Since the second edition of Diabetes Cookbook For Dummies came out,
there have been a number of studies that indicate that a vegetarian diet
may be beneficial in the prevention and treatment of diabetes.
In this new
edition, we provide some of the rationale for that type of diet. You will also
find 28 new recipes from some of the finest vegetarian restaurants in the
country. They and the older vegetarian recipes will be marked with a tomato.
In this chapter, you get the latest information about what diabetes means,
how diabetes is diagnosed, and the things you need to do to thrive with diabetes. Don’t waste another minute. Get started right away.
Recognizing Diabetes
With so much diabetes around these days, you may think that recognizing it
should be easy. The truth is that it’s not easy, because diabetes is defined by
blood tests. You can’t just look at someone and know the level of glucose —
blood sugar — in his or her blood.
Diabetes by the numbers
The level of glucose that means you have diabetes is as follows:
✓ A casual blood glucose of 200 milligrams per deciliter (mg/dl) or more at
any time of day or night, along with symptoms such as fatigue, frequent
urination and thirst, slow healing of skin, urinary infections, and vaginal
itching in women. A normal casual blood glucose should be between 70
and 139 mg/dl.
✓ A fasting blood glucose of 126 mg/dl or more after no food for at least
eight hours. A normal fasting blood glucose should be less than 100 mg/dl.
✓ A blood glucose of 200 mg/dl or greater two hours after consuming 75
grams of glucose.
A diagnosis of diabetes requires at least two abnormal levels on two different
occasions. Don’t accept a lifelong diagnosis of diabetes on the basis of a
single test.
A fasting blood glucose between 100 and 125 mg/dl or casual blood glucose
between 140 and 199 mg/dl is prediabetes. See Dr. Rubin’s book Prediabetes
For Dummies (Wiley). Most people with prediabetes will develop diabetes
within ten years.
Although people with prediabetes don’t usually develop
small blood vessel complications of diabetes like blindness, kidney failure,
and nerve damage, they’re more prone to large vessel disease like heart
attacks and strokes, so you want to get that level of glucose down.
Sixty million people in the United States have prediabetes.
Types of diabetes
The following list describes the three main types of diabetes:
✓ Type 1 diabetes: This used to be called juvenile diabetes or insulindependent diabetes. It mostly begins in childhood and results from the
body’s self-destruction of its own pancreas.
The pancreas is an organ of
the body that sits behind the stomach and makes insulin, the chemical
or “hormone” that gets glucose into cells where it can be used. You can’t
live without insulin, so people with type 1 diabetes must take insulin
shots. Of the 24 million Americans with diabetes, about 10 percent have
type 1.
✓ Type 2 diabetes: Once called adult-onset diabetes, type 2 used to begin
around the age of 40, but it is occurring more often in children, many of
whom are getting heavier and heavier and exercising less and less.
The problem in type 2 diabetes is not a total lack of insulin, as occurs in type
1, but a resistance to the insulin, so that the glucose still doesn’t get into
cells but remains in the blood.
✓ Gestational diabetes: This type of diabetes is like type 2 diabetes but
occurs in women during pregnancy, when a lot of chemicals in the mother’s
blood oppose the action of insulin.
About 4 percent of all pregnancies are
complicated by gestational diabetes. If the mother isn’t treated to lower
the blood glucose, the glucose gets into the baby’s bloodstream. The baby
produces plenty of insulin and begins to store the excess glucose as fat in
all the wrong places.
If this happens, the baby may be larger than usual and
therefore may be hard to deliver. When the baby is born, he is cut off from
the large sugar supply but is still making lots of insulin, so his blood glucose
can drop severely after birth.
The mother is at risk of gestational diabetes in
later pregnancies and of type 2 diabetes as she gets older.
✓ Other types: A small group of people with diabetes suffer from one of
these much less common varieties of diabetes:
• Latent autoimmune diabetes on adults (LADA), which has characteristics of both type 1 and type 2 diabetes
• Genetic defects of the beta cell, which makes insulin
• Medications that affect insulin action like cortisol or prednisone
• Diseases or conditions that damage the pancreas like pancreatitis
or cystic fibrosis
• Genetic defects in insulin action
Consequences of diabetes
If your blood glucose isn’t controlled — that is, kept between 70 and 139 mg/
dl after eating or under 100 mg/dl fasting — damage can occur to your body.
The damage can be divided into three categories: irritations, short-term complications, and long-term complications.
Irritations
Irritations are mild and reversible but still unpleasant results of high blood
glucose levels. The levels aren’t so high that the person is in immediate lifethreatening danger.
The most important of these irritations are the following:
✓ Blurred vision
✓ Fatigue
✓ Frequent urination and thirst
✓ Genital itching, especially in females
✓ Gum and urinary tract infections
✓ Obesity
✓ Slow healing of the skin
Short-term complications
These complications can be very serious and lead to death if not treated.
They’re associated with very high levels of blood glucose — in the 400s and
above.
The three main short-term complications are the following:
✓ Ketoacidosis: This complication is found mostly in type 1 diabetes. It
is a severe acid condition of the blood that results from lack of insulin,
the hormone that is missing.
The patient becomes very sick and will die
if not treated with large volumes of fluids and large amounts of insulin.
After the situation is reversed, however, the patient is fine.
✓ Hyperosmolar syndrome: This condition is often seen in neglected
older people. Their blood glucose rises due to severe dehydration and
the fact that the kidneys of the older population can’t get rid of glucose
the way younger kidneys can.
The blood becomes like thick syrup. The
person can die if large amounts of fluids aren’t restored. They don’t
need that much insulin to recover.
After the condition is reversed, these
people can return to a normal state.
✓ Hypoglycemia or low blood glucose: This complication happens when
the patient is on a drug like insulin or a pill that drives the glucose down
but isn’t getting enough food or is getting too much exercise.
After it
falls below 70 mg/dl, the patient begins to feel bad. Typical symptoms
include sweating, rapid heartbeat, hunger, nervousness, confusion, and
coma if the low glucose is prolonged.
Glucose by mouth, or by venous
injection if the person is unconscious, is the usual treatment. This complication usually causes no permanent damage.
Long-term complications
These problems occur after ten or more years of poorly controlled diabetes
or, in the case of the macrovascular complications, after years of prediabetes
or diabetes.
They have a substantial impact on quality of life. After these
complications become established, reversing them is hard, but treatment is
available for them early in their course, so watch for them five years after
your initial diagnosis of diabetes.
See Dr. Rubin’s book Diabetes For Dummies,
3rd Edition (Wiley), for information on screening for these complications.
The long-term complications are divided into two groups: microvascular,
which are due at least in part to small blood vessel damage, and macrovascular, associated with damage to large blood vessels.
Microvascular complications include the following:
✓ Diabetic retinopathy: Eye damage that leads to blindness if untreated.
✓ Diabetic nephropathy: Kidney damage that can lead to kidney failure.
✓ Diabetic neuropathy: Nerve damage that results in many clinical symptoms, the most common of which are tingling and numbness in the feet.
Lack of sensation in the feet can result in severe injury without awareness unless you carefully look at your feet regularly. Such injury can
result in infection and even amputation.
Macrovascular complications also occur in prediabetes and consist of the
following:
✓ Arteriosclerotic heart disease: Blockage of the blood vessels of the
heart. This is the most common cause of death in diabetes due to a
heart attack.
✓ Arteriosclerotic cerebrovascular disease: Blockage of blood vessels to
the brain, resulting in a stroke.
✓ Arteriosclerotic peripheral vascular disease involving the blood vessels of the legs: These vessels can become clogged and result in amputation of the feet or legs.
If you control your blood glucose, none of these complications need ever
occur. Controlling your blood pressure and your cholesterol also helps prevent these complications.
Treating diabetes
Treatment of diabetes involves three essential elements:
✓ Diet: If you follow the recommendations in this book, you can lower
your average blood glucose by as much as 30 to 50 mg/dl. Doing so can
reduce the complication rate by as much as 33 percent.
✓ Exercise: We touch on exercise in Chapter 3 and cover it more extensively in Diabetes For Dummies, 3rd Edition (Wiley).
✓ Medication: Diabetes medications abound — there are far too many to
discuss here.
- Controlling Calories
Just as the three most important factors in the value of a house are location,
location, location, the three most important factors in diet for people with
diabetes are moderation, moderation, moderation.
If you’re overweight or
obese, which is true of most people with type 2 diabetes and a lot of people
with type 1 diabetes who are on intensive insulin treatment (four shots of insulin daily), weight loss will make a huge difference in your blood glucose
levels.
If you maintain the weight loss, you’ll avoid the complications of diabetes discussed earlier in this chapter.
To successfully lose weight, you need to control your total calories. You
must burn up the same amount of calories you take in by mouth, or you will
gain weight. To lose weight, you need to burn up more calories than you
eat. Sounds simple, eh!
And it doesn’t matter where the calories come from.
Studies that compare diets low in fats, proteins, or carbohydrates result in
the same weight loss after a year.
As you reduce your portions, reduce your intake of added sugars, fats, and
alcohol. These items contain no nutrients such as vitamins and minerals and
are simply sources of empty calories.
If you are predisposed to have diabetes because, for example, your parents
both had diabetes, you can prevent it by maintaining a healthy weight.
If you
already have diabetes, you can minimize its impact by losing weight and keeping it off.
Do you need a highly complicated formula to figure out how to moderate
your food intake? No! It’s as simple as looking at the portions you currently
eat and cutting them in half. At home, where you control the amount of food
on your plate, you can start with a small portion, so you may not need to
reduce it by half.
However, in restaurants, where more and more people are
eating their meals, especially the fast-food restaurants, discussed extensively
in the rule of eating half may not be strong enough.
There you may need to eat only a third of the portion.
You may need to apply
the same portion control when you eat at someone else’s home.
Use these tips to help you visualize portion sizes:
✓ An ounce of meat is the size of a pack of matches.
✓ Three ounces of meat is the size of a deck of cards.
✓ A medium fruit is the size of a tennis ball.
✓ A medium potato is the size of a computer mouse.
✓ A medium bagel is the size of a hockey puck.
✓ An ounce of cheese is the size of a domino.
✓ A cup of fruit is the size of a baseball.
✓ A cup of broccoli is the size of a light bulb
- Including Exercise (And Rest)
Exercise is just as important as diet in controlling your blood glucose. A
group of people who were expected to develop diabetes because their parents both had diabetes was asked to walk 30 minutes a day. Eighty percent of
those who did walk did not develop the disease.
These people didn’t necessarily lose weight, but they did exercise.
Too many people complain that they just can’t find the time to exercise.
But
a recent study showed that just 71⁄2 minutes of highly intense exercise a week
had a profound effect on the blood glucose.
So this excuse isn’t acceptable,
especially when you realize how much difference exercise can make in your
life and your diabetes.
Here are some ways that different amounts of exercise
can help you:
✓ Thirty minutes of exercise a day will get you in excellent physical shape
and reduce your blood glucose substantially.
✓ Sixty minutes of exercise a day will help you to maintain weight loss and
get you in even better physical shape.
✓ Ninety minutes of exercise a day will cause you to lose weight.
An exercise partner helps ensure that you get out and do your thing. We find
it extremely helpful to have someone waiting for us so that we can exercise
together.
Here are some more facts about exercise to keep in mind:
✓ You don’t have to get in all your minutes of exercise in one session. Two
30-minute workouts are just as good as and possibly better than one
60-minute workout.
✓ Although walking is excellent exercise, especially for the older population, the benefits of more vigorous exercise and for a longer time are
greater still.
✓ Everything counts when it comes to exercise. Your decision to take the
stairs instead of the elevator may not seem like much, but if you do so
day after day, it makes a profound difference.
Another suggestion that
may help over time is to park your car farther from your office or bike to
the office.
✓ A pedometer (a small gadget worn on your belt that counts your steps)
may help you to achieve your exercise goals. The objective is to get up
to 10,000 steps a day by increasing your step count every week.
You also want to do something to strengthen your muscles. Larger muscles
take in more glucose, providing another way of keeping it under control.
You’ll be surprised by how much your stamina will increase and how much
your blood glucose will fall.
Place a daily limit on activities that are completely sedentary, such as watching television or surfing the Web.
Use the time you might have once spent on
these activities to exercise. This advice is especially helpful for overweight
children who should be limited to two hours a day.
You want to be active, but don’t do it at the cost of getting plenty of rest each
day.
People who sleep eight hours a night tend to be less hungry and leaner
than people who sleep less.
Of course, it is possible to overdo it. One French diplomat found the phenomenal
energy of President Theodore Roosevelt too much for him. After two sets of
tennis at the White House, Roosevelt invited him to go jogging. Then they had a
workout with a medicine ball.
“What would you like to do now?” the president
asked his guest when his enthusiasm for the exercise seem to be flagging. “If it’s
all the same to you,” gasped the exhausted Frenchman, “lie down and die.
- Controlling Your Blood Pressure
Keeping your blood pressure in check is particularly important in preventing
the macro vascular complications of diabetes. But elevated blood pressure
also plays a role in bringing on eye disease, kidney disease, and neuropathy.
You should have your blood pressure tested every time you see your doctor.
The goal is to keep your blood pressure under 130/80. (See Dr. Rubin’s book
High Blood Pressure For Dummies, 2nd edition, published by Wiley, for a complete explanation of the meaning of these numbers.)
You may want to get
your own blood pressure monitor so that you can check it at home yourself.
The statistics about diabetes and high blood pressure are daunting. Seventy one percent of diabetics have high blood pressure, but almost a third are
unaware of it.
Almost half of them weren’t being treated for high blood pressure. Among the treated patients, less than half were treated in a way that
reduced their pressure to lower than 130/80.
You can do plenty of things to lower your blood pressure, including losing
weight, avoiding salt, eating more fruits and vegetables, and, of course, exercising. But if all else fails, your doctor may prescribe medication.
Many blood
pressure medicines are available, and one or two will be exactly right for you.
See High Blood Pressure For Dummies, 2nd Edition, for an extensive discussion of the large number of blood pressure medications.
One class of drugs in particular is very useful for people with diabetes with high
blood pressure: angiotensin converting enzyme inhibitors (ACE inhibitors),
which are especially protective of your kidneys. If kidney damage is detected
early, ACE inhibitors can reverse the damage.
Some experts believe that all
diabetics should take ACE inhibitors. We believe that if there’s no evidence of
kidney damage and the diabetes is well controlled, this isn’t necessary.
- Considering the Rest of Your Lifestyle
Diabetes is just one part of your life. It can affect the rest of your lifestyle, however, and your lifestyle certainly affects your diabetes.
In this section, we take
up some of these other parts of your lifestyle, all of which you can alter to the
benefit of your health and your diabetes. Try making changes one at a time,
and when you think you have that one under control, move on to the next.
Drinking alcohol safely
A glass of wine is a pleasant addition to dinner, and studies show that alcohol
in moderation can lower the risk of a heart attack.
For a diabetic, it is especially important that food accompany the wine because alcohol reduces the blood glucose; a complication called hypoglycemia may occur (see the section “Short-term complications,” earlier in this post. Never drink alcohol without food, especially when you’re taking glucose lowering medication.
The following people should not drink alcohol at all:
✓ Pregnant women
✓ Women who are breastfeeding
✓ Children and adolescents
✓ People who take medications that interact with alcohol
✓ People with medical conditions that are worsened by alcohol, such as
liver disease and certain diseases of the pancreas
The amount of wine that is safe on a daily basis is a maximum of two 4-ounce
glasses for a man or one 4-ounce glass for a woman. Men metabolize alcohol
more rapidly than women, so they can drink more. But you should drink no
more than a maximum of five days out of seven.
In terms of alcohol content, 11
⁄2 ounces of hard liquor, such as gin, rum,
vodka, or whisky, or 12 ounces of light beer are the equivalent of a 4-ounce
glass of wine.
Alcohol adds calories without any nutrition. Alcohol has no vitamins or minerals, but you do have to account for the calories in your diet. If you stop
drinking alcohol, you may lose a significant amount of weight.
For example,
a person who has been drinking three drinks a night and stops will lose 26
pounds in a year.
Alcohol can cause cirrhosis of the liver and raises blood pressure. It also
worsens diabetic neuropathy. Do you need any more reasons not to drink
alcohol?
In addition to drinking alcohol in moderation, here are major ways you can
improve the rest of your lifestyle:
✓ Avoid tobacco in any form. It is the number-one killer.
✓ Avoid illicit drugs.
✓ Drive safely.
✓ Benefit from relationships.
✓ Maintain your sense of humor.
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