Diet and Exercise

The incidence of diabetes has soared to epic proportions in the United States today. According to the American Diabetes Association (ADA), 20.8 million children and adults in America have diabetes. That's 7% of the population! In addition, it's estimated that 6.2 million people suffer from diabetes but have not been diagnosed. If you or someone you love has been diagnosed with diabetes, there are many things you can do to optimize your health. Diet, exercise, and medication (especially insulin) play important roles in the management of diabetes.

Eating Right

The food you eat is a key element of diabetes management. One useful tool in choosing healthful foods is the ADA's Diabetes Food Pyramid, which is based on the United States Department of Agriculture's (USDA) Food Pyramid of 2005. The Diabetes Food Pyramid differs from the USDA's Food Pyramid in that it evaluates foods based on their carbohydrate and protein count, rather than on the food group to which they belong. Cheese, for example, is classified as a meat serving rather than a milk serving. Serving size may also be smaller for the Diabetes Food Pyramid to account for a higher number of carbohydrates in a particular food.

How does the Diabetes Food Pyramid work? Foods are divided into groups, with serving sizes indicated for various types of foods. The pyramid recommends a range of servings that should be eaten from each group, every day. Before embarking on a new eating regimen to help manage your diabetes, you will need to consider your caloric and nutritional needs. An extremely active man, for example, would need to consume a greater number of calories per day than a sedentary man. Talk to your doctor about your lifestyle and decide together on an appropriate number of calories that you should aim for as a daily goal.

The main food groups of the Diabetes Food Pyramid are listed below, along with the number of daily servings that should be consumed. Examples of foods and their recommended serving sizes are given for each group.

• Grains and Starches (6-11 servings per day) - Examples: 1 slice of bread, 1 cup of dry cereal, 1 (6") tortilla, 1/3 cup of rice or pasta.
• Vegetables (3-5 servings per day) - It is important for diabetics to be aware that starchy vegetables (such as potatoes, corn, and peas) are a part of the Grains and Starches group in the Diabetes Food Pyramid. Examples: 1 cup of spinach leaves, 1 cup of cooked carrots, 1 cup of diced tomatoes.
• Fruits (2-4 servings per day) - Examples: 1 small fresh fruit, _ cup of canned fruit, 2 tablespoons of dried fruit.
• Milk (2-3 servings per day) - Examples: 1 cup of yogurt, 1 cup of low-fat milk.
• Meat and Meat Substitutes (4-6 ounces per day). Included in this category are proteins such as eggs, dried beans, cheese, and peanut butter - Examples: a 4-ounce lean beef patty, 1 egg (equivalent to 1 ounce of meat), _ cup of cottage cheese (equivalent to 2 ounces of meat).
• Fats, Sweets, and Alcohol - Examples (of sweets): 2 small cookies, 1 cup of ice cream.

Fat is an important part of a healthy diet, and should come from sources that offer nutritional benefits, such as olive oil or nuts. Talk with your doctor about the amount of fat you should consume each day, and try to limit your intake of saturated fat to less than 7% of your daily calories. Choose lean cuts of meat, eat reduced-fat dairy products, and read food labels to check their fat content.

Consumption of alcohol must be carefully monitored, as alcohol can cause hypoglycemia (low blood sugar). Diabetics should not drink alcohol on an empty stomach or when their blood sugar is low. Since many of the signs of hypoglycemia (sleepiness and dizziness, for example) can be mistaken for drunkenness, many diabetics choose to wear a health alert bracelet or I.D. tag.

It is recommended that you eat only small portions of sweets or enjoy them as an occasional treat. Select a small portion of your favorite dessert and eat it once or twice a week to help satisfy your sweet tooth. Or, you might decide to try sugar-free sweetened foods, such as diet sodas or sugar-free chocolates, instead of the full-sugar versions. Hundreds of sugar-free products exist on the market today, from sugar-substitutes for baking and sweetening drinks to ready-to-bake brownie mixes and ready-to-eat frozen confections. Sugar-free cocktail mixes, cookies, and baked goods can allow diabetics to savor a sweet treat without the worry of all that sugar! Sugar-free cereals, pancake mixes, maple syrup and practically anything that tastes sweet comes in a sugar-free form today. Take a walk down the aisles of your local grocery store; you might be amazed at the number of sugar-free products that you never knew existed!

Exercise and Weight Loss

Exercise and weight loss often go hand-in-hand for the treatment of diabetes. Losing even a few pounds could help you manage your diabetes more effectively. Speak with your doctor or your doctor's recommended dietician when deciding whether a weight-loss program is appropriate for you.

Beyond weight loss, exercise offers important benefits for diabetics. Exercise can lower your blood glucose level and help insulin work more effectively. Regular activity can lower your blood pressure and your cholesterol level, too. Exercise reduces stress levels and strengthens your heart, bones, and muscles, making your whole being healthier. It can also improve your circulation and help build or maintain overall flexibility.

Exercise is an important factor in managing diabetes, so be sure to talk to your doctor about the kinds of exercise that are appropriate for your age and state of health. Since exercise can affect diabetics seriously, carefully monitor your blood glucose levels frequently when beginning a new activity program. Exercise can lead to hypoglycemia during or after exercise, when the body has burned up its store of sugar in the bloodstream. Exercise can also cause hyperglycemia (high blood sugar). The body releases extra glucose into the blood to fuel exercise, but the insulin available may not be enough to effectively manage the surge of sugar. Monitoring your blood glucose levels is the most effective way to avoid complications from exercise.

Any type of exercise can be beneficial for diabetics, from a simple bike ride to a heart-pounding game of competitive basketball! Being a diabetic doesn't necessarily mean that you will have to cut out your favorite activity; it just means that you'll need to monitor your blood glucose levels more carefully while participating. Here are some general activity recommendations for diabetics of different ages:

• Children. Kidshealth.org recommends that children exercise 60 minutes a day for 5-6 days per week. Some children may need to ease into exercise and may not be ready for team sports or intense activity right away. Help your child get started on by exercising together! Go for a family hike in a nearby park, take a walk around the block, or play a friendly game of catch in the backyard. Exercise doesn't have to be strenuous to count! Your child (and you!) can build up to more intense or prolonged exercise gradually; Rome wasn't built in a day, and neither is good health. Work cooperatively with your child to set achievable activity goals, starting with a number that isn't too daunting. Most children would agree that, yes, they can walk just ten minutes a day! Start from there, and work your way up.
  
  For those children who already enjoy exercise or who participate in vigorous sports, work with your doctor to develop a plan to integrate your child's diabetes management into his or her activity schedule. Inform your child's coaches of his or her condition, and let them know what to do should an emergency occur. Make sure that snacks, water, and needed medication are always at hand when your child plays a sport. And finally, teach your child to take a time-out when he or she must attend to a diabetic need, such as taking a shot or having a snack.
• Adults. The range of activities available to adult diabetics is without limits! However, some diabetics are overweight or obese, while others may have additional medical conditions that necessitate caution when exercising. Many adult diabetics will need to begin a more modest exercise program after discussing activity options with their doctor. Diabetics should always exercise with a partner or a group, in case of medical emergency.
  
  There are many exercises that diabetics may safely begin incorporating into their daily routine. Walking is one of the easiest and safest activities to do, and can be done just about anywhere and anytime! Do what you can at first, and build up to longer walks over time. Another extremely beneficial activity is stretching. Never stretch beyond your range of motion; simply stretch to your comfortable limit and hold the stretch for 15-30. Over time, your range of motion and flexibility should increase. Stretching must be done on a regular basis to maintain its benefits. Luckily, it only takes a few minutes a day!
  
  Some diabetics may experience trouble walking due to foot problems or pain. If you are one of those people, try an exercise that is less weight-bearing. Riding a stationary bike is an excellent example of such an activity. Even a gentle bicycling motion can increase circulation, especially to extremities such as the hands and feet. Another moderate form of exercise is swimming or aquatics fitness classes. The buoyancy of the water relieves the body of weight, allowing you to concentrate on your motions and on maintaining an optimal heart rate for your level of health. If you suffer from foot pain due to diabetes, you may wish to try diabetic foot care products such as InStride Comfort diabetic socks by InStride, insoles such as Quikfit Lite Dual Durometer Insoles by ACOR, and DiabetiDerm Foot Rejuvinating Cream by Health Care Products.
  
  Any form of aerobic exercise can help you to manage diabetes. If team sports, exercise machines, or running aren't your cup of tea, how about dancing? You can go out on the town with friends to kick up your heels, or dance around in the privacy of your own home while dusting the bookshelves!

Medications for Diabetics

While diet and exercise are vital to a diabetic's health, medicine often plays a crucial role in managing the condition of diabetes. According to Wikipedia.org, some of the key medications used in diabetes management are oral hypoglycemic agents. These medicines usually work by lowering the blood glucose levels. A wide variety of diabetic medications have been developed, including:

• Sulfonylureas These pills cause insulin to be released to the bloodstream.
• Meglitinides - Similar to sulfonylureas, these medications cause insulin to be released to the bloodstream, but for a shorter and more intense time period. Meglitinides are often taken with meals to maximize the insulin response to the food consumed.
• Biguanides - Biguanides reduce the output of glucose while at the same time increasing the uptake of glucose by the body. The most common biguanide is metformin.
• Thiazolidinediones These medications work by decreasing insulin resistance, rather than increasing insulin secretion.
• Alpha glucosidase inhibitors - These agents do not directly affect the sensitivity to or production of insulin. Instead, they slow the digestion of starches, allowing the glucose from the starch to enter the bloodstream at a steadier, slower rate.
• Insulin - Insulin is currently taken primarily by injection. In 2006, an inhalable insulin was also approved for use. An oral dosage of insulin is not currently available to the market, though numerous laboratories are continuing research to develop such a product. For more information about the use of insulin, please read below.
• Exenatide - This medication helps regulate glucose levels by speeding the release of the body's insulin, suppressing the release of glucagon (a hormone that counteracts the effects of insulin), and reducing the appetite.
• Pramlintide acetate - Pramlintide works by slowing the rate of digestion, by creating a sense of fullness, and by suppressing the release of glucogon.

Monitoring Your Blood Glucose Level

Monitoring your blood glucose level regularly is perhaps the most important aspect of diabetes management. There are numerous tools to monitor blood glucose, such as the ones listed here.

• Glucose test strips - To use a glucose test strip, a very small sample of blood must be collected, usually by pricking the skin on test sites such as the fingertip, palm, forearm, upper arm, thigh, or calf. Glucose test strips are designed to work with glucose monitoring systems. Examples of test strips include Accu-Check Comfort Curve test strips by Roche, Ascencia Autodisc glucose test strips by Bayer, BD glucose test strips by BD, Precision Xtra, MediSense Optium and the popular FreeStyle blood glucose test strips by Abbott, Uni-Check and One Touch Ultra glucose test strips by LifeScan, Trackease and Prestige glucose test strips by Home Diagnostics, and others.
• Blood glucose monitoring systems - These systems read your blood glucose level by analyzing test strip blood samples. Some systems include Accu-Chek Active Diabetes Meter Kit by Roche, Ascencia Breeze 2 Diabetes Monitoring Kit by Bayer, BD Logic Diabetes Meter Kit by BD, True Track Smart System Diabetes Meter by Home Diagnostics, MediSense Optium Diabetes Meter Kit by Abbott, and many more.
• Lancets and other devices - Lancets and lancing devices offer quick and less painful means of collecting blood samples for glucose monitoring systems. Some of these include the Accu-Chek Multiclix glucose lancets by Roche, Ascencia Microlet Adjustable Lancing Device by Bayer, BD Ultra-Fine 33 Gauge lancets by BD, One Touch UltraSoft lancets by LifeScan, Therasense FreeStyle lancets by Abbott, and VitalCare lancing device by VitalCare Group, Inc.
• Urinalysis test strips - These test strips allow you to test your blood pH without the need for a blood sample. Such products include Bayer Ketostix by Bayer, Ezy-Dose Universal pH Indicator test papers and Flents Universal pH strips by Diabetic Specialty Products.

Insulin Usage

Insulin injections are one of the most common means of treating diabetes. For the administration of insulin, needles and syringes are required. Many quality products are available to the diabetic. Some recommended needles and syringes are BD Ultra-Fine U-100 insulin syringes and BD Ultra-Fine III Short Pen needles by BD, and UltiCare U-100 insulin syringes and UltiCare Mini Pen needles by Ulti Med. Accessories for use with these products include BD alcohol swabs by BD, Ezy-Dose 7-Day Diabetic Syringe Organizer by Diabetic Specialty Products, and Medline Alcohol Prep Pads.

You can help manage your diabetes by following these diabetic rules to live by: eat right, exercise, monitor your blood glucose level, and use medications as prescribed by your doctor. Here's to your health!