People who have diabetes can't properly make or use insulin, a chemical that your body needs. Insulin helps change sugar and other foods into something called glucose, which fuels your body. Seventeen million Americans have diabetes. A third of people with diabetes don't know they have it. If you don't take care of it, diabetes can lead to blindness, kidney problems, heart disease, wounds that don't heal, and impotence in men.

People with diabetes take care of themselves by watching what they eat, checking their blood sugar level, and taking pills or insulin shots. It's very important to take care of yourself if you have diabetes. If you have your diabetes under control, you can lead a normal life.

There are two kinds of diabetes:
Type 1: Most people with type 1 get it as children and cannot avoid getting it. Their bodies make little or no insulin so they have to take insulin shots.

Type 2: Most people who get type 2 diabetes are adults. They have insulin resistance, which means that their bodies don't use insulin properly. They need to watch what they eat and exercise in order to control their diabetes.

Who Is At Risk
Doctors aren't quite sure what causes type 1 diabetes so there is no set of risk factors. Parents just need to know the symptoms of it so they can see a doctor if they think their children have it.

People who have are at risk of getting type 2 diabetes:

Are 55 or older
Are African-American or Latino (the risk is twice as high as it is for white people)
Have a close relative (parent, brother, or sister) who has diabetes
Are overweight or don't exercise
Have a history of high blood pressure or high blood cholesterol
Children and young adults have been getting type 2 diabetes in the past few years because they eat a lot of fat and sugar and don't exercise enough. Healthy living (link to new Healthy Living home page) is important in preventing diabetes in not only adults but in children as well.

Symptoms of Diabetes

Children who have type 1 diabetes show these symptoms:

Overwhelming thirst that does not go away.
Frequent and/or uncontrollable urination
Weight loss or weight gain
Fatigue
Nausea or vomiting
Many times children with type 1 diabetes find out they have it after getting sick. Parents should know the symptoms of it so they can get their children to a doctor.

Adults who develop type 2 diabetes show these symptoms:

Overwhelming thirst that does not go away.
Frequent and/or uncontrollable urination
Fatigue
Blurred vision
Slow-healing infections
Impotence in men
If you notice these symptoms in yourself or a loved one, call a doctor. Diabetes can be treated, but it can also do damage to your body if the symptoms are ignored.

Diabetics 'must test blood more'


Diabetics tend to check their blood sugar levels twice a day
Diabetics should be checking their blood sugar levels more regularly to reduce the risk of heart disease and strokes, US research shows.
People with diabetes type I and II tend to check their levels twice a day by testing blood by pricking their finger.

But the Johns Hopkins University study said diabetics should test more often to make sure the levels do not exceed a set limit for a sustained period.

Researchers pooled data from 13 earlier studies, involving 10,000 people.


Diabetics are advised to make sure their blood sugar levels stay between 4mmol/l (millimoles per litre) and 7mmol/l (80 to 120 milligrams per decilitre in US measurements) but the levels can vary between readings.

The study said diabetics that test more regularly should make sure their levels do not exceed 8mmol/l (150 mg/dl) for a long period.

If the blood sugar levels exceeded the limit, diabetics were increasing their chances of developing cardiovascular disease, including heart disease and stokes, it warned.

Disease

The report, published in the Annals of Internal Medicine, also urged diabetics to have their long-term blood sugar levels monitored.

Diabetics can have an HbA1c test from their GP which can give an average blood sugar level for the previous few months by reading the glycated haemoglobin rate.

Researchers found that for every 1% rise in glycated haemoglobin in people with diabetes type II there was an 18% increase in getting cardiovascular disease.

People living with diabetes are twice as likely to die from cardiovascular disease compared to those without diabetes

Sherita Golden, report author
For diabetes type I, there was a 15% rise in risk - although the study said the estimate was not as accurate as for type II as researchers looked at fewer studies.

The recommended glycated haemoglobin rate was 7%.

Report author Sherita Golden, assistant professor of medicine and epidemiology at the university's school of medicine in Baltimore, said diabetics needed to pay attention to blood sugar levels as well as cholesterol and blood pressure.

"The relationship between blood sugar levels in people with diabetes and whether this increases their risk of developing heart disease has remained unclear until now.

"People living with diabetes are twice as likely to die from cardiovascular disease compared to those without diabetes.

Tough targets

"As a result, many people living with diabetes monitor their health for well-known risk factors for heart disease, such as obesity, cholesterol levels and blood pressure - but the big unknown has been the role of blood sugar levels in managing their risk of developing cardiovascular disease.

"Our research suggests that management of blood sugar levels is still a key part of cardiovascular disease prevention in diabetes."

He admitted keeping within the report's limits would be tough.

Among the 13 studies analysed by the team was the UK Prospective Diabetes Study, which was published in 1998 and was the first time blood sugar level and cardiovascular disease was linked.

About 1.4 million people have diabetes in the UK although another 1m are thought to be diabetic but not aware of it.

A spokesman for the charity Diabetes UK agreed some diabetics should be testing themselves more.

"For some diabetics more regular more testing would be helpful but it is not necessarily needed for everyone.

"And some do not always know what to do. People need to be provided with information about why they are testing and what they should do about their test results.

"There is also some suggestion people have struggled to get hold of the necessary equipment to test blood sugar levels.

"We have heard some PCTs are reluctant to provide the glucose testing strips for measuring blood sugar levels on prescription - that is worrying."


Treatment of Diabetes

There are several aspects in the treatment of diabetes, each one with a very important role.

The mainstays of treatment are:

Working towards obtaining ideal body weight
Following a diabetic diet
Regular exercise
Diabetic medication if needed
Note: Type 1 Diabetes must be treated with insulin. This involves injecting insulin under the skin for it to work. Insulin cannot be taken as a pill because the digestive juices in the stomach would destroy the insulin before it could work. Scientists are looking for new ways to give insulin. But today, shots are the only method. There are, however, new methods to give the shots...Insulin Pumps are now being widely used and many people are having great results. A new page on insulin pumps will be on line soon.

Working towards obtaining ideal body weight.

An estimate of ideal body weight can be calculated using this formula:

For women: Start with 100 pounds for 5 feet tall. Add 5 pounds for every inch over 5 feet. (If you are under 5 feet, subtract 5 pounds for each inch under 5 feet). This will give you your ideal weight. If you have a large frame, add 10 percent. If you have a small frame, subtract ten percent. ( A good way to decide your frame size is to look at your wrist size compared to other women's)

Example: a woman who is 5' 4" tall and has a large frame.

100 pounds + 20 pounds (4 inches times 5 pounds per inch) =120 pounds.

Add 10% for large frame (in this case 10% of 120 pounds is 12 pounds).

120 pounds + 12 pounds = 142 pounds ideal body weight.

For men: Start with 106 pounds for a height of 5 foot. Add 6 pounds for

every inch above 5 foot. For a large frame, add 10%. For a

small frame, subtract 10 percent. (See above for further details).

The Diabetic Diet

Diet is very important in diabetes. There are differing philosophies on what is the BEST diet but below is a guideline with some general principles.

Patients with Type 1 diabetes should have a diet that has approximately 35 calories per kg of body weight per day (or 16 calories per pound of body weight per day). Patients with Type 2 diabetes generally are put on a 1500-1800 calorie diet per day to promote weight loss and then the maintenance of ideal body weight.. However, this may vary depending on the person's age, sex, activity level, current weight and body style. More obese individuals may need more calories initially until their weight is less. This is because it takes more calories to maintain a larger body and a 1600 calorie diet for them may promote weight loss that is too fast to be healthy. Men have more muscle mass in general and therefore may require more calories. Muscle burns more calories per hour than fat. (Thus also one reason to regularly exercise and build up muscle!) Also, people whose activity level is low will have less daily caloric needs.

Generally, carbohydrates should make up about 50 percent of the daily calories ( with the accepted range 40-60 percent). In general, lower carbohydrate intake is associated with lower sugar levels in the blood. However the benefits of this can be cancelled out by the problems associated with a higher fat diet taken in to compensate for the lower amount of carbohydrates.. This problem can be improved by substituting monounsaturated and polyunsaturated fats for saturated fats.

Most people with diabetes find that it is quite helpful to sit down with a dietician or nutritionist for a consult about what is the best diet for them and how many daily calories they need. It is quite important for diabetics to understand the principles of carbohydrate counting and how to help control blood sugar levels through proper diet. Below are some general principles about the diabetic diet.

Understanding Food Groups

There are three basic food groups: fats, proteins and carbohydrates. The carbohydrates are the foods that can be broken down into sugar. It is essential to have all three food groups in your diet to have good nutrition.

1. Why count carbohydrates?

Carbohydrate makes your blood glucose level go up. If you know how much carbohydrate you've eaten, you have a good idea what your blood glucose level is going to do. The more carbohydrates you eat, the higher your blood sugar will go up.

2. Which foods contain carbohydrate?

Most of the carbohydrate we eat comes from three food groups: starch, fruit and milk. Vegetables also contain some carbohydrates, but foods in the meat and fat groups contain very little carbohydrate. Sugars may be added or may be naturally present (such as in fruits). The nutrient term for sugars can also be identified by looking for -ose at the end of a word ( i.e. glucose, fructose, sucrose, etc. are all sugars). Look for these on food labels to help identify foods that contain sugar.

To make things easy, many people begin carbohydrate counting by rounding the carbohydrate value of milk up to 15. In other words, one serving of starch, fruit or milk all contain 15 grams carbohydrate or one carbohydrate serving. Three servings of vegetable also contain 15 grams. Each meal and snack will contain a specific total number of grams of carbohydrate.

For example: Each gram of carbohydrate provides 4 calories. A diabetic on a 1600 calorie diet should get 50% of these calories from carbohydrate. This would be a total of 800 calories or 200 gms of carbohydrate (at 4 calories per gram) spread out over the day. At 15 grams per exchange, this would be about 13 exchanges of carbohydrate per day.

The amount of food you eat is closely related to blood sugar control. If you eat more food than is recommended on your meal plan, your blood sugar goes up. Although foods containing carbohydrate (carb) have the most impact on blood sugars, the calories from all foods will affect blood sugar. The only way you can tell if you are eating the right amount is to measure your foods carefully. Also, it is important to space your carbohydrates out throughout the day to avoid sugar "loading." Measuring your blood sugar regularly also provides important feedback on how high your sugar went based on what you ate and your level of activity.

Where do you get carbohydrate information?

The "Nutrition Facts" label on most foods is the best way to get carbohydrate information, but not all foods have labels. Your local bookstore and library have books that list the carbohydrate in restaurant foods, fast foods, convenience foods and fresh foods. You will still need to weigh or measure the foods to know the amount of grams of carbohydrates present.

How do you count carbohydrate?

Carbohydrates can be counted in number of grams or can be counted as exchanges. One carbohydrate exchange equals 15 grams of carbohydrate. A good reference for learning how to count calories in this manner will be on line here

soon including a calorie computer.

Free Foods:

These are foods that you can eat without counting. A free food or drink is one that contains less than 20 calories and 5 grams or less of carbohydrate per serving. If your serving or a food contains more than 5 grams of carbohydrate, you should count it in your meal plan.

Examples of free foods:

Bouillon or broth
Carbonated or mineral water
Club soda
Coffee or tea
Diet soft drinks
Drink mixes, sugar-free
Tonic water, sugar free
Sugar-free hard candy
Sugar-free Jell-O
Sugar-free gum
Jam or jelly, light or low-sugar, 2 tsp.
Sugar free syrup, 2 tsp.

You should spread out free foods throughout the day and not eat them in one sitting.

Fitting Sugar in Your Meal Plan

It is commonly thought that people with diabetes should avoid all forms of sugar. Most people with diabetes can eat foods containing sugar as long as the total amount of carbohydrate (carb) for that meal or snack is consistent. Many research studies have shown that meals which contain sugar do not make the blood sugar rise higher than meals of equal carbohydrate levels which do not contain sugar. However, if the sugar-containing meal contains more carb, the blood sugar levels will go up.

Does this mean I can eat cake and not worry about it?

No! A slice of white cake with chocolate icing ( 1/12 of a cake or 80 gram weight) will give you about 300 calories, 45 grams of carb and 12 grams of fat. That is three starch servings and over 2 fat servings. Before you have a slice of cake, ask yourself the following questions: Will that small piece of cake be satisfying or will I still be hungry? How it will fit into my meal plan? Do I have 300 calories to "spend" on this? Are there other choices I could make which would contribute less fat? A 1/12 slice of angel food cake has less than 1 gram of fat and only 30 carb. This may be a better choice.

Controlling all carbohydrates

It is important to realize that sugar is not the only carbohydrate that you have to "control". The body will convert all carbohydrates to glucose - so eating extra servings of rice, pasta, bread, fruit or other carbohydrate foods will make the blood sugar rise. Just because something doesn't have sugar in it doesn't mean you can eat as much as you want. Your meal plan is designed so that the carbohydrate content of your meals remains as consistent as possible from day to day.

A word of caution:

Although sugar does not cause the blood sugar to rise any higher than other carbohydrates, it should be eaten along with other healthy foods. If you choose to drink a 12 ounce can of a sugar-sweetened soft drink, that would use up about 45 grams carb - and you wouldn't have gotten any nutrition (protein, vitamins or minerals). What a waste of calories! High sugar foods are more concentrated in carb. Therefore the volume would be smaller than a low sugar food. High sugar foods might not be a good choice if they will just tempt you to eat more. If you would rather eat larger portions, select low sugar choices. Look at the differences in portion size you get for equal amounts of carbohydrate in these cereals!

In addition, many sugar-containing foods also contain a lot of fat. Foods such as cookies, pastries, ice cream and cakes should be avoided largely because of the fat content and because they don't contribute much nutritional value. If you do want a "sweet" - make a low-fat choice, such as low-fat frozen yogurt, gingersnaps, fig bars or graham crackers and substitute it for another carbohydrates on your meal plan.