Diabetes

What Is Diabetes?

Diabetes (medically known as diabetes mellitus) is a chronic metabolic disorder characterized by elevated levels of blood glucose, or sugar. It occurs when your body produces little or no insulin or when your cells don’t respond appropriately to the insulin that is produced. Diabetes usually can’t be cured; left untreated — or poorly managed — it can lead to serious long-term complications, including kidney failure, amputation, and blindness. Moreover, having diabetes increases your risk for cardiovascular disease, including heart attack and stroke.
 
The odds are that you or someone you know has diabetes already or is at risk of developing this disease. The number of Americans with diabetes currently tops 18 million, or roughly 1 out of every 15 people, and many more are at risk.
 
Of course, if you or someone you love has diabetes, the disorder is about much more than a statistic. It means a new way of life. Eating a meal, planning a vacation, or going for a run requires forethought and planning. From testing your blood sugar, to planning your meals, to injecting yourself with insulin, managing your diabetes takes effort and discipline.
 
What’s more, you not only have to think about keeping your blood sugar levels as normal as possible from day to day, you also have to worry about finding ways to avoid long-term complications that may develop as a result of having diabetes. People with diabetes face an increased risk of such complications as blindness, kidney failure, amputation, and heart attacks and stroke.
Small wonder, then, that a diagnosis of diabetes may seem overwhelming. Both people with diabetes and their families may find themselves struggling with negative emotions — fear, frustration, anger —as they learn more about the disease and the lifestyle changes it requires.
 
However, there’s plenty of good news emerging about diabetes. Research shows that keeping your blood sugar levels as close to normal as possible is worth the time and effort. Rigorous blood sugar control can enable you to delay or even prevent the progression of diabetes and its debilitating long-term complications. Such tight control is now possible thanks to recent innovations such as high-tech monitoring devices, improved medications, and nearly painless insulin injectors.
 

How Sugar Is Metabolized

Many of the cells in your body need sugar as a source of energy. When you eat carbohydrates, such as a bowl of pasta or some vegetables, your digestive system breaks the carbohydrates down into simple sugars (generally glucose), which are ferried into and through your bloodstream to nourish and energize cells.
 
A key player in the metabolism of sugar is the pancreas, an elongated gland behind your stomach and liver. The pancreas fills two roles. First, it produces enzymes that flow into the small intestine to help your body digest proteins, carbohydrates, and fats. Second, it makes hormones that regulate the disposal of nutrients, including sugars. The islets of Langerhans, tiny clusters of cells found throughout the pancreas, are responsible for producing these hormones. They are composed of alpha cells, which produce the hormone glucagon, and beta cells, which secrete insulin. These hormones generally have opposite actions, but both are important in regulating your body’s use of sugar, fat, and protein.
 
Much like traffic cops dispatched at rush hour to ease congestion, insulin is released by beta cells in response to the rise in blood sugar levels after you’ve eaten. By directing sugar into liver and muscle cells, it promotes the storage of nutrients and prevents blood sugar levels from rising excessively. It also increases the uptake of amino acids (the building blocks of proteins) and fatty acids (the building blocks of fats) into protein and fat stores, respectively. Insulin thus serves as one of the principal gatekeepers of metabolism, promoting energy storage and growth.
The liver converts glucose that is not needed immediately for energy into glycogen. When blood glucose levels drop too low, your pancreas releases the hormone glucagon, which prompts your liver to reconvert stored glycogen into glucose and release it into the bloodstream. Usually insulin and glucagon levels fluctuate in a coordinated fashion to keep your blood glucose levels within a rather narrow range. This is important because certain organs, such as the brain and kidneys, depend on a consistent, steady supply of glucose. A normally functioning pancreas assures your body of a stable supply of nutrients.
 
In healthy people, insulin prevents a large rise in blood sugar after eating. The normal blood sugar level before breakfast usually hovers between 70 and 110 milligrams per deciliter (mg/dL). Normal levels of sugar in the blood rarely exceed 180 mg/dL, even after having eaten a meal.

Diabetes Mellitus Through Time

The first mention of symptoms characteristic of diabetes is found in the Ebers papyrus, which contains medical writings from the ancient Egyptian city of Thebes that date to about 1550 B.C. The Greek physician Aretaeus (200 A.D.) coined the term "diabetes," which in Greek means "siphon" or "pass through," to denote the excessive urination and constant thirst that he observed in his patients.
 
The Latin word mellitus, which means honeyed or sweet, was added centuries later, when medical practitioners realized that the urine of people with diabetes seemed to contain sugar. Documents traced to an Indian physician, Susruta, from 400 B.C., noted that some people produced "honey urine" that attracted flies. Pouring urine onto an anthill to see whether the insects swarmed to it was a crude diagnostic test.
 
Two 19th-century discoveries shed a great deal of light on diabetes. In 1869, while examining pancreatic tissue under a microscope, German medical student Paul Langerhans noticed groups of tiny cells like islands in the midst of a sea. He didn’t know it, but these islets of Langerhans, as they are called today, contain the beta cells that produce insulin. In 1889, while exploring how the body metabolizes fat, European scientists Joseph von Mering and Oskar Minkowski found that when they removed the pancreas from a dog, the animal started to urinate uncontrollably. They tested the urine and found that it contained glucose. Recognizing that the dog had developed diabetes, the scientists concluded that the key to the illness resided in the pancreas.

Types of Diabetes

The two main types of diabetes mellitus are designated type 1 and type 2. While the mechanisms that cause them differ, they’re both characterized by high blood glucose levels and, if left untreated, have similar long-term consequences. Gestational diabetes, which occurs during pregnancy, resembles type 2 diabetes. However, it usually disappears after the baby is delivered.
 
Type 1 diabetes
This type of diabetes, also known as insulin-dependent diabetes mellitus (IDDM), is an autoimmune disease. That means the body’s immune system turns inexplicably against its own cells, destroying them as if they were foreign invaders.
 
Type 1 diabetes is sometimes referred to as juvenile diabetes because it usually develops in children and adolescents, most often around puberty. It’s the most common serious chronic disorder in children and adolescents. Type 1 can also develop in adulthood, although this is uncommon.
 
Type 1 diabetes is an inherited disease, so people with a family history of it are at greatest risk. For instance, if you have an identical twin with type 1, you have a 50% chance of getting it as well. If you have a sibling with the disorder, your risk of developing it is 5%–10%; that’s 10 times the rate of someone without a diabetic sibling. White people of northern European heritage are more prone to type 1 than members of other racial and ethnic groups. (For more, visit the Type 1 Diabetes Center.)

Type 2 diabetes
A combination of abnormalities is responsible for type 2 diabetes. The first is probably insulin resistance, a condition in which body cells become less responsive to insulin. Therefore, the body must secrete more insulin to maintain normal metabolism. Insulin resistance, which is very common, doesn’t cause type 2 diabetes by itself. The pancreas usually rallies to compensate for the resistance by pumping out more insulin. For most people with insulin resistance, blood sugar levels stay within a normal range. But for some, the insulin-producing cells eventually fail to keep up with the increased demand. Blood sugar levels rise, resulting in type 2 diabetes.
 
Essentially, type 2 diabetes is a problem of supply and demand. The pancreas supplies too little insulin to keep up with the increased demand that occurs with insulin resistance. For this reason, people with type 2 diabetes can be treated with therapies that decrease insulin demand, including diet, exercise, and drugs; with medications that increase insulin supply, such as sulfonylureas or meglitinides; or with insulin itself. (For more, visit the Type 2 Diabetes Center.) 

Gestational diabetes
Gestational diabetes mellitus occurs in about 135,000 U.S. women each year, usually around weeks 24–28 of pregnancy. Hormones produced by the placenta that hinder the action of the mother’s insulin probably trigger it. This disorder can result in babies who are larger than normal, and it puts the woman and her baby at greater risk for complications at the time of delivery. Diet, insulin therapy, or glucose-lowering medications are often needed to help control blood sugar levels. (For more, visit the Gestational Diabetes Center.)

Other types of diabetes
Diseases or chemicals that damage or destroy the pancreas can also cause diabetes. Examples include pancreatitis, pancreatic cancer, and hemochromatosis, a disorder in which excessive amounts of iron accumulate in the pancreas and other organs.

Surgical removal of the pancreas, which is sometimes necessary to treat chronic pancreatitis or pancreatic cancer, causes a form of type 1 (insulin-deficient) diabetes. Some medications, such as corticosteroids, diuretics, beta blockers, or a new class of drugs called "atypical" or second-generation antipsychotics, originally developed to treat schizophrenia, can increase insulin resistance or decrease insulin secretion. Such drugs may thus precipitate type 2 diabetes in people who are susceptible.
 
Toxic substances known to cause beta cell destruction include the rat poison pyriminil (Vacor); pentamidine (Pentam), a drug used to treat a type of pneumonia associated with AIDS; and asparaginase (Elspar), a cancer drug. All can cause a form of insulin-deficient diabetes.

Types of Diabetes

The Diabetes Epidemic in a Nutshell

The prevalence of diabetes has increased so quickly, in such a short amount of time, that many refer to it as an "epidemic"— a term once reserved only for infectious diseases. Although the exact cause of diabetes is unclear, one thing is certain: Excess body fat is the leading controllable risk factor for the most common form of this disease, type 2 diabetes. And it’s not just Americans who are getting fatter. Diets high in saturated fat and refined carbohydrates coupled with the modern sedentary lifestyle have been instrumental in the alarming rise in obesity and diabetes around the world. Here’s how all those burgers and shakes add up:  
  • About 64% of U.S. adults (180 million people) are overweight or obese; 30% (85 million) of them are obese. (People who are overweight have a body mass index, or BMI, of 25 or more; those who are obese have a BMI of 30 and above. Calculate Your BMI..)
  • Worldwide, 1 billion adults are overweight or obese, with 300 million being obese. Rates vary widely among countries; fewer than 5% of people in China are obese, compared with more than 75% of those in urban Samoa.
  • There are 1.3 million new cases of diabetes per year in the United States — about twice the 1992 number. The disease is expected to grow another 165% in this country by the year 2050.
  • In 1985, about 30 million people in the world had diabetes. By 2025, 10 times as many — an estimated 300 million people worldwide — are expected to have this disease.
  • Diabetes is the sixth leading cause of death in the United States. Worldwide, the disease contributes to nearly 1 out of 10 deaths.
Race and ethnicity also play a crucial role: The disease is far more common among African Americans, Asian Americans, Hispanics, Pacific Islanders, and Native Americans than among whites. One tribe of Native Americans living in Arizona has the highest rate of type 2 diabetes in the world, with the illness affecting about 50% of their adults ages 30–64.

Recognizing the Symptoms of Diabetes

While type 1 diabetes usually has obvious symptoms, such as frequent urination, increased thirst, and weight loss, type 2 often develops insidiously, showing few or no symptoms. This may explain why it often goes unnoticed at first. On average, people have type 2 diabetes for 9–12 years before they're diagnosed. To reduce this delay, experts now recommend that people ages 45 or older be regularly tested for diabetes (see Guidelines for Diabetes Screening).
 
Regardless of which type of diabetes you have, the symptoms of high blood sugar, or hyperglycemia, are similar. 

Symptoms of hyperglycemia

  • blurry vision
  • excessive thirst
  • frequent urination
  • feeling very hungry or tired
  • weight loss (without trying)

Symptoms of Type 1 Diabetes

When beta cells stop producing insulin, your body’s cells take in less glucose, while your liver releases more, resulting in a dramatic rise in blood sugar levels to as much as 10 times above normal. The excess sugar "spills" into your urine, drawing water with it. This accounts for the frequent urination (polyuria) and insatiable thirst (polydipsia) that can accompany this form of diabetes. It can also lead to dehydration.
 
You may also notice that while your appetite has increased, you’ve lost weight; this occurs because your cells are literally starved from a lack of nutrients and from the loss of sugar (since each gram of sugar in the urine equals four calories). Dehydration also contributes to weight loss. You may also feel fatigued and irritable, and your vision may be blurry because high sugar levels can change the shape of the lens in your eye and impair its ability to focus.
 
The start of symptoms in type 1 diabetes is usually abrupt and severe, occurring within days to weeks. Extreme hyperglycemia happens rapidly and leads to dehydration. Insulin deficiency causes other metabolic problems, including the unregulated breakdown of fat stores. This releases fatty acids, which are further broken down to ketones, products of fat digestion that accumulate in the blood. If your ketone concentration gets too high, your blood becomes acidic and diabetic ketoacidosis may occur, sending you into a coma. Fortunately, the condition can usually be averted or treated. (For more, visit the Type 1 Diabetes Center.)

Symptoms of Type 2 Diabetes

Because blood sugar levels rise slowly in type 2 diabetes, the symptoms of this more common form of the disease may develop over years or may not occur at all. The early signs and symptoms are the same as for type 1 diabetes: repeated trips to the bathroom, thirst, and fatigue. But they may develop gradually enough to be easily overlooked. Other symptoms can include recurrent urinary infections, tingling or numbness in the hands and feet as a result of nerve damage, and recurring vaginal yeast infections. (For more, visit the Type 2 Diabetes Center.)

 

Guidelines for Diabetes Screening

The American Diabetes Association (ADA) periodically updates its screening recommendations for diabetes. Because type 1 diabetes usually is diagnosed soon after symptoms develop, the ADA does not recommend widespread screening. The ADA does recommend screening for type 2 diabetes because this form of the disease is more common and may go unrecognized for years.

The ADA recommends that everyone age 45 or over be tested for diabetes at least once every three years to ensure earlier diagnosis and intervention before complications develop. People under age 45 should also be tested as often as yearly if they have a BMI of 25 or more (see Calculate Your BMI) and have one or more of the following additional risk factors:
  • have a mother, father, brother, or sister with diabetes
  • are physically inactive
  • are African American, Asian American, Hispanic American, Native American, or of Pacific Islander descent
  • have given birth to a baby weighing more than 9 pounds or had diabetes during pregnancy (see Gestational Diabetes)
  • have blood pressure of 140/90 millimeters of mercury (mm Hg) or higher
  • have abnormal blood lipid (fat) levels, such as HDL cholesterol levels below 35 mg/dL or triglyceride levels over 250 mg/dL
  • have had impaired glucose tolerance or impaired fasting glucose when previously tested for diabetes
  • have polycystic ovary syndrome or a history of vascular problems.

Tests for Diabetes

If you display any of these symptoms or suspect that you might have diabetes, see a doctor promptly. Your doctor will take a full medical history and will probably perform one of three simple blood tests: a random plasma glucose test, a fasting plasma glucose test, or an oral glucose tolerance test. All these tests require a small blood sample that a lab will analyze for glucose content.

Random plasma glucose test
The random plasma glucose test measures glucose levels in your blood. If the glucose level exceeds 200 mg/dL, you probably have diabetes, especially if you’ve noticed symptoms. You don’t have to refrain from eating before having this test done, but the glucose content of your meals can affect the results, so it’s considered less reliable than the fasting plasma glucose test.

Fasting plasma glucose test
This test is the current standard for diabetes diagnosis. Like the random plasma glucose test, it measures blood glucose levels, but in this case, blood is drawn after you’ve refrained from eating for at least eight hours so there isn’t any chance of a meal interfering with the results. Normal fasting plasma glucose levels are less than 100 mg/dL, and levels at or above 126 mg/dL indicate diabetes. However, if your first test indicates diabetes, have a second one to confirm the results.

Oral glucose tolerance test
Currently, the American Diabetes Association doesn’t recommend an oral glucose tolerance test for detecting diabetes. This doesn’t reflect any doubts about the test’s accuracy. In fact, the oral glucose tolerance test is probably more sensitive than the fasting test. Instead, it’s an issue of practicality: The test is considerably more time-consuming and cumbersome than the fasting plasma glucose test.

For the oral glucose tolerance test, your glucose level is measured after you’ve fasted overnight. You drink a sugary solution, and then another blood sample is drawn two hours later. Glucose levels will rise and fall quickly in healthy people. But they rise above normal and decrease slowly in those with diabetes. A person whose glucose level is 200 mg/dL or higher when the second blood sample is drawn has diabetes. This test, like the fasting plasma glucose test, should be repeated on another day to confirm the diagnosis.

Tests After Diagnosis

A fourth test, the glycosylated hemoglobin test, is generally used to monitor diabetes after a diagnosis has been made.

Glycosylated hemoglobin test
Another measurement widely used in diabetes management is the glycosylated hemoglobin test. This blood test reflects the average blood sugar level over the preceding two to three months and will help your doctor monitor your efforts to keep your blood sugar as close to normal as possible. Because having food or a drink before the test won't skew the results, a glycosylated hemoglobin test can be performed at any time of day, even after a meal.

Hemoglobin is the oxygen-carrying protein in red blood cells. When glucose in the blood attaches to hemoglobin, the bound product is called HbA1c. (It's also known as glycosylated hemoglobin, glycated hemoglobin, or glycohemoglobin.)

Healthy, nondiabetic people usually have an HbA1c level of about 5%, meaning that approximately 5% of their hemoglobin molecules have glucose attached to them. If your diabetes has been well controlled during the previous two to three months, the HbA1c level should be close to normal, that is, less than 7%. If your blood sugar has been high, the level will be elevated. Studies have shown that keeping HbA1c levels low reduces the chances of developing complications of diabetes. It is therefore wise to keep HbA1c levels as close to the nondiabetic range as is safely possible. The American Diabetes Association advises people with the disease to strive for an HbA1c level of 7% or less.

Not quite diabetes
Some tests can also uncover lesser degrees of abnormal glucose metabolism, which may eventually develop into full-blown diabetes. A fasting plasma glucose reading between 100 mg/dL and 126 mg/dL indicates impaired fasting glucose. If this is the case and an oral glucose tolerance test is performed, a two-hour glucose result between 140 mg/dL and 200 mg/dL is considered impaired glucose tolerance. Both conditions raise your risk for diabetes and cardiovascular disease. To monitor these conditions, it's best to have annual glucose tests.

Dealing With the Diagnosis

Learning that you have diabetes is traumatic, and it can set off an emotional crisis. That’s understandable: Diabetes is a chronic, lifelong disease that affects nearly all aspects of your daily life, including the food you eat, the activities you pursue, and possibly even your choice of a career. Indeed, because of the amount of self-care required, diabetes places an extraordinary burden on those it affects. You must pay special attention to diet and exercise. You may need to test your blood glucose levels several times a day. In addition, you may have to take oral medication or give yourself multiple daily insulin injections.

But ignoring diabetes or failing to treat it correctly only paves the way for dangerous episodes of hyperglycemia, ketoacidosis, and hypoglycemia (low blood sugar). It may also result in serious long-term complications, such as blindness, kidney failure, and heart disease. Those who fare best and lead the healthiest lives accept their disorder, learn as much about it as they can, and work vigilantly to control their blood glucose levels.

Managing Your Diabetes

The treatment regimens needed to achieve and maintain near-normal, or "tight," blood sugar control differ for type 1 and type 2 diabetes. Type 1 treatment centers on replacing insulin to offset the body’s inability to produce it (see Managing Type 1 Diabetes). Type 2 treatment typically relies on exercise, weight loss, and one or more medications to overcome insulin resistance and compensate for the insulin shortfall (see Managing Type 2 Diabetes). Insulin injections, though, often become necessary. Most people with type 2 diabetes also have the added burden of managing one or more other conditions, such as obesity, high blood pressure, or high cholesterol.

Your treatment goal, regardless of which type of diabetes you have, is to keep your blood sugar levels as close to normal as possible (see Optimal Blood Sugar Levels ) to prevent damage to your eyes, kidneys, heart, nerves, and blood vessels.

A Team Approach to Managing Diabetes

You are the most important person involved in your treatment. But the attention and advice of a skilled physician, and often a team of health professionals, is vital to helping you develop the daily practices and lifelong habits necessary for effective diabetes management.

In many instances, particularly for type 2 diabetes, your primary care physician may be able to provide all that’s needed to ensure good care. But if extensive monitoring and adjustment of your diet, medications, and exercise regimen become necessary, you’ll probably best be served by a multidisciplinary team of professionals. Ideally, such a team would include your primary care doctor or an endocrinologist who specializes in diabetes, a diabetes educator (usually a nurse or nurse practitioner), and a dietitian.

Other professionals may be called to your team from time to time. For instance, diabetes puts you at risk for eye disease and blindness, so it’s important to visit an ophthalmologist regularly. Because the disease can damage the peripheral nerves that provide sensation to your feet, proper foot care is essential. Therefore, you may benefit from seeing a podiatrist periodically. If efforts to prevent the development of kidney or vascular disease fail, you may need to consult with a nephrologist (kidney specialist), cardiologist, or vascular surgeon.

Diet: The Foundation of Diabetes Treatment

Diet therapy is crucial to treating diabetes, but the approaches are quite different for type 1 and type 2. In type 1 diabetes, your diet must be coordinated with your insulin regimen. Because the goal is to match insulin delivery to insulin requirements, which are largely dictated by meal size and content, understanding the impact of specific foods on your blood sugar levels is key. On the other hand, type 2 diabetes is largely a consequence of overeating, so cutting calories is vital. In both forms of diabetes, it is important to consume the right mixture of carbohydrates, proteins, and fats every day to keep blood sugar levels as normal as possible throughout the day.

One dietary recommendation applies universally: Aim for a diet low in saturated fats and high in fiber, fruit, and vegetables. Why? Because both types of diabetes are associated with cardiovascular disease. The American Diabetes Association and the American Dietetic Association recommend that people with diabetes get most of their daily protein requirement from beans, grains, and vegetables, not meat. By cutting down on animal proteins, your diet will have less fat and cholesterol. And high-fiber foods may help lower both your cholesterol and blood sugar levels. A 2000 study in the New England Journal of Medicine found that a diet rich in fiber (about 50 grams per day) lowered blood sugar levels by 10%.
   
What Is a Standard Drink? Close Window

A standard drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled liquor.

   

Your Dietitian: A Valuable Ally

A dietitian or nutritionist can provide invaluable help as you develop a personalized eating plan. After all, you’re not making temporary adjustments; this is a lifelong commitment. Using food to prevent hypoglycemia, or to treat it if it occurs, is also a critical safety issue.

People who’ve been recently diagnosed are usually asked to keep a food diary to track their calories, carbohydrates, and fats. A dietitian can instruct you on how to meet your caloric and blood glucose needs by counting fat and carbohydrate grams, measuring portions, and adjusting your food intake to the amount of exercise you get. If you prefer, more structured menus have been developed specifically for people with diabetes. Check your library or bookstore, or contact the American Diabetes Association (see Resources).

Even once you’ve learned to manage your diabetes, you may find that a change in schedule, a trip, or a move to another part of the country necessitates some adjustments in your meal plan. On such occasions, consult your dietitian.
   
What Is a Standard Drink? Close Window

A standard drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled liquor.

   

Monitoring Carbohydrates

People with diabetes should try to get about 45%–55% of their daily calories from complex carbohydrates — that is, from vegetables, whole-grain breads and cereals, and simple sugars that exist naturally in fruit and low-fat milk.

Watching your carbohydrate intake is particularly important because most of the glucose flooding your bloodstream after you eat comes from the breakdown of carbohydrates. But not all carbohydrates are equal. The amount of glucose and the speed with which it’s released into your bloodstream varies, depending on the food’s manner of preparation, its fiber content, and other foods it’s combined with. For example, raw vegetables are digested more slowly than cooked ones; eating fats with carbohydrates retards digestion; and drinking a glass of apple juice raises blood sugar more rapidly than eating an apple.
   
What Is a Standard Drink? Close Window

A standard drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled liquor.

   

Targeting Fats

Recently there has been a keen interest in high-fat, high-protein, low-carbohydrate diets as a means to lose weight. Although short-term studies have shown that these eating plans can be an effective way to drop pounds, no long-term studies have verified that they are more effective than other low-calorie diets. In addition, some of these diets fail to distinguish between unhealthy saturated and trans fats (which increase the risk of heart attacks, strokes, and other forms of cardiovascular disease) and healthier unsaturated fats (which may lower cardiovascular risk when consumed in moderation). As a result, experts question the safety of the high-fat, low-carbohydrate diets in the long run, especially in regard to cardiovascular risk. That’s why no more than 20%–35% of your total daily calories should come from fat, and less than 7% from saturated fat.

Saturated fat is notorious for raising unhealthy LDL cholesterol levels. And it speeds the artery-clogging process called atherosclerosis, raising your risk for heart disease. It’s found in meat, dairy products, and certain vegetable oils, such as palm oil and coconut oil, and it’s generally solid at room temperature.

Trans fats, partially saturated vegetable oils produced through a chemical process called hydrogenation, also pose health dangers. These fats —  commonly found in margarine, deep-fried foods, commercial baked goods, and many other products — are identified on the label as "hydrogenated" or "partially hydrogenated." They raise the harmful blood lipids LDL cholesterol, triglycerides, and lipoprotein(a), all of which have been linked to heart disease. And they depress the healthy HDL cholesterol.
Instead, opt for polyunsaturated or monounsaturated fats. Polyunsaturated fats (such as corn, safflower, and soybean oils) and monounsaturated fats (such as olive, peanut, and canola oils) don’t raise cholesterol levels. Indeed, research indicates that monounsaturated oils reduce LDL cholesterol and increase HDL cholesterol.

The best way to reduce the saturated fat in your diet is by limiting your consumption of red meat, fatty dairy foods, and poultry skin. Choose skim or 1% milk, and buy light or low-fat cheeses and yogurt. To keep trans fats to a minimum, avoid margarine, shortening, and commercial baked goods. When eating dessert, stick with ice milk, low-fat or nonfat frozen yogurt, or fat-free ice cream.
   
What Is a Standard Drink? Close Window

A standard drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled liquor.

   

Sugar and Alcohol

Limiting sugar
Although sugar and so-called concentrated sweets that contain a lot of sugar were once considered dangerous for people with diabetes, small amounts won’t necessarily thwart your effort to control your blood glucose. Most people with type 1 and type 2 diabetes can consume some sugar as long as they count it as a carbohydrate and don’t add it to their diet indiscriminately. Of course, they must adjust their insulin dosage accordingly. Nevertheless, experts still advise limiting simple sugars because they raise blood glucose levels quickly. Artificial sweeteners, such as saccharin or aspartame (NutraSweet), don’t raise blood glucose levels.

Alcohol
You can drink alcohol in moderation if you account for the calories in your daily meal plan. Research has shown that drinking moderate amounts of alcohol can lower heart disease risk. Moderate drinking is defined as one standard drink a day for women and up to two a day for men (see What Is a Standard Drink? ).

You must be cautious, however. Alcohol can cause low blood sugar or further exacerbate a low blood sugar reaction. And because some effects of alcohol (such as drowsiness or slurred speech) resemble those of hypoglycemia, it can be hard to recognize a true diabetic emergency (see Symptoms of Hypoglycemia). Finally, while moderate drinking may have benefits, there is always the risk of developing alcohol dependence. Certainly no one should drink and drive, and drinking during a pregnancy can hurt your baby.

Healthy Eating Away From Home

For people with diabetes, eating out —whether at a restaurant, a function, or a friend’s home — is always a challenge. Portions can be hefty and packed with calories and saturated fat. When you eat out, it may help to follow these simple guidelines:
  • Ask how entrées are prepared, and avoid fried foods or dishes served in heavy sauces or gravies.
  • Choose skinless chicken, fish, or lean meat that’s broiled, poached, baked, or grilled.
  • Get the server’s advice in selecting healthy, low-fat dishes. Restaurants are used to dealing with special diets.
  • Don’t feel obliged to clean your plate. Eat a reasonable portion, and take the remainder home.
  • Choose steamed vegetables and salads to accompany your meals. Request low-calorie dressings and toppings, and if they’re not available, ask for all dressings, butter, and sauces to be served on the side so you can use them sparingly.
  • If you take insulin and know your meal will be delayed, time your injection appropriately. You may need to eat a roll or piece of fruit to tide you over.
  • If you crave a dessert, share it.

http://www.everydayhealth.com/diabetes/understanding/index.aspx           ( click here for more info )

Diabetes

http://www.fda.gov/diabetes/qna.html#1       ( click for more info )

Diabetes mellitus is a chronic disease in which blood glucose (sugar) levels are too high. Cells in the body break down glucose in order to provide energy for movement, growth, and repair. The hormone insulin is responsible for regulating glucose levels in the blood. Abnormally high levels of glucose can damage the small and large blood vessels, leading to diabetic blindness, kidney disease, amputations of limbs, stroke, and heart disease.

There are three common types of diabetes. Type 1 diabetes is usually (but not always) diagnosed in children and young adults. Persons with type 1 diabetes make no insulin and must take insulin every day. Type 2 diabetes is usually (but not always) diagnosed in adults over the age of 45. In type 2 diabetes, either the person is not making enough insulin, or the body is resistant to insulin and cannot use it properly. Gestational diabetes occurs during pregnancy: 2-4 percent of all pregnant women have gestational diabetes. If a woman has gestational diabetes, she has about a 40 percent chance of having type 2 diabetes later in her life.

About 17 million persons in America have Diabetes mellitus, but five million of them don't even know it. Nearly 1 million new cases are diagnosed each year. The disease affects men and women of all ages and ethnic groups. African Americans, Latinos, American Indians, Alaskan Natives, Asian Americans, and Pacific Islanders are more greatly affected than other groups.

For more information about diabetes, use the following links:

National Institute of Child Health and Development: Understanding Gestational Diabetes

MedlinePlus Health Information on Type 1 Diabetes

MedlinePlus Health Information on Type 2 Diabetes

HealthFinder: Diabetes

 

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