What Is Diabetes?
Type 2 diabetes is a chronic disorder characterized by elevated levels of glucose (sugar) in the blood. You are most likely reading this book because you have been diagnosed with type 2 diabetes, suspect you might have it, or know that a loved one has it. You are not alone. There are somewhere between 16 and 20 million people in the United States afflicted with diabetes, according to Dr. Gerald Bernstein, former president of the American Diabetes Association, although the official count has not been updated in several years. About one third of those millions are undiagnosed.
The very fact that you picked up this book and are aware of the problem of diabetes means that you are on the road to controlling it. And it can be controlled. Type 2 diabetes is so intertwined with lifestyle that it is almost impossible to discuss it without talking about the management of what you eat and the kind of exercise you get. Educate yourself and then you can use your diagnosis as an opportunity to wake up to the needs of your body, as well as your mind and spirit.
Throughout the book, you'll be given useful information to understand the physical processes that occur with diabetes.
People differ in the ways they deal with health issues--which one describes you? Some people are naturally curious about what is happening to their bodies. They visit their doctor every year and stay current with the latest medical news. And then there are people who are so busy with daily life that they don't often think about their health unless some medical problem hits them directly. These are the people who only go to the doctor if they are dragged, and rarely take a sick day even if they have the flu and a 103° temperature!
Well, to both types of people, this is your book. For the first kind, you will hopefully be interested in what is happening to your body and eagerly pursue the advice set forth within these pages. To the second set of people, this is, now more than ever before, the time when you must take notice of what is going on inside of you, so you can keep that engine running smoothly.
Your first step in dealing positively with this disease is to learn something about it. With this knowledge, diabetes is no longer a mystery that you can't explain to your loved ones. The information in this chapter will assist you in understanding the steps that you need to take to live well with this disease.
Real Lessons on Nutrients and Diabetes
Educating yourself about diabetes can require time and effort, but understanding it can provide you with the self-management to take control of blood sugars. Diabetes is a complex disease that affects your body on a variety of levels. The scientific community is always at work gathering data on causes, risk factors, and prevention. Take the time here to read about the processes that occur in your body when you are healthy and when you have diabetes. I have broken the information down into easy steps to follow so you can learn about how your body reacts to the food you consume--the type and amount of nutrients affects your everyday life by affecting your mood, your weight, your energy, and, now, your diabetes.
How Food Becomes Energy
Getting sufficient energy for the body from the food we eat is a daily pursuit--and for the senses, a pleasure. But how does the body convert food into energy? How does the cereal we eat for breakfast provide us with the power we need to function during the day, or at least until lunch?
After a meal, the body digests the food we eat. The goal of digestion is to break food down into the smallest components so that the nutrients can be released and absorbed. This is a process that begins in the mouth as we chew and ends in the small intestine with the absorption of foods' nutrients into the blood. Carbohydrates are one of the most important nutrients; they are released into the bloodstream as glucose, a simple sugar that provides for brain and nerve function and physical activity. Some glucose can be stored in the liver and muscles to be used as the body needs it. The liver, an organ in front of the stomach, is responsible for regulating storage and releasing it when needed into the bloodstream to be carried throughout our body by arteries, veins, and capillaries, and eventually to our cells. Cells, which make up our entire body, are dependent on glucose to function.
The cells throughout the body are like furnaces that need fuel every minute of every day. Imagine that the tiny molecules of glucose in the blood are the coal keeping that furnace (the cells) filled with fuel. Asleep or awake, the body is functioning constantly and it requires energy to do that: the heart beats, the brain receives and delivers messages, and muscles support the skeleton. The cells require glucose to perform, and there are several regulatory systems in our body that control how much glucose is circulated in our blood.
The Role of the Pancreas and Insulin
The pancreas is an organ behind the stomach that is the regulator of glucose in our bloodstream. Inside the pancreas there are small clusters of special cells called islets of Langerhans. That's where insulin is produced.
Insulin's job is to signal the small receptors that are present in cells to open so that they can receive glucose and thus get fueled. As the cells burn the glucose, the levels of glucose circulating in the blood, and the levels of insulin, decrease. The cycle begins again when the body detects we need more fuel and insulin levels rise to accommodate this.
When the Process Breaks Down
Sometimes the fuel that you are giving your body doesn't get absorbed. This can occur in two ways. Either the cells' receptor sites do not open when signaled by insulin or else there are too few receptors on the cells to allow the glucose to enter. As the cells fail to open to let the fuel in, glucose is built up in the blood. The pancreas knows that the cells aren't getting fed, so it keeps adding insulin into the blood. The result is that the cells experience a kind of starvation even though there is a veritable banquet on the other side of the door.
When the glucose does not get absorbed, it flows into the kidneys as a waste product and gets passed out of the body in your urine. This increases urination and causes thirst. (The kidneys are a pair of organs that filter impurities from the blood and out to the bladder.) The body does not get its fuel, calls for more food, causing increased hunger, and starts to suffer from its absence, causing fatigue.
Why Does the Process Break Down?
Many people have the genetic predisposition to develop diabetes. This may be translated into insulin resistance. This means that cells sometimes would take up the call to open from the insulin circulating in your blood and sometimes would not. As a result, your body then pumps extra insulin through your bloodstream, not knowing that there is still the initial lot of insulin that hasn't been utilized. The excess amount of insulin in your blood can be damaging to your cardiovascular system (the heart and blood vessels), causing a greater risk of heart disease.
Another damaging aspect to insulin resistance is what happens to the dietary fat you consume. Fat, found in many types of foods, needs insulin in order to shuttle it and break it down into the cells. When your cells are insulin resistant, the fat does not totally go into the cells; it continues to get pumped through the blood and eventually builds up along the walls of your veins and arteries, which can produce problems such as heart disease. Insulin resistance causes damage to the body, and should be paid attention to with the same sort of lifestyle changes recommended throughout this book.
People can move from insulin resistance to developing type 2 diabetes due to genetics and, most importantly, lifestyle practices. Different organs in the body can cause the progression from insulin resistance to type 2 diabetes. The liver may be producing too much glucose. The pancreas may be sending too little insulin into the blood. The cell receptors may not be functioning properly so that the glucose is not accepted. And of course, all this can be exacerbated by poor food choices and a lack of exercise that will lead to obesity, a risk factor for diabetes.
The Role of Fat and Other Risk Factors in Developing Diabetes
So why does the body stop behaving itself and get diabetes? Well, one of the reasons comes from the natural aging process. This process determines that after about the age of 40 our metabolism begins to slow down, we start losing muscle mass, our hormone activity decreases, and often our physical activity levels slow down incrementally. Weight is gained more easily. For many people, weight collects around the stomach, resulting in an "apple-shaped figure." That fat, and the slow-down of physical activity, sets off a chain of reactions in the body that can increase insulin resistance. The greater the degree of obesity, the greater the degree of insulin resistance.
Fat around the middle sits right on your organs, such as the heart, lungs, stomach, kidneys, and liver, and puts pressure on them. One way to visualize this is to think of how a pregnant woman becomes increasingly uncomfortable the bigger the baby gets in her uterus--as the baby grows it pushes up the lungs and the stomach, making it harder to breathe and digest comfortably, and it constricts the intestines, and the bladder has constant pressure on it. While fat does not grow and impair the organs in such an obvious way that a baby does, it can very much hinder what's going on with organ function. Think of how difficult it is to move comfortably the bigger you are. Think of how it becomes harder to breathe. And think of all the pressure the fat is putting on your system. Your body has to work harder to function. The larger you become, the further the capillaries have to travel in order to deliver blood to your entire body.
Fat resting in your middle provides for the ready access of fat to travel to those organs, thus impeding their activity. The fat that is present in your blood requires insulin to get absorbed into your cells, and if you are insulin resistant, the fat does not settle. If your fat does not get into the cells, then it cannot be burned, and therefore it builds up in the blood. As the blood full of fatty particles circulates it can clog your arteries and lead to cardiovascular disease.
The following are some of the risk factors that can contribute to your developing diabetes. Some are in your control, like exercising regularly, and others are not, such as having a history of diabetes in your family. Because you are reading this book, you may already know that you have diabetes. But be sure to learn the risk factors for those around you, especially your close relatives who may be at risk for the disease, and friends and colleagues who may have risk factors similar to yours. Encourage them to be tested for diabetes if you think they are at risk.
In addition to being overweight or obese (see Body Mass Index chart), over 45, and not exercising enough, here are some additional risk factors for developing type 2 diabetes:
* Having a close relative with diabetes, which indicates a genetic predisposition to diabetes
* Being a woman who has given birth to a child weighing 9 pounds or more and has had complications such as frequent miscarriage, premature delivery, or toxemia
* Being a woman who has had gestational diabetes
* Having hypertension
* Triglyceride levels over 250 mg/dl
* Being of African American, Hispanic, Native American, or Asian descent
Measuring Your Body Mass Index (BMI)
Your body mass index (BMI) is a measurement used to calculate your weight as a health factor. It has been shown that as your BMI rises so does your risk for diabetes, hypertension, heart disease, and other health problems. BMI is your weight (in kilograms) divided by your height (in meters) squared.
BMI = weight (kg) divided by height (m)2
As most of us don't measure our weight in kilograms or our height in meters, multiply your weight by 703 and then divide it by your height (in inches) squared.
If you don't have a calculator, use the chart below. The left-hand side of the chart shows height. Find yours and move across to locate your weight. From there look up and you will find your BMI. Example: a woman who is 5 feet 5 inches tall and weighs 174 pounds has a BMI of 29 and is considered overweight.
BMI of less than 20 is considered underweight
BMI between 20 and 24 is considered desirable
BMI between 25 and 29 is considered overweight
BMI of greater than 29 is considered obese
Symptoms of Type 2 Diabetes
Bonnie, fit and 54, was tired. What began as a need to rest on the weekends became a full-scale battle to get through the workweek. Her solution to this loss of energy? Lots of sugar. Milk shakes, ice cream, candy bars for a mid-morning snack. Bonnie thought that some extra-quick fuel would perk her up. The opposite occurred. She found herself becoming more and more exhausted until the day was measured by when she could get back into bed. When she began losing weight rapidly, having unquenchable thirst, and making many nighttime trips to the bathroom, she knew it was time to go to her doctor. There was no mistake about it: the symptoms equaled type 2 diabetes.
There are any number of ways that people discover they have diabetes, especially because there are so many different symptoms. Sometimes the onset is so gradual you don't even recognize that you are feeling badly. Maybe a few things have been nagging you, but nothing so severe as to send you rushing to see your doctor. So you may have only discovered it during a routine physical, like I did. Or, you may have seen your doctor because of some unusual symptoms.
Here are some of the common symptoms for type 2 diabetes that you may or may not have noticed:
* Fatigue and/or weakness
* Increased urination, especially causing you to awake in the middle of the night
* Increased thirst
* Increased hunger
* Weight loss or gain
* Higher occurrence than normal of colds and infections
* Longer healing time for scrapes, cuts, and bruises
* Tingling or numbness in hands and feetFrom the Hardcover edition.
Excerpted from Carol Guber's Type 2 Diabetes Life Plan by Carol Guber, M.S. with Betsy Thorpe. Copyright © 2002 by Carol Guber with Betsy Thorpe. Excerpted by permission of Harmony, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.