Everything You Need to Know to Manage Type 2 Diabetes

Chapter 1

What you need to know about type 2 diabetes

Type 2 diabetes is a chronic condition. In simple terms, it means that your blood glucose (sometimes you will hear it called blood sugar, but it is the same thing) is too high. You can manage your diabetes successfully, but it will never go away and as yet there’s no cure.

The most important thing to keep in mind is that having diabetes need not stop you from enjoying life to the full. However, it is important that you:

•   Are informed about your body and blood glucose levels (BGLs), and

•   Take control of the things in your life you can change (like what you eat, how active you are and quitting smoking).

Understanding what diabetes does to your body and knowing what you need to do to manage it will allow you to live well and reduce your risk of complications. And that’s what this book is about. In Part 2 we give you the five key steps to managing your diabetes successfully, and in Part 3 we get down to exactly what to eat for better blood glucose with meal plans and food guides for adults, children and pregnant women.

What you need to know about your body and blood glucose levels

Your diet is a key factor in managing diabetes successfully. Here’s why.

Our bodies run on fuel, just like a car runs on gas. In fact, our bodies burn a special mix of fuels that come from the protein, fat and carbohydrate in the foods we eat.

When we eat carbohydrate-rich foods such as bread, potatoes and other starchy vegetables, pasta, rice and other grains, noodles, breakfast cereals and fruit, our body converts them into a sugar called glucose during digestion. This glucose is then absorbed from our intestine and becomes the fuel that circulates in our bloodstream, and that’s when our blood glucose levels rise. At this point, our pancreas gets the message to release a hormone called insulin to drive glucose out of the bloodstream and into our body’s cells where our body can either use it as an immediate source of energy or convert it into glycogen (the name for the storage form of glucose) or into fat.

Sometimes glucose levels build up in the bloodstream and lead to high blood glucose levels and a diagnosis of diabetes or prediabetes. There are two reasons for this.

•   When the insulin can’t do its job properly, it is called insulin resistance.

•   When the pancreas does not produce enough insulin to reduce blood glucose levels, it is called insulin deficiency.

Insulin resistance, which occurs without you even knowing it, is thought to be a contributing factor in the development of diabetes. Having insulin resistance means that your muscle and liver cells are not good at taking up glucose from the blood, unless there’s a truckload of insulin about. This makes the beta cells in your pancreas work overtime to produce extra insulin so that your muscle cells get enough glucose for making energy. Once your beta cells are unable to produce enough insulin to overcome the resistance, you get high blood glucose levels . . . and along with that, the diagnosis of diabetes. In Chapter 2 we look at insulin resistance in more detail and explain how it is diagnosed.

Many factors are being identified as contributing to this failure of the beta cells, and it is believed to be at least partly in your genes. This is why diabetes is more common among certain groups. African-Americans, Hispanic Americans, Native Americans, Aboriginal Australians or Torres Strait Islanders, Maoris, Pacific Islanders, Southeast Asians and Asian Indians are at a greater risk than people from an Anglo-Celtic background.

Two other key risk factors for diabetes are:

•   Your age. Older people are more at risk than younger people.

•   Your lifestyle. Being overweight and not exercising enough can contribute to the development of type 2 diabetes, especially in families where someone already has diabetes. In fact, about 80 percent of people with type 2 diabetes are overweight.

Occasionally there are other causes of diabetes. There are some medical disorders that cause secondary diabetes, such as pancreatitis (inflammation of the pancreas) and acromegaly (due to excessive production of growth hormone).

A number of medications also increase the risk of diabetes—the most important of these are the glucocorticoids or “steroids” that are often used by people with severe asthma or arthritis. People who need to take certain antipsychotic drugs for mental disorders or anti-HIV drugs for AIDS may also increase their risk of developing type 2 diabetes.

Diagnosing diabetes

The main symptoms of diabetes are:

•   Increased thirst

•   Tiredness

•   Blurred vision

•   Leg cramps

•   Increased urine output

•   Always feeling hungry

•   Itching, skin infections, cuts that won’t heal, and

•   Unexplained weight loss (which may occur when glucose levels are very high).

However, most people with type 2 diabetes, especially early on, have no obvious symptoms at all.

Diabetes is diagnosed by a blood test. Diagnosing and treating diabetes early is an important way to prevent complications. If your doctor suspects diabetes, either because of your symptoms or because you are in one of the high risk groups, he or she will arrange for you to have a blood glucose test to measure your blood glucose level. This is best done after fasting overnight (no food between dinner and the test that is carried out the following morning).

•   If the result of your test is very high and you have some of the symptoms we listed, that is all that your doctor needs to make the diagnosis.

•   If the result of your test is moderately high, the test should be repeated to make sure of the diagnosis.

•   If the result is a little bit higher than normal, you will need to have an oral glucose tolerance test to make the diagnosis. This involves fasting overnight, having a blood test to measure the fasting blood glucose, drinking a sweet drink of 75 grams of glucose and then measuring the blood glucose again 2 hours later.

Chapter 2

What you need to know about insulin resistance

Insulin resistance means that your body does not react in a normal way to insulin in the blood—it is insensitive, or “partially deaf,” to insulin. Just as we may shout to make a deaf person hear, the body makes more insulin in an effort to make it work. So moving glucose into cells requires more insulin. This is why high insulin levels are part and parcel of insulin resistance, which in turn can lead to high blood pressure, due to the effect of the high insulin levels on your kidneys.

While some insulin resistance is determined by your genes, what you do to your body is also very important. People who are overweight and do not exercise can often become insulin resistant.

How do you know if you have insulin resistance?

You probably have insulin resistance if you have two or more of the following:

•   High waist circumference

•   High blood pressure

•   Low HDL (good) cholesterol levels

•   Prediabetes

•   High triglycerides, and

•   High uric acid levels in your blood.

You might be normal weight but with a high waist circumference (more than 32 inches in women, more than 37 inches in men). This indicates excessive fat around the abdomen, which is also a heart health risk.

But the red flag is if your blood glucose and insulin levels are high.

Why is insulin resistance so common?

The answer is that both genes and environment play a role. People of Asian and African-American origin, and descendants of the original inhabitants of Australia and North and South America, appear to be more insulin resistant than those of Caucasian extraction, even when they are still young and lean. But regardless of ethnic background, insulin resistance develops as we age, probably because as we grow older we gain fat, become less active and lose some of our muscle mass.

What we eat plays an important role, too. Specifically, eating too much of the wrong kind of fat (saturated fat) and too much of the wrong kind of carbohydrate can increase your insulin resistance. If your carbohydrate intake is high, eating high GI foods can make pre-existing insulin resistance worse. In Chapter 10 we explain all about the GI (glycemic index).

Why is it a big deal?

The higher your insulin levels, the more carbohydrate you burn at the expense of fat. This is because insulin has two powerful actions: one is to “open the gates” so that glucose can flood into the cells and be used as the source of energy; the other is to stop the release of fat from fat stores. The burning of glucose reduces the burning of fat, and vice versa.

These two things keep going on even if you have insulin resistance because your body overcomes the extra hurdle by just pumping out more insulin into the blood. Unfortunately, the level that finally drives glucose into the cells is 2 to 10 times more than is needed to switch off the use of fat as a source of fuel.

If insulin levels are high all day long, as they are in insulin resistant and overweight people, the cells are constantly forced to use glucose as their fuel source. They draw it from either the blood or stored glycogen. The blood glucose level then swings from low to high and back again, playing havoc with appetite and triggering the release of stress hormones. And stores of carbohydrate in the liver and muscles also undergo major fluctuations over the course of the day.

When you don’t get much chance to use fat as a source of fuel, it is not surprising that fat stores accumulate wherever they can:

•   Inside the muscle cells (a sign of insulin resistance if you are not an elite athlete)

•   In the blood (this means you have high triglycerides, and many people with diabetes or the metabolic syndrome have this)

•   In the liver (non-alcoholic fatty liver), and

•   Around the waist.

Insulin resistance gradually lays the foundations for heart attack and stroke.

Chapter 3

What you need to know about prediabetes

If you have prediabetes (the term used to describe impaired glucose tolerance and/or impaired fasting glucose), it means that you have blood glucose levels somewhere between normal and diabetes. It’s diagnosed by either a fasting blood glucose test, a glucose tolerance test or a hemoglobin A1c test.

Left untreated, prediabetes can develop into type 2 diabetes. It also puts you at risk of some of the complications associated with diabetes, such as heart attacks and stroke.

The good news is that you can prevent, or at the very least delay, getting type 2 diabetes—and all of its complications. In fact we now know that 3 out of 5 people with prediabetes can prevent the development of type 2 diabetes by making some lifestyle changes such as losing weight, eating a healthy low GI diet, being more active and quitting smoking.

Risk factors for developing prediabetes

If there’s type 2 diabetes in your family, you probably already know that you have an increased chance of getting it too. But genes alone don’t account for the current diabetes/prediabetes epidemic. Instead, it’s the food we eat and our sedentary lifestyle. The most obvious trigger is that we’re all getting heavier; and carrying extra body fat goes hand in hand with prediabetes and diabetes. People who are overweight, particularly around their middle, have up to three times more chance of developing diabetes than people who are in the healthy weight range.

Risk factors for prediabetes you cannot change

•   A family history of diabetes

•   Your ethnic background (people of African-American, Hispanic/Latino, Native American, Asian American and Pacific Island background have a greater risk)

•   Having polycystic ovarian syndrome (PCOS)

•   Having diabetes in pregnancy or giving birth to a big baby (more than 9 lbs)

•   Having heart disease, angina, or having had a heart attack, and

•   Having familial hypercholesterolemia (an inherited condition that leads to higher than normal LDL cholesterol and potentially a heart attack early in life).

Risk factors for prediabetes you can do something about

•   Smoking

•   Being sedentary