If you are already dealing with a diabetes diagnosis, day-to-day life will obviously be different from your average Joe’s or Jane’s. And while you would do well to practice the advice on diabetes prevention, it’s important to up your game if you are living with the real thing. Your life doesn’t have to revolve around medications and measurements, but awareness of all the factors is key.
You may not just be reading about insulin; you may be taking it yourself. What is the safest way to do so? Do you or your caretaker know how to measure your glucose or how it might vary at certain times of the day? Even seemingly irrelevant circumstances such as weather can suddenly come into play, but armed with the following articles (and in some cases, a warm coat), you can brave any storm.
Stay-Well Secrets for People with Diabetes or Prediabetes
Many people downplay the seriousness of diabetes. That’s a mistake. Because elevated glucose can damage blood vessels, nerves, the kidneys, and eyes, people with diabetes are much more likely to die from heart disease and/or kidney disease than people without diabetes—and they are at increased risk for infections, including gum disease, as well as blindness and amputation. (Nerve damage and poor circulation can allow dangerous infections to go undetected.)
And diabetes can be sneaky—increased thirst, urination, and/or hunger are the most common symptoms, but many people have no symptoms and are unaware that they are sick.
Despite these sobering facts, doctors rarely have time to give their patients all the information they need to cope with the complexities of diabetes. Fortunately, diabetes educators—health care professionals, such as registered nurses, registered dietitians, and medical social workers—can give patients practical advice on the best ways to control their condition.*
Good news: Most health insurers, including Medicare, cover the cost of diabetes patients’ visits with a diabetes educator.
SAVVY EATING HABITS
Most doctors advise people with diabetes or prediabetes to cut back on refined carbohydrates, such as cakes and cookies, and eat more fruits, vegetables, and whole grains. This maximizes nutrition and promotes a healthy body weight (being overweight greatly increases diabetes risk). Other steps to take include the following:
•Drink one extra glass of water each day. The extra fluid will help prevent dehydration, which can raise glucose levels.
•Never skip meals—especially breakfast. Don’t assume that bypassing a meal and fasting for more than five to six hours will help lower glucose levels. It actually triggers the liver to release glucose into the bloodstream.
Better strategy: Eat three small meals daily and have snacks in between. Start with breakfast, such as a cup of low-fat yogurt and whole-wheat toast with peanut butter or a small bowl of whole-grain cereal and a handful of nuts.
Good snack options: A small apple or three graham crackers. Each of these snacks contains about 15 g of carbohydrates.
•Practice the “plate method.” Divide a nine-inch plate in half. Fill half with vegetables, then split the other half into quarters—one for protein, such as salmon, lean meat, beans, or tofu, and the other for starches, such as one-third cup of pasta or one-half cup of peas or corn. Then have a small piece of fruit. This is an easy way to practice portion control—and get the nutrients you need.
•Ask yourself if you are satisfied after you take each bite. If the answer is yes, stop eating. This simple strategy helped one of my clients lose fifty pounds.
•Be wary of “sugar-free” foods. These products, including sugar-free cookies and diabetic candy, are often high in carbohydrates, which are the body’s primary source of glucose. You may be better off eating the regular product, which is more satisfying. Compare the carbohydrate contents on product labels.
GET CREATIVE WITH EXERCISE
If you have diabetes or prediabetes, you’ve probably been told to get more exercise. Walking is especially helpful. For those with diabetes, walking for at least two hours a week has been shown to reduce the risk for death by 30 percent over an eight-year period. For those with prediabetes, walking for thirty minutes five days a week reduces by about 60 percent the risk that your condition will progress to diabetes. But if you’d like some other options, consider the following:†
•Armchair workouts. These exercises, which are performed while seated and are intended for people with physical limitations to standing, increase stamina, muscle tone, flexibility, and coordination.
•Strength training. This type of exercise builds muscle, which burns more calories than fat even when you are not exercising.‡ Use hand weights, exercise machines, or the weight of your own body—for example, leg squats or bicep curls with no weights. Aim for two to three sessions of strength training weekly, on alternate days.
•Stretching, even while watching TV or talking on the phone. By building a stretching routine into your daily activities, you won’t need to set aside a separate time to do it. If your body is flexible, it’s easier to perform other kinds of physical activity. Stretching also promotes better circulation. Before stretching, do a brief warm-up, such as walking for five minutes and doing several arm windmills. Aim to do stretching exercises at least three times weekly, including before your other workouts.
CONTROL YOUR BLOOD GLUCOSE
If you are diagnosed with diabetes, blood glucose control is the immediate goal. Self-monitoring can be performed using newer devices that test blood glucose levels.
Good choices: LifeScan’s OneTouch Ultra, Bayer’s Contour, or Abbott Laboratories’ FreeStyle.
The hemoglobin A1C test, which is ordered by your doctor and is typically done two to four times a year, determines how well glucose levels have been controlled over the previous two to three months.
If you have prediabetes: Don’t settle for a fasting glucose test, which measures blood glucose after you have fasted overnight. It misses two-thirds of all cases of diabetes. The oral glucose tolerance test (OGTT), which involves testing glucose immediately before drinking a premixed glass of glucose and repeating the test two hours later, is more reliable. If you can’t get an OGTT, ask for an A1C test and fasting glucose test.
If you have diabetes or prediabetes, you should have your blood pressure and cholesterol checked at every doctor visit and schedule regular eye exams and dental appointments. In addition, don’t overlook the following:
•Proper kidney testing. Doctors most commonly recommend annual microalbumin and creatinine urine tests to check for kidney disease. You also may want to ask for a glomerular filtration rate test, which measures kidney function.
•Meticulous foot care. High glucose levels can reduce sensation in your feet, making it hard to know when you have a cut, blister, or injury. In addition to seeing a podiatrist at least once a year and inspecting your own feet daily, be wary of everyday activities that can be dangerous for people with diabetes.
Stepping into hot bath water, for example, can cause a blister or skin damage that can become infected. To protect yourself, check the water temperature on your wrist or elbow before you step in. The temperature should be warm to the touch—not hot.
STAY UP TO DATE ON MEDICATIONS
Once diabetes medication has been prescribed, people with diabetes should review their drug regimen with their doctors at every visit. Insulin is the most commonly used diabetes drug, but you may want to also ask your doctor about these relatively new medications:
•DPP-4 inhibitors. These drugs include sitagliptin, which lowers glucose levels by increasing the amount of insulin secreted by the pancreas. DPP-4 inhibitors are used alone or with another type of diabetes medication.
•Pramlintide. Administered with an injectable pen, pramlintide helps control blood glucose and reduces appetite, which may help with weight loss. It is used in addition to insulin.
If you have prediabetes or diabetes: Always consult a pharmacist or doctor before taking any over-the-counter products. Cold medicines with a high sugar content may raise your blood glucose, for example, and wart removal products may cause skin ulcers. Pay close attention to drug label warnings.
›Theresa Garnero, advanced practice registered nurse (APRN), certified diabetes educator (CDE), and clinical nurse manager of the Center for Diabetes Services at the California Pacific Medical Center in San Francisco. She is author of Your First Year with Diabetes: What to Do, Month by Month.
Four Big Mistakes Most People with Diabetes Make…and the Right Ways to Stay Healthy
If you have diabetes, you may think that you are taking all the right steps with your diet, medication, and exercise habits.
But the truth is, virtually all people with this common disease make mistakes in managing their condition—and unknowingly increase their risk for diabetes complications, such as heart attack, stroke, kidney failure, and blindness.
Small changes can give big results: Fortunately, you can correct these missteps if you understand some of the subtle aspects of diabetes that can easily derail one’s care. To learn more, we spoke to Richard K. Bernstein, MD, an outspoken diabetes specialist who gives his patients no-holds-barred advice on controlling their disease.
Guerrilla tactics that really work: Dr. Bernstein, who was diagnosed himself with type 1 diabetes at age twelve, is vigorous and healthy at almost eighty. He swears by the sometimes unconventional but highly effective approach that he has developed and adopted for himself and the thousands of patients with type 1 and type 2 diabetes he has treated.
Here’s where Dr. Bernstein thinks people with diabetes—and many mainstream medical authorities—have got it all wrong.
Mistake #1: Not recognizing hidden causes of elevated blood sugar. Acute stress—such as a fight with your boss or anxiety about a key presentation—can raise it. If your glucose reading is higher than expected when you’re stressed, an injection of rapid-acting insulin will bring it down if you have type 1 diabetes. If you have type 2, your own insulin secretions will likely lower blood sugar within twenty-four hours.
Infection raises blood sugar levels—and high blood sugar increases infection risk. Suspect infection if your glucose level is up and insulin isn’t working as well as usual. Get prompt treatment so that your blood sugar will go down and the infection will heal. Beware of dental infections and gum disease.
What I do: I brush twice daily, floss after meals, and get tartar and plaque scrapings from a periodontist every three months.
Mistake #2: Using the wrong glucose meter. Whether you inject insulin for type 1 diabetes, take oral drugs for type 2, or control your disease with diet and exercise alone, you must accurately track your blood sugar with home testing.
My advice: Test a meter you are considering buying in the store—take ten readings in succession using the manufacturer’s “normal” control solution. A pharmacy with glucose meters on display will usually let you test them—ask the pharmacist. Readings should be within 6 mg/dL of the midpoint of that normal range.
Important: Make sure that you can return the device if you find it to be inaccurate later. If your insurance company won’t cover a meter you like, file an appeal.
My favorite glucose meter: Of the many glucose meters for home use that I have tried, the FreeStyle Freedom Lite by Abbott, available at most drugstores or online for about twenty dollars, has been the most accurate.
Mistake #3: Pricking your finger the wrong way. If you use a glucose meter, your doctor will probably tell you to wipe the site with alcohol before pricking it. I disagree.
First, it isn’t necessary to wipe your finger with alcohol—this dries out the skin and can lead to calluses, which makes it difficult to get a blood sample. Neither my patients nor I have ever developed an infection from not using alcohol.
However, you should wash your hands before drawing blood. This is especially true if you’ve been handling food or glucose tablets or applied hand cream—all of which can cause false high readings.
Helpful: Rinse your finger with warm water to get the blood flowing, and prick the back of your finger between the joints—this area may produce more blood and cause less pain.
Mistake #4: Overdoing vitamin C. In excess, vitamin C raises blood sugar and inactivates the glucose-processing enzyme in the test strip, resulting in deceptively low glucose readings. You’ll probably get all the vitamin C you need from vegetables (you shouldn’t rely on fruit—it has too much natural sugar). If you must take supplements, 250 mg daily in a sustained-release form is tops. These formulations are less likely to cause blood sugar spikes.
HOW TO USE INSULIN THE RIGHT WAY
Insulin injections are crucial for type 1 diabetes and often needed for type 2 diabetes. To use effectively:
•Change with the seasons. Most people need less insulin in summer than winter (or during a warm spell in colder months). Capillaries dilate when warm, and more blood containing insulin is delivered to peripheral tissues. Adjust your dose accordingly.
•Prevent blood sugar spikes by correctly gauging how much insulin you need to cover each meal and when to inject it. With regular (a type of short-acting insulin), that’s usually thirty to forty-five minutes before the meal.
To determine your best timing: Inject an insulin dose, and check blood sugar after twenty-five minutes, then at five-minute intervals. When it has dropped by 5 mg/dL, it’s time to eat. This may not work for people who have diabetic gastroparesis, which causes unpredictable stomach emptying.
›Richard K. Bernstein, MD, a diabetes specialist in private practice in Mamaroneck, New York. Dr. Bernstein is also author of several books on diabetes, including Dr. Bernstein’s Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars, DiabetesBook.com. His free monthly teleseminars are available at AskDrBernstein.net.
The All-Day, All-Night Guide to Controlling Your Diabetes
From the time you wake up until you go to bed, it is essential to keep your blood sugar as stable as possible if you have diabetes.
Reasons: Over time, uncontrolled elevated blood sugar harms the blood vessels, kidneys, eyes, and nerves, increasing the risk for heart attack, stroke, kidney failure, blindness, and tissue damage that can require limb amputation.
DIABETES IS ALSO LINKED TO DEMENTIA
Despite these dangers, scarcely half of the twenty-three million Americans who have been diagnosed with diabetes have their disease under control. If you’re struggling, you can significantly improve your blood sugar control by eating the right foods and doing the right things at the right times of day.
THROUGHOUT THE DAY
It is key to eat foods that digest slowly, so blood sugar remains relatively stable, and avoid foods that are digested quickly, triggering rapid blood sugar spikes. This also helps control weight—an important factor because excess weight contributes to diabetes complications. Follow these guidelines:
•Have 40 to 50 g of carbohydrates at each meal. Stick with mostly complex carbs (whole grains, vegetables, nuts), and limit refined carbs (cakes, white pasta). Check labels!
•Avoid foods with more than 10 g of sugar per serving.
•Have some lean protein every day—chicken, fish, lean beef, low-fat dairy, eggs, tofu. Most people get enough protein, so you do not need protein with each meal unless your doctor recommends this.
•Limit starches (corn, peas, potatoes, sweet potatoes) to one serving per meal.
•Limit fruit to two servings per day. A serving equals one small handheld fruit (peach, plum), half an apple or half a banana, twelve grapes, one cup of strawberries, or one-half cup of blueberries, raspberries, or diced fruit (such as melon). Avoid pineapples and dried fruits, which are high in sugar.
•At wake-up time: Test your blood sugar before breakfast. If it is high, you may have eaten too many carbohydrates too close to bedtime the night before. Or your levels may have fallen too low during the night, so your liver released more glucose, causing a blood sugar “rebound.” Talk to your doctor—you may need to adjust your medication dosage and/or timing.
•At breakfast: The morning meal helps get your metabolism running efficiently, so don’t skip it.
Ideal: One or two slices of whole-grain bread with a soft spread that contains cholesterol-lowering plant sterols, such as Smart Balance or Promise Activ, plus a two-egg vegetable omelet. It is fine to use whole eggs, but if you have high cholesterol, make your omelet with egg whites instead and limit egg yolks to two per week.
Another good choice: One cup of unsweetened or lightly sweetened whole-grain cereal that contains no more than 25 g of carbohydrates per cup, such as Cheerios or Product 19, plus one-half cup of blueberries and one cup of low-fat milk. Don’t be fooled into thinking that high-fiber necessarily equals healthful—you still must check labels to see if the food is too high in carbs.
Your doctor may advise you to take a dose of diabetes medication right before breakfast.
Also: If you have diabetic nerve damage, take 100 mcg of vitamin B-1 daily. If you take blood pressure medication, morning is the best time, because blood pressure typically is higher during the day than at night. If you plan to drive, test your blood sugar before leaving home.
•In midmorning: A midmorning snack is generally not necessary unless your doctor advises you to have one (for instance, due to the type of insulin you are on). However, if you start to feel weak or dizzy, have a snack that provides no more than 10 g of carbohydrates—for instance, a small tangerine, half a banana, or two graham cracker squares.
•At lunch: Good choices include a sandwich, such as turkey, lettuce, and tomato on whole-wheat bread, or sushi with rice (preferably brown).
Common mistakes: Eating too much (especially at restaurants), choosing a fruit plate (too much sugar and no protein), overdoing it on chips or condiments (which can be high in fat or sugar).
•In midafternoon: Again, have a snack only if you feel weak or your doctor recommends it, and limit yourself to no more than 10 g of carbs.
Good choices: About fifteen pistachios, ten almonds, or one-third of an ounce of whole grain crackers.
•At dinner: Check your blood sugar before dinner. If you are on oral diabetes medication, take it just before your meal.
Dinner should include four ounces of lean protein, several generous servings of vegetables, and one serving of a starch. Have a green salad, but skip the high-carb, high-fat dressings. Instead, drizzle greens with lemon juice, balsamic vinegar, safflower oil, and/or olive oil.
Limit: One alcoholic drink daily, consumed with a meal. Opt for five ounces of wine, twelve ounces of a low-carb beer, such as Miller Lite, or one ounce of distilled liquor (Scotch, vodka). Avoid mixed drinks, which are often high in carbs.
Dessert options: A scoop of low-carb, no-sugar-added ice cream, berries, two Lorna Doone cookies, or three Social Tea Biscuits.
•In the evening: This is the best time to exercise to maximize muscle cells’ absorption of glucose. Strength training and stretching are good, but aerobic exercise is most important because it increases insulin sensitivity (cells’ ability to respond to insulin) for up to fourteen hours. Each week, aim for two and a half hours of moderate-intensity aerobic exercise, such as walking, or one and a half hours of strenuous activity. For blood sugar control, thirty-minute workouts are generally most effective. As part of your exercise regimen, consider tai chi. In one study, diabetes patients who did this martial art significantly lowered their blood sugar levels.
Caution: Ask your doctor before starting an exercise program. Test blood sugar before each workout. If it is below 100 mg/dL, have a snack before exercising. Do not work out when your blood sugar is higher than 250 mg/dL—when blood sugar is this high, exercise may elevate it even further. If you have retinopathy (damaged blood vessels in the retina), to protect vision, do not lift weights above eye level.
•At bedtime: If you are on long-acting insulin, a bedtime injection controls nighttime glucose levels. If you take cholesterol-lowering medication, do so now—it is most effective at night. Test your blood sugar at bedtime. If it is somewhat elevated (but not above 250 mg/dL), lower it with ten minutes of moderate exercise.
Insomnia doesn’t raise blood sugar, but the stress it creates can.
To promote sleep: Turn off the cell phone, TV, and computer at least thirty minutes before bedtime so your mind can quiet down. Take a warm bath, checking your feet for wounds or signs of infection, because diabetes often damages nerves in the feet.
Have you been told that you snore? Diabetes patients are prone to sleep apnea (repeated halts in breathing during sleep), which contributes to poor blood sugar control. Do you frequently get up at night to urinate? It could be a sign that your medication needs adjusting. If you have either symptom, tell your doctor.
›The late Stanley Mirsky, MD, coauthor of the Diabetes Survival Guide. Dr. Mirsky was a practicing internist and diabetologist, a past president of the American Diabetes Association of New York State, and a board member of the Joslin Diabetes Center. He was named Endocrinologist of the Year for 2005 at the Mount Sinai School of Medicine.
Minor Missteps Can Make Your Diabetes Worse
Despite what you may have heard, type 2 diabetes doesn’t have to be a lifelong condition. It can be controlled and even reversed in the early stages or stopped from progressing in the later stages—with none of the dire consequences of out-of-control blood sugar.
The problem is, even people who are following all the doctor’s orders may still be sabotaging their efforts with seemingly minor missteps that can have big consequences. Among the most common mistakes that harm people with diabetes are oversights in the way they eat and exercise. For example:
Skimping on protein. The majority of people with type 2 diabetes are overweight or obese. These individuals know that they need to lose weight but sometimes fail despite their best efforts.
Here’s what often happens: We have had it drummed into our heads that the best way to lose weight is to go on a low-fat diet. However, these diets tend to be low in protein—and you need more protein, not less, if you have type 2 diabetes and are cutting calories to lose weight.
What’s so special about protein? You need protein to maintain muscle mass. The average adult starts losing lean muscle mass every year after about age forty. If you have diabetes, you’ll probably lose more muscle mass than someone without it. And the loss will be even greater if your diabetes is not well controlled.
Muscle is important because it burns more calories than other tissues in your body. Also, people with a higher and more active muscle mass find it easier to maintain healthy blood glucose levels, since active muscle doesn’t require insulin to clear high glucose from the blood.
My advice: Protein should provide 20 to 30 percent of total daily calories. For example, if you’re on an 1,800-calorie diet, that’s about 90 to 135 g of protein a day. If you’re on a 1,200- to 1,500-calorie diet, that’s about 60 to 113 g of protein a day.
Examples: Good protein sources include fish, skinless poultry, nonfat or low-fat dairy, legumes, and nuts and seeds. A three-ounce chicken breast has about 30 g of protein; a three-ounce piece of haddock, 17 g; one-half cup of low-fat cottage cheese, 14 g; and one-quarter cup of whole almonds, 7 g of protein.
Note: If you have kidney problems, you may need to limit your protein intake. Check with your doctor.
Not doing resistance training. It’s widely known that aerobic exercise is good for weight loss and blood sugar control. What usually gets short shrift (especially among older people) is resistance training, such as lifting weights and using stretch bands.
When you build muscle, you use more glucose, which helps reduce glucose levels in the blood. If you take insulin for your diabetes (see below), toned muscles will also make your body more sensitive to it.
An added benefit: People who do resistance training can often reduce their doses of insulin or other medications within a few months.
My advice: Do a combination of resistance, aerobic, and flexibility exercises. Start with twenty minutes total, four days a week, splitting the time equally among the three types of exercise. Try to work up to sixty minutes total, six days a week. An exercise physiologist or personal trainer certified in resistance training can help choose the best workout for you.
IF YOU TAKE DIABETES MEDS
Sometimes, diet and exercise aren’t enough to tame out-of-control blood sugar. Avoid the following traps:
•Drug-induced weight gain. Ironically, the drugs that are used to treat diabetes also can cause weight gain as a side effect. If you start taking insulin, you can expect to gain about ten pounds within six months. With oral drugs, such as glipizide, you’ll probably gain from four to seven pounds.
My advice: Ask your doctor if you can switch to one of the newer, “weight-friendly” medications.
Examples: A form of insulin called insulin detemir causes less weight gain than insulin glargine or insulin isophane. Newer oral drugs called DPP-4 inhibitors, such as sitagliptin, saxagliptin, and alogliptin, don’t have weight gain as a side effect.
Important: The newer drugs are more expensive and may not be covered by insurance. But if they don’t cause you to gain weight, you might get by with a lower dose—and reduced cost.
•Erratic testing. You should test your blood sugar levels at least four to six times a day, particularly when you’re making lifestyle changes that could affect the frequency and doses of medication. Your doctor has probably advised you to test before and after exercise and before meals.
My advice: Be sure to also test after meals. This will help determine the effects of different types and amounts of foods.
›Osama Hamdy, MD, PhD, medical director of the Joslin Diabetes Center’s Obesity Clinical Program and an assistant professor of medicine at Harvard Medical School, both in Boston. He is also coauthor of The Diabetes Breakthrough.
No Two Diabetes Patients Are the Same
Chances are you know one or more people who have type 2 diabetes, or perhaps you have been diagnosed with the condition yourself.
The number of Americans with diabetes is truly staggering—a new case is diagnosed every seventeen seconds. And of course, the consequences of uncontrolled diabetes are dire, including increased risk for heart attack and other cardiovascular problems, blindness, leg amputation, kidney failure, and, ultimately, premature death.
To help meet this enormous challenge, medical research has been stepped up.
Now: American researchers have joined forces with their European counterparts to devise new strategies to diagnose and manage diabetes more effectively than ever before.
EASIER DIAGNOSIS
In the United States, twenty-nine million people have diabetes. This includes roughly twenty-one million who have been diagnosed and an estimated eight million who are undiagnosed. To break it down even further, more than 25 percent of the U.S. population aged over sixty-five years has diabetes!* Experts hope that a change in the diagnostic process will lead to more widespread testing and fewer undiagnosed cases.
Until recently, diabetes was typically diagnosed using one of two standard tests—a blood test that requires an overnight fast to measure blood glucose levels and an oral glucose tolerance test, which involves drinking a high-sugar mixture and then having blood drawn thirty minutes, one hour, and two hours later to show how long it takes blood glucose levels to return to normal.
The problem: Both of these tests are inconvenient for the patient, and they measure blood glucose levels only at the time of the test. Many people never get tested because they don’t like the idea of having to fast overnight or wait hours to complete a test.
New approach: More widespread use of the A1C test. For decades, the A1C test, which provides a person’s average blood glucose levels over a period of two to three months, has been used to monitor how well people with diabetes were controlling their disease. However, it wasn’t deemed a reliable tool for diagnosis.
Now, after major improvements that have standardized the measurements from laboratory to laboratory, the A1C test is considered a practical and convenient diagnostic option.
The A1C requires no fasting or special preparation, so it’s the perfect “no excuses” test. A1C tests analyzed by accredited labs (such as LabCorp and Quest Diagnostics) meet the latest standardization criteria.
UPDATED TREATMENT GUIDELINES
Recently, the American Diabetes Association and the European Association for the Study of Diabetes collaborated on recommendations for best treatment practices for type 2 diabetes. The most significant change in the recent guidelines is the concept of individualized treatment.
The problem: In the past, diabetes care was based on a one-size-fits-all strategy—with few exceptions, everyone with the condition got basically the same treatment.
New approach: The recently released guidelines acknowledge that there are multiple treatment options for each patient and that the best treatment for one patient may be different from what another patient requires.
This is important because diabetes affects an enormously wide range of people. For example, diabetes can strike a thin seventy-seven-year-old woman or a three-hundred-pound teenage boy, and their treatment needs and goals will be as different as their characteristics.
After reviewing a patient’s medical history and individual lifestyle, the doctor and patient consider treatment options together and decide on the best fit. Factors that are more explicitly spelled out in the new guidelines include:
•Other medical conditions and medications. If diabetes treatments interact badly with a patient’s current medications, it may cause one of the medications to become ineffective, amplify the effects of the drugs, or cause allergic reactions or serious, even life-threatening side effects. This is especially true for people being treated for kidney disease or heart problems, as many diabetes medications may exacerbate those health issues.
•Lifestyle and daily schedule. Diabetes management is easier for people who have predictable schedules. For example, a full-time worker who regularly wakes up at seven a.m., eats breakfast, takes a lunch hour, and is home for dinner will have simpler treatment needs than a college student who sleeps past noon, eats cold pizza for breakfast, then pulls an all-nighter.
If a physician gives standard insulin recommendations to someone who has an unusual eating and sleeping schedule, it is easy to have blood sugar drop too low, a dangerous condition called hypoglycemia. That’s why it is important that patients share as many details of their lives as possible, even if the information seems irrelevant.
BEST TREATMENT STRATEGIES
Until recently, diabetes has been treated with a stepwise approach—starting with conservative treatment, adding medication later only when needed. This sounds good, except that new treatments are incorporated only after previous treatments fail and blood glucose rises.
The problem: Depending on scheduled doctor visits, blood sugar may remain elevated for months or even years before anyone catches the change.
New approach: Research suggests that if physicians intervene more intensively at the beginning, they have the potential to stop the progression of diabetes. With this in mind, treatment aims to decrease the rate at which the body loses insulin-producing ability and prevent diabetes complications by not allowing blood sugar to exceed safe levels.
Under this new scenario, doctors hit diabetes full force with the patient’s individualized treatment plan (including lifestyle changes and medication), instead of with graduated, step-up treatments.
What the new guidelines mean for anyone diagnosed with diabetes: If your current diabetes treatment plan does not address the points described in this article, see your doctor. Your treatment may need to be more customized.
›Ildiko Lingvay, MD, MPH, an assistant professor in the departments of internal medicine and clinical science and a practicing endocrinologist at the University of Texas Southwestern Medical Center in Dallas. Dr. Lingvay is an internationally recognized researcher who has authored several dozen articles related to type 2 diabetes, obesity, and metabolic syndrome.
If You Have Diabetes…How to Fast Safely for a Medical Test
Recently, an employee at Bottom Line Publications was scheduled for a colonoscopy, the screening test for colon cancer. The medical test turned into medical mayhem.
The day before the test, the woman followed her doctor’s orders to start ingesting a “clear liquid” diet, which includes soft drinks, Jell-O, and other clear beverages. But when she drank the “prep”—the bowel-cleaning solution that is consumed the evening before a colonoscopy (and sometimes also the morning of)—she vomited. Over and over. As a result, her colon wasn’t sufficiently emptied to conduct the test, which had to be postponed.
What went wrong?
The woman has diabetes, and her glucose (blood sugar) levels had become unstable, triggering nausea and vomiting. Yet not one medical professional—not a doctor, not a nurse, not a medical technician—had warned her that people with diabetes need to take special precautions with food and diabetes medicine whenever they have any medical test that involves an extended period of little or no eating. Unfortunately, this lack of diabetes-customized instruction about medical tests is very common.
DO IT EARLY
If you’re undergoing a test that requires only overnight fasting, which includes many types of CT scans, MRIs, and X-rays, make sure that the test is scheduled for early in the morning—no later than nine a.m. That way, you will be able to eat after the test by ten or eleven a.m., which will help to stabilize your blood sugar as much as possible.
Don’t expect your blood sugar levels to be perfect after the test. The important thing is to keep them from getting too high or too low.
THE RIGHT CLEAR LIQUIDS
Conventional dietitians and doctors specify clear liquids and foods that reflect the conventional American diet, such as regular soda, sports drinks, Popsicles, Kool-Aid, and Jell-O (no red or purple). But the pH of these products is highly acidic. And that could contribute to diabetic ketoacidosis, a potentially life-threatening condition where the body burns fat instead of glucose for fuel, producing ketones, substances toxic to the liver and brain.
When my clients with diabetes are on a clear-liquid diet before a test, I recommend that they consume liquids with essential nutrients and a more balanced pH, such as apple juice, white grape juice, and clear, fat-free broth (vegetable, chicken or beef). A typical dinner could include up to three-quarters cup of juice (to limit sugar) and any amount of broth. A bedtime snack could include one-half cup of juice and any amount of broth. Plenty of good pure water between meals is also important to stay well-hydrated.
CHECK BLOOD SUGAR OFTEN
Many people with diabetes check their blood sugar a few times a day, typically right before a meal and again one to two hours afterward. But if you’re on a clear-liquid diet or fasting before a medical test, you should check your glucose level every two to three hours. If it’s too low, correct it with a fast-acting carbohydrate, such as four ounces of 100 percent fruit juice or a glucose gel (a squeezable, over-the-counter product).
Important: Take fruit juice or a glucose gel with you to the test—if the test is delayed for any reason, you can ingest the carb and keep your blood sugar on track.
STOP TAKING METFORMIN
Your doctor likely will recommend that you stop taking the diabetes medication metformin twenty-four hours before the test. Metformin also can contribute to acidosis and typically is stopped twenty-four hours before and up to seventy-two hours after any test that requires a contrast agent (an injected dye often used in an X-ray, CT scan, or MRI that helps create the image). Talk to your doctor about when to stop taking your medication and when to resume or about the possible need for an alternative diabetes drug during this period.
An unexpected threat: Metformin is a component of many multi-ingredient diabetes drugs, so you may not realize you’re taking it and therefore may need to discontinue it. Drugs that include metformin are Actoplus Met and Actoplus Met XR, Glucovance, Janumet and Janumet XR, Jentadueto, Kazano, Kombiglyze XR, and PrandiMet. New drugs are being developed constantly, so check with your pharmacist to see if yours contains metformin.
Also important: Many X-rays, CT scans, and MRIs utilize an injected dye or a contrast agent that can damage the kidneys in people with diabetes (contrast-induced nephropathy). Before restarting metformin, have a kidney function test (such as blood urea nitrogen, which requires a blood sample, and creatinine clearance, which requires a urine sample and a blood sample) that confirms that your kidneys are working normally. These tests are recommended twenty-four to forty-eight hours after your procedure is completed and usually are covered by insurance.
DECREASE INSULIN
Insulin is the hormone used by the body to regulate blood sugar—and many people with advanced diabetes give themselves shots of short- and/or long-acting insulin to keep glucose levels steady. But if you’re consuming only clear liquids or fasting before a medical test, you likely will need to take less insulin.
Excellent guidelines for insulin use before a medical procedure have been created by the University of Michigan Comprehensive Diabetes Center. In general, it recommends:
•Take one-half of your usual dose of long-acting insulin the evening before the procedure.
•Take one-half of your usual dose of long-acting insulin the morning of the test and no short-acting insulin the morning of the test.
You can find the complete guidelines in downloadable PDF form at the University of Michigan website (link in Resources section at the back of the book). Print them out, and discuss them with your doctor.
REDUCE ANXIETY
Anxiety triggers the release of the stress hormone cortisol, which in turn sparks the production of glucose. To keep blood sugar balanced before a test, use these two methods to keep anxiety in check:
•Get all your questions answered. Fear of the unknown is the greatest stress. Before your procedure, create a list of questions to ask your doctor or nurse practitioner. Examples: What is going to happen during the procedure? What is it going to feel like? What are the potential side effects from the test, and how can I best avoid them? When will I be informed of the test results? How will the test results affect future decision-making about my health?
•Breathe deeply. Deep breathing is the easiest and simplest way to reduce anxiety. My recommendation, based on the approach of Andrew Weil, MD:
Repeat this breathing exercise three times, and do it three times a day every day: Inhale for a count of four, hold for a count of seven, and exhale for a count of eight. (Don’t worry if you can’t do the entire count—shorter counts also work.) Do this exercise when you get up in the morning, at midday, and at bedtime. You can do it more often, but most people find three times simple and easy to integrate into their routines.
Also, you can use this breathing technique in any situation that you find anxiety-producing, such as before and during the test itself. Breathe deeply three times every ten or fifteen minutes, and be sure to keep the 4:7:8 ratio—inhale for four, hold for seven, exhale for eight.
›Paula Vetter, RN, MSN, a diabetes educator, holistic family nurse practitioner, personal wellness coach and former critical care nursing instructor at the Cleveland Clinic.
Jewelry That Can Save Your Life
Medical ID jewelry has evolved. Those simple and basic necklaces and ID bracelets that people used to wear to alert others to medical problems, such as a heart condition or a seizure disorder, have gone high-tech, offering an array of data-sharing options so emergency responders can gain instant access to your comprehensive medical information. The new generation of medical emergency bracelets and tags uses portable computer memory devices (typically a USB drive) or an internet component to store and share your medical information. Here’s a sampling of what’s available:
•The CARE medical history bracelet is basically a USB drive you wear strapped to your wrist. It holds software and forms. It alerts emergency personnel that you have a medical condition and, once plugged into a computer (it works on both PC and Mac), downloads a detailed medical history. The waterproof bracelet comes in five colors.
•Similar in appearance to a traditional dog tag, the American Medical ID is a USB drive that carries a summary of medical information. It is easy to use and update. The tag can be engraved with four lines summarizing your critical medical information, such as food or drug allergies or a seizure disorder.
•ICEdot invisible bracelet, a web-based service supported by the American Ambulance Association, assigns each wearer a personal identification number (PIN) that first responders use to trigger a text message detailing critical medical information, emergency contacts, or whatever other data you choose to provide.
How it works: Your ten-dollar-per-year membership buys a sticker pack displaying the PIN (to be displayed in convenient places, for instance on your driver’s license) that allows emergency responders to access your information.
•Road ID Interactive is an ID band, tag, or pouch you can wear on your wrist, ankle, or shoe. It is engraved with two lines of personal information (name, address) and a toll-free phone number, web address, and PIN that responders can use to get more details.
•MedicAlert is the classic line of jewelry, now in an updated variety of attractive styles (for instance, made with Swarovski beads or sterling silver), including bracelets, necklaces, sports bands, shoe tags, and even a watch. These pieces can be engraved with medical information and also provide phone access to a twenty-four-hour emergency service that provides more detailed information. The service notifies anyone you designate that you’ve had an emergency and provides information on where you’re being treated.
HOW TO CHOOSE
Only about 20 percent of patients come in to a hospital emergency department with any sort of information at all. Yet these products can provide comprehensive information very quickly.
This is especially helpful for patients with chronic conditions, but even healthy folks would be well advised to take a few minutes to consider and make notes on their medical history in order to have important information at the ready in the event of an emergency. At minimum, write down your information on an index card, have it laminated (you can do this at many office-supply stores), and store it in your wallet, as EMTs know to look there.
Information that emergency physicians would like to get from every patient in order to deliver the best possible emergency care includes:
•Name, date of birth, address(es)
•Your phone numbers.
•Contact for next of kin or significant other(s)
•Identifying features—moles, tattoos, scars, etc.—that can positively distinguish you from others
•Contact information for your primary care physician and relevant specialists, including name, phone number, location
•A list of all known allergies
•An up-to-date list of medications and any supplements you take
•Information on previous surgery or planned elective surgery (such as an upcoming gallbladder surgery or a scheduled biopsy)
•Current immunization information, including flu and other vaccines, along with the date of your most recent tetanus shot and others as appropriate
•List of other medical problems such as diabetes, cancer, etc.
•List of any medical devices that you have or use, such as pacemaker, prosthesis, cochlear implant, etc.
Whether it is recorded on a flash drive, a bracelet, an index card, or elsewhere, putting this information together and keeping it with you can make all the difference—at the very least, by expediting treatment in the event of an emergency and quite possibly even saving your life.
›The late Richard O’Brien, MD, former spokesperson, American College of Emergency Physicians, and associate professor, the Commonwealth Medical College of Pennsylvania, Scranton.
Don’t Be One of the Millions of Americans Overtreated for Diabetes
Bringing blood sugar down with diabetes drugs might be too simple an approach and, worse, ineffective and even harmful for some of us, especially those of us who are sixty-five or older. What’s more, the reason why so many Americans have diabetes might not be because their blood sugar levels are dangerously high but because the system that defines what constitutes diabetes is rigged. And even doctors might not realize it!
Here’s how to really protect your health and protect yourself from overtreatment when a doctor tells you that your blood sugar is high.
FOLLOW THE MONEY
Diabetes management has become big business, amassing billions of dollars in annual sales. In 2014, sales of diabetes drugs alone reached $23 billion. For this, we can thank, in part, the changing definition of what exactly diabetes is. Since 1997, the American Diabetes Association and other professional endocrinology groups have twice lowered blood sugar thresholds for type 2 diabetes and prediabetes. Each time they did this, millions more Americans were suddenly considered, by definition, diabetic or prediabetic.
But the doctors making these blood sugar threshold changes have strong incentives to do so that have nothing to do with your well-being, according to a recent exposé published by the medical news outlet MedPage Todayand the Milwaukee Journal Sentinel. Many of these doctors receive speaking and consulting fees from diabetes-drug manufacturers. In one analysis, the authors of the exposé found that thirteen of nineteen members of a committee responsible for diabetes guidelines accumulated a combined sum of more than $2 million in speaking and consulting fees from companies that make diabetes drugs. Whether doctors responsible for diabetes guidelines are intentionally and systematically basing their decisions on their bank account balances isn’t known, but the findings do reveal an obvious and material conflict of interest.
EFFECTIVENESS OF THERAPIES QUESTIONED
The authors of the exposé also pointed out that although they reduce blood sugar, none of the thirty diabetes drugs approved since 2004 has been definitively proven to reduce the risk of heart attack and stroke, blindness, or any other diabetes-related complication. “In order to approve a new diabetes drug, the FDA requires evidence that the drug effectively reduces hemoglobin A1C levels—a measure of blood glucose—and that it doesn’t result in an unacceptable increase in heart disease risk. The evidence that the drug reduces the risk of complications of diabetes, such as heart attacks and stroke, is not required,” explains endocrinologist Kasia Lipska, MD, assistant professor of medicine at Yale School of Medicine. She is the leader of a recent, related study that showed that mature adults are being treated too aggressively for diabetes, sometimes with dangerous consequences. The study population of nearly thirteen hundred adults, selected from the National Health and Nutrition Examination Survey database, represents a cross section of senior Americans with diabetes.
Similar to a recent study showing that tight blood pressure control may not be beneficial in older adults, prior studies suggest that tight blood sugar control in people sixty-five and older who have serious health problems actually may do more harm than good. Tight blood sugar control is defined by the American Diabetes Association as a hemoglobin A1C level of less than 7 percent.
DANGEROUS SIDE EFFECTS
When it comes to drug treatment for diabetes, most doctors will turn to the older drug metformin first, says Dr. Lipska. It has been used in the United States since 1994 and has had a good safety record here and in Europe, where it has been used much longer. It is considered safe and effective. In addition, it does not cause low blood sugar reactions or weight gain. However, after metformin, there is no clear winner among the diabetes drugs, and the choice of drug depends on a number of trade-offs and risks, particularly for older adults, she says. Insulin and sulfonylurea drugs such as glipizide, glyburide, and glimepiride have been associated with dangerously low blood sugar (hypoglycemia), and other drugs, such as pioglitazone, with risk of fluid retention and fractures. Some drugs, such as saxagliptin, may be associated with heart failure, while, for very new drugs, such as canagliflozin, the risks are not yet known.
Although the American Diabetes Association and other professional groups have been lowering the threshold for what constitutes diabetes (and, thereby, driving the market for diabetes drugs, at least according to the MedPage exposé), the American Diabetes Association and the American Geriatrics Society discourage tight blood sugar control in older adults. They acknowledge that older adults whose blood sugar is too aggressively controlled are more vulnerable to the dangerous side effects mentioned above, says Dr. Lipska. She adds that one treatment standard does not fit all in older adults, because their health and treatment preferences vary greatly. Tight control may be safe and appropriate for one person and not another.
AVOID TREATMENT
Diabetes in older people should be generally managed through lifestyle modification first, including exercise, according to Dr. Lipska. Nevertheless, medications are often required to bring down blood sugar levels, she says. “For many older people with serious health problems or a history of hypoglycemia, tight blood sugar control may not be worth the risks involved. But for some relatively healthy people, tight blood sugar control may make sense. Treatment should be individualized, which requires a careful case-by-case approach,” she says. Unfortunately, this is not always the case in practice. Her study found absolutely no difference in how people were treated based on their health. In other words, patients in poor health and at risk for hypoglycemia tended to be treated as aggressively as far healthier patients. What’s more, 55 percent of older adults with diabetes who achieved tight blood sugar control were taking insulin or sulfonylureas—drugs that can lead to hypoglycemia—regardless of whether they were healthy, had complex health issues, and/or were in poor health.
To avoid overtreatment for diabetes, Dr. Lipska recommends that you make the necessary lifestyle changes and work together with doctors and other health-care providers on a personalized approach to your specific health needs and safety. You need to be engaged and part of the plan. The plan should involve much more than simply prescribing a diabetes drug if your blood sugar is above the recommended threshold.
›Kasia Joanna Lipska, MD, MHS, assistant professor of medicine (endocrinology), department of internal medicine, Yale School of Medicine, New Haven, Connecticut. Her study was published in JAMA Internal Medicine.
Test Your Glucose Meter for Accuracy
Glucose meters that check blood sugar should be tested for accuracy every time users open a new pack of test strips, get a new meter, or suspect a malfunction. A recent survey found that only 23 percent of patients with diabetes who use glucose meters said they followed these manufacturer recommendations.
Here’s how to test a glucose meter: Use one drop of the control-solution liquid on the test strip (just like you would check your own blood sugar) to test the accuracy of both the meter and packages of test strips.
›Katherine O’Neal, PharmD, assistant professor, University of Oklahoma College of Pharmacy, Tulsa.
Timing Is Everything…Especially with Your Medications
The time of day that you take your medication can make a big difference in how well you do.
Few doctors talk to their patients about the best time of day to take medication or undergo surgery, but it can make a big difference.
If you have high blood pressure, it’s usually best to take slow-release medication at bedtime. For osteoarthritis, your pain reliever needs to work hardest in the afternoon. Why does the timing matter?
Virtually every bodily function—including blood pressure, heart rate, and body temperature—is influenced by our circadian (twenty-four-hour) clocks. External factors, such as seasonal rhythms, also play a role in certain medical conditions.
Physiological reactions that are more detrimental at night than in the morning are believed to play a role in both type 2 diabetes and metabolic syndrome—a constellation of conditions that includes insulin resistance (in which the body’s cells don’t use insulin properly), abdominal obesity, high blood pressure, and elevated LDL “bad” cholesterol.
The body produces and uses insulin most effectively in the daytime hours, and its metabolism is most active during the day. The liver, pancreas, and muscles are better able to utilize blood sugar (glucose) and burn calories when metabolism is high. Because metabolism slows at night, someone who eats a lot of snack foods, for example, at night will be unable to efficiently remove the resulting glucose and fats from the blood. Over time, this can cause a chronic rise in insulin and cholesterol and may lead to metabolic syndrome.
For best results: People with metabolic syndrome or diabetes (or those who are at increased risk for either condition due to obesity or high blood pressure) should synchronize their meals with their metabolic rhythms. Consume most of your calories early in the day. Eat a relatively light supper—for example, a piece of fish, a green salad, and vegetables—preferably at least a few hours before going to bed. Diabetes drugs, such as insulin, should be taken in anticipation of daytime calories and carbohydrates.
›William J. M. Hrushesky, MD, principal investigator at the Chronobiology and Oncology Research Laboratory at the Dorn Research Institute VA Medical Center in Columbia, South Carolina. He is also an adjunct professor of epidemiology and biostatistics at the University of South Carolina School of Medicine in Columbia and author of Circadian Cancer Therapy.
Measure Sugar Before Meals
Diabetics should measure blood sugar before meals to best establish their long-term blood sugar levels. Premeal sugar level is more closely aligned with long-term levels than standard blood sugar measurements taken two hours after a meal. Postmeal levels are still important to measure the effects of the meal on blood sugar.
Important: Those with diabetes should maintain a low-sugar and low-carbohydrate diet.
›The late Stanley Mirsky, MD, coauthor of the Diabetes Survival Guide. Dr. Mirsky was a practicing internist and diabetologist, a past president of the American Diabetes Association of New York State, and a board member of the Joslin Diabetes Center. He was named Endocrinologist of the Year for 2005 at the Mount Sinai School of Medicine.
Chamomile Tea Protects Against Diabetes Damage
Chamomile is one of the most popular herbal teas. Moms give it to their children to soothe tummy aches and may have a cup themselves to relieve stress or gastrointestinal discomfort. People turn to chamomile tea to calm themselves at bedtime or to reduce cold and flu symptoms, and now evidence has emerged that it may also be helpful in preventing complications of type 2 diabetes.
CHAMOMILE QUENCHES FREE RADICALS
According to Stanley Mirsky, MD, former associate clinical professor of medicine at the Mount Sinai School of Medicine in New York and coauthor of the Diabetes Survival Guide, chamomile is thought to be beneficial for people with diabetes because it is so rich in antioxidants, which quench free radicals in the body that contribute to disease by allowing inflammation to flourish. In Japan and the United Kingdom, multiple researchers fed diabetic rats a chamomile extract prepared from the dried flowers of Matricaria chamomilla for twenty-one days. When compared with a similar group of rats who also had diabetes and were fed the same diet but without the chamomile, the chamomile-treated animals had a significant drop in blood sugar. There was also a decline in two enzymes that are associated with dangerous diabetic complications such as loss of vision, nerve damage, and kidney damage.
Results of the study were published in the Journal of Agricultural and Food Chemistry. The researchers expressed hope that these preliminary findings might one day lead to a chamomile-based treatment for diabetes that would be cheaper and have less side effects than pharmaceutical treatments.
Even as this research continues, it may be helpful to add chamomile tea to your diet. For those who like it (and have no contraindications, as it is known to interact with certain medications), it may be a good substitute for sugary sodas or fruit juices, which can wreak havoc on blood sugar levels. Check with your doctor first.
›The late Stanley Mirsky, MD, coauthor of the Diabetes Survival Guide. Dr. Mirsky was a practicing internist and diabetologist, a past president of the American Diabetes Association of New York State, and a board member of the Joslin Diabetes Center. He was named Endocrinologist of the Year for 2005 at the Mount Sinai School of Medicine.
Control Diabetes with Qigong
Wouldn’t it be great if you could just wave your arms to get better control over your blood sugar? A research scientist at Bastyr University in Washington has adapted the ancient Chinese practice of movement called qigong (pronounced chee-GOONG) to help people with type 2 diabetes achieve better blood sugar control, feel better, and even reduce their reliance on drugs.
Study author Guan-Cheng Sun, PhD, assistant research scientist at Bastyr University, qigong teacher, and executive director and founder of the Institute of Qigong & Internal Alternative Medicine in Seattle, says there are many types of qigong. What makes his version unique is the way it explicitly incorporates a specific energy component.
Dr. Sun named his new system Yi Ren Qigong (Yi means “change” and Ren means “human”) and says it works by teaching patients with diabetes to calm the chi, or “life energy,” of the liver (to slow production of glucose) and to enhance the chi of the pancreas (exhausted by overproducing insulin). The goal of this practice is to “improve the harmony between these organs and increase energy overall,” he says, noting that his patients have achieved significant results—reduced blood glucose levels, lower stress, and less insulin resistance. Some were even able to cut back the dosages of their medications.
HOW DO THEY KNOW IT WORKED?
Dr. Sun’s research team studied thirty-two patients, all on medication for their diabetes. They were divided into three groups. One group practiced qigong on their own at home twice a week for thirty minutes and also attended a one-hour weekly session led by an instructor. The second group engaged in a prescribed program of gentle exercise that included movements similar to the qigong practice but without the energy component for an equivalent period of time. And the third group continued their regular medication and medical care but did not engage in structured exercise.
The results: After twelve weeks, the qigong patients had lowered their fasting blood glucose and their levels of self-reported stress and improved their insulin resistance. The gentle exercise group also brought down blood glucose levels, though somewhat less, and lowered stress. It was worse yet for the third group—blood glucose levels climbed, and so did insulin resistance, while there was no reported change in their stress levels. The study was published in Diabetes Care.
While Yi Ren Qigong is not available anywhere beyond Bastyr, Dr. Sun is developing a training program for instructors who can then teach in their own communities.
›Guan-Cheng Sun, PhD, assistant research scientist at Bastyr University, Kenmore, Washington, qigong teacher, and executive director and founder of the Institute of Qigong & Integrative Medicine, Seattle.
The Martial Art That Defends Against Diabetes
People with diabetes often assume that for exercise to be beneficial, you have to be huffing and puffing, sweating, and red-faced afterward,” says Beverly Roberts, PhD, RN, a professor at University of Florida College of Nursing. “However, we found that a gentle activity such as tai chi can be just as beneficial in improving the health of people with diabetes.”
Dr. Roberts is talking about a recent study that she and her colleagues conducted showing that regular practice of tai chi—an ancient martial art from China consisting of deep breathing and gentle, flowing movements—can help you lower blood sugar, manage diabetes more effectively, improve mood, and boost energy levels.
TAI CHI FOR GLUCOSE CONTROL
A team of researchers from Korea and the United States studied sixty-two people with type 2 diabetes. Thirty-one practiced tai chi twice a week, and thirty-one didn’t.
After six months, those practicing tai chi had a greater drop in fasting blood sugar (a test that measures blood sugar after you haven’t eaten for eight hours); a bigger decrease in A1C (a measurement of long-term blood sugar levels); more participation in diabetic self-care activities, such as daily measuring of glucose levels; happier social interactions; better mood; and more energy.
“For those with type 2 diabetes, tai chi could be an alternative exercise to increase glucose control, diabetic self-care activities, and quality of life,” conclude the researchers in the Journal of Alternative and Complementary Medicine.
“Tai chi has similar effects as other exercises on diabetic control,” says Dr. Roberts. “The difference is that tai chi is a low-impact exercise, which means that it’s less stressful on the bones, joints, and muscles than more strenuous exercise.
“Tai chi provides a great alternative for people who want the benefits of exercise on diabetic control but may be physically unable to complete strenuous activities because of age, health condition, or injury.”
HELPS IN SEVERAL WAYS
“These and other studies show that tai chi can have a significant effect on the management and treatment of diabetes,” says Paul Lam, MD, of the University of South Wales School of Public Health, the author of five scientific studies on tai chi and diabetes.
“Tai chi can help with diabetes in several ways,” he continues. “It can help you control blood sugar, reduce stress, and minimize the complications of diabetes, such as high blood pressure, high cholesterol, and the balance and mobility problems that accompany peripheral neuropathy.”
Dr. Lam developed the tai chi program that was used in several studies on tai chi and diabetes—Tai Chi for Diabetes. It is available on DVD and includes a complete tai chi routine, along with a warm-up, stretches, and qigong exercises (also from China) that increase the flow of chi (life force) in the parts of the body affected by diabetes.
Dr. Lam is also the coauthor of the book Tai Chi for Diabetes: Living Well with Diabetes, which supplements the DVD.
Both the DVD and the book are available at www.amazon.com. You can also learn more about the Tai Chi for Diabetes program at Dr. Lam’s website www.taichifordiabetes.com, where you can order his DVD and book.
Also helpful: If you decide to take a tai chi class, look for an instructor who has practiced for at least three to four years and who inspires you to the regular practice of tai chi, says Daniel Caulfield, a teacher of tai chi at Flow Martial and Meditative Arts in Keene, New Hampshire. “The greatest benefit from tai chi comes from both taking a class with a qualified instructor and practicing at home at least twenty minutes a day.”
›Beverly Roberts, PhD, RN, professor, University of Florida College of Nursing.
›Paul Lam, MD, family physician, tai chi master, clinical teacher and lecturer, University of South Wales, Australia.
›Daniel Caulfield, tai chi instructor at Flow Martial and Meditative Arts, in Keene, New Hampshire. FlowMMA.org.
Watch Out for Extreme Weather
Extreme heat is more dangerous for individuals with diabetes.
Recent finding: People who have type 1 or type 2 diabetes often have difficulty adjusting to rises in temperature. Also, due to nerve damage associated with diabetes, their sweat glands may not produce enough perspiration to cool them down. This may explain why people with diabetes have higher rates of hospitalization, dehydration, and death in warmer months. Winter also can be a problem for diabetics because poor circulation increases the likelihood of skin damage in the cold weather.
›Jerrold S. Petrofsky, PhD, professor of physical therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California, and coauthor of a study published in the Journal of Applied Research.
*See the Resources section for more information on how to find an educator near you.
†Consult your doctor before starting a new exercise program.
‡Be sure to check with your doctor before starting a strength-training program—this type of exercise can raise blood pressure.
*Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2011. Atlanta, Georgia, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011, http://care.diabetesjournals.org/content/35/12/2650.full.