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It would be nice if there were a magical, precise diet to follow that would keep blood sugar levels stable for everyone with diabetes—but no such luck. “There is no perfect ratio of carbs, protein, fats for all people with diabetes,” says Sarah Rettinger, MD, an endocrinologist at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California.
Instead, Dr. Rettinger suggests a reasonable distribution of nutrients for each meal. “One of my favorite ways to think about meal planning is using the ‘plate method.’ Envision a small plate filled with one-quarter complex carbohydrates, one quarter protein, and one-half low-carbohydrate vegetables.” If you’re looking for a diet plan that’s a little more structured, Dr. Rettinger recommends the Mediterranean Diet, the DASH (Dietary Approaches to Stop Hypertension) diet, or a plant-based diet as healthy choices for people with diabetes.
This may be sobering, but it’s important: "People with diabetes usually don’t die from blood sugar problems, most often they die from cardiovascular-related disease, which is why you need to focus not only on blood sugars, but also blood pressure, cholesterol, and smoking," says Kellie Rodriguez, MSN, MBA, CDE, director of the Global Diabetes Program at the Parkland Health & Hospital System in Dallas, Texas. Adults with diabetes are two to four times more likely to die from heart disease than people who don't have diabetes.
Depending on your risk factors, your doctor might offer (or you could ask about getting) a baseline EKG as part of your initial diabetes care, suggests Luigi Meneghini, MD, MBA, executive director of the Global Diabetes Program at Parkland Health & Hospital System and a professor of internal medicine at University of Texas Southwestern Medical Center.
“After that, cardiac testing is reserved for those that develop suspicious cardiac symptoms like chest pain, pressure, change in physical endurance, shortness of break with activities, etc,” says Dr. Meneghini.
You probably know your blood sugar or A1C readings cold, but your blood pressure should also be checked every three to six months during routine diabetes visits. (Here’s more information on what your blood pressure numbers mean.) Your doctor will keep a close eye on cholesterol too. (Here’s more info on what your cholesterol numbers mean.) “Most people with diabetes over age 40 should take a statin drug, regardless of their cholesterol level, and should start a baby aspirin after the age of 50,” says Dr. Meneghini.
It’s no secret exercise is an important part of managing diabetes, but it’s not always enjoyable or easy to squeeze into your busy day. The American Diabetes Association (ADA) recently issued updated recommendations and they are so much more doable. The ADA now recommends short periods of movement every 30 minutes. “This stimulates the muscle to use a bit of glucose and reducing sedentary time is also linked to better heart health,” says Jill Weisenberger, MS, RDN, CDE, author of Diabetes Weight Loss Week by Week.
Set a timer if you need a reminder. You could keep some light weights handy by the sofa and crank out a few biceps curls or shoulder raises while watching TV. If you’re at the office, walk to your coworker’s desk instead of emailing, pace the room walk while you’re on a conference call, or take a short walk after a meal. “Every single time you exercise, you boost your insulin sensitivity,” says Weisenberger.
Fats generally don’t have immediate effects on blood sugar levels, so we tend to focus more on carb choices, but being smart about dietary fat is critical for two reasons, Weisenberger says. “First, your fat choices affect the health of your heart and blood vessels. Second, when diets have a lot of saturated and trans fats, insulin resistance worsens. It improves when unsaturated fats replace the less healthy fats.”
Fill your grocery cart with unsaturated fat options like avocado, nuts, seeds, olive oils, peanut and canola oil, flaxseed, and fish. Leave the butter, lard, margarine and coconut oil on the grocery shelves.
“One of the biggest issues I see with patients with diabetes is putting off eating or eating too little at mealtime order to control their blood sugars,” says diabetes educator Alison Pelz, RD, LD, LCSW, who has a private practice in Austin, Texas. “While this may work for a while eventually your body’s biology takes over and the drive to eat large amounts of food is strong.” The result: You could lose control and possibly binge eat, which will drive up blood sugars—and guilt—often resulting in repeating the whole feast-famine eating pattern again. “What I recommend to patients is to eat regular meals—and snacks if hungry—throughout the day. These should include all macronutrients, including carbohydrate, protein, and fat,” says Pelz. “This leads to more consistent blood sugars, less overeating, and feeling more at peace with food.” Here are nutritionist-approved snacks for diabetes, as well as tips for eating carbs with diabetes and the best protein choices on a diabetes diet.
High blood glucose levels can cause dry skin because the body attempts to remove the extra glucose by increasing urination. Another factor is neuropathy, in which the damaged skin nerves can cause decreased sweating and contribute to dryness and cracking of the skin. Cracking and bleeding skin isn’t just a nuisance—it can increase your risk of infection. Rodriguez recommends using fragrance-free, non-greasy cream or lotion on your skin after you shower. But don’t use the moisturizer between your toes. “They could remain moist and this could lead to fungal infections,” says Rodriguez. Here’s more info on picking the right moisturizer for dry skin.
You may have gotten the foot-care lecture at your doctor’s office, but the importance of wearing proper-fitting shoes and taking good care of your feet can’t be understated. One shoe you may want to avoid: flimsy flip-flops. They tend to bang against the sole of the foot while you walk, which dries and hardens the skin and can lead to cracks. They also leave most of your foot exposed compared with more supportive sandals, which can make it more likely you could stub your toe or experience other foot injuries.
As for your hands, keep your hands and fingers from drying out by avoiding alcohol wipes to sanitize your skin before you test your blood sugar (unless there is no soap and water available). Besides drying the skin, you have to wait for the alcohol to dry before you check your glucose as wet alcohol will affect glucose readings. Here are other rules to follow for testing your blood sugar.
Most people with diabetes begin treatment with antidiabetic pills, but if your doctor suggests insulin at some point, don’t worry about myths about certain side effects. “Insulin does not damage your own pancreas; if anything, it helps it rest and maybe even helps it make more insulin,” says Dr. Meneghini. “It does not damage your eyes, nerves or kidneys, but actually protects them by lowering your blood sugar, which is itself the cause of the damage.”
When you have diabetes it’s harder to fight infections, and this can make you more prone to gum disease, cavities due to dry mouth, and slow wound healing. These oral health conditions cause inflammation, which can in turn affect blood sugar control and worsen the condition of your diabetes, says Scott Eisen, DDS, a dentist with Catonsville Dental Care in Catonsville, Maryland. “A dentist may prescribe a high fluoride toothpaste, a saliva-substitute to help counteract the harmful effects of dry mouth, or an antibiotic to fight infection,” says Dr. Eisen. Be sure your dentist knows about your current medications and management of your blood glucose. Maintain good oral hygiene (that means not skipping flossing and brushing twice a day) and keep your regularly scheduled dental cleaning appointments.
You may have heard about diabetic retinopathy, a retinal disease that can lead to poor vision and even blindness, but you may not know there are ways to prevent or slow your risk of damaging your retina—if you act now. “Damage usually happens slowly and is due to uncontrolled blood sugars from a few years ago, not because of the extra cookie you had last night or the extra piece of cake you had last month at the wedding. It’s an accumulation of damage over several years,” says Vivienne Hau, MD, PhD, a Kaiser Permanente ophthalmologist and retina specialist in Riverside, California. If blood sugars are consistently high, diabetic retinopathy will keep getting worse. “The blood vessels in the eye get weak, which can cause bleeding, swelling and scarring, retina detachments, and early cataracts,” says Dr. Hau. “In fact, studies show diabetic retinopathy is the leading cause of blindness in working-age populations.” It’s very important, she continues, to get your eyes checked at least once a year if you have diabetes. “Finding retinopathy or other eye conditions early gives you a better chance of avoiding vision loss and blindness,” says Dr. Hau.
“The daily, unrelenting needs of managing diabetes can be very challenging,” says Rodriguez. "Diabetes distress and depression are very common in people living with diabetes. There’s no need to feel embarrassed or that you’re not tough enough.” Create your own support team with your doctors, nutritionist, family, and friends. Utilize online support groups or join a support group in your area. And if you still feel like you can’t get out of your funk seek counseling. “It is a sign of strength to reach out to others,” Rodriguez says.