Chapter 1

What It Means to Flourish with Diabetes

In This Chapter

Getting a grip on diabetes

Controlling calories

Working exercise into your schedule

Keeping your blood pressure down

Making lifestyle changes that count

Since the third edition of Diabetes Cookbook For Dummies came out, there have been a number of studies that indicate that a Mediterranean diet may be beneficial in the prevention and treatment of diabetes. In this new edition, we provide some of the rationale for that type of diet. You will also find 25 new recipes from some of the finest Mediterranean restaurants in the country. In this chapter, you get the latest information about what diabetes means, how diabetes is diagnosed, and the things you need to do to thrive with diabetes. Don't waste another minute. Get started right away.

Recognizing Diabetes

With so much diabetes around these days, you may think that recognizing it should be easy. The truth is that it's not easy, because diabetes is defined by blood tests. You can't just look at someone and know the level of glucose - blood sugar - in his or her blood.

Defining diabetes

The level of glucose that means you have diabetes is as follows:

• A casual blood glucose of 200 milligrams per deciliter (mg/dl) or more at any time of day or night, along with symptoms such as fatigue, frequent urination and thirst, slow healing of skin, urinary infections, and vaginal itching in women. A normal casual blood glucose should be between 70 and 139 mg/dl.
• A fasting blood glucose of 126 mg/dl or more after no food for at least eight hours. A normal fasting blood glucose should be less than 100 mg/dl.
• A blood glucose of 200 mg/dl or greater two hours after consuming 75 grams of glucose.

A diagnosis of diabetes requires at least two abnormal levels on two different occasions. Don't accept a lifelong diagnosis of diabetes on the basis of a single test.

A fasting blood glucose between 100 and 125 mg/dl or casual blood glucose between 140 and 199 mg/dl is prediabetes. See Dr. Rubin's book Prediabetes For Dummies (Wiley). Most people with prediabetes will develop diabetes within ten years. Although people with prediabetes don't usually develop small blood vessel complications of diabetes like blindness, kidney failure, and nerve damage, they're more prone to large vessel disease like heart attacks and strokes, so you want to get that level of glucose down. Sixty million people in the United States have prediabetes.

The American Diabetes Association has added a new criteria for the definition of diabetes, based around a person's A1C number. A1C is a measure of the average blood glucose for the last 60 to 90 days. If the A1C is equal to or greater than 6.5 percent, the person is considered to have diabetes.

Categorizing diabetes

The following list describes the three main types of diabetes:

• Type 1 diabetes: This used to be called juvenile diabetes or insulin-dependent diabetes. It mostly begins in childhood and results from the body's self-destruction of its own pancreas. The pancreas is an organ of the body that sits behind the stomach and makes insulin, the chemical or "hormone" that gets glucose into cells where it can be used. You can't live without insulin, so people with type 1 diabetes must take insulin shots. Of the 26 million Americans with diabetes, about 10 percent have type 1.
• Type 2 diabetes: Once called adult-onset diabetes, type 2 used to begin around the age of 40, but it is occurring more often in children, many of whom are getting heavier and heavier and exercising less and less. The problem in type 2 diabetes is not a total lack of insulin, as occurs in type 1, but a resistance to the insulin, so that the glucose still doesn't get into cells but remains in the blood.
• Gestational diabetes: This type of diabetes is like type 2 diabetes but occurs in women during pregnancy, when a lot of chemicals in the mother's blood oppose the action of insulin. About 4 percent of all pregnancies are complicated by gestational diabetes. If the mother isn't treated to lower the blood glucose, the glucose gets into the baby's bloodstream. The baby produces plenty of insulin and begins to store the excess glucose as fat in all the wrong places. If this happens, the baby may be larger than usual and therefore may be hard to deliver. When the baby is born, he is cut off from the large sugar supply but is still making lots of insulin, so his blood glucose can drop severely after birth. The mother is at risk of gestational diabetes in later pregnancies and of type 2 diabetes as she gets older. Women should be screened for gestational diabetes at 24 to 28 weeks of the pregnancy.
• Other types: A small group of people with diabetes suffer from one of these much less common varieties of diabetes:
  • Latent autoimmune diabetes on adults (LADA), which has characteristics of both type 1 and type 2 diabetes
  • Genetic defects of the beta cell, which makes insulin
  • Medications that affect insulin action like cortisol or prednisone
  • Diseases or conditions that damage the pancreas like pancreatitis or cystic fibrosis
  • Genetic defects in insulin action

Knowing the consequences of diabetes

If your blood glucose isn't controlled - that is, kept between 70 and 139 mg/dl after eating or under 100 mg/dl fasting - damage can occur to your body. The damage can be divided into three categories: irritations, short-term complications, and long-term complications.

Irritations

Irritations are mild and reversible but still unpleasant results of high blood glucose levels. The levels aren't so high that the person is in immediate life-threatening danger. The most important of these irritations are the following:

• Blurred vision
• Fatigue
• Frequent urination and thirst
• Genital itching, especially in females
• Gum and urinary tract infections
• Obesity
• Slow healing of the skin

Short-term complications

These complications can be very serious and lead to death if not treated. They're associated with very high levels of blood glucose - in the 400s and above. The three main short-term complications are the following:

• Ketoacidosis: This complication is found mostly in type 1 diabetes. It is a severe acid condition of the blood that results from lack of insulin, the hormone that is missing. The patient becomes very sick and will die if not treated with large volumes of fluids and large amounts of insulin. After the situation is reversed, however, the patient is fine.
• Hyperosmolar syndrome: This condition is often seen in neglected older people. Their blood glucose rises due to severe dehydration and the fact that the kidneys of the older population can't get rid of glucose the way younger kidneys can. The blood becomes like thick syrup. The person can die if large amounts of fluids aren't restored. They don't need that much insulin to recover. After the condition is reversed, these people can return to a normal state.
• Hypoglycemia or low blood glucose: This complication happens when the patient is on a drug like insulin or a pill that drives the glucose down but isn't getting enough food or is getting too much exercise. After it falls below 70 mg/dl, the patient begins to feel bad. Typical symptoms include sweating, rapid heartbeat, hunger, nervousness, confusion, and coma if the low glucose is prolonged. Glucose by mouth, or by venous injection if the person is unconscious, is the usual treatment. This complication usually causes no permanent damage.

Long-term complications

These problems occur after ten or more years of poorly controlled diabetes or, in the case of the macrovascular complications, after years of prediabetes or diabetes. They have a substantial impact on quality of life. After these complications become established, reversing them is hard, but treatment is available for them early in their course, so watch for them five years after your initial diagnosis of diabetes. See Dr. Rubin's book Diabetes For Dummies, 4th Edition (Wiley), for information on screening for these complications.

The long-term complications are divided into two groups: microvascular, which are due at least in part to small blood vessel damage, and macrovascular, associated with damage to large blood vessels.

Microvascular complications include the following:

• Diabetic retinopathy: Eye damage that leads to blindness if untreated.
• Diabetic nephropathy: Kidney damage that can lead to kidney failure.
• Diabetic neuropathy: Nerve damage that results in many clinical symptoms, the most common of which are tingling and numbness in the feet. Lack of sensation in the feet can result in severe injury without awareness unless you carefully look at your feet regularly. Such injury can result in infection and even amputation.

Macrovascular complications also occur in prediabetes and consist of the following:

• Arteriosclerotic heart disease: Blockage of the blood vessels of the heart. This is the most common...