It is very important for people with type 1 diabetes or type 2 diabetes who are on insulin or oral medication to maintain a normal blood glucose levels and to establish treatment goals:

-to control their blood pressure

-to obtain the ideal body weight

-to prevent diabetes complications (heart, kidney disorders)

Those are general dietary goals, but the US Dietary Guidelines for healthy eating for all Americans, includes the following: to use in alimentation monounsaturated fats(virgin olive oil, canola oil) and polyunsaturated oils (sunflower, rapeseed) and to avoid the use of saturated fats(animal products)and avoid cholesterol consume. To eat plenty of fiber-rich foods (whole grains, fresh foods, vegetables), nuts, seeds or legumes. Pay attention to the sugar in foods.(especially in fruits).

Protein intake should be reduced: fish and soy-protein are recommended.

Salt intake should also be limited. American Diabetes and Dietetic Association recommend a balanced meal plan: More calories should be taken from carbohydrates, second comes fat and third protein.

As a general line everyone should serve: two portions of fatty fish., five of fruits and vegetables and six of whole grains. Diet plans are planned with dietitians in order to meet the needs of every person with diabetes type I and type II.

For example during a study the scientists have come to the conclusion that if people stay focused on it any healthy diet (a high-carbohydrate/high-fiber diet, a low-fat diet, and a weight management diet)is good for those with diabetes type II, after one year and a half the results were for the people in the study improved glycolated hemoglobin and cholesterol levels. Other effective methods are on diabetes exchange list: counting carbohydrate grams, using the glycemic index.

Monitoring blood glucose carefully is suggested by doctors, to prevent hypoglycemia and hyperglycemia. Glycemia should have the following values: 80-140mg/dL pre-meal, 100-160 bedtime levels determined four or more times a day. Of course for very young, very old individuals, pregnant women and those with a precare health condition there are different values.

A very easy to use at home test is: glycosylated hemoglobin test which evaluates the severity of the diabetes, normal values are below 7%, high levels are a marker for kidney complications and poor control of carbohydrates. Hypoglycemia occurs when blood sugar is very low and is very dangerous for drivers when it occurs suddenly, it may also occur at night.

Patients with diabetes should always carry sweets or glucose substitutes specially for diabetic individuals to prevent collapse in case of hypoglycemia.

Other recommended tests are: for high blood pressure, unhealthy cholesterol levels, urine tests which are significant when traces of albumin are found that indicate severe kidney disease.

Fasting blood sugar or FBS is a test for the levels of glucose in blood. Glucose is the major monosaccharide in blood. Its measurement is vital to the diagnosis of diabetes mellitus. Fasting, because the patient has to fast for 8-12 hours before testing. Fasting is crucial to come up with reliable laboratory results and consequently – diagnosis.

How is Fasting Blood Sugar performed?

1. When the test is ordered, the patient should contact the health worker responsible in the collection of the specimen.

2. Proper instructions are given. Instructions may vary, if there are other tests simultaneously done with FBS. Examples are: If it is done with triglyceride test, fasting would be 12-14 hours. If electrolyte is performed, water may not be permitted.

3. Fasting usually starts after the evening meal. 7 pm to 7 am. Nothing is eaten; not even candy, coffee, tea or any beverage.

4. Before 7 am, the patient should already be in the laboratory.

5. Blood then is extracted and properly labeled and encoded.

6. The patient can eat after the blood extraction.

7. The fasting hours should not be shortened or prolonged.

Other tests that can be performed with glucose in the diagnosis of Diabetes Mellitus (DM) are:
1. 2 -hour post prandial test (2-HPPT)

This is the most sensitive parameter in diagnosing diabetes mellitus. It is because two hours after a meal (post prandially), glucose levels in normal persons will go back to normal.

Normal blood glucose levels in adult:

Orthotoulidine method = 60-110 mg/dL
Nelson-Somogyi method = 80-120 mg/dL

2. Oral Glucose Tolerance Test (OGTT)

The patient ingests a glucose load/challenge or solution. Then timed specimens are collected at 30 minutes or one-hour intervals. The results are compared to standard results for normal patients.

3. Intravenous Glucose Tolerance Test (IGTT)

This is the same as OGTT. The difference is that the glucose load is injected intravenously. Persons who have gastrointestinal problems employ IGTT. Obtained results are interpreted just like OGTT.

4. HbA1C test (Hemoglobin A1C).

This test is a measure of the patient’s compliance to his drug treatment. If the patient is dutifully taking in his medicine, the obtained result would be normal. If the patient is not complying with his medications, then the result is elevated.

It is good that people become aware of these different tests, so that they would be able to monitor their glucose levels or that of diabetic relatives and friends.

Yes, it can and here is how.

The most frequent cognitive deficits in persons with diabetes are:

o Slowing of information processing speed

o Slowing of motor speed

o Decreases in vocabulary and intelligence

o Lessening of attention span

o Decreases in motor strength

o Loss of memory

The single most important factor is glycemic or sugar control. Both too low (hypoglycemia) and too high (hyperglycemia) blood glucose can affect cognitive function. All of these above items improve with better glucose control.

Complications such as neuropathy (loss of feeling), retinopathy (loss of eye sight), and nephropathy (loss of kidney function) may take years to occur with diabetes. Cognitive deficits can occur much earlier (especially when your hemoglobin A1C is higher than 8.4%).

In elderly diabetic persons, this is especially true, with more than 10% showing at least some cognitive deficit due at least in part to poor blood sugar control.

Okay, so what can you do to keep your brain sharp? In other words, how do you keep all your marbles?
You keep your blood glucose levels as close to normal as possible. In keeping a tight control over your blood glucose you will sharpen your brain and prevent any further deterioration.

There are three main ways of doing this.

o The first is to control your diet by counting your carbohydrates. Your health care professional can tell you how many carbohydrates that you should eat.

o The second method is to exercise. Exercise has been proven over and over again to lower blood glucose (and it makes you feel better). Exercise can lower your blood glucose for hours to days (after your exercise is complete). Make sure to check your blood glucose both before and after you exercise. You want it to remain within a normal level. Your health care provider can tell you what normal levels are for you. Never start an exercise routine without checking with your health care provider.

o The third method is medications. Not all diabetics take medications but if you do, make sure you take them properly.

It appears much more education of people with diabetes needs to be done.

Glucose, the primary energy source for human and animal cells, is a type of sugar that travels through the bloodstream. Glucose enters your body whenever you eat carbohydrate foods. Glucose levels are regulated by insulin and glucagon. Insulin is a hormone that is produced by the pancreas and released into the bloodstream when glucose levels rise.

Normal glucose levels fall between 70 and 150 mg. Levels typically are lower in the morning, and rise after meals. Blood sugar levels falling consistently above 150 are indicative of hyperglycemia, or high blood sugar. Chronic low levels, falling below 70, characterize hypoglycemia, or low blood sugar. Hypoglycemia is a potentially fatal condition. Symptoms of this condition are lethargy, impaired mental functioning, irritability and loss of consciousness. Persistent hyperglycemia results in diabetes mellitus, which is the most common disease related to blood sugar regulation failure. Diabetes can cause eye, kidney and nerve damage.

A blood glucose test measures the amount of glucose in the bloodstream. Reasons for testing glucose levels are to check for diabetes, to monitor treatment of diabetes, and to check for hypoglycemia. There are several different types of glucose tests. The ‘fasting blood sugar’ test checks glucose levels after an eight-hour fast and is often the first test performed when checking for diabetes. For this test, levels have to fall between 70 and 99 in order to be considered normal. The ‘two-hour postprandial blood sugar’ test measures glucose levels two hours after eating a meal.

Normal glucose levels for this test fall between 70 and 145. Random blood sugar testing checks glucose levels randomly throughout the day, regardless of meal times. If levels vary widely, there could be a problem. Blood sugar levels should be between 70 and 125 in order to be considered normal for random testing. The ‘oral glucose tolerance test’ diagnoses diabetes and predicaments. This tests your blood after drinking a glucose drink. If you think you may have a blood sugar disorder, contact your primary care physician for testing. There are many conditions that can cause a change in your blood glucose levels. Normal results may vary depending on the lab.

Influenza is more dangerous for diabetics than it is for others. Why is this so? Any kind of sickness raises blood-sugar levels in diabetics. In fact, an Illness can prevent a diabetic from eating properly, which further affects blood-glucose levels. Diabetes compromises the immune system by causing people to become more vulnerable to severe cases of the flu, (Centers for Disease Control (CDC)). Diabetics who contract the flu usually get very sick, a lot sicker than other people who get the flu. In many cases, diabetics with the flu end up in the hospital.

People with diabetes can help keep themselves safe from the flu by getting a flu shot yearly, provided that they are not allergic to it, like many people are. The flu is definitely not good for everyone. Many people complain of getting sick after taking the flu shot. However, for the most part, it is very good in preventing the flu. It is recommended that everyone with diabetes, even pregnant women, should get a yearly flu shot, and the best time to get one is in October or mid-November before the flu season begins, (CDC).

According to the CDC, if one has diabetes, a flu shot can be the difference between life and death. In addition to the influenza vaccine, diabetics should also get the pneumococcal vaccine along with the Tetanus/Diphtheria (Td) Toxoid vaccine. All measures should be taken to stay as safe as possible from infections.

There are some important measures one can take to avoid getting sick. Washing hands regularly is a very good practice in stopping the spread of influenza and other infections. One should avoid contact with sick people. Influenza for example is thought to spread from person-to-person through coughing, sneezing, or contact with infected people. If one is feeling under the weather, the CDC recommends that one should stay home from work or school to limit contact with others to keep them from getting sick also.

Regardless of the circumstances, diabetics should continue taking their medications (pills or insulin), even if they cannot eat while sick with the flu. Health care providers may at times advise diabetic patients to take more insulin during sickness, depending on the situation, (CDC).

Very close supervision should be employed by diabetics when they are experiencing any form of sickness. Here are some critical steps to follow in the case of illness: test blood-glucose levels every hour–all results should be recorded and monitored; drink extra (calorie-free) liquids, and try to eat normally; if eating normally isn’t possible, eat soft foods and liquids containing the same amount of carbohydrates one normally consumes; weigh oneself every day-losing weight without effort could be a sign of high blood-glucose; and check body temperature every morning and evening–an onset of fever could be a sign of infection, (CDC).

One should call her or his health care provider or go to the emergency room if any of the following occurs: feeling too sick to eat normally-unable to keep down food for more than 6 hours; episodes of severe diarrhea; losing 5 pounds or more; body temperature is over 101 degrees F; blood-glucose is lower than 60 mg/dL or remains over 300 mg/dL; experience moderate or large amounts of ketones in urine; feeling sleepy or unable to think clearly; and having trouble breathing, (CDC).

Diabetics have to be extra careful when it comes to the flu because diabetes itself compromises the immune system of diabetics. Therefore, prevention of the flu is the best medicine. Although the flu shot doesn’t agree with everyone, it is still the most effective remedy against the flu. So, all efforts should be made in getting a flu shot every year.

Please visit the CDC for more information on diabetes and influenza.

For people with diabetes, meal planning takes on a new importance. The food you eat has a significant effect on your current and future well-being. Eating an appropriate diet means eliminating or reducing certain types of foods that can contribute to or worsen your diabetes. It means counting carbohydrates, because they have the greatest influence on your blood glucose levels.

One of the first things you’ll want to do is track your food intake and activity levels to see how they affect your blood sugar levels. This information will guide you in adjusting the quantity and types of foods you eat, how much you exercise, and the amount and frequency of your required diabetes medication. Achieving the correct relationship between all factors will help you to control your blood sugar, which is crucial for diabetics.

Your ultimate goal is to develop a meal plan that ensures you regularly eat well-balanced meals on a regular schedule. In doing so, you will benefit by leveling your blood pressure, controlling your blood glucose levels, reducing your cholesterol, fulfilling your nutritional needs, and maintaining a healthy body weight.

What is a good meal plan?

A person with diabetes can eat pretty much the same foods everyone else eats. However, more attention should be paid to reducing carbohydrates in your diet as these affect your blood glucose more than other foods. The key is to eat them in moderation. Read product labels to see how many grams of carbs are in a serving and limit your serving size for that food.

Carbohydrate-rich foods to watch are:

Starchy vegetables (corn, potatoes, peas, beans and others) Dairy foods (milk, ice cream, yogurt) Baked goods (bread, crackers, cereals) Pasta, rice, grains Fresh, canned and dried fruit, and fruit juices Sugary foods (soft drinks, sherbet, cake, cookies, pies, candy) Alcoholic drinks and drink mixes (beer, wine)
Use the food exchange method to ensure proper nutrition

A technique that will help ensure you get adequate nutrition is called food exchanging. In short, it’s simply a way to minimize unwanted foods and still get the nutrients they provide. The six exchange groups are:

starches and breads meat and meat by-products fruits vegetables milk fats

You can exchange any food serving in one group for another. For instance, in the meat and meat by-products category, you can swap one meat for low-fat or non-fat cottage cheese or white skinless chicken or turkey. Ensure that you eat foods from each of these six groups to be sure you get a complete and balanced diet.

Avoid or reduce the following foods:

Salt: Excess salt (sodium) can cause high blood pressure which damages blood vessels and the heart. Foods that contain hidden and often high quantities of salt include fast foods, cheese, soy sauce, canned goods, salad dressings and prepared foods.

Sugar: While sugar doesn’t raise blood glucose any more than do potatoes, rice and pasta, the foods containing sugar generally contain large quantities of carbohydrates and fats. If your favourite foods are too tempting, simply keep your portion size small to minimize your sugar and carbohydrate intake.

Alcohol: Alcohol can trigger a drop in blood sugar and cause hypoglycemia. Alcohol is best consumed with a meal or a snack to minimize this possibility.

These are just some of the things to keep in mind when putting together your meal plans. A dietitian can assist you in developing a suitable program to manage your diabetes. Once you understand what to avoid, you can enjoy healthy, nutritious meals that will keep you at a healthy body weight and your diabetes in check.