter or cheese.
• Barley and Oats – Barley and oats are a great substitute for rice, pasta, and breadcrumbs. All of which will raise blood sugar. They contain the fiber beta-glucan, which improves insulin use, lowers blood glucose levels, and cleans out the digestive tract. A serving of barley contains 6 grams of fiber, and a serving of oats contains 4 grams of fiber.
• Beans – Beans are a colorful addition to any meal. They range from 13 to 18 grams of fiber per serving. Beans also contain a starch that is resistant to digestion. This starch feeds the good bacteria in your gut. A by product of the bacteria eating the starch is fatty acids. These fatty acids go on to promote better use of insulin and healthier colon cells.
• Berries – Berries are another colorful addition to your daily diet. They are packed with fiber, antioxidants, and many other nutrients. One cup of raspberries or blackberries contains 7 grams of fiber. Berries are also a great alternative to a sugary desert when you are in the mood for something sweet.
• Broccoli – One cup of broccoli contains 2.5 grams of fiber and 2.5 grams of protein, and it is very rich in vitamins C, K, folate and the mineral potassium.
• Lentils – Lentils are a legume that is packed with protein and fiber. About 40% of the carbohydrates in lentils are fiber. Because of the high fiber content lentils will not raise your blood sugar as high or as fast as other carbohydrates. One serving of lentils packs 15 grams of fiber and 18 grams of protein.
• Peas – Peas are a great source of fiber as well as the vitamins A, C, and K. One serving of green peas has 7 grams of fiber, and one serving of split peas has 16 grams of fiber.
• Pears – Pears contain 7 grams of fiber and are also high in vitamin C and potassium. Pears make a great snack and can even be a substitute for dessert when cooked.

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Tips for Diabetics Preparing for Labs and Other Tests

Lab and other tests can be difficult for diabetics, but with a little planning, they should not affect your blood glucose levels too much. It is important that you talk with your doctor and the testing facility before hand to make sure everyone is on the same page. Some tests will require no change, while others will require you to stop taking medications or to fast.

Some tests will require you to be at a facility for several hours. Even if you do not need to make any changes to your medications or diet, you will still need to be prepared. Some things that you should plan for include:

• What time is the test, and how long will it last
• Does the test fit in with your routine of eating and taking medications
• Is the facility aware of the fact that you have diabetes
• Will you be able to eat, drink, and take medications normally
• Be sure to bring glucose tablets or a snack in case your blood sugar drops to low
• Be sure to bring your medication in case you need to take a dose

Some tests will require you to fast for 8-10 hours before the test can be performed. This will allow the facility to have an accurate measurement of certain things like cholesterol and glucose level. This can be tricky for diabetics who normally have a low fasting blood glucose level already. Before you have a test that requires fasting consider these tips:

• Ask your doctor if you need to adjust your medications the day of the test. In general, you will hold any injections or oral pills until you are ready to eat again. If you are taking metformin(Glucophage) and will be having an intravenous injection of dye, you may need to stop taking the medication for at least 48 hours after the test to ensure normal kidney function.
• Make sure the testing facility knows that you have diabetes. They can schedule your appointment is first thing in the morning so that you may resume eating and taking your medications as soon as possible.
• Check your blood sugar before the test. If you fall below 70 you will need to eat something in order to bring your blood sugar back up and avoid complications from hypoglycemia. You will also need to reschedule the test. Your blood sugar does not have to be perfect, the goal is to keep it from getting too high or low.
• Bring your medication and breakfast with you to the testing facility. This way, as soon as you are done, you can resume eating and taking medication as usual, and avoid hypoglycemia.
• Drink plenty of water. Water will make your stomach feel fuller while you are fasting. Also, it will be much easier to draw your blood if you are hydrated.

It is important that you try to get back on your normal schedule as soon as possible. You may feel sick for a couple days if your blood glucose gets either too low or high. But the quicker you get back in control of your blood glucose management, the quicker you will start to feel better.

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Reversing Prediabetes

An estimated 86 million adults over the age of 20 have prediabetes. Prediabetes is diagnosed when the person has a high blood glucose level, but it is not high enough for a diagnosis of diabetes yet. If left untreated, prediabetes can develop into full blown type 2 diabetes.

There are many lifestyle changes that can be made to avoid developing type 2 diabetes or to better manage blood glucose in people who have already been diagnosed with type 2 diabetes. Here are a few things that might help:

Get more Exercise – Ideally you should get at least 30 minutes of physical activity at least 5 days a week. This will lead not only to a reduction in fat, but also a lower blood glucose level.

Lose Weight – Even a small reduction in weight, just 5-7% has been shown to reduce the likelihood of developing type 2 diabetes by up to 58%. In a person weighing 200 pounds, that is only 10 – 14 pounds.

Eat a Healthy Diet – Try to make your meals as colorful as possible. This will ensure that you are eating a healthy balanced diet. Try to eat at least 5 servings of fruits and vegetables a day.

Eat more Fiber – Fiber is available in a number of foods; whole grains, vegetables, even coconut oil. It will help you feel fuller longer, which will allow you to eat less. It also is an important part of the digestive process.

Get Plenty of Sleep – Not getting enough sleep can make it harder for your body to properly use insulin. This can lead to higher blood glucose levels. It is also much harder to lose weight when you are sleep deprived because your body is more stressed than normal.  

Have an A1C Test Performed Annually – Changing your lifestyle can be hard and frustrating. Check in with your doctor regularly. Being told about the positive changes can be very uplifting and help to keep you on track. If your A1C numbers are not better, you doctor will be able to suggest changes that you can make to avoid developing diabetes.

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