The Marlowe Diabetes Library Good control is in your hands.
SINCE 1999, Marlowe & Company has established itself as the nation’s leading independent publisher of books on diabetes. Now, the Marlowe Diabetes Library, launched in 2007, comprises an ever-expanding list of books on how to thrive while living with diabetes or prediabetes. Authors include world-renowned authorities on diabetes and the glycemic index, medical doctors and research scientists, certified diabetes educators, registered dietitians and other professional clinicians, as well as individuals living and thriving with prediabetes, type 1 or type 2 diabetes. See page 491 for the complete list of Marlowe Diabetes Library titles.
ACCLAIM FOR THE NEW GLUCOSE REVOLUTION FOR DIABETES
“Dr. Brand-Miller’s pioneering research has clearly shown that all carbohydrates are not created equal—and everyone having problems with glucose metabolism needs to know the difference.”
—WALTER WILLETT, MD, professor of epidemiology and nutrition, Harvard School of Public Health, and author of Eat, Drink, and Be Healthy
“Diabetes is the epidemic of the twenty-first century and this book will empower you to take charge of your life and ‘live well’ with diabetes. Written by the world’s experts on diet and the glycemic index, this book will provide the tools you need to make dietary and lifestyle changes to achieve lifelong health. The authors are to be congratulated for an eminently lucid book with the potential for real impact on public health.”
—JOANN E. MANSON, MD, professor of medicine, Harvard Medical School, and chief of preventive medicine, Brigham and Women’s Hospital
“The New Glucose Revolution for Diabetes
, written by a compassionate team of experts, combines years of clinical experience and state-of-the-art research into a comprehensive approach to diabetes. The book is loaded with practical information, step-by-step guidance, recipes and other supports that will guide the reader to prevent a problem from developing, or effectively manage one that has. I recommend it enthusiastically.”
—DAVID LUDWIG, MD, PhD, director, Optimal Weight for Life program, Children’s Hospital Boston, and author of Ending the Food Fight
“These authors get it: People with diabetes must actively participate in their self-care. To do this effectively, they must be properly informed. The New Glucose Revolution for Diabetes
arms the patient with practical information that assists them in managing their diabetes on a day-to-day basis.”
—JOHANNA BURANI, RD, CDE, coauthor of Good Carbs, Bad Carbs
“For a dozen years I have been writing about the glycemic index. Now, here is finally a book about the GI specifically for those of us who need it the most—people with diabetes. We need to know about it more than anyone else. Jennie Brand-Miller and her associates give us here what we must have to control our diabetes, rather than letting it control our lives.”
—DAVID MENDOSA, diabetes journalist, patient-advocate, and author of Losing Weight with Your Diabetes Medication and coauthor of The New Glucose Revolution What Makes My Blood Glucose Go Up . . . and Down?
OTHER TITLES IN THE NEW GLUCOSE REVOLUTION SERIES
For the definitive overview of the glycemic index . . .
■ The New Glucose Revolution (third edition): The Authoritative Guide to the Glycemic Index—the Dietary Solution for Lifelong Health
For a focus on recipes, shopping, and the GI in the larger nutrition picture . . .
■ The New Glucose Revolution Low GI Vegetarian Cookbook
■ The New Glucose Revolution Life Plan
■ The New Glucose Revolution Shopper’s Guide to GI Values 2007
■ The New Glucose Revolution Low GI Guide to Sugar and Energy
For a basic introduction to the GI plus the top 100 low-GI foods . . .
■ The New Glucose Revolution Low GI Eating Made Easy: The Beginner’s Guide to Eating with the Glycemic Index
For a focus on weight loss . . .
■ The Low GI Diet Revolution: The Definitive Science-Based Weight Loss Plan
■ The Low GI Diet Cookbook: 100 Simple, Delicious Smart-Carb Recipes-The Proven Way to Lose Weight and Eat for Lifelong Health
■ The New Glucose Revolution Low GI Guide to Losing Weight
For a focus on the GI and specific health conditions . . .
■ The New Glucose Revolution Low GI Guide to the Metabolic Syndrome and Your Heart: The Only Authoritative Guide to Using the Glycemic Index for Better Heart Health
■ The New Glucose Revolution What Makes My Blood Glucose Go Up . . . And Down? 101 Frequently Asked Questions about Your Blood Glucose Level
■ The New Glucose Revolution Guide to Living Well with PCOS
To stay up to date with the latest research on carbohydrates, the GI, and
your health, and the latest books in the series, check out the free online
monthly newsletter GI News, produced by Dr. Jennie Brand-Miller’s GI
Group at the University of Sydney: http://ginews.blogspot.com.
This book is for all the people who live
with diabetes and have so openly shared
their experiences with us.
Diabetes has been around for thousands of years, and was once relatively rare. Its literal meaning is “to pass through”—referring to the passing of liquids through the body. The ancient Egyptians recommended that those suffering from “the passing of too much urine” eat a diet of fruit, grain and sweet beer. The Greeks, who mistakenly thought it was a weakness of the kidneys, prescribed exercise, “preferably on horseback.”
Diabetes is no longer rare. In fact, it is one of the fastest-growing diseases in the world. About 246 million people in the world have diabetes, and that number is expected to reach 380 million by the year 2025. It can cause heart disease, blindness and kidney failure, and can lead to amputation. It can be a killer.
In the United States, diabetes and prediabetes affect 62 million adults. Every day nearly 300 people, including children, are being diagnosed with diabetes. And for every person diagnosed there’s someone else who is undiagnosed. Millions of dollars are being spent by governments in treating, managing and preventing the epidemic, but the way to stem the tide really begins with us as individuals.
Living in the United States and Canada offers us immense potential for good health, but many people are uninformed about or confused by what’s involved in a healthy lifestyle. Living well with diabetes doesn’t mean being on a “diet.” It means eating nutritious foods—and not eating whatever happens to be in front of you. It means making smarter food choices. And making the effort to move more.
In the last decade, research has yielded overwhelming evidence that lifestyle changes such as maintaining a healthy eating plan and increasing exercise can make a real difference in our risk of developing diabetes and in the quality of our health if we already have it. It’s never too late to make a difference. There is the potential to turn back the clock.
HOW TO USE THIS BOOK
There are many types of diabetes and many different approaches to managing it. As the title says, this book is a diet and lifestyle guide to living well with diabetes or prediabetes, and there are many ways to do that. Our aim is to translate the current scientific evidence about managing and preventing diabetes into an accessible, practical resource, giving you the information to use so that you can discover what works best for you.
Whether you have prediabetes, type 1 diabetes, type 2 diabetes or gestational diabetes, this book has something for you.
The book sets out clearly and simply what you need to eat and do to:
➧ Reduce your risk of developing diabetes
➧ Improve your cardiovascular health
➧ Keep your blood glucose levels (BGLs), blood pressure and blood fats under control, and
➧ Maintain a healthy body.
Part 1: Understanding diabetes, prediabetes and the metabolic syndrome will spell out the differences between the various types of diabetes, tell you how they are diagnosed and explain key aspects of their management.
In Part 2: What you can do, you’ll learn the five fundamental steps to take to maintain a healthy lifestyle.
Part 3: Living with diabetes and prediabetes consists of sections on each type of diabetes and includes daily food guides, sample menu plans, recipes, a chart for converting from imperial to metric measurements (for Canadian readers) and the answers to frequently asked questions.
We have also included comprehensive GI tables to help you make smart food choices, and a detailed glossary to help demystify common medical terms and inform you so you can take control of your diabetes.
Diabetes is a complex condition, and there are aspects of its management—such as blood glucose monitoring, medications and insulin—which are not covered in detail. Nor do we cover management of diabetes complications (we hope this book will mean you never get them). The information in this handbook is not intended to take the place of individual consultation with your doctor or diabetes health professionals.
We hope that this book will help you to manage your diabetes successfully or turn back the clock with prediabetes. On the pages you will find anecdotes, comments and stories from people with diabetes whom we’ve spoken with throughout the years. We hope these inspire you, although keep in mind that what works for one person may not work for another. At the very least, we hope you might find familiarity with some of them and realize that you are not alone in your experience of managing diabetes.
We wish you success in preventing or managing diabetes.
Sydney, January 2007
Understanding Diabetes, Prediabetes and the Metabolic Syndrome
■ 1 ■
BACK IN LATE 2003, at age 41, although my general health appeared okay, I began to notice that my weight was inexplicably starting to drop, and I was starting to drink a lot of water and felt the need to urinate a lot. By early 2004 things had worsened considerably. Basically, I began to feel very unwell. Dizzy, extreme lethargy, blurry vision . . . and the weight loss continued. Although I realized that something was clearly wrong with my health and I was worried, I was extremely reluctant to visit my doctor! In the end, urged by family, I did, and the blood tests that followed showed a very high blood glucose level of 414. Yes, I had type 2 diabetes.
Diabetes mellitus is a chronic condition. In simple terms, this means that your blood glucose (sometimes called blood sugar) is too high. There is no cure. It can be successfully managed, but it will never go away. It changes your life, so it’s not surprising that anger and denial are really common reactions to a diagnosis of diabetes.
In fact, the range of feelings many people experience when first diagnosed are not dissimilar to those of grieving. In a way, a diagnosis of diabetes represents the loss of your healthy whole self. Your initial reaction may be “not me” denial or “why me?” anger. You may even try bargaining, perhaps with the “Almighty.” You may experience a period of depression. Hopefully, finally will come acceptance that you have diabetes, that life will be different, but you can manage it successfully, and life will go on.
Whatever your reaction to the diagnosis, your feelings are perfectly natural. You are not alone. If it is any consolation, the pain you are feeling now may help you manage your health positively in the years to come. Having diabetes need not stop you from enjoying life to the full and achieving whatever you want from life.
According to research from the Diabetes Information Jigsaw, “depression greatly reduces the ability of people with diabetes to manage their condition, which can result in poorer management of blood glucose levels and difficulty in sticking to exercise, diet and treatment programs.” The most important thing you can do is take control of the things in your life you can change and get informed about your body and what is happening to it. Knowing what you need to do to manage diabetes will allow you to live well and lessen the impact of this disease.
To understand why diet and lifestyle are so important in managing diabetes successfully, it is useful to know about how your body normally handles the nutrients in the food you eat, and how (and why) disturbances to its metabolism can affect your overall health.
BLOOD GLUCOSE AND INSULIN
Your body is incredibly complex, and is delicately tuned to deliver peak performance. You really are what you eat. “Metabolism” is the term that describes the processes (a complex series of biochemical reactions) that direct energy from the food you eat into fueling normal growth, development and physical activity; or into storage, such as fat.
Your body needs protein to build and maintain tissues, good fats to function and thrive, and carbohydrates as an energy source. It is important to understand carbohydrate’s role. When you eat carbohydrate foods such as bread, cereals and fruit, your body converts them into a sugar called glucose. It is this glucose that is absorbed from your intestine and becomes the fuel that circulates in your bloodstream.
Glucose is a universal fuel for your body cells, the primary fuel source for the brain, red blood cells and a growing fetus, and the main source of energy during strenuous exercise.
In a healthy person, when glucose levels in the blood rise after a meal, the beta cells in the pancreas get the message to secrete a hormone called insulin. Insulin drives glucose out of the blood and into the cells. Once inside the cells, glucose is channeled into various pathways—to be used as an immediate source of energy, or converted to glycogen (a storage form of glucose) or to fat. Insulin has been likened to the key that opens the cell door to let the glucose inside.
Sometimes glucose builds up in the blood. There are two reasons for this. Either the pancreas can’t produce enough insulin on demand (some or all of the keys are missing) or the cells do not respond to the insulin in the blood the way they should (the locks are malfunctioning).
“Insulin deficiency” is when the pancreas does not produce enough insulin to reduce blood glucose levels; “insulin resistance” is when the insulin can’t do its job properly. Both these conditions lead to glucose accumulating in the bloodstream and to high blood glucose levels. Depending on how high the levels of glucose are, the condition is classified as:
➧ Diabetes, or
➧ Prediabetes (see chapter 2).
How active you are and how much you weigh have a very important effect on your metabolism, especially on the way your body handles carbohydrates. Being overweight or obese is a very common cause of insulin resistance, and losing a little weight is a powerful way of reducing insulin resistance. Exercise and improving your physical strength are also good ways of reducing insulin resistance.
TYPES OF DIABETES
There are three main kinds of diabetes, and although many of the symptoms are the same, the causes are very different.
Type 1 diabetes
Type 1 diabetes is an autoimmune disease and is one of the most common childhood diseases. Rates are increasing throughout the world, and no one knows exactly why. Certain environmental triggers have been proposed as possible contributors.
About 10 percent of people with diabetes have type 1. In this type of diabetes, the pancreas does not produce any insulin, so you need insulin injections. Maintaining a balanced blood glucose level (BGL) requires regulating your food intake, your insulin dose and your exercise.
Formerly called juvenile diabetes or insulin-dependent diabetes, type 1 diabetes is usually first diagnosed in children, teenagers or young adults. At the moment, half of all people with type 1 diabetes are diagnosed before the age of 16. Within this group there are two peaks in the age of onset: the major peak at 10-12 years and a smaller one at 5-6 years. For some reason, type 1 diabetes is more commonly diagnosed in the winter months.
The risk of someone developing type 1 diabetes if no one in the family has it is around 1 in 200. If there is a family history, the chances of developing it are much higher: about 1 in 17 if you have a brother or sister under the age of 30 who has it, and about 1 in 3 if your identical twin has it. Children whose mothers have type 1 diabetes have about a 1 in 75 chance of developing the condition; children whose fathers have it have a much higher chance—1 in 16.
Where you live also seems to affect your chances of developing the disease. Children in Finland have the greatest risk (37 per 100,000), whereas children in Fiji have a very low chance (1 per 1 million). Overall, boys and girls have the same degree of risk.
In chapters 30-34 we look at managing type 1 diabetes.
Type 2 diabetes
Eighty-five to ninety percent of people with diabetes have type 2 diabetes. Usually, type 2 diabetes develops after the age of 40. With our society’s increasing trend to physical inactivity and obesity, however, this type of diabetes is being found in younger and younger people, and in some indigenous populations, even in children less than 10 years old. Overeating, being overweight and not exercising enough are important factors (what we call lifestyle factors) that can lead to this type of diabetes, especially in a family where someone already has diabetes.
WORLDWIDE, OVER THE last twenty years the total number of people with diabetes has risen from 30 million to 230 million. Similarly, data collected in the United States confirms the rising rate of diabetes among children—around 39,000 teenagers between the ages of twelve and nineteen may have type 2 diabetes, and 2.8 million may have prediabetes.
Most children with type 2 diabetes are being diagnosed in ethnic groups that already have a high susceptibility: African Americans, Latinos, Pacific Islanders, subcontinental Indians, and Asians. This link with ethnicity reflects a genetic susceptibility, as does a strong family history of type 2 diabetes. For example, we know it’s highly likely that a child with type 2 will have at least one parent or grandparent with type 2 diabetes.
People get type 2 diabetes because their insulin is not working properly (insulin resistance, when the locks are malfunctioning). For a long time the body will struggle to make extra insulin to overcome the problem, but eventually people with type 2 diabetes develop a shortage of insulin (the keys get lost). The aim of treatment is to help people with type 2 diabetes make the best use of the insulin they have and make it last as long as possible. Pills or insulin injections may be necessary.
Being diagnosed with type 2 diabetes can be a shock. However, if current estimates are anything to go by, you shouldn’t feel that you have been singled out. There are around 246 million people with diabetes worldwide; this number is expected to reach 380 million, or 7 percent of the adult population, by 2025. A recent Canadian study found that the rate of diabetes among people 20-50 years old has increased almost 100 percent in the last ten years—and it’s still on the rise.Right now in America there are nearly 21 million people with diabetes—almost 10 percent of the population. Makes it sound pretty common, doesn’t it?
In fact, scientists are predicting that 1 out of every 3 people born in the United States during the year 2000 will develop type 2 diabetes.
The cost of having type 2 diabetes to you as an individual and our community as a whole is enormous. The American Diabetes Association in 2002 found that total healthcare cost for people with type 2 diabetes who had no complications was over $13,000 for each person, each year. One out of every $10 spent on health care in the United States goes toward diabetes The total annual healthcare cost for diabetes and its complications is $92 billion—10% of the money spent on health care in the United States. The real challenge will be to fund and develop medical and public health programs that will help people manage their condition and prevent its complications.
The other scary thought is that for every person with diagnosed diabetes, there is someone else walking around with the conditiondoesn’t know it. In fact, many people have type 2 diabetes for several years before it is picked up—often during a routine medical exam, or after a major event like a heart attack or stroke. Regular health checks and screening by your doctor are a good idea after the age of 45, particularly if you have a close relative with the condition.
Why did you get it?
We know that the number of people with type 2 diabetes is increasing dramatically. Why? Mostly, it’s a combination of unlucky genetics, increasing rates of overweight and obesity, and other lifestyle factors, particularly decreasing levels of physical activity. People from certain ethnic backgrounds and age groups are at greatest risk. Also, many people who develop type 2 diabetes have had impaired glucose tolerance or impaired fasting glucose (both are early signs of imminent diabetes) for many years.
Insulin resistance, which occurs without your even knowing it, is thought to be an underlying cause of type 2 diabetes. With insulin resistance, your muscle and liver cells are not good at taking up glucose from the blood, unless there’s a truckload of insulin around. 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.
IMPAIRED GLUCOSE TOLERANCE and impaired fasting glucose are often referred to as prediabetes. They are conditions in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. People with prediabetes are at increased risk of developing diabetes, heart disease and stroke.
Coming to terms with prediabetes (“impaired glucose tolerance” and “impaired fasting glucose”).
■ Prediabetes is a term used to describe people who are at increased risk of developing diabetes.
■ Impaired fasting glucose is a condition in which the fasting blood glucose level is elevated (110-125 mg/dL [6.1-7.0 mmol/L]) after an overnight fast, but is not high enough to be classified as diabetes.
■ Impaired glucose tolerance is a condition in which the blood glucose level (BGL) is elevated (greater than 140 mg/dL [7.8 mmol/L]) 2 hours after an oral glucose tolerance test, but is not high enough to be classified as diabetes (that is, less than 200 mg/dL [11.1 mmol/L]).
Many factors are being identified as contributing to this failure of the beta cells, and it is believed to be at least partially genetically preprogrammed. This is why type 2 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. People from an Anglo-Celtic background, on the other hand, appear to be less susceptible.
Genetics may load the cannon,
but human behavior pulls the trigger.
United States Centers for Disease Control and Prevention
However, genes alone do not account for the increasing diabetes rates. Environmental factors such as reduced activity and a high-calorie diet have led to increased rates of overweight and obesity. Not surprisingly, around 80 percent of all people with type 2 diabetes are either overweight or obese.