Pray it Off Meeting June 3, 2010 Diabetes Information

I'd like to thank one of our group members who spoke on Diabetes. The following are supplemetal hand-outs that I encourage you all to read.

Pre-Diabetes FAQs*

Q: What is pre-diabetes and how is it different from diabetes?
A: Pre-diabetes is the state that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. About 11 percent of people with pre-diabetes in the Diabetes Prevention Program standard or control group developed type 2 diabetes each year during the average 3 years of follow-up. Other studies show that many people with pre-diabetes develop type 2 diabetes in 10 years.

Q: Is pre-diabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?
A: Yes. Doctors sometimes refer to this state of elevated blood glucose levels as Impaired Glucose Tolerance or Impaired Fasting Glucose (IGT/IFG), depending on which test was used to detect it.

Q: Why do we need to give it a new name? Has the condition changed?
A: The condition has not changed, but what we know about it has. We are giving IGT/IFG a new name for several reasons. Pre-diabetes is a clearer way of explaining what it means to have higher than normal blood glucose levels. It means you are likely to develop diabetes and may already be experiencing the adverse health effects of this serious condition. People with pre-diabetes are at higher risk of cardiovascular disease. People with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. People with diabetes have a 2- to 4-fold increased risk of cardiovascular disease. We now know that people with pre-diabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes.

Q: How do I know if I have pre-diabetes?
A: Doctors can use either the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT) to detect pre-diabetes. Both require a person to fast overnight. In the FPG test, a person's blood glucose is measured first thing in the morning before eating. In the OGTT, a person's blood glucose is checked after fasting and again 2 hours after drinking a glucose-rich drink.

Q: How does the FPG test define diabetes and pre-diabetes?
A: Normal fasting blood glucose is below 100 mg/dl. A person with pre-diabetes has a fasting blood glucose level between 100 and 125 mg/dl. If the blood glucose level rises to 126 mg/dl or above, a person has diabetes.

Q: How does the OGTT define diabetes and pre-diabetes?
A: In the OGTT, a person's blood glucose is measured after a fast and 2 hours after drinking a glucose-rich beverage. Normal blood glucose is below 140 mg/dl 2 hours after the drink. In pre-diabetes, the 2-hour blood glucose is 140 to 199 mg/dl. If the 2-hour blood glucose rises to 200 mg/dl or above, a person has diabetes.

Q: Which test is better?
A: According to the expert panel, either test is appropriate to identify pre-diabetes.

Q: Why do I need to know if I have pre-diabetes?
A: If you have pre-diabetes, you can and should do something about it. Studies have shown that people with pre-diabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle that include modest weight loss and regular exercise. The expert panel recommends that people with pre-diabetes reduce their weight by 5-10 percent and participate in some type of modest physical activity for 30 minutes daily. For some people with pre-diabetes, intervening early can actually turn back the clock and return elevated blood glucose levels to the normal range.

Q: Will my insurance cover testing and treatment?
A: Because all insurance plans are different, this is a difficult question to answer. However, Medicare and most insurance plans cover diabetes testing for people suspected of having diabetes. People at risk for diabetes are also at risk for pre-diabetes. Since the test is the same and the risk factors are the same for both conditions, a pre-diabetes test may be covered. It is best to consult your physician and health insurance representative with specific coverage questions.

Q: What is the treatment for pre-diabetes?
A: Treatment consists of losing a modest amount of weight (5-10 percent of total body weight) through diet and moderate exercise, such as walking, 30 minutes a day, 5 days a week. Don't worry if you can't get to your ideal body weight. A loss of just 10 to 15 pounds can make a huge difference. If you have pre-diabetes, you are at a 50 percent increased risk for heart disease or stroke, so your doctor may wish to treat or counsel you about cardiovascular risk factors, such as tobacco use, high blood pressure, and high cholesterol.

Q: Who should get tested for pre-diabetes?
A: If you are overweight and age 45 or older, you should be checked for pre-diabetes during your next routine medical office visit. If your weight is normal and you're over age 45, you should ask your doctor during a routine office visit if testing is appropriate. For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or pre-diabetes. These include high blood pressure, low HDL cholesterol and high triglycerides, a family history of diabetes, a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds, or belonging to an ethnic or minority group at high risk for diabetes.

Q: How often should I be tested?
A: If your blood glucose levels are in the normal range, it is reasonable to be checked every 3 years. If you have pre-diabetes, you should be checked for type 2 diabetes every 1-2 years after your diagnosis.

Q: Could I have pre-diabetes and not know it?
A: Absolutely. People with pre-diabetes don't often have symptoms. In fact, millions of people have diabetes and don't know it because symptoms develop so gradually, people often don't recognize them. Some people have no symptoms at all. Symptoms of diabetes include unusual thirst, a frequent desire to urinate, blurred vision, or a feeling of being tired most of the time for no apparent reason.

Q: Should children be screened for pre-diabetes?
A: We are not recommending screening children for pre-diabetes because we don't have enough evidence that type 2 diabetes can be prevented or delayed in children at high risk for the disease. However, a study published in the March 14, 2002, issue of the New England Journal of Medicine found 25 percent of very obese children and 21 percent of very obese adolescents had pre-diabetes. If future studies show that early intervention also works for children, a recommendation could be forthcoming.

*www.diabetes.org

Diabetes Forecast

Know Your Blood Sugar Numbers

Meal Planning Made Simple*
By Tracey Neithercott

“DOCTOR'S ORDERS: You need to completely change the way you think about food. Eat healthy. Watch the carbs. Stick to a meal plan. OK—but what does that mean?

Too often, people newly diagnosed with diabetes are told they need to develop better eating habits without being given specific information about how to do it on a day-to-day—or meal-to-meal—basis. It’s like telling someone who’s never been behind the wheel to drive a car down the interstate. The general idea is easy to understand, but the logistics are insurmountable.

Eating well with diabetes doesn’t have to be as difficult as that. But it’s going to take some work on your part, and perhaps even a new attitude. If you keep dwelling on what you can’t do instead of what you can, you’ll hinder your ability to manage your diabetes. But once you’re willing to learn a little bit about nutrition, carbohydrates, and meal planning, you’re ready. “You have to start here with a commitment and make your diabetes a priority,” says Toby Smithson, RD, LDN, CDE, a spokesperson for the American Dietetic Association and a dietitian with the Lake County (Ill.) Health Department. She and other experts helped us develop the healthy-eating primer that follows.

5 Steps to Meal-Planning Success

1. Visualize Your Plate 2.Count Carbs 3. Watch Those Portion Sizes 4.Consider Nutrition 5. Keep Learning

Strategy No. 1: Visualize Your Plate

What’s It Look Like?

Toby Smithson, RD, LDN, CDE, a spokesperson for the American Dietetic Association, created these sample meals based on the plate method. Dinner (above): 1 cup broccoli; 2 to 3 oz. baked chicken; 1 small baked potato; 1 tsp. margarine for potato; 1 (6 oz.) container nonfat, sugar-free yogurt; ½ mango

How To Do It:

The most basic meal-planning tool is the “plate method.” It’s pretty simple: Fill half of your plate with nonstarchy vegetables like broccoli, peppers, and snow peas; fill a quarter of your plate with lean meat, such as fish or chicken breast; and cover the final quarter of your plate with carbs, including grains or starchy veggies like corn and potatoes. On the side, you can also have a serving of low-fat dairy (like skim milk or low-fat yogurt) or soymilk and a serving of fruit, such as an apple or a half cup of berries. You can add a small amount of fat to the meal, but avoid saturated fats, such as in butter. Check out the photo above for an example.

Next: Count Carbs

Strategy No. 2: Count Carbs

What’s It Look Like?

Hope Warshaw, MMSc, RD, CDE, BC-ADM, author of Diabetes Meal Planning Made Easy, created these sample dishes based on the carb-counting system. The breakfast portion has about 55 grams of carbs; lunch has about 60. Lunch: Tuna salad made with ½ cup (2 oz.) tuna packed in water, 1 Tbsp. light mayonnaise, 2 Tbsp. diced celery, 1 Tbsp. diced onions, tomato slices, 2 slices whole wheat bread; 1 cup zucchini; 1 cup fat-free milk; ½ large apple

How To Do It:

Following the plate method is a good way to learn how to balance your diet, but many people who take insulin use another tool: carbohydrate counting. Foods like crackers, oatmeal, apples, and bread all contain carbohydrates, one of your body’s main energy sources. Your dietitian, diabetes educator, or doctor will help you determine how much carbohydrate you should get per meal—say, 40 to 60 grams—for optimal blood glucose control. (You can also use carb counting to figure out how much insulin to take at meals, as explained here.)

Though carb counting focuses on the amount of carbohydrates in each meal or snack, you still need to pay attention to overall nutrition. “The meal plan that you have is somewhat of a puzzle,” says Debby Johnson, RD, LD, CDE, coaching manager and nutrition coach for the diabetes Web site Fit4D, who has type 1 diabetes. But it’s not a particularly complicated one: “If you can have 40 grams of carbohydrates, it’s a puzzle of do I want two servings of fruit and one serving of rice? Or two servings of rice and one serving of fruit?” Pick healthier carbs over junk food; an apple and a half cup of ice cream both have 15 grams of carbohydrates, but the apple is a smarter choice.

If carb counting seems daunting at first, understand that it’s a process you’ll continually get better at. “You learn which are foods that have carbohydrates,” says Smithson, who has had type 1 diabetes for 41 years. “You learn what the portions are for a 15-gram serving.”

Next: Watch Those Portion Sizes

Strategy No. 3: Watch Those Portion Sizes

There’s an overarching message that everyone—not just those with diabetes—should keep in mind: Portion control is key. Restaurants in particular can pack two or three servings onto one jumbo plate. But despite what they may have you believe, the recommended serving of meat is only 3 ounces, or the size of a deck of cards. A serving of pasta or rice should be the size of a clenched fist. A baked potato should be about the size of your computer mouse. A cup of veggies is the size of a baseball, a 2-tablespoon serving of peanut butter is equivalent to a ping-pong ball, and an ounce of cheese is the size of four dice. “It’s a bit of a learning process,” says Smithson. “You’ll get to a point where you know what a serving size is. In the beginning, you may need to look it up.”

• 1 cup steamed green beans or 1 cup low-fat yogurt is the size of a baseball
• 1 cup brown rice is the size of a light bulb
• 2 to 3 oz. grilled salmon is the size of a deck of cards
• 1 oz. dried fruit is the size of a golf ball

Next: Consider Nutrition

Strategy No. 4: Consider Nutrition

What’s It Look Like?

Get a feel for a full day of healthy eating by following the sample plan created by Debby Johnson, RD, LD, CDE, coaching manager and nutrition coach for the diabetes Web site Fit4D. It boasts a balance of carbs, fat, and protein and averages 1,400 calories for women and 1,700 calories for men.

Breakfast
½ cup cooked oatmeal
¾ cup blueberries
1 whole egg and 1 egg white, scrambled
1 cup (8 oz.) 1% milk
Coffee
(Men: Add a cup more cooked oatmeal)
Total Carbs
Women: 40 grams
Men: 55 grams Lunch
2 slices light whole wheat bread
2 oz. turkey
1 slice reduced-fat Swiss cheese
Mustard
4 oz. apple
1 cup (6 oz.) nonfat yogurt
1 cup baby carrots
2 Tbsp. light ranch dressing
Caffeine-free diet soda
(Men: Add ¾ oz. tiny pretzels)
Total Carbs
Women: 45 grams
Men: 60 grams Dinner
3 oz. broiled pork chop
2/3 cup brown rice
¼ cup brown gravy
½ cup steamed green beans
1 cup salad
1 Tbsp. Italian dressing
1½ cup light or no-sugar-added
ice cream
Decaf unsweetened iced tea
(Men: Add 1/3 cup more rice)
Total Carbs
Women: 60 grams
Men: 75 grams Snack
½ cup sliced peaches in light syrup
¼ cup 1% cottage cheese
Total Carbs
15 grams

How To Do It:
Whichever meal-planning tools you use, keep in mind the basic nutrition recommendations that all Americans should follow. “What we need to talk to people about is healthy eating and behavior changes,” says Hope Warshaw, MMSc, RD, CDE, BC-ADM, author of Diabetes Meal Planning Made Easy. Aim to get a balance of carbohydrates, protein, and fat at each meal, and pay attention to the source of these nutrients. Warshaw suggests getting 50 percent of calories from carbohydrates, 20 percent from protein, and 30 percent from fat. (The sample menu above to this recommendation.)

Lean meat always trumps fattier cuts when it comes to protein because it has less saturated fat, which can raise your cholesterol and put you at risk for heart disease and stroke. Whole grains and fruits are better than refined grains, fruit juice, and fruit in syrup when you’re considering carbs. Low-fat dairy is a better source of protein than the full-fat variety, so stick with skim or 1 percent milk and cheese, and low-fat or nonfat yogurt. And monounsaturated fats, like those found in olive oil, canola oil, and avocados, are better for your heart than the saturated fats found in butter, red meat, and cheese. “There is no perfect food,” says Johnson. “It’s about balance.”

Next: Keep Learning

Strategy No. 5: Keep Learning

The preceding strategies might be the most common meal-planning tools, but they’re not the only way to judge the nutrition content of what you eat. If you haven’t found your ideal method yet, it’s worth investigating other options. One size truly does not fit all.

The exchange system, for example, helps people balance their diet by controlling the number of carbohydrates as well as calories in a meal. Foods are grouped into categories with similar nutrient content—such as starches, carbohydrates, nonstarchy veggies, fruits, fats, and meat. Within each group, you can exchange one item for another because all foods have roughly equal carbs, fat, protein, and calories.
Another tool you may hear of is the glycemic index (GI), which measures how quickly carbohydrates raise blood glucose. Foods with a high GI raise glucose levels faster than those with a low GI do. For example, a potato with 15 grams of carbs might raise your blood glucose quicker than an apple with 15 grams.

Whatever method you choose, remember that a meal plan isn’t about dieting—it’s a lifestyle change. Enlist the help of a dietitian to better understand which foods are the most nutritious. Check out ADA’s My Food Advisor for comprehensive nutrition information on thousands of foods. Or join a support group to trade meal-planning tips with other people with diabetes. “A lot of it is experimentation,” says Johnson. “It’s learning your body. You kind of have to be your own scientist.”

http://forecast.diabetes.org/magazine/features/meal-planning-made-simple

Photo:http://nanomegamedical.com/images/type2_diagram.jpg