So You Have Diabetes: What Now?

You may feel a little scared and unsure. Heck, you may feel petrified and think your life is over. That's normal. You may have heard as a diabetic you are destined to go blind, die of heart disease, and have all your limbs chopped off.

All that bad stuff can happen: if you don't take your diabetes seriously and do something about it. But, if you do some learning and take action, you can live a long healthy life with diabetes. Diabetes is not a death sentence. But diabetes is a wake-up call telling you to start doing things differently in your life. You may find some of what you need to do hard, but the alternative is far worse.

You may end up thinking diabetes is the best thing that ever happened to you. Diabetes has a way of slapping you upside the head and motivating you to make important changes in your life.

So relax. Don't panic. Take it slow. Learn about diabetes. Take small positive steps. You'll do great. Many, many people live long and good lives with diabetes. It's these people you need to learn from. And you can be one of those people too.

This is the page I wish I could have found when I was diagnosed. With this page I have two goals:

1. Provide references to information sources that will teach you everything you need to know about diabetes. I don't even try to include everything you need to know about diabetes on this page.
2. Communicate some of my own lessons learned. I feel if everyone took the time to share their lessons we would all be better off.

Dislaimer: I am not a doctor and I don't play one on TV. Everything here is my opinion and my opinion alone. Double Disclaimer: I am a T2 diabetic and to the extent I know anything that's all I know anything about. The advice here does not apply to T1s and could be dangerous if followed by T1s. The advice here does not apply to any other type of diabetic. In fact, I am not giving any advice at all. You are not here :-)

Contents:

What Should You Do About Your Diabetes?

So, what should you do?

Good Diabetes Web Sites

Many of these links to pages created by Jenny and Jennifer, regulars on alt.support.diabetes. Their information is the best you can find. My page is not trying to replace theirs in any way. I would send people to these pages first to learn more. But I also think my page has a unique take that can help people too.

Jennifer's Advice to New the Newly Diagnosed

How Do You Know if You Have Diabetes?

I had symptoms for many years before I found out I had diabetes. Some clear symptoms are:

1. You feel thirsty and drink a lot of water. If they are filling up your water glass a lot at restauraunts, you may have diabetes.
2. You notice you don't heal as well you used to from cuts or injuries.
3. You feel pain and tingling in your hands and feet.

T2 Diabetes starts either 5, 6.5 or 10 years before the average diagnosis (http://www.medscape.com/viewprogram/145), so you don't want to wait.

If you have a friend with a blood glucose reader you can do some testing as a guide. With your friends meter if you see any reading over 170 then get checked. If in the morning, before eating, you see a reading above 110 then get checked. But if there is any doubt at all, go see your doctor and get tested.

Do People with Type 2 Always Deteriorate?

T1 Vs T2 Diabetics

Are You to Blame For Your Diabetes Because You are Fat?

I found out after my diagnosis that almost everyone on my Grandma's side of the family has diabetes, but she does not. She has also eaten moderately for her entire life.

One thought is that if you exercise and maintain a normal weight then it's possible you could postpone diabetes for your entire life. Or you could still get diabetes. In the end, you simply don't know.

So the blame game is useless because there's no real answer for you individually. What mattters is how you handle your diabetes now, that you do have control over.

You also have influence over your children. Educate your children about diabetes and how to prevent it. Teach them about exercise and proper nutrition. Give them a fighting chance of never getting diabetes, or at least delaying when they get diabetes for as long as possible. This is one situation where you'll be happy when your children don't follow in your foot-steps.

Relationship Between Obesity and Insulin Resistance (IR)

Diabetics Should Eat to Their Meter

1. Blood glucose meter. The meter shows you how you are doing during the day and how you specifically respond to foods.
2. A1C test. The A1C test shows you how you are doing over a period of time.

Get a meter and test strips from your doctor. Using the blood glucose meter tells you if your blood sugar is too high. You don't have to guess. You never have to guess. You can always tell how food is effecting you simply by eating and then testing your reaction to what you have eaten.

Once you start eating to your meter you'll notice you need to eliminate many high carb foods from your diet. You'll notice that veggies are good for your health and good for your meter. You'll notice you'll start losing weight. You'll notice eatin too much of any food will cause high blood sugar numbers. And you'll notice your blood work will show improved numbers. Your doctor may do a happy dance over your blood work.

Using your meter is easy. You just poke yourself with your needle, get a little drop of blood, and put it on the test strip that is connected to your meter. The meter will then tell you your blood sugar level. Around 80, but no lower, is an ideal "normal" number. You probably won't see that range very often. Anything above 140 could be damaging your body. You may think poking yourself to get a drop of blood hurts, but it doesn't really. You soon get used to it. Many people find they can poke the same area all the time without doing damage. Poke on the outsides of your finger, near the tip. Some people don't like poking their finger tip because then their finger hurts when they hit the tip. I don't find it hurts on the tip. As always, your mileage may vary (YMMV), so figure out what works for you.

Everyone is different. Some people can eat, without raising their blood sugar, a lot a food you can't touch. So your best bet is to try foods and test one hour after eating the food and then two hours after eating the food. You want your blood sugar at 140 or under. If it's over 140 then you ate too much. You can eat anything you want. There is no food you can't have. You just can't have too much.

You can have has much of a food as you are willing to have your blood sugar rise. Carbs directly raise your blood sugar levels. You can choose to eat a high carb food, like a potato, as long as you eat a portion that will keep your numbers within your target range. You find out how much of a food you can eat by testing.

For example, I can barely have any rice. Even small amounts of brown rice make my blood sugar skyrocket. Yet I can have a good amount of apple and oranges. I can have a couple tablespoons of ice cream as well without having any problems.

The way you figure all this out is to test. Don't rely on what anyone says. Don't rely on packaging. Test what your body does when you eat certain foods. Pretty soon you'll learn how your body reacts and you'll know what you can eat and how much you can eat.

Calories still count, so you can't only eat to your meter. With a meter only strategy you may find you can eat too much. It's not too hard to have good numbers yet eat way too many calories. Just keep your weight and calorie count in mind.

Studies show "normal" people spike at 30 minutes after eating carbohydrates. After 1 hour they are back under 120 mg/dl. They are often under 100. As a diabetic you probably won't see these numbers unless you eat low carb and smaller portions.

Some studies show your .5 hour readings don't correlate to heart disease and other problems whereas people who spiked at 1 hour were correlated with problems. So if you can only test once you might want to test at 1.5 hours after eating carbs. You'll miss your peak reading, but you'll be able to tell if your readings are heading down, which is what you want.

Using Your A1C Test to Control Diabetes

You'll probabably be asked to take the test every 3 months. If you aren't asked to take the tests several times a year you may want to force the issue. Your A1C is an important marker of how you are doing. Without knowing your A1C you lose valuable input into tracking your progress and making necessary changes.

A lower A1C means your blood sugar has been generally lower than if you had a higher A1C. And a lower A1C is better because it means you have a much lower risk of diabetes related complications.

A good target A1C is in the 5 range. Lower is better. Being in the 5 range is called being in the 5 percent club. This is a club you want to be in. Research has shown being in the five range means you'll have less of a chance of complications. Anything over 6 means you are at a higher risk for a heart attack and other complications. There are no guarantees of course. Complications may still happen even if you are in the 5 percent club. But I play the odds and the odds are better if you are in the 5 percent club.

Recommendations differ widely on what's an OK A1C. You'll be tempted to accept a higher A1C because it means you'll be able to eat a more "normal" diet, but that's not healthy. Death rates are directly tied to your A1C level so you want to keep it as low as you can.

If your A1C is high it means you need to tighten your control by exercising more and being more careful about your diet. If you do those two things your number will magically go down. It's fun to track your progress that way. You'll notice that if you say screw it and loosen your control your numbers will go back up too.

Your A1C is a longer term check on how you are doing. You still need to test using your meter and make adjustments according to your meter.

Some people don't use A1C in controlling their diabetes. I believe strongly in getting the most information you can and using it. The A1C is a good measure to have. A1C is used in many studies so if you don't track it you are losing valuable insight into your health.

For example, one study found a 1% increase in A1C was associated with a 28% increased risk of death, which was independent of age, blood pressure, cholesterol, body mass index and smoking. So your A1C is an important test.

Apply the Test Results to Continually Help Make Yourself Better

Many people will test but not use the results to adjust their behaviour. The test results always tell you something, you just need to learn to read them.

If your numbers are rising and you think your control has been good, then it might be that you are getting a cold. Your blood sugar rises in response to sickness and stress. When I see that I immediately rest more which hopefully helps me get better faster.

You'll here people talk about control a lot. How is your control?, someone might ask. Control is keeping your blood glucose within your specific goal target range. When you are out of control your numbers are too high and that's when damage happens to your body. You stay in control through all the informaion you'll find in this page and all the sources of information you'll read. Clearly, staying in control is an important goal for a diabetic.

If your numbers are high then you need to find out why. Did you eat too much? Did a food contain hidden sugars? You can't trust labels. Are you particularly sensitive to a certain food? If you are then avoid the food or eat less of it. Or does a food not cause you to spike (really increase your blood sugar level)? It's always exciting to find a new food you can eat without worrying too much about how it will impact you.

If your numbers are trending up it could mean you aren't exercising enough or that you are gaining weight.

Every reading tells you something new. Use the information to learn and make yourself better.

Seek out a proactive doctor who is willing to give you a prescription for at least 300 test strips while you discover and customize your diet for you.

Carefully watch food does to you and base your diet on your personal response to food. You may not so low a carb diet to succeed.

To avoid complications from diabetes you do not need to maintain absolute, perfect control. That isn't physically possible anyway. What you need to do is maintain consistent control. Studies have shown that even if you make a few slip-ups in your control you are still helping yourself enormously in the times you have good control, so don't give up just because you are human and make a few mistakes.

When Should You Test Your Blood Sugar?

Test about 15 minutes before you eat so you can how many carbs you can get away with eating. If your numbers are low then you can eat more carbs than you could if your numbers are high. That might mean you could have a food you weren't planning on eating or you could have more of an old favorite.

I definitely test one hour and two hours after eating new foods or eating more of a food than I usually do. Times start from when you take the first bite of food. This is how I experiment and learn what I can eat and how much I can eat. If I try a 1/4 cup of rice, for example, and my numbers spike then I'll pretty much give up on rice for a long while. Then I'll try rice again later and see if anything has changed.

I know I can eat about 1/2 orange without spiking. I know that because I test eating different amounts of orange to see how I react. My standard is that I should never go over 140. Many people think this standard is too strict, but that's my standard.

Your readings will vary hour by hour, day by day, week by week, even for the same foods. No two days will be the same no matter how many pills you take or how much exercise you do. This will frustrate and anger you and sometimes you just will want to give up. But don't. It gets better. Then it gets worse again. Be prepared for a wild ride for a while.

Some people like to make a game of it. Your meter is like a Nintendo game machine and your blood sugar becomes the game score. You make whatever moves will get you to your score. If you are a competitive person this can be a useful way to see the whole process.

When you first start testing be prepared for how high your numbers can get after what you may consider a normal meal. It can be shocking. Until you start eating to your meter and you try to create your own low-spike diet by changing your meals, your numbers may be all over the place. You may find you have high morning numbers, high pre-meal numbers, and high post-meal numbers. As you test and eat to your meter, all those numbers will come under control.

Get Your Raw Tests Results Back from Your Doctor

The doctor may have much less strict standards than you do. If your doctor tells you you are doing fine you may actually be doing terrible.

Demand your tests results be sent to you so you can see the real numbers and make your own decisions on how you are doing.

Eating Smaller Portions Helps Manage Diabetes

Diabetic Treatment is All Over the Map

Many people disagree with my statement about not trusting the health care system and want me to water down the statement to say something softer. I won't. Everyone in the system is human and is capable of making mistakes. If you happen to be one of the mistakes then you are dead. Trust but verify may be a softer way of saying it, but in the end you are responsible for you.

Exercising and Losing Weight Helps Diabetes A Lot

Here are some resources you may find interesting on the exercise subject:

Diabetes Doesn't Go Away

Don't get sucked into buying miracle cures or magic herbs. They don't work. When something really works to cure diabetes we'll all know. It won't be a secret, hidden on web page somewhere. There is no conspiracy against publishing a cure.

Exercise, eat small portions, take a few drugs if your doctor recommends them, eat to your meter, and you'll be fine. There aren't any shortcuts.

Are Carbs Evil?

I am not able to answer that question, as much as I would like to. As usual I'll give you how I see it, and you can feel free to ignore everything I say. Given how confused I personally feel about the issue, that may not be such a bad idea.

There are two general issues as I see it:

1. Are carbs bad in your diet if you are not a diabetic?
2. If you are diabetic what should you think of carbs?

Humans don't seem to have a single perfect diet. People all over the world live on all kinds of different diets. We humans are marvelously adaptive in the foods we can eat. It doesn't seem that we can count on science to say exactly how we should eat.

From a general diet point-of-view, the opinion on carbs seems to be all over the map. It ranges from our ancestors didn't eat a high carb diet so neither should we to the only healthy diet is to eat high carbs because look at how long the Japanese (or insert your long-lived group here) live.

Most of those long-lived people eat moderately and get exercise. My guess is that has as much to do with their good health as anything. Plus, they usually eat fish which gives them all the good omega oils, which has got to help. Plus, they eat plenty of veggies and the veggies may do as much good as anything else they do.

You need vegetables and at least some fruits for vitamins and fibre, and they contain carbs. So you will need to eat some carbs to get proper nutrition.

In my mind there's no question that refined carbs, like white flour, especially when combined with fat, are both bad for your heart and bad for your weight. The more weight you gain the more medical problems you have the more likely you are to become T2.

Many of the studies saying saturated fat is bad for you don't control for carbs, so it's hard to separate out properly the interaction between carbs and saturated fat. In my mind at least, I am not going to eliminate saturated fats from my diet, as long as I am eating low carb. But I have somewhat reduced my consumption of saturated fats (steak, hamburger, etc).

If you eat unrefined carbs, from vegetables and whole grains, then it seems you'll be healthy. Could you be healthier eating some other way? Everyone says yes, but they don't agree on what way is better. It doesn't matter anyway for most people. Most people drink Big Gulps worth of sugar, eat McDonalds every day, eat candy bars, and all that high calorie low nutrition stuff. I would say refined carbs, especially in the large portions in which they are eaten, make for a really bad diet. A cookie every couple of days won't hurt.

But for diabetics that's not the whole carb story. Diabetics have a malfunctioning body when it comes to carb processing. For a diabetic a whole cookie could hurt because eating too many carbs causes a spike, a sharp rise, in your blood sugar. Spike can help make you diabetic. Spikes also cause a diabetic further damageand we want to avoid that damage if we can. And we can.

In your day-to-day life this means reducing carbs on a per meal basis so as to minimize your chance of spiking. As a diabetic an ambitious goal is to get all your calories and nutrition without spiking.

Eating carbs is a balancing act for the diabetic. That's why I'll say about 50,000 times on this page that your best friend is your blood glucose meter. Using your meter you can test how you are responding to food. It's your meter that tells you how many carbs you can eat.

There's a kind of parallel between carbs and cholesterol. Cholesterol isn't evil though it has got a lot of bad press lately. You need cholesterol for building your cell membranes. The difference between cholesterol and carbs is that you don't need to eat any carbs to survive. Your required daily intake of carbs is 0. Surprising? I thought so too. Your body will make the carbs it needs from protein and you are required to enough protein.

So you aren't required to eat carbs, but will eating carbs make your life better? I don't think you can realistically get all your nutritition in today's world without eating carbs from veggies and fruits. The Eskimos did eat mostly meat, but they ate their meat raw and they ate every part of their catch. I don't think most people will do that today.

Carbs are also likely a necessary part of endurance exercise. Carbs have been shown to help both performance during exercise, and promote healthy muscle recovery after exercise. Again, carbs come into the picture.

So I am not a frothing-at-the-mouth low carber. As a diabetic you should control your carbs to prevent spikes. Like many other T2s my choice of how to control the spikes is by eating a low to moderate carb diet. A better way to say it is that I eat an appropriate carb diet for my body and my life. If you are eating low carb as part of a weight loss program then that is another kettle of fish that I won't comment on.

I don't intend this to be a low carb advocate site. I am just telling you the decisions I have made and why.

Why I Chose a Low Carb Diet

1. Eat relatively normally and use medication to control your blood sugar.
2. Eat low carb to control your blood sugar. Low carb means different things to different people. My personal target is between 80 and 100 grams of carbs a day. More importantly, my target is to never go over 140 on my meter, regardless of the number of carbs. Perhaps if I ate smaller more frequently meals I could eat more carbs, but that approach won't work for me as I tend to eat too much when I eat more meals.

My choice is to eat low carb. My reasoning is:

1. Eating low carb gives me the greatest amount of control over my blood sugar. This is because if I don't eat a lot of carbs then I know my blood sugar won't spike.
2. If I don't spike then I won't do further damage to my body.
3. If I don't do further damage to my body then some of the damage that has been done will reverse and I won't get worse. My neuropathy has been getting better, so I know this approach works.

Other people will make a different decision based on their own priority list. It's your choice of course. If my body could tolerate more carbs, believe me, I would eat more carbs. But through my testing program I know what I can eat and not eat. If I had more faith in medicines to keep my blood sugar under tight control I might make that choice, but I don't think medicines will meet my stringent blood sugar control targets. They may meet your personal targets however.

Low carb is not the same as no carb. You don't have to be on Atkins or a South Beach diet to be on low carb diet. You just need to limit your carb intake to what your meter shows you can eat without spiking your numbers above your blood sugar target.

In the US the the average carb intake is 350 grams or more a day. I eat at 100 or less. So I eat low carb by definition, but that's still not no carb.

Diabetics Are All About the Vegetables

I find I eat acceptably well on a low carb diet. I miss bread and donuts, but I still eat them, just in very small quantities. I still eat fruit. I eat chocolate. And I eat a lot of veggies. It's not as bad a way to eat as you may think. And when you see your blood sugar and your A1C under tight control, it's a good feeling.

You won't eat a lot of processed foods on a low carb diet. I eat veggies (broccoli, carrots, lettuce, cucumber, peppers, cauliflower, etc), lean meat (chicken, turkey, fish, tuna), some not so lean meat (hamburger, steak), and some fruit (strawberry, orange, apple). More veggies than meat. I also eat a lot of cheese, salsa, nuts (almonds, cashews), sour cream, and spices. Depending on what by numbers are I made have a little potato or kidney beans.

It's the processed foods that contain sugar and trans fats and all the bad stuff for you. By eating low carb from natural foods you are eating better all the way around. That's why many of the low carb food vendors are going out of business now. You don't need specialized processed foods to eat low carb. You visit the produce section and the meat section and you are pretty much taken care of.

And I never go without a dessert, I just eat small portions or eat a low carb dessert. Food is still very fun for me.

Some Low Carb Foods I Would Hate to Live Without

Some foods I especially like are:

1. Dreamfields pasta. This is a low carb pasta that doesn't shoot my numbers (blood sugar) up and doesn't taste like cardboard. Some people find they can't eat it because it raises their blood sugar too much or causes them stomach discomfort (gas). I wouldn't like to do without this processed food item because adds more variety to my diet. It also makes it so I can fix a meal people who aren't diabetics will find more "normal."
2. Low carb tortillas. Low carb tortillas are a great bread substitute. You can make burritos out of them for a good low carb dinner or a quick snack. They are very versatile.
3. Low carb bread. Most low carb bread is horrible, but some is good enough.
4. Good quality chocolate. A high quality dark chocolate (85%) is a great a dessert. It tastes wonderful and you can have quite a bit of it without a lot of carbs.
5. Cheese. Cheese is low carb and very tasty. It is high in calories so you have to be careful about how much you eat.
6. Diet soda. Low carb and good to drink.
7. Splenda. Splenda is a sugar substitute that tastes very much like sugar but does not raise your numbers. It's great to put in anything. I use it to sweeten kool-aide, cheese cake, or on top of strawberries.
8. Breyers low carb ice cream. This stuff is so good. It's as good as any ice cream you'll taste.
9. Strawberries. Strawberries are a great low carb fruit. I can have quite a few strawberries without raising your numbers. As always test, but give them a try. Nothing is better than a fresh ripe strawberry. One my favorite desserts is fresh strawberries, cinnamon, splenda, smothered in cream. Delicious.
10. Carl's Junior low carb hamburger. You want a good quick meal, try the Carl's Junior low carb burger. It's excellent tasting and comes with a fresh salad. That's a good meal and you can almost pretend you aren't diabetic :-)
11. Subway salads. The problem with Carl's Junior is they aren't everywhere yet. Subway is pretty much everywhere and they have a lot of good low carb food choices in their salads. When you are on vacation and traveling you can usually always find a Subway and get a nice salad or wrap.
12. Grocery store salad bars. Many grocery stores have salad bars these days. You can often find a good meal in a grocery store.

Some more thoughts on food:

1. Raw carrots are usually OK. Cooked plain carrots will probably spike you.
2. Leafy greens are probably free in either either raw or cooked form.

What junk foods are there for diabetics?

1. Nuts. High in calories, but very tastey.
2. Popcorn. Works for many people but spikes others.
3. Sugar Free Candy. Most contain sugar alcohols that spike some people. And they give you explosive diarrehea, but they do taste good!
4. Wasa Cracker with Cheese. If you put them in the microwave they are very tastey. You can also add pepperoni and make a pizza.
5. A bite of any dessert you love. Do some testing, but have a single bite of any dessert you really love and thoroughly enjoy it.
6. Low carb icecream. Some is really excellent. It's still high in carbs though and high in calories.

Why are Your Morning Numbers So High?

Seeing your numbers high can be depressing so it's important you know it can happen. Your body is putting more sugar into your system so you'll have energy when you wake up.

The effect seems to vary a lot by person and even the same person over time. You may never know why it happens to you. I've tried over the years to figure out what causes it, but I've never found a consistent trigger.

Your test in the morning, after 8 or more hourse of sleep, is called your fasting blood glucose (FBG).

To attack the dawn phenomenon you need to mix things up. Some possible changes you can make are:

1. Meds like Metformin may help.
2. You may want to take your meds either earlier or later in the evening.
3. If I exercise very hard my numbers are always lower the next morning. YMMV.
4. Exercise in general may bring your FBG down.
5. I think if I eat too much food the night before then my morning numbers are higher. But this isn't always true.
6. Some people find eating a little protein before bed helps their morning numbers. The type and amount of food varies a lot by person, so you may have to experiment with different foods and when to eat them before going to bed.

There is a lot of discussion on this topic in the groups so pay attention when it comes up.

The dawn phenomenon is mysterious, but don't let it get you down. Your A1C can still be fine. The numbers that matter most are your post meal numbers and those you can control.

Help! My Numbers are Spiking. What should I do?

1. Try Another Meter

   By another cheap meter and strips to check you meter. Meters do go bad so you definitely want to rule out any problem with your meters before you start getting really concerned.

2. Check Your Control

   How are you doing with eating to your meter and exercising? Are you starting to eat more? Are you starting to eat different more "risky" foods lately? Are you not exercising as much? Have you been injured so it's been difficult for you to be as active lately?

   Take a look at retightenting your control. This is a constant process too. We always seem to adapt and ratchet up our less useful behaviours. Sometimes we need to reset ourselves back to our best habits.

3. Talk to Your Doctor

   Your IR may be going up or your beta cells may be dying in greater numbers so a change of treatment may be necessary. Diabetes doesn't stand still. We are never done with it. It's always a game of act and react. Diabetes an individual desease. What works for you may not work for others.

   You may need to up dosages of your existing medicines. You may need to go on a different drugs. You may need to start insulin. There are lots of things you can do.

   So see your doctor.

Are You Doing everything Right and Your Numbers are Going Up?

This is something I live in fear of. Enough beta cells can die that no matter what you do you can't manage your diabetes without insulin. Now I really shouldn't afraid. Using insulin is fine, it's just that I am trying not to so I would consider a sort of defeat.

Alcohol Lowers My Numbers

So if you think all pleasures have been denied you, it's not true. You can drink. Wine is even good for your heart and as a diabetic you have a much higher risk of heart disease, so wine drinking is a double win.

Just don't over do it. It can be tempting.

Having Diabetes Means You've Already Had a Heart Attack

This means your doctor should be talking to you about your cholesterol numbers (LDL, HDL, and triglycerides). If your doctor isn't talking to you about your heart then you may need a different doctor.

Your doctor may want you to take statins to lower your cholesterol. Consider this option carefully as many people have a bad reaction (fuzzy mind and body pain) to statins. I have a bad reaction to statins so I have decided not to take them. YMMV. Because of diabetes your cholesterol targets are so low you can't possibly hit them without taking statins. Diet and exercise won't be enough. A low carb diet has a very positive effect on cholesterol for many people. Your tris may drop way down. Your HDL can be increased quite a bit through exercise.

The whole cholesterol/heart diesease issue is a complex one. Do your own research and figure out what is best for you.

Your Doctor is Your Consultant

When you see your doctor:

1. Know yourself. Do you think you can stick to a strict program of diet and exercise? Or do you think you want a more medication based approach?
2. Take a notebook for writting down notes and questions.
3. Gather all information possible.
4. Bring any papers you have questions about along with you. Ask your doctor about them.
5. Ask about options, both drug, and non-drug. Make sure you cover diet and exercise options with your doctor.
6. Tell your doctor you do not want a one-size fits all approach. Tell your doctor you want a custom program fine-tuned for you and your life.
7. If your doctor isn't answering your questions or doesn't want to treat you like an individual, then don't be afraid to get another doctor.

Diabetes News Groups

Diabetes Books, Magazines, and Organizations

Diabetes Health Targets

1. Damages your beta cells in your pancreas which causes you to produce less insulin.
2. Damage your large blood vessels (heart, legs, brain. etc) and small blood vessels (kidney, eyes, nerves, etc).

Dealing With Diabetic Neuropathy

Neuropathy is not pleasant. Not pleasant at all. And there's not much that can be done about it.

Asprin won't help. It's not that kind of pain.

The biggest problem I had with neuropathy is that I had it for a long time yet I didn't know I had it. I ignored or explained away all the little pains neuropathy creates. Looking back it's hard to believe how stupid I was. But I am not alone. A lot of people report ignoring the symptoms of neuropathy. What stinks is that neuropathy could tell you that you have diabetes, but you don't understand about neuropathy until you find out you have diabetes!

What can you do about neuropathy? Neuropathy can be reduced, even somewhat reversed. Here's my plan:

1. Get your blood sugar under control. Controlling your blood sugars is the most important thing you can do to control neuropathy. Control means getting your morning numbers (fasting) and your post meal (post-prandial) numbers under control. Both need to be under control, not just one or the other.
2. Take Evening Primrose. I take 1300 mg at night.
3. Take ALA (Alpaha Lipoic Acid). I take 300 mg evening and night.

What Will Happen If You Ignore Your Diabetes?

The temptation to ingore diabetes is immense because the complications seem so far in the future. You can have the donut now and nothing bad will happen now or even a month from now. The bad stuff happens later. For many people having the effect of complications so far in the future helps then pretend to be a normal person and eat whatever they want. That's a mistake.

It doesn't hurt to snatch a peak behind the curtain and see what awaits those who don't control their diabetes. Most real life T2s don't own a meter. Most don't keep their blood sugar under tight control. What can they expect?

Diabetes is really a group of serious diseases caused by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin.

Diabetes can lead to: severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputations. Yes, lots of people have their parts chopped off or go blind. Excess blood glucose also impairs the ability of your white blood cells to fight off infections and heal wounds.

Diabetes is the fifth leading cause of death by disease in the U.S. T2 diabetes involves insulin resistance (IR). IR the body's inability to properly use its own insulin. IR usually occurs in those who are over 45 and overweight, but IR has now become a popular disease with obese children and teens in recent years.

How do you get your morning numbers downs?

This is the advice from oldal on alt.support.diabetes:

  FbG is difficult to control because it represents a balance between your
current level of insulin resistance;   the current level of damage to your
beta cells;  and your liver's response to your Circadian rhythm.     You can
react  to  a 2-hour-after-eating problem by cutting your carbs for that meal
but it's rather difficult to wake up some morning and decide to cut your
Insulin Resistance that day (especially since you have been working
diligently to cut your I.R. ever since you were diagnosed).

 Some approaches to reducing FbG:

   1.  Fool your liver somehow   (low G.I./ low carb snacks at bedtime)

   2.  Order your liver to cut  down  the !#%! glucose releases  (metformin,
alcohol)

   3.  Reduce your Insulin Resistance

       a.  Become an aerobics instructor
       b.  Intensify your exercise regime  (become an aerobics student)
       c.  Add anti-I.R. meds to your regime  (metformin, TZDs)

   4.  Supplement your damaged beta cells  (Lantus, Levemir,  NPH insulin at
bedtime)

Why is High Blood Sugar Bad For You?

It is said the damage from high blood sugar begins with damage to blood vessels. Clinical studies have shown, over time, high blood sugar levels cause an impressive number of serious health problems: diseases of the kidney, retina, nerves and heart.

Live Longer By Brushing Your Teath and Flossing

Diabetes and Insurance

Diabetics at Risk of Low Testosterone and Sexual Disfunction

Can a Diabetic Give Blood, Organs or Bone Marrow

Donating Blood

Some people are told taking Metformin or insulin means they can't donate. Some people are told they can't donate because taking blood may upset their blood glucose levels. Some people are told they can't donate because we aren't sure yet what causes diabetes so they don't want to take the risk. There are many possible reasons to be denied.

The Red Cross guidelines allows diabetics in good control to donate whether taking oral medications or insulin (except those who have taken Bovine insulin since 1980).

In the UK if your diabetes is treated with tablets or insulin, then you will not be able to give blood.

Overall, many diabetics give blood on a regular basis, so you might be able to as well.

Donating Bone Marrow

Donating Organs

Take Care of Your Feet

Diabetes and Kidney Disease

Which Blood Glucose Meter Should You Use?

You should be able to get your meter for free. Either your hospital, doctor, or the manufacturer will probably give away a monitor. They give away monitors because it is the test strips that are expensive. They must make a fortune on tests strips. You need the test strips for the rest of your life and they price accordingly.

Decide if you want to keep your free monitor. Use your free monitor for a while and then decide if you want to keep it or use another one. You'll have to do some research to see if there is another monitor that you will like better. There are different kinds and one kind may appeal to you more.

Some issues to consider when picking a meter:

1. Strip Cost. Test strips are designed for a particular meter or meter family. As part of your meter selection process take a look at what you can buy test strips for. Strips vary widely in price and it could make a big difference to you.
2. Amount of Blood. Meters differ in the amount of blood they need to get an accurate test. Some meters require smaller drops and that means you need a smaller prick which should hurt less. This may be an important consideration.
3. Strip Loading Style. Some meters uses a motorized drum like device which loads a bunch of strips at once. It can make testing a much simpler experience, especially if you aren't coordinated or have a medical condition that makes gripping difficult. Test strips are small and can be hard to handle.
4. Bulk. Meters differ in their size. Having a small meter may be important to you or it may not matter at all.

Where can you buy test strips?.

1. Meter manufacturer. If they sell the strip they might be cheaper than other sources. They may just direct you to another more expensive source.
2. Ebay. This may not be your cheapest source, but it is a source.
3. Your pharmacy or other retail store.
4. Your doctor may give them to you for free.

How do you know if your monitor is accurate?. This is a question that I had. How do I know the number on the meter is any good? There are several methods of verifying your meter.

You will get tested regularly through your hospital. Take a reading with your meter before you go get tested at the hospital. Write down the reading from meter for later. When the results come back from the hospital compare the numbers. They should be pretty close. Blood testing is a relatively inexact procedure, so don't expect too much.

Another way to tell if your meter is accurate is to use the Check Solution. The instructions on how to run the test should be in your meter's manual. Run the test about five times. A wide spread in the readings could mean your meter is broken or that the test was run improperly. Try a new batch of strips. Perhaps your strips are old or contaminated? Or perhaps the first drop out of the Check Solution was not discarded.

Readings from your right and left side can be different. Do some testing of your own to see how your numbers differ by side. My numbers are lower on my left side so that's the side I test on :-)

If you run 10 tests on yourself in a row the numbers will be all different. Your blood glucose is changing all the time so there's no real reason to expect the readings to ever be exactly the same. Plus, there's just a natural variation because of the mechanical reading process. If you get a really high number that doesn't seem right then run another test to check. Wash and dry your hands before taking the second test.

Many meters come with sofware that will run on your PC and you can download your meter readings into the software. Then the software will culculate highs, lows, averages, and produce all sorts of pretty graphs. If that sounds good to you then be sure and check if your meter will have that feature.

For what it is worth, at the time of this writing (July 2005), Dr. Bernstein's clinic recommends the Bayer Contour meter.

Advances in Monitors

When Should You Fire Your Doctor?

Diabetes, in particular, is a disease with a wide range of treatment options. This is partly because diabetes is defined by having blood glucose of certain levels at certains times (fasting, etc). Over time the blood glucose levels defining a diabetic have been going way down. People diagnosed as diabetics today may not have been diagnosed as diabetics 20 years ago, simply because the blood glucose entrance criteria has gone lower.

There are many cases on the news groups of people with high and even very high blood glucose levels who are being told by their doctor that they aren't diabetic. If your morning reading is high and your doctor isn't concerned, then get another doctor.

There are people with high A1Cs that are being told their control is great and they are doing great and there's nothing to change. Get another doctor.

There are people who are still given very high 1 hour post meal and 2 hour post meal blood glucose targets. Get another doctor.

There are people who are told they don't need to test frequently. Get another doctor.

If a doctor insists on treating with meds and refuses your requests to try more diet and exercise as well, then it may be time to find another doctor.

If your doctor only gives you 15 minutes of office time, that's normal.

How do you find another doctor?

You are Your Own Doctor

For example, if your doctor prescribes you cough medicine, it's your responsibility to ask if it's sugarfree. Your doctor may forget you are diabetic and prescribe you normal people cough medicine.

What Tests Might You Have Done?

1. c-peptide - This test indirectly determines the amount of insulin your pancreas produces. Sometimes people are misdiagnosed as being a type T2 diabetic when they are really a T1. Very high fasting BGs can be and indication that you are really a T1. Not all docts will do the c-peptide test and that test can help confirm which type of diabetic you are.
2. complete thyroid analysis
3. estrogen/progesterone/testosterone
4. lipid profile

Blaming the Patient

Now we have the real attitude. So it has nothing to do with
poor advice and guidelines - non-compliance is the real
problem! What you're implying is that it doesn't really
matter what is advised - it won't be followed anyway. So
it's the patient's fault.

I don't comply with the ADA/Diabetes Australia guidelines
either. Nor do some of the other posters here. In fact, I
directly contradict their guidelines on diet and testing. 

Odd, that.

It's also odd that back when I dropped in on the local
support group people asked the CDE questions like "I'm
taking the pills the doctor told me to and I lost a lot of
weight and my numbers are still too high - Why? What should
I do?" 

After the CDE had responded I would ask just two questions:

"What did you eat for breakfast?"
"How often and when do you test?"

The answers were invariably a version of "Oh, I eat my
healthy three "carbs" of cereal, skim milk, toast, just like
the Diabetes Australia dietician told me" and "before
breakfast and before dinner, just like the doctor told me".
Well, like the doctor used to; it seems the local one is
suggesting some extra testing these days.

Blame the patient. How often have we heard that before?

Does it never occur to those with the responsibility of
advising on public health that, if the advice is not
producing the right results, the problem may be the quality
of the advice and not the level of compliance?

Should You Take a Vacation From Diabetes? Dealing with Diabetes Burnout

One suggestion is to take a periodic vacation from your diabetes. Don't worry about what you eat. The idea is this will lessen the constant stress of dealing with your disease.

In the US Independence Day is on July 4th. Some people declare that day independence day from their diabetes as well. They will have the foods they would normally deny themselves: apple pie, buns on their hot dogs, french fries, mash potatoes, potatoe salad, corn on the cob, and all the other most excellent picnic foods.

Should you take a short vacation from diabetes? I can't answer that. As always, it's up to you.

It's impossible to have perfect control in general. So you will always have some times when you do well and other times when you do poorly. The key is not letting a relapse turn into colapse. Don't let a little bad control push you over the edge into saying it doesn't matter and then falling off the control wagon for years. A couple of weeks of bad control probably won't hurt you that badly. A year of bad control will probably do some damage.

One suggestion for when you purposely practice bad control is to still take blood glucose readings. This helps give you an idea what's happening to you and in time it will likely prompt you back into better control. Once you say screw it and stop testing then you know you are in a bad place. What will start you testing again? What will start you bad on the path of good control?

Like for exercise, an all or nothing attitude for control doesn't work. One study showed those people who exercised 30 minutes at time wouldn't get as much total exercise as those people who just tried to walk a certain number of steps a day. The reason was that the people who blocked of exercise in time chunks would skip exercise completely if they didn't have time. The people who tried to walk a certain number of steps would still get some exercise, even when they didn't reach their target.

Maybe contol is the same. When you try for perfect control you end up with a worse overall results because when you lose control you go out of control. Allowing a little bad control at times may give you better control over the long run. Forgive yourself and be understanding for the times when you don't live up to your expectations.

Software for Diabetics

Disaster Prep - Know Your Meds

What can you do?

1. Keep a list of the medications you take.
2. For each medication know your dosage. Many people (like me) just take the right numbr of pills and couldn't tell you what dosage they take.
3. Keep your meds together you can quickly take them if you have to evacuate.
4. Have an ID with you to help with expedite your medical care. At least have your social security number memorized.
5. Keep a copy of your meds list in your wallet.

Disaster Food Supplies Considering the Diabetic

I try to eat as much fresh and unprocessed foods as I can so my normal pantry would not otherwise have the foods I could eat in a disaster. Your situation may be different.

Some thoughts on what you need and/or could do:

1. The Red Cross will probably start distributing water if you don't have power for a while.
2. Leave right away if your local authorities tell you to evacuate.
3. Call your Red Cross shelters if you don't have transportation.
4. Without electricity food in your refrigerator will only be good for about 2 days. Food in your freezer will probably last 4 days. The more you open the door the shorter your food will last.
5. I have all my medications in a central place so I can just scoop them up within a minute. Acutally my plan is take the whole drawer with me. I try to keep at least a weeks worth of meds at all time, including test strips.
6. Gallons and gallons of bottled water. Have individual sized bottles for each person as well.
7. Buy as much ice as you can store. If you have some lead time get and make as much ice as you can and store it in whatever coolers you can.
8. Lots of toilet paper and paper towels.
9. Can you flush your toilet using a bucket of water? Modern toilets may need pressure/electicity to work so you may need to make some alternative arrangements for going to the bathroom.
10. Have lights and a radio that don't require a battery. We have crank versions of each.
11. Good solid hiking shoes with socks.
12. Manual can opener.
13. Fill the gas tanks of all vehicles.
14. Fill the bathtub with cold water.
15. Aspirin and other first aid kit items.
16. Vitamins.
17. Pet food.
18. Important photographs and papers.
19. Packets of condiments like mayo, mustard, relish, ketchup.
20. Penut butter.
21. Wasa crackers.
22. Canned fruits and vegetables of all descriptions. They can be eaten directly from the can.
23. Jerky.
24. Nuts.
25. Dark chocolate.
26. Sugar of some sort if you have hypos.
27. Diet soda.
28. Low carb bread.
29. Low carb protein bars.
30. Cans of tuna, salmon, corned beef, chicken, spam, chili, and corned beef.
31. Powdered milk.
32. Coffe and tea.
33. MRIs- which are ready to eat meals you can purchase over the web or at survival stores. They won't work for diabetics, but they will work for other people in your party and that leaves more of the other food for the diabetics in your household.
34. Candles.
35. Fresh Veggies: lettuce (for the first day or so), celery, cucumbers, tomatoes, peppers, apples.
36. Ice chest full of ice. Put the stuff you use frequently (milk, mayo, cheese, etc) in the ice chest, not your fridge or freezer as these get warm fast when opened.
37. Before your food goes bad have a big party with your neighbors so it doesn't go to waste.
38. If you are a T1 you need to consider your insulin supplies. I don't know what special considerations are appropriate.

If you have some lead time before the disaster get what you need before everyone else hits the store. On a permanent basis keep as many of the items on hand as you can.

Why Test On the Side of the Finger and Not the Pad?

No technical reason that I know of. It doesn't matter. Use any part of your finger from which you can get a good drop of blood.

People say they use the side of your finger because it hurts less. Fingertips in general are pretty sensitive because they have many nerves which means they have more feeling and are more likely to hurt when poked. As we use our fingers all the time any injury on the fingertips may be more annoying.

There is some thought that a wound on the sides of your fingers are less likely to get irritated by friction because they are more protected.

But you can pick the part of your finger that hurts less for you.

If you bruise easily, you may want to test on the pad of your thumb as the bruises will be less visible. People with slender fingers also may want to try testing on their fingertips. Bruising and irratation can be minimized by holding direct pressure on the test site for at least thirty seconds.

If you play a musical instrument you may want to restrict testing to your off hand or select a suitable part of your hand. If you play the guitar, for example, you may not want to test on the fingertips of your fingerpicking hand.

Perhaps other jobs have similar considerations? People who type a lot may not want to test on their fingerips either because their fingertips will be constantly hitting the keys.

Many people end up using the same finger and the spot all the time because they don't see any spots and don't create painful areas over repeated tests.

The side of the finger close to the fingernail is an area many people have found works for them.

Some people have complex rotation patterns so they can cycle through different tests sites over time. This ensures when you cycle through your test sites again your wounds should be completely healed. One example rotation pattern is to use both hands, try the outside edge of each finger, then try the inside edge of each finger. Every pass through pick a different test site so you don't use the same test sites again for a long time. This kind of pattern gives you a lot of testing options and should help you reduce your pain.

How Should You Use Your Lancet? (the thing you stick yourself with)

The Stick: Stories of Complications from Diabetes

Being afraid isn't bad if it motivates you to do something different from what you have been doing. Use the fear to rethink your life and find the motivation to make changes. The average T2 doesn't make changes and bad things happen to them. Once you learn to take personal responsibility and you learn what changes you can make, you can end up feeling better than you ever have before.

Misc Bad Things

1. Four out of five diabetics will develop some sort of complications.
2. 95% of amputations not related to trauma are from diabetes.
3. Diabetes is a leading cause of blindness
4. Ron Santos, a former major league ball player, lost his legs.

Yes, It's Serious

Foot Problem Story #1

Missing Toe

The Carrot: People Do Get and Stay Better

If you read the news groups you'll read about people all the time that start of with really high A1Cs and blood glucose levels and bring them down very fast with a good diet and exercise. It can be done and people do do it. So can you. Don't every think that you can't. It can be done. And you can do it. You really can.

Issues to Consider at the Dentist

Bad Gums and Teeth

Now that my numbers are under control my teeth and gums are better. They aren't great, they are just better.

I think dental hygienists could be a big help in diagnosing diabetes if they would bring it up to their patients who have problems and appear to be a little overweight.

Feeling Jittery and Heart Racing

Novocaine has epinephrine in it to limit bleeding. Epinephrine is adrenalin and causes tachycardia (rapid heart rate) and increases blood pressure.

Discuss it with your dentist. Consider asking your dentist to use a local with less epinephrine.

Good Teeth Care is Also Good Heart Care

Eat Before or After Walking?

But your liver may sense falling glucose and it can dump glucose in support of your effort. This is like the dawn liver dump that happens to many people and is why your numbers can sometimes be higher after exercise. Having your numbers higher after exercise can be very frustrating because exercise is supposed to help, not hurt!

Some people are more sensitive to exercise that others. How sensitive are you? Test! You may find there's a lot of variability in your response to exercise and food. I know patterns are hard to find.

I usually eat a small snack before exercise and after exercise just to try and even my numbers out. Other people don't need to do this. You'll have to figure out what you need to do.

I know you are thinking "I'll just skip this whole problem and not exercise!" Naughty naughty.

A List of Lowcarb Fruits and Vegetables

A common misconception about low carb is that it's all about eating meat. It's not. You can have fruits too, in moderation, and you can have almost all the veggies you can eat. Personally, I think one of the great pleasures of life is eating fresh summertime veggies and fruit, I would never give those up for the sake of any diet. They are one life's great pleasures and a gift of nature. When eaten properly there are no worries.

What are some good low carb fruit options?

1. Avocado
2. Blackberries
3. Blueberries
4. Cantaloupe
5. Cherries
6. Honeydew
7. Peaches
8. Plums
9. Raspberries
10. Strawberries

Berries of all sorts are often safer for diabetics than other fruit. Try them in cottage cheese or yogurt. Sugarless berry jams are also very tastey.

What are some good low carb veggie options?

1. alfalfa sprouts
2. arugula
3. artichoke
4. artichoke hearts
5. asparagus
6. bamboo shoots
7. bean sprouts
8. bok choy
9. broccoli
10. broccoli rabe
11. brussel sprouts
12. cabbage
13. cauliflower
14. celery
15. chard
16. chicory
17. chives
18. collard greens
19. cucumber
20. dandelion greens
21. endive
22. eggplant
23. escarole
24. fennel
25. hearts of palm
26. kale
27. kohlrabi
28. leeks
29. lettuce
30. mushrooms
31. onion
32. parsley
33. radicchio
34. radishes
35. red, green, yellow and hot peppers
36. rhubarb
37. sauerkraut
38. scallions
39. snow peas
40. spaghetti squash
41. spinach
42. string or wax beans
43. summer squash
44. zucchini

To see how much of a fruit or vegetable you can safely eat, what you do? Test. That's the only way you'll know for sure. Don't stop eating high quality foods like fruits and veggies just because you think they are too high in sugar. Test and find out.

Can I Go on Vacations as a Diabetic?

1. Have a letter from your doctor stating that which medications you need for which particular problems. Make sure to include your strips and meter. If they are lost or stolen insurance should pick up the tab for buying new ones.
2. Get extra scripts to take with you in case something is lost or stolen.
3. Leaving medications and test strips in your car can destroy them if the car temperatures get too high.
4. Keep your medications in their original packaging. Cops, airlines, and pharmacists react better to medicines in their original bottles.
5. Be prepared to have you medications and devices confiscated. In this era of paranoia about terrorism all sorts of wierd things can happen.
6. I take low carb protein bars along just in case I can't find any food I can eat.
7. Take a backup meter and replacement batteries.

Newly Diagnosed. Why am I so Hungry?

Diabetics can suffer from a condition called "Glucose Toxicity." Glucose Toxicity is caused by extended exposure to high blood sugars before diagnosis.

Many people find when their blood glucose is very high they get very hungry, extremely tired, and feel lots of aches and pains. When the blood sugrar comes under control then so will many of the symptoms.

But getting your blood sugar under control is difficult because Glucose Toxicity messes up your already messed up glucose metabolism. Yet you have to get your blood sugars under control and keep them that way for a while.

That's why for the newly diagnosed diabetic the early Days can be frustratingly difficult.

Is Walking Getting More Painful?

It can be caused by high blood glucose, like Peripheral Neuropathy. Both nerves and the wall of the arteries get stiff and brittle by the glycation process.

Your doctor, of course, will have to diagnose what's really wrong, and there are treatments.

What is important is to not just ignore the pain you are feeling as nothing. It could be something so get it checked out.

For more information take a look at:

I Got a Gusher. Blood Sprayed Everywhere! Why?

It seems to happen most when you are wearing white.

I haven't seen explanation of why this happens. But it does seem to be fairly common, so there doesn't seem to be a reason to be concerned.

Some people think it happens more when you have been active and your heart rate up, but this hasn't been true for me.

The gusher is one reason I would never test in public or at an eating table. It's disturbing enough to me when it happens, it would probably freak other people out.

Is Coffee OK for Diabetics?

Who should you believe?

No idea.

May current opinion is that coffee is fine for me and the majority of science is on the side of coffee being Ok to even being protective. I test after drinking coffee and my numbers seem fine. You should do your own tests too.

And there's a larger point here about acceptable risk. Even if coffee was a little bad for you, does that mean you shouldn't drink coffee? That is of cource a personal opinion. I love coffee and I drink a lot of it. I don't want to give up one of the few simple pleasures I have left without a darn good reason. Your mileage may very.

Be Careful of What You Eat at Hospitals

To get the food you want you may need to become the "patient from hell." That doesn't be mean or nasty, but it means you need to take charge of your diet and don't meekly go along to get along. You need to make sure you are being taken care of and you are getting the diet appropriate for you.

Some points to consider:

Why is My Blood Sugar Higher After Exercise?

What is happening is you are probably using enough glucose during exercise to cause your blood sugar to drop. Your liver sees this and causes more glucose to be dumped to help you sustain your exercise level.

This is a known effect so don't get worried.

Try eating 2 or 3 gram dose of pure glucose every 15 minutes while you exercise. That might prevent the glucose dump. Glucose will go straight to your blood stream and might work better than eating food because food must be digested and may dump a lump of sugar into your system all at once.

Or try eating a light carb snack, like a slice of bread or a portion of fruit, before exercising. If you know you are going to exercise hard you may want to eat more carbs before exercising.

Some people exercise after eating. Most people don't feel comfortable exercising after eating though.

Muscle holds about 6 - 7 minutes of stored glucose to handle energy demands. When you need to suddenly run away from a lion, this is the energy that's used.

Then your muscles start using the blood glucose which doesn't require insulin during exercise.

Then when your blood glucose is lowered to a point your liver releases more glucose to replinish the blood. But because of your diabetes your liver may overshoot and doesn't stop releasing sugar when the previous level is reached.

You may find the less strenuous exercise, like walking, just lowers your numbers. More extreme exercise may raise your numbers. If you exercise really hard you may blow through the spike and your numbers will lower again. Exercise hard for 90 minutes and your numbers will probably be low. They may go really low, so be careful.

The solution isn't to stop exercising. That would be too easy :-) Exercise helps:

1. Your blood sugar control all day every day.
2. Reduce your risk of heart disease. A critically important point for diabetics who are at increased risk of CHD.
3. Improve your overall life quality.

You'll have to experiment to find what works best for you. Test all throughout various exercise lengths and intensities using different strategies for handling your BG.

Does a Low Glycemic Diet Help Prevent Spikes?

I can't answer this question for you. You'll need to perform your own testing to see a low glycemic approach works for you.

For me though it doesn't work. They raised my blood sugar, it just took longer to see the raise, which at first lead me to believe my numbers were better. They weren't better. Instead of seeing a spike at 1 hour after eating I might see the spike at 1.5 hours instead.

So the spike was still there. And as the goal is to not have a spike a LG diet wasn't effective for me. Controlling the number of carbs I eat works, the type isn't as important.

Your mileage may vary though. You'll have to test to find out.

The glycemic index approach works better for people with normal second phase insulin release because by the time the slower carb hits their system their beta cells have produced enough insulin to have caused the glucose to be taken up by their cells. For most T2s this doesn't work because their second phase insulin response isn't enough. If you don't know what this means don't worry about it, but you may want to do a little research.

Carpal Tunnel May be Sign of Impending Diabetes

Famouse Diabetics

1. Mary Tyler Moore
2. Billy Talbert
3. Ham Richardson
4. Halle Berry
5. Larry King
6. Dick Clark
7. B B King

Researching Diabetes

Some More Resources

Recipes

A Low BG 4th of July by Jennifer

For a low BG fourth of July Jennifer suggests the following very tasty sounding meal plan:

1. Grilled chicken with sweet and spicy rub (use the spices you like, add Splenda... rub on and grill)
2. Turkey burgers (add in some veggies - onions, mushrooms chopped FINE in a food processor, they'll keep your turkey burger moist)
3. If your food plan allows... regular hamburgers and hot dogs are also low carb.
4. Faux Potato Salad made with cauliflower (recipe follows)
5. Cole Slaw (if your recipe calls for sugar, sub in Splenda)
6. Red and Blue Berries for dessert

Fauxtato Salad

Serves 6, Per serving: 4.8g carbs.

1. 1 medium head of cauliflower, broken into florets
2. 1/2 C sliced scallions, including the firm green
3. 3 celery ribs, chopped fine, including some inner leaves
4. 1/2 green pepper, chopped fine
5. 1/4 C chopped parsley
6. Salt & Pepper to taste

Dressing

1. 2 teaspoons Colman's dry mustard
2. 2 Tablespoons cider vinegar
3. 1C mayonnaise (I use the new Best/Hellmans made with Canola oil... no trans fats)
4. 3 hard cooked eggs, chopped
5. 1/2 to 1 teaspoon celery seeds to taste
6. Paprika for garnish

1. Steam the cauliflower florets until tender, but not soft. Set aside to cool.
2. Put the scallions, celery, bell pepper, and parsley in a large salad bowl, add salt and pepper.
3. Make the dressing: mix the mustard, vinegar and mayo together in a small bowl until smooth.
4. When the cauliflower is cool, chop and add it to the veggies and mix with enough dressing just to coat the vegetables (you may have dressing leftover, depending on the size of your cauliflower). Stir in the eggs and celery seeds and mix well. Sprinkle paprika on top and cover with plastic wrap. Let sit in fridge for at least 2 hours for flavors to develop.

Anil's Advice on the Options for T2s

As a lifestyle modification statement, T2's have few options. When ever possible they should max out on exercise. This is true for non-T2s as well. There are simply way too many benefits for maxing out on this option.

Folks who max out on exercise

1. These guys have larger wiggle room in their total energy input in their diet. They can consume a bit more ready to digest high energy density processed foods. Depending on age and stage at which their diabetes is discovered the wiggle room may be more or less. Examples of high energy density (HED) foods: Candy, Pizza, Pasta, various examples of white bread, grain based products with all the fiber removed, icecream, many tropical fruits like Banana, Mango, Grapes, Pineapple.
2. Depending upon the stage at which the their diabetes is uncovered, they may or may not need medication. I suspect Tom, Roger, are an example of later while many of us who do take exercise seriously still need some medication.
3. To get good A1c results, the amount of exercise one has to do will change and is based on Age, Gender, fitness level before discovery of T2. Basically how much have you have neglected your self before discovery and how much you pigged out on your way to this place will influence intensity of lifestyle change necessary.
4. Exercise includes all the physical day to day activity. So a person who is bicycling for 30-40 miles a day may not need much more exercise as long as one has a prudent diet (i.e. diet free of HED foods).
5. When a person has been very active from the early discovery stage the need for medication is substantially less. If such person is further careful in either eliminating HED foods early on, the person is less likely to need much of medication. Assumption here is of course that the person is otherwise healthy.

Folks who do not exercise or can not exercise

1. They have to be very strict about intake of HED foods.
2. If they manage to reduce their weight and come near BMI 19-21 they may be able to do with few medication or no medication.
3. If the person's BMI is outside the "normal" range, need for medication does not go away no matter what the diet is. The further away you go the more cocktails of medication you may need. Again diet will influence only the strength and mix of medication you may need.
4. Diet strictness will control regression rate. But the rate of regression is steeper for these folks than one in first group.
5. The older you are (60 and above) harder it would be to control T2 with diet alone.
6. Possibility of other related diabetes related complications significantly increase when exercise is not part of ones lifestyle. Medication may be able to help for a while but over the lifetime it may not be possible completely avoid complications.
7. Side effects from the medications alone get aggravated for folks in sedentary lifestyle.

References

1. Physical Activity and Life Expectancy With and Without Diabetes Jacqueline T. Jonker, MSC1, Chris De Laet, PHD1, Oscar H. Franco, MD, DSC1, Anna Peeters, PHD2, Johan Mackenbach, MD, PHD1 and Wilma J. Nusselder, PHD
2. Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women Frank B. Hu, M.D., JoAnn E. Manson, M.D., Meir J. Stampfer, M.D., Graham Colditz, M.D., Simin Liu, M.D., Caren G. Solomon, M.D., and Walter C. Willett, M.D
3. Effects of exercise and diet on chronic disease J Appl Physiol 98: 3-30, 2005; doi:10.1152/japplphysiol.00852.2004 http://jap.physiology.org/cgi/content/full/98/1/3

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