Chapter 1

Delving into Diabetes and Carb Counting

IN THIS CHAPTER

Understanding how carb choices, portions, and timing affect your health

Getting started with carb control and advancing your carb-counting skills

Living well with diabetes through self-management education

Diabetes is a condition that is largely self-managed. You are the one making the daily decisions that affect your health outcomes. That's a significant responsibility! The thought of taking on diabetes may seem overwhelming, but you can do it.

There's a learning curve, of course. Being successful at any skill, sport, task, or job takes effort, training, patience, and support. Think about a preschool child who picks up his parent's paperback novel and stares blankly at the foreign squiggles on the page, wondering how anyone could possibly read it. We've each been that child and faced that same challenge. We still encounter words that we don't recognize from time to time, but we can look them up.

Learning about diabetes is similar. First you tackle the basics, and then you build on that foundation. Learning to manage your own diabetes requires diabetes self-management education. This book is designed to be your companion text in the learning process. The goal is to build knowledge and foster the skills needed for successful self-management. This chapter introduces you to the world of diabetes and carb counting.

Getting Up to Speed on Diabetes Basics

Diabetes is a condition of abnormal blood-glucose regulation. Lack of insulin (type 1 diabetes) or ineffective insulin (type 2 diabetes and prediabetes) both lead to elevated blood-glucose levels and a diagnosis of diabetes or prediabetes. See Chapter 2 for more about the various types of diabetes.

Diabetes and diet are intimately intertwined. It's impossible to talk about managing diabetes without discussing food in great detail. Blood-glucose levels are influenced by what you eat, how much you eat, and when you eat. The goal is to eat healthy foods, properly portioned, at appropriate times. The following sections introduce the basics of managing diabetes.

Checking out concerning trends in the diabetes epidemic

Over 38 million Americans are living with diabetes. Type 2 diabetes accounts for roughly 95 percent of cases. Over 98 million American adults have prediabetes, a condition where blood-glucose levels are above normal but not yet high enough to be classified as diabetes. That equates to more than one in three American adults with prediabetes. It is estimated that 80 percent are not yet diagnosed. That speaks to the importance of being screened for diabetes.

The best way to turn that trend around is to improve dietary choices, lose weight if you are overweight, and exercise regularly. Prediabetes can progress to type 2 diabetes, but lifestyle changes cut the risk by up to 58 percent. If you already have diabetes, eating right and exercising comprise the foundation of treatment.

Improving outcomes and preventing complications

I don't plan to list scary statistics on how many people with diabetes have developed complications. Fear isn't a good motivator. Hope is. In this book, I focus on how to better manage diabetes to help prevent complications. Keep in mind that when people developed diabetes many years ago, they simply did not have the resources, knowledge, tools, medications, and technologies needed to adequately manage their condition. Those tools are available now: blood-glucose monitors, continuous glucose monitors, insulin and other medications, insulin pens, insulin pumps, and a whole lot more information. The roles of diet and exercise in managing diabetes are understood. Multiple studies from around the globe provide a hopeful message, which is taking care of your diabetes has a big payoff: your improved health.

While the onset of type 1 diabetes is more obvious, type 2 diabetes can go undiagnosed for many years. Screening is critically important and may alert you to your risk long before diabetes develops. Chapter 2 sorts through the types of diabetes, delineates risk factors, and explains diagnostic criteria.

You should take diabetes seriously. Uncontrolled diabetes may lead to complications. For example, high blood-glucose levels over time can damage blood vessels, organs, and tissues. People with diabetes are twice as likely to suffer a heart attack or stroke. Your eyes, kidneys, feet, and nerves are all vulnerable to the damages inflicted by persistently elevated glucose levels.

If you currently have complications, talk to your diabetes specialist for appropriate treatment. Request a referral to a registered dietitian if treatment for your complication has a dietary component. Two examples: Kidney disease (renal disease) may require restrictions on dietary sodium, potassium, phosphorus, fluid, and possibly protein. Treating gastroparesis (nerve damage that alters the digestive system) involves dietary modifications to improve digestion and absorption of food. Strategies include low-fat, low-fiber, easily digested foods and dividing intake into smaller more frequent meals. When diet becomes part of the treatment for a disease, it's referred to as medical nutrition therapy. In the United States, a registered dietitian (RD), also called registered dietitian nutritionist (RDN), is a trained medical professional who can help you learn to make dietary changes that support the treatment of diabetes, heart or kidney disease, lipid problems, hypertension, and more. Other countries also have reputable trained nutrition specialists.

A landmark study called the Diabetes Control and Complication Trial (DCCT 1983-1993) followed 1,441 people with type 1 diabetes for ten years. Results showed definitively that improving blood-glucose control reduces the risks of developing complications. The results were astounding: 76 percent reduction in eye disease, 50 percent reduction in kidney disease, and 60 percent reduction in nerve disease. The United Kingdom Prospective Diabetes Study (UKPDS 1977-1997) focused on people with type 2 diabetes. With 5,102 study participants, it was shown conclusively that both blood-glucose control and blood-pressure control are important in reducing complications. The Diabetes Prevention Program (DPP) shows that diet modifications and exercise can prevent or delay prediabetes from progressing to type 2 diabetes.

Building your diabetes team

Your diabetes team starts with you. You are the team captain, and you get to pick who will be there to assist you on your diabetes management journey:

• Your primary care provider manages your overall healthcare needs. Look for one who has experience with diabetes.
• If you have type 1 diabetes or your type 2 diabetes is not under adequate control, ask your general practitioner to refer you to an endocrinologist, a doctor who specializes in diabetes.
• You may also benefit from the expertise of a diabetes nurse educator (registered nurse or nurse practitioner), who can teach you how to monitor your glucose levels, keep and review blood-glucose records, properly administer insulin, handle travel and sick days, and more. In addition, a RD or RDN can help you plan balanced meals, teach you label reading and carb counting, and provide dietary advice to help you achieve weight goals, manage blood pressure, improve cardiovascular health, understand the impact of alcohol, treat hypoglycemia, and more.
• A certified diabetes care and education specialist (CDCES) is a healthcare provider who has advanced training in diabetes management and has passed a comprehensive national exam. To maintain the CDCES status, the healthcare professional must complete 75 hours of continuing education in the field of diabetes every five years.
• Also on the roster to join your team are an eye doctor (either an ophthalmologist or an optometrist), a dentist, and a pharmacist.
• At times you may choose to see a mental-health specialist: a counselor, social worker, psychologist, or psychiatrist.
• Should you need them, a podiatrist is available for foot care and an exercise physiologist or physical therapist can guide your physical fitness plan.

• Don't forget your loved ones, family, and friends. Enlist the support and help of the important people in your life. People want to help; just let them know how best to assist.

Staying up to date with advances in diabetes care

Diabetes Self-Management Education and Support (DSMES) teaches a person with diabetes to how to safely manage all aspects of their diabetes. DSMES specialists include registered dietitians, diabetes nurse educators, pharmacists, counselors, and other diabetes professionals. The American Diabetes Association notes five critical times to meet with diabetes care specialists to learn and hone self-management skills: at diagnosis; annually; when treatment goals are not being met; when complicating factors occur (medical, physical, psychosocial); and at transition periods in life (for example when adolescents transition to adult care, a woman embarks on pregnancy, or when transitioning care from a hospital stay to home). Diabetes specialists stay current on the latest advancements in the field of diabetes. Capitalize on their knowledge; stay up-to-date with your medical appointments and healthcare screenings. Having a few reputable diabetes management books (like this one!) on your...