Smart Dietary Guidelines For Diabetics

FILED IN Other No Comments

You will find that doctors will send you to a dietitian the moment they diagnose you with diabetes. A dietitian will guide you in such a way that you can eat healthier and control the sugar or glucose levels within your blood. This will also ensure that your weight is under control as excess weight can make the matter worse than it is.

It is not only sugary snacks and food causing this terrible disease affecting so many people. Food with a lot of calories as well as fat also causes your blood sugar levels to rise very high.

If you do not control the levels of your blood sugar, you might end up damaging your kidneys, eyes and liver completely. Your organs cannot cope without the necessary insulin.

Some people have lost limbs before due to insufficient blood flow to their feet caused by the damage in cells through diabetes.

This is why it is so important that you follow a special diet for diabetes so that you can be healthy and stop further damage to your body.

Type 1 diabetes is the stage where you cannot live without having to inject yourself with insulin everyday.

If you have type 2 diabetes you can still control it with tablets, by losing weight as well as eating foods that do not produce excess sugar.

By following the various diets for diabetes from a well-established dietitian, you will be able to reach the weight that you need to be in a very short time. Extra weight is surely going to increase your sugar levels. When you are with a dietitian, he or she will be able to explain the consequences of eating incorrectly.

A dietitian will also be able to give you an indication as to which foods will increase your sugar levels as well as what food will keep it at a regular level.

As a person suffering with diabetes you need to take care of the types of carbohydrates you are eating. Bad carbohydrates can increase your sugar levels so much that you end up in hospital. Some of the healthier carbohydrates you can consider will include your various fruits, beans, lentils, peas as well as whole grains.

You can also take yoghurt or other dairy products that is low in fat. Nuts also help you control the sugar levels and decrease some of the heart diseases you might pick up with diabetes.

There is not any type of food better than fish for diabetes. If you eat a fish type containing many omega 3 fatty acids at least twice a week you are surely on the road to becoming healthy. These types of fish will include your herring, mackerel and salmon.

When you prepare your fish, you must either steam or grill it. The moment you add a batter and deep-fry your fish, you are adding fats that is not good for your illness. Most importantly,avoid foods that can clog or harden your arteries.


Structured Personal Diabetes Care in Primary Health Care Affects Only Women’s HbA(1c): Research Design And Methods

FILED IN Other No Comments

This is a cross-sectional subgroup study focusing on sex, performed 6 years after diabetes was diagnosed in patients participating in the DCGP, a pragmatic, open, controlled trial with randomization of practices to structured personal care or routine care.

In 1988, 484 volunteer general practitioners were randomly assigned to an intervention group and a comparison group (Fig. 1). Randomization produced two comparable patient groups.

Of 1,263 patients, 874 completed the final 6-year examination and were included in this substudy (Fig. 1). At least 97.5% of the diabetic patients included were considered to have type 2 diabetes. A similar proportion of patients in each group (190 vs. 199, P = 0.21) had no follow-up.

The intervention

The intervention general practitioners were instructed to give structured personal care, which included quarterly consultations and individualized goal setting for important risk factors. These general practitioners were supported by prompting, short clinical guidelines, feedback on individual patients, and a brief training program. The routine care doctors were free to decide and change treatment.

Ethical considerations

All participants gave informed consent. The protocol was in agreement with the Helsinki Declaration and was approved by the ethics committees of Copenhagen and Frederiksberg.


The final 6-year examination included doctor questionnaires, information on hospital admissions for relevant conditions, blood and urine samples, weight measurement, and a patient questionnaire (22). The patient questionnaire was based on a literature review and interviews with type 2 diabetic patients. Experienced general practitioners and sociologists reviewed the questionnaire before pilot testing. It contained questions on knowledge about own blood glucose, attitudes toward treatment and diabetes, lifestyle, and social support. Knowledge was measured by two questions concerning the patients’ knowledge of their own blood glucose level and knowledge of the general practitioner’s view of their blood glucose level. Behavioral and attitudinal variables were gathered from questions concerning lifestyle (leisure time physical activity, dietary habits, and the patients’ indication of change in lifestyle after diagnosis) and attitudes (the patients’ feelings about the illness and whether they had worked intentionally with their illness). Furthermore, the patients reported whether they got the necessary support and understanding from family and significant others (social support).

The general practitioners reported the patients’ antidiabetic treatment and the number of diabetes-related consultations within the last year. Practicing ophthalmologists reported the results of funduscopy.

Fig. 1


Structured Personal Diabetes Care in Primary Health Care Affects Only Women’s HbA(1c)

FILED IN Other No Comments

OBJECTIVE—Diabetic men and women differ in lifestyle and attitudes toward diabetes and may benefit differently from interventions to improve glycemic control. We explored the relation between HbA1c (A1C), sex, treatment allocation, and their interactions with behavioral and attitudinal characteristics in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODSSix years after their diabetes diagnosis, a population-based sample of 874 primary care patients cluster-randomized to receive structured personal care or routine care reported lifestyle, medication, social support, diabetes-related consultations, and attitudes toward diabetes. Multivariate analyses were applied, split by sex.

RESULTS—A marked intervention effect on A1C was confined to the structured personal care women. The median A1C was 8.4% in structured personal care women and 9.2% in routine care women (P < 0.0001) and 8.5% in structured personal care men and 8.9% in routine care men (P = 0.052). Routine care women had a 1.10 times higher A1C than structured personal care women, (P < 0.0001, adjusted analysis). Structured personal care women had relatively more consultations than routine care women, but neither number of consultations nor other covariates helped to explain the sex difference in A1C. Irrespective of treatment allocation, women had more adaptive attitudes toward diabetes but lacked support compared with men.

CONCLUSIONS—In this study, the observed effect of structured personal care on A1C was present only among women, possibly because they were more inclined to comply with regular follow-up and had a tendency to have a more adaptive attitude toward diabetes.


Pre-Diabetes – The Early Warning Signs of Type 2 Diabetes!

FILED IN Type 2 Diabetes No Comments

Months, years, and even decades before developing full-fledged Type 2 diabetes, many people develop a condition termed pre-diabetes. They have blood sugar levels that are too high to qualify as normal, but not quite high enough to require diabetes treatment. The reason many people with these conditions go undiagnosed, however, is that their doctors almost always rely on blood tests taken while the patient is fasting.

When fasting blood sugar readings range between 100 to 125 mg/dL (5.5 to 7 mmol/L) doctors put the patient on watch for future diabetic developments. These readings mean that for some reason, too much sugar is floating around in your bloodstream. It may be because your body:

  • doesn’t make enough insulin
  • you eat more food for fuel than you can handle
  • for some reason your insulin isn’t working right, or
  • a combination of all these factors

The problem with relying on fasting sugar levels, however, is that sometimes they don’t detect an important part of the pre-diabetic condition known as impaired phase 1 secretion.

The insulin-producing beta cells of the pancreas don’t churn out insulin at the same rate all the time. They spend all their energy making pro-insulin, which they “unzip” to get sugar levels down when they are highest, which is about 90 to 120 minutes after eating, when sugars are digested from food.

Pre-diabetics often have an “unzipping” defect. The beta cells are so burdened by toxic free radicals they just can’t get their work done fast enough to keep blood sugar levels in check after meals. They can, however, release enough insulin to get fasting sugar levels back down to normal or nearly normal the next morning. Only after a period of years, as most of the beta cells die off, do fasting blood sugar levels get so high that the doctor then makes a diagnosis of Type 2 diabetes.

Don’t rely on fasting readings alone. If you blood sugar levels go up to 140 to 199 mg/dL (7.8 to 11 mmol/L) after you eat, this is also a sign that you have pre-diabetes. An occasional blood test that isn’t taken while you are fasting can give you an early warning years sooner, giving you precious time to control and even reverse your pre-diabetes.

You may be asking… what’s the big deal? Why should you worry? You haven’t been diagnosed with Type 2 diabetes… yet! Pre-diabetes, diabetes and obesity are associated with an increased risk of developing many other health problems. People don’t wake up one day to discover they’ve suddenly developed Type 2 diabetes. The progression from normal to pre-diabetic and then to Type 2 diabetic typically occurs over many years.



Symptoms of Adult Diabetes – Information That You Should Know

FILED IN Other No Comments

Diabetes is a disease associated with the body’s inability to produce the required amount of insulin or the inability of the body cells to use the produced insulin. In either case glucose level builds up in our blood leading to diabetes. The hormone insulin secreted by the pancreas is actually a glucose regulator. It activates the cells to burn down the glucose, absorb it and convert it in to energy required by the body for day to day acts. If insulin produced falls short of the required amount, as in the case of Type 1 diabetes, one has to inject insulin to combat the disease. Type 1 diabetes is also known as juvenile diabetes. Type 2 diabetes occurs when cells grow non-reactive to insulin. This is the commonest type of diabetes attacking adults. Poor nutritional habits, inactive lifestyle, obesity are factors leading to Type 2 diabetes. Gestational diabetes is another type affecting pregnant women.

Major Symptoms of Adult Diabetes

1. Frequent urination is a prominent symptom of adult diabetes. One feels a fullness of bladder even after excreting urine. This happens because the body of a patient of diabetes tries to flush out fluids through kidneys in order to balance and dilute the high levels of glucose in the patient’s urine.

2. Constant thirst is usually felt by a diabetic. Due to increased urination, the body needs to replace the lost fluids and the result is feeling thirsty frequently. Not taking water may lead to dehydration and further complications.

3. Feeling extremely hungry frequently is another major symptom. The body cells become inert to insulin, and the cells do not get glucose to convert into cells. The starved cells make the feel a persistent hunger.

4. Excessive loss of fluids, reversed metabolism of body fats and proteins lead to loss of weight drastically. Thus weight loss is another symptom.

5. Muscles cells are deprived of enough fuel to convert it in to energy in a diabetic. Often body fat is consumed due to a reverse calorie effect, leading to much fatigue. Fatigue is common symptom of diabetes.

6. Vomiting and nausea is a symptom that occurs when ketone acid builds up in blood due to the reverse calorie effect.

7. Irritability is common in a diabetic. Inadequate glucose supply to brain may make the patient suffer from excessive mood swings or feel cranky.

8. A diabetic also suffers from blurry vision. Excessive glucose may get in to eyes changing the shape and create problems in focusing.

9. Poor wound healing is also a symptom. Excess glucose in blood lowers the production of white blood cells and thereby weakens the immune system. This leads to very slow healing of wounds.

10. A diabetic is more prone to any infections due to the suppression of the immune system.

11. A diabetic may feel an itching sensation on the skin around genitals.

12. A feeling of numbness or a tingling sensation on legs, feet and finger is another symptom a diabetic may suffer from.

, ,


Fifty Percent Of Us Are On The Road To Diabetes

FILED IN Other No Comments

One of the harmful affects on our bodies of living our modern sedentary lifestyle that no longer has enough physical activity to keep our muscles strong is that our muscle cells become less responsive to the hormone insulin.

Insulin is the ‘key’ that tells the muscle cells to unlock the door and ‘open up’ to take in glucose from the blood stream that has been converted from the food we eat to be used for energy. But our muscles have grown flabby and weak from our inactive lifestyles so they cannot use the glucose.

So, with the cell door closed glucose remains in the blood stream circulating around with nowhere to go but eventually into the fat stores. But the levels are consistently higher than they should be so more and more insulin is produced to try and get the levels down. Then there are not only high blood sugar levels but high insulin levels as well hanging around where they should not be doing major damage to cells, tissue and organs.

You may be wondering why this is important but this is a condition called ‘Insulin Resistance’ which if you have it will lead you down a path to full blown diabetes. This devastating disease does major damage to sensitive organs like the brain, eyes and kidneys and that is what leads to a shortened life if you are unfortunate enough to go on to develop diabetes.

This condition is becoming more common and is affecting up to 50 percent of adults who either have this condition or are in the process of developing it and one third of all children. As we get older we become more prone to develop it as the combination o our no-exercise lifestyles together with a diet of refined foods takes it toll on our health.

It can easily be reversed though but it will take some action to restore good health. Firstly a strength training program done just 2-3 times a week will get those muscles toned back up so they can soak up excess sugar from the blood stream and burn it up harmlessly for energy. Muscle tissue is highly active and has high energy demands so taking this step alone will go a long way to getting a healthy body back.

The next thing is to get rid of as much refined and processed foods as possible as the more of them we eat the more insulin is required to metabolize them. The more insulin needed and present in our blood the less the cells can take it up and the more damage is caused to other organs and tissues.

Women especially around mid-life are especially prone to this condition. A waist measurement of over 35 inches (40 for men) is one sign, fatigue, climbing blood pressure and blood fats are all other indicators.

In essence our lifestyles along with our environment have all evolved and changed too rapidly for our bodies to keep up the pace. We still have the same genetic blue-print of our ancestors who thrived on a diet of natural, nutrient rich foods low in carbohydrates. They were also highly active on a day-to-day basis with much greater levels of vigorous movement and exercise than our modern sedentary lifestyles.

But we can put some of these things back into our life and make some changes that will keep us healthy and well. It will not be easy though as we are surrounded by mountains of processed ‘junk’ food and leisure activities that involve no more activity than sitting.



Decreasing the Risk of Diabetic Retinopathy in a Type 2 Diabetes Study: Part 4

FILED IN Type 2 Diabetes No Comments

Mexican pharmacy

Case management may also have played a role in attendance at sessions when the photographs were taken and the immediate feedback that nonmydriatic photography can give to the health care team and thus facilitate the follow-up of patients with documented retinopathy. Whether it is the support associated with case management and the resultant adherence to nonglycemic targets such as hypertension that led to the improved retinal status, independent of improved glycemic control, cannot be addressed by this study. However, perhaps because case management clearly improves glucose control in a Medi-Cal–type population and is associated with decreased risk of new-onset retinopathy, comprehensive case management may be justified in similar health care settings.

Limitations of this study include the fact that it was not of sufficient duration to address whether case management may have also prevented progression of previously recognized retinopathy, which may have required more time or larger numbers to see an effect. Another limitation is the fact that we only used a single field for evaluation of the retina rather than the seven fields used in other studies of retinopathy, although in previous reports, this technique for diabetic retinopathy screening has been shown to be effective. In this way, minimal retinopathy may have been missed in the periphery at baseline and at the follow-up study. However, since both baseline and follow-up retinal fields were identical, it is most likely that our findings reflect a clinically meaningful decrease in the development of retinopathy over the 2-year time span that was tested. Furthermore, seven-field photography was not practical in this case management setting. Although all participants were urged to visit an ophthalmologist, those subjects with evidence of any retinopathy on the photograph were personally followed by the case management team to facilitate the consultation.

Although other studies show that improved glycemic control decreases the risk of retinopathy, this study is the first to show that even a relatively short duration of improved control (?2 years) instituted before the onset of clinically identifiable retinopathy can decrease the risk of developing new retinopathy. This study also underscores the risk of retinal disease in type 2 diabetes in that progression of retinopathy occurred within a relatively short time when glycemic control was not achieved. Further studies are necessary to determine whether early intervention to achieve glycemic control in established diabetes has a greater effect to reduce diabetic retinopathy than its introduction at a later stage of the disease.

, ,


Decreasing the Risk of Diabetic Retinopathy in a Type 2 Diabetes Study: Part 3

FILED IN Type 2 Diabetes No Comments

This report is the first evidence that intensive case management reduces risk of new-onset retinopathy in people with established type 2 diabetes. The U.K. Prospective Diabetes Study first demonstrated the effects of improved glycemic control on retinopathy in type 2 diabetes, but the subjects who participated in that landmark study were all newly diagnosed, whereas the patients without retinopathy in this study had a mean duration of diabetes of 7.5 years by the time the case management intervention was begun. Although the number of subjects with established retinopathy in this study was not sufficient to draw conclusions about progression of retinopathy compared with those who had none at baseline, the response observed in the latter suggests that early intervention with case management is an effective approach to reducing the burden of retinopathy in patients with type 2 diabetes. This conclusion is reinforced by the finding that even when case management is maintained for a short duration (mean <2 years), it is sufficient to diminish the risk of retinopathy.

The mechanisms for the effect of case management on reduction in the development of new-onset retinopathy may be related to any of the different facets of the case management process, although the major factor is likely to be improved glycemic control. Although A1C concentrations were not consistently evaluated at the time the follow-up photographs were taken, in the main trial the case management group showed a persistent improvement in the A1C that was greater than in the standard care group (6), suggesting that the decreased risk of retinopathy is likely due to improvement in glycemia. This study, therefore, confirms the necessity of providing adequate education and follow-up support, as delivered in this trial that utilized case management and frequent intervention, in order to achieve and maintain an A1C improvement over and above the standard care given to this county clinic Medi-Cal population.

However, other elements of the case management approach may well have contributed to the reduction in development of new-onset retinopathy. With adequate surveillance and support, glycemia improves, but, as demonstrated in our primary report, this improvement was associated with significant decreases from baseline to end of study in diastolic blood pressure, LDL cholesterol, and total cholesterol and an increase in HDL cholesterol in the intervention group. Thus, case management not only resulted in improvement of glycemic control but also had an effect on diminishing the risk of microvascular disease, as measured by retinopathy.

, ,


Decreasing the Risk of Diabetic Retinopathy in a Type 2 Diabetes Study: Part 2

FILED IN Type 2 Diabetes No Comments

One photograph was taken of each eye with a Canon CR4-45° nonmydriatic camera. Photographs were taken in a dark room to facilitate dilatation of the pupils and improve the quality of the photographs. Additionally, at the Los Angeles site, pupils were dilated before taking the photos. The retinal field photographed was identical at both sites and consisted of the area nasal to the disc and temporal to the macula and the superior and inferior arcades. All photographs were labeled with only the patient’s identification number and were sent for reading in Santa Barbara. Polaroid prints from the Canon camera were examined and graded by an experienced endocrinologist (L.J.) who, before this study, had readings verified by an ophthalmologist until agreement was virtually 100%. An overall grading was assigned for each eye at each examination using the Wisconsin Epidemiologic Study of Diabetic Retinopathy II/III–modified diabetic retinopathy levels, which used a modification of the Airlie House Criteria. This scale has nine levels per eye, ranging from no retinopathy to total vitreous hemorrhage. The scale was used as follows: no retinopathy (grade 10), very-mild nonproliferative diabetic retinopathy (NPDR) (grade 20), mild NPDR (grade 35), moderate NPDR (grade 43), severe NPDR (grade 53), mild proliferative diabetic retinopathy (PDR) (grade 61), moderate PDR (grade 65), high-risk PDR (grade 71), and advanced PDR and/or fundus partially obscured by disease (grade 85). Photograph quality was deemed adequate for accurate assignment of retinopathy grade in all of the graded photographs included for analysis. The primary outcome measures are the development of retinopathy of any degree in subjects without retinopathy at baseline and the progression of retinopathy in subjects with nonproliferative retinopathy at baseline.

Statistical analyses were performed using SAS statistical software for Windows version 9.1 (SAS Institute, Cary, NC). Continuous data were compared between groups with an unpaired t test, and categorical data were compared with a ?2 test. Odds ratio (OR) for progression of retinopathy in each group was estimated using the PROC GENMOD procedure while accounting for duration of follow-up and controlling for confounders. A repeated statement was used to specify within-subject effect. The first-order Taylor expansion approximation was used to estimate the variance of difference in the ORs between the two groups. Logistic regression with the development of any degree of retinopathy as the binary outcome variable was used to control for covariates in the subset of subjects who had no retinopathy in the baseline photograph.

There were 200 subjects (56 male and 144 female subjects) from the two centers who were included in the retinal photographic studies. Subjects randomized to the intervention (n = 102) and control (n = 98) groups were of similar age and diabetes duration, had similar A1C concentrations, had similar follow-up periods during this study, and had similar drop-out rates.

The progression or development of retinopathy was noted in both the intervention and control group, and the difference in the ORs for progression between the two groups (?0.65) was not statistically significant (P = 0.226). Subjects without evidence of retinal disease at baseline were evaluated separately. As with the total sample, the intervention and control groups were similar, with the exception of follow-up time. However, among 82 subjects who remained in the study through at least a second photograph and could therefore be used to assess the development of retinopathy, the follow-up was similar in the intervention (22.0 months) and the control groups (24.6 months, P = 0.136, data not shown). Those in the intervention group who had no evidence of retinopathy at baseline (Airlie House score = 10 in each eye) were less likely to develop diabetic retinal changes during a mean of 23.1 months of follow-up (5/48) than were those in the control group (10/34, ?2 = 4.805, df = 1, P = 0.028). This difference remained significant in a logistic regression model that controlled for age at diagnosis, duration of diabetes at baseline, duration of follow-up, A1C, ethnicity, and sex (OR 5.35 [95% CI 1.14–2.12], P = 0.034). In a stepwise logistic model, only randomization group, baseline A1C concentration, and age were significant predictors of developing retinopathy (data not shown).



Decreasing the Risk of Diabetic Retinopathy in a Type 2 Diabetes Study: Part 1

FILED IN Type 2 Diabetes No Comments

Between 1 July 1995 and 30 June 1999, a randomized, controlled study of subjects aged ?18 years who had type 2 diabetes of at least 1-year duration was conducted in southern California. Detailed information about the methods used in this study was presented in an earlier publication and will be briefly summarized here. Subjects with type 2 diabetes, as defined by the American Diabetes Association, were recruited at clinical sites in Santa Barbara, Los Angeles, and San Diego counties, three California counties serving predominantly ethnic minority, low-income Medicaid (called Medi-Cal in California) populations. Although specific income data were not collected as part of this study, overall 93.9% of the Medi-Cal–eligible population is classified as medically indigent or needy or is eligible for public assistance. Two of these sites, in Santa Barbara and Los Angeles counties, had access to fundus cameras and participated in the retinal photograph component of the study, and the data provided in this manuscript are limited to those two sites. Signed, witnessed, informed consent was obtained from all prospective participants using forms approved by local institutional review boards.

As previously described, the main trial recruited participants with HbA1c (A1C) levels >7.5%. At the two participating sites, 121 subjects were randomized to the intervention group and 119 to the control group. Intensive diabetes case management was provided to the intervention group in addition to the standard care that was received by both groups from a primary physician not connected with the trial. In the intervention group, subjects were seen or contacted by the case management staff at varying intervals according to the need (at least monthly) to lower A1C. In the control group, blood for A1C determination was collected at 6-month intervals, and contact between study staff and participants was generally limited to that needed to assure collection of A1C samples or to obtain retinal photographs. All subjects, in both the intervention and control groups, were referred for retinal photographs at baseline and then at least yearly. Two hundred subjects (98 control and 102 intervention subjects) had at least one photograph and 149 (70 control and 79 intervention subjects) had least two sets of retinal photographs that could be analyzed in this study. For subjects with more than two sets of photographs, only the first and last were used in this analysis. Only the main study had sufficient power to see differences in metabolic variables. Thus, for this small ancillary study of retinopathy, which utilized only two of three original participating centers, follow-up analyses of A1C, blood pressure, and lipids were not planned. Photographs were obtained at a separate case management visit, and, after baseline, photographs were not necessarily scheduled to coincide with the laboratory tests or physical examinations.

The study staff at each site, consisting of registered nurses and registered dietitians working in close collaboration with an endocrinologist, provided diabetes case management to the intervention group only. Evidence-based practice guidelines and algorithms for oral medicines and insulin initiation and adjustment were used in a collaborative practice model with the primary care provider. Treatment goals and targets for therapy were uniform across sites, with flexibility to utilize individualized treatment algorithms and strategies at each site. Interactions between the participant and study staff occurred in person at the clinic site and via telephone between visits as needed. The need for ancillary medical evaluations and/or services such as ophthalmologic examinations was monitored, with subsequent follow-up to ensure receipt of services, results retrieval, and communication of results to the primary care provider.

, ,