Q:
What's the prevalence of type 2 diabetes in the U.S.
right now and is the percentage
of people with type 2
diabetes increasing? What is type 2 diabetes?
A:
There are 13 million people in the US with diagnosed
diabetes and another 5.2
million who don't know they have diabetes. 90-95%
of diabetes is type 2.
Type
2 diabetes is considered an "epidemic" presently
because of the increasing
prevalence related to the increasing obesity of America.
This is also showing in
our children and teenagers. Type
2 diabetes is characterized by high levels of blood
glucose/sugar resulting
from defects in insulin production, insulin action
or both. It usually begins
as insulin resistance, a disorder in which the cells
do not use insulin properly.
Over time the pancreas can lose its ability to make
insulin. It is usually associated
with older age, obesity, family history of
diabetes, prior history of gestational
diabetes, impaired glucose tolerance, physical
inactivity and race/ethnicity. African Americans,
Hispanic/Latino Americans,
Native Americans and some Asian Americans have higher
incidence. Due to increasing
obesity and lack of activity we are seeing the increased
incidence in younger and younger
people.
Q:
What should a person do to decrease there chances
of developing type 2 diabetes?
A:
Maintain a reasonable weight, lose weight if you are
overweight, and get moving
- have regular physical activity, and make healthy
food choices (which helps
with weight loss and maintenance).
Q:
When you first see a new type 2 diabetes patient what
do you tell them about
eating?
A:
Stop the junk - eat less processed foods and "sweets",
less fried foods, more whole
grains, fruits and vegetables, lean meat. Portion
size is also very important.
Not just the right foods, but the right amounts.
Q:
Is fiber important? If so, why?
A:
Fiber has been shown to help improve blood sugar levels.
The harder the body has
to work on the food to get to the sugar, the less
rapid rise in blood sugar
levels. That is why fruit is a better choice than
juice, whole wheat bread
a better choice than white, 5 minute cooked oatmeal
a better choice than micro-waved
packets, etc. Fiber is also good for feelings of fullness,
digestion and cholesterol.
Q:
Should certain fruits be avoided.
A:
All fruit is acceptable - it is the amount that is
important. Portion size again
is the issue. Serving size is that amount that equals
about 15 gms of carbohydrate.
Ex: 1 small apple, 1/2 cup canned fruit, 1 cup melon,
15 grapes, 2 Tbs raisins,
etc.
Q:
So it's important to eat small quantities of food
at one time?
A:
Consistency in the amount of carbohydrate meal to
meal is important. If you try
to put 15 gallons of gas in a 10 gallon tank it just
runs out on the ground.
If you overeat at a meal your blood sugars can go
too high and the extra
calories are stored. Smaller amounts at regular intervals
(4-5 hours) is a better
choice for blood sugar control. Waiting too long between
meals often leads to overeating
because you feel so hungry.
Q:
Are whole grains important?
A:
Whole grains are higher in fiber. As mentioned previously
- the more fiber the less
rise in blood sugar. Read labels carefully for ingredients.
For example, if whole
grain/wheat is not the first ingredient in bread,
it is really brown white
bread.
Q:
Is diet for a type 2 diabetic any different from a
general very healthy diet?
A:
focusing on fruits, veggies,
whole grains, and lean meats? No,
but attention to portion size makes a big difference
in BS control.
Q:
Can type 2 diabetes be reversed? Have you had patients
that are successful with
this?
A:
Losing weight and getting 30 minutes of activity on
most days makes a significant
effect on blood sugar results. It is possible for
many to reach and maintain
normal blood sugars with weight loss, activity and
a healthy meal plan, especially
early in the disease. There are many that could
decrease or stop medication with
these consistent lifestyle changes.
Unfortunately,
many do not make the necessary changes and underestimate
the severity of uncontrolled
blood sugars and the resulting complications. Yes,
I have seen people successfully
reach normal blood sugars without medication.
Q:
Anything else?
A:
Education is one of the greatest tools for blood sugar
control. Know what diabetes
is and what you can do about it. All people with diabetes
should be doing self monitoring
of blood sugars at home. The frequency is a minimum
of 1-2 times per day,
but depends on the individual's treatment plan and
current level of control. The
bottom line is healthy food choices - the right
food in the right amount and a minimum of 30 minutes
of activity 5 days per
week and medication as ordered by your physician.
Most important, don't
ignore diabetes just because you "don't feel
bad". Don't ignore other risk
factors or complications like lipid (cholesterol)
and blood pressure control.
