One of the first things that doctor advises a patient to do when they are diagnosed with Type 2 Diabetes is lose weight. I always wondered if the docs didn't think the person standing before them already knew they were overweight. It has always annoyed me. If we knew how to lose weight and keep it off, we would. It is important to understand what has transpired prior to the diagnosis and what is happening now in order to lose weight. Start with one area - medication or exercise or diet adjustment. Do that for a month, then add another area. Otherwise, you set yourself up for failure.
Insulin Resistance: nearly anyone who has that little spare tire or poochy belly has some insulin resistance. Insulin has one primary job: to move the glucose out of your blood stream and into the cells which need it. Any left over glucose is then moved into storage - wrapped in fat and stored as a triglyceride and then deposited on the belly. Insulin resistance is the condition of having extra fat ( which has extra estrogen) that increases the need for insulin. Instead of it taking one unit of insulin to do the job of clearing the glucose, now it takes two, then three and so on. The more fat a person has, the more insulin resistant they are said to be. Metformin, Actos and Avandia work to reduce insulin resistance.
Insulin: Good blood sugar control is imperitive in getting weight off. Insulin's primary job is to keep the blood glucose in check, but it is single-minded. As long as there are insulin molecules in the blood stream, they will keep grapbbing glucose until they all "have one" This phenomenon is why sometimes blood sugars come down too fast, or get to low causing hypoglycemic symptoms. Everytime the blood glucose is above normal range, insulin is secreted in response - and if the cells are full, that extra glucose gets stored as fat. For example, if your blood sugar is 160 after breakfast and then before lunch it is down to 120, that extra 40 points of blood sugar have most likely gone to storage. For many people, getting dietary control will help lower their need for insulin injections. The studies show that overall blood sugars can be reduced by about 30 - 60 points overall by changing the diet. Coming off insulin is only a possibility for people with Type 2 diabetes.
Activity: I mentioned full cells earlier. This is important because we have some control over emptying out the cells to make room for more glucose from the blood stream. The muscle cells burn their sugar when we are active. When the glucose has been burned from those cells, the insulin can easily move the glucose out of your blood stream and into these cells - no resistance, no fat storage. This is why people typically decrease their diabetes medicines while they build muscle and lose weight with activity. Even light activity is better than none at all. The ADA recommends 60 minutes of exercise 7 days a week. That is a pretty lofty goal for most of us. But the rationale is that good glycemic control - having blood sugars in a normal range - is what staves off complications. If you don't routinely exercise, start walking. If that is prohibitive, find something else you can do and get moving.
Diet: Most of us need improvements in three areas: consistancy, quality and quantity. However, it is important to understand why we need to eat. The body is loaded with back up mechanisms. One of these is stored sugar which is kept in the liver and kidneys. If a person skips a meal, or does not take in enough to sustain the body, this emergency sugar is released. It is calle hepato-neoglucogenesis. Since it is an emergency mechanism, like your emergency brake, it is great in a pinch - like if we are stuck snowbound in a car for three days - but not so great on a daily basis. This release of sugar can be seen in people who see a rise in their sugars between when they go to sleep and when they wake up, since this sugar is often released at night as well as at meal times. This can be controlled through diet, but eating consistantly, and also by using Metformin.
Consistancy: in Type 2 diabetes, the pancreas is ticked off, not broken. It tends to work in fits and starts, so part of what we want to do is take some of the workload off by eating consistantly.A person should not go for more than 4 hours without eating something, except of course, overnight. If possible, it is best to break daily intake into 5 or 6 small meals, consisting of 20-40 grams of Carbohydrates at each meal. (it is easier to start on the low side and add, rather than the reverse) This gives the body steady fuel throughout the day and allows the pancreas to react gradually. Do not go without carbohydrates, or with a lower amount without first checking with your doctor. If you cannot do 5-6 meals, then at your three meals, aim for 45 grams each. If you have to have a snack due to increase activity or a late meal, try to keep it around 15 grams.
Blood glucose testing can also give you feedback on how you are doing. If you are having the right amount of carbs at your meals, you should see a difference of less than 30 points between your fasting glucose in the morning and your glucose 2 hours after any meal. If it is more than 30 points, try less carbs at a meal, and moving those carbs to a snack 2-3 hours after the meal.
Quality: If you could hunt it down, grow it on a farm or pick it off a tree it is probably good for you, if not it should not be the crux of your diet ( there is no Macaroni and Cheese tree!) Fresh fruit, fresh vegetables, lean meats and dairy and whole grains. Lay off the processed food and let the quality of the vitamins and nutrients in these foods feed your immune system and heal your body. The fiber is good for your heart, good for your sugars and helps fight cancer - what a deal.
Quantity: People with diabetes are hungry more often because the stomach tends to empty faster - usually in 2 hours. Some people have found that using Byetta or Januvia along with their metformin will significantly decrease these hunger pangs and slow the emptying of the stomach. If you are a quantity eater, fill your plate half full of vegetables - 1 1/2 cups cooked vegetables is about one serving - and that's a lot of broccoli. Have salads, have a glass of water before you eat and for heaven's sake, don't cut out the protien in your diet - it keeps you feeling full longer.
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