We are Here to Help Type 2 Diabetes

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Article by Dr. Sheri Colberg, Phd, FACSM

 

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TYPE 2 DIABETES AND NUTRITION


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Adopting a healthier lifestyle plays a crucial role in better management of your type 2 diabetes. Healthy and relatively simple changes to the way you eat, coupled with regular exercise, can make all the difference.

By easing yourself into a routine that features a balanced, nutritious diet and physical activity, you can experience the benefits of weight loss and provide yourself with the potential to reduce many of the harmful effects of diabetes. Better health and a greatly improved sense of well being are likely to follow.

Controlling blood glucose levels is one of the keys to managing diabetes and these levels are mainly kept in check by insulin and other medications.

Type 2 diabetes usually occurs from the imbalance of blood glucose and insulin levels called Insulin Resistance, which desensitizes the cell wall to insulin, as well as a reduced amount of insulin secretion by the pancreas. A balanced, nutritious diet leading to weight loss can benefit persons with diabetes by increasing insulin sensitivity and reducing dependence on insulin.

Hand holding raspberries.The majority of people with type 2 diabetes are Insulin Resistant, which means that insulin does not work efficiently in helping glucose be converted into energy. As a result, large amounts of insulin are needed to reduce blood glucose levels. If the beta cells that produce insulin in the pancreas are placed under too much strain, they may not be able to produce these large amounts of insulin, so blood glucose levels rise and type 2 diabetes results.

People who are overweight and inactive are more likely to be Insulin Resistant than lean people who exercise regularly, though the latter can still be vulnerable to diabetes.

Unfortunately, persons with diabetes can become resistant to insulin over time. The longer persons with diabetes use insulin and the more insulin they need to add to their system, the more likely they are to develop Insulin Resistance. Given that many oral medications for persons with diabetes stimulate the beta cells in the pancreas to secrete more insulin, their use can also worsen Insulin Resistance over time.

The opposite of Insulin Resistance is insulin sensitivity. Raising insulin sensitivity can greatly improve the health of a person with diabetes because the more sensitive the body is to insulin, the less insulin is needed to control blood glucose levels.

The body can be made more sensitive to its insulin in a number of ways, such as:

  • By increasing the level of daily activity (1)
  • By reducing the intake of carbohydrates to lose weight as part of a balanced nutritious diet (2)
  • By improving Insulin Resistance through other means, as in the Insulite program.

If less insulin is needed, then less strain is put on the beta cells in the pancreas. Researchers feel that lowered insulin levels over time greatly reduces the possibility of the eventual onset of such distressing complications of diabetes as blindness, kidney and heart disease and the need for amputation.

Food, blood glucose and insulin

Man dining at a restaurant.Carbohydrate foods have the greatest direct effect on blood glucose levels. Carbs are broken down into glucose and other sugars by digestive enzymes and these are then absorbed from the intestine into the bloodstream, usually 1-2 hours after eating. This causes blood glucose levels to rise after a meal.

Insulin is needed so that the body's cells can take this glucose from the bloodstream and either use it for energy right away or store it for later. People who do not have diabetes will produce just the right amount of insulin to cope with the rise in blood glucose that occurs after a meal. Insulin on demand allows the person without diabetes to keep blood glucose levels within the normal range, even after a meal rich in carbohydrates.

If you have diabetes, however, your body either no longer produces insulin or produces too little insulin to keep blood glucose levels within the normal range or the cells of your body.

Choosing food types that are more slowly digested can reduce the post-meal spike in blood glucose, which, in turn, either reduces the demand on beta cells in the pancreas to produce insulin or reduces the need to inject large amounts of insulin.

The differing rates at which food is converted into glucose and absorbed into the bloodstream to be converted into energy is called the Glycemic Index (GI). Low GI food is a crucial aid for persons with diabetes to prevent spikes in their glucose and insulin levels. (For more GI information, see The Glycemic Index section on this website.)

Blood Fats

Woman eating a salad.Many people with diabetes have unhealthy levels of blood fats like triglycerides and LDL “bad" cholesterol. This is commonly referred to as an unhealthy blood lipid profile. Too much of the wrong type of fat in the blood increases the risk of heart disease and circulatory problems. Another important aim of diet and exercise in the management of your diabetes is therefore to help keep your blood lipid levels normal.

Reducing your intake of saturated fat and alcohol can help to bring down levels of cholesterol and triglycerides in the blood. Your blood lipid profile will also improve with regular exercise in addition to healthy eating. (3)

Diabetes is often accompanied by high blood pressure (hypertension) and this increases the risk of eye and kidney damage, as well as heart disease. Regular exercise, reducing alcohol intake and eating less saturated fats and salt can help reduce blood pressure. (4)

Different food types

You need to learn about different food types so that you can make healthy choices when it comes to meal planning.

The overall effect of a meal on blood glucose levels will depend on the different types of foods comprising the meal. High carbohydrate foods have the greatest effect on blood glucose levels because, after digestion, they are mostly converted to glucose, which is absorbed from the intestine straight into the bloodstream. However, proteins and fats in the diet do affect blood glucose levels, too.

Chef cutting a piece of salmon.You will need to pay attention to the amount and type of fat that you eat. Fatty foods tend to be high in calories and eating too much saturated fat can raise your blood fat levels, increasing the risk of heart disease and circulation problems. Healthier fats include the omega-3 variety found in fish like salmon as well as walnuts, seeds and flax oil. Unsaturated fat, like monounsaturated and polyunsaturated fats also have health benefits.

Sugar

It is still widely believed by the general public that people with diabetes should avoid eating sugar because it causes a rapid increase in blood glucose levels. But this is not precisely true.

The sugar that gets sprinkled on cornflakes, for example, actually causes less of a spike in blood glucose than the cornflakes themselves.

Table sugar is not the same as glucose. It's called sucrose and is a disaccharide because it contains two sugar molecules: one fructose and one glucose.

Freshly picked green onions.Surprisingly, table sugar has a lower Glycemic Index rating than cornflakes because it needs to be broken down by digestive enzymes before the fructose and glucose can be absorbed. Glucose is absorbed quickly because it does not need to be broken down or digested first.

Doctors and nutritionists advise cutting back or eliminating sugar entirely from a diet because it is a source of empty calories which promote weight gain. Table sugar is eventually broken down to glucose, which promotes Insulin Resistance and fat storage. (5) It also has little nutritional value and it does next to nothing to satisfy the appetite.

Fats in Food

The most significant effect of fat on blood glucose levels is to slow down the rise in blood glucose after a meal. Fat delays the rate at which the stomach empties and this has the added effect of slowing down the absorption of glucose from digested carbohydrate foods.

There are, however, different types of fats and some can be beneficial. Others, however, can increase the risk of high blood pressure and heart disease.

Too much saturated fat and cholesterol in the diet can result in unhealthy levels of blood fats. However, monounsaturated fats may improve your lipid profile.

Protein

Protein in the diet is a great way to help stabilize blood sugar. It is not broken down as quickly to glucose like carbohydrates and it therefore decreases the demand for insulin on your pancreas. However, it's still important not to consume protein in excess, because it can be converted to glucose by the liver.

Putting the theory into good practice

Ketchup bottle standing next to a spilled over salt shaker.There's an old joke that says French intellectuals like to complicate life unnecessarily by saying: "Well, something may work in practice but does it work in theory?"

Efficiently managing your diabetes works both in theory and in practice when it comes to improving your health and well-being. You just need to take a few practical steps to gain the maximum benefit from the Insulite Diabetes Advanced Management System.

Scientifically-designed, the system can help you to take control of your condition. It's important to remember that, when starting a new system, consult with your physician because your diabetes medication may need to be adjusted.

The Insulite System is a comprehensive program to help you better manage your life with diabetes. It's important to begin slowly.

Change takes time and we are here to support you.

Look at your usual eating and exercising patterns and see where you could make small changes for the better. Set yourself achievable targets.

Woman slicing a strawberry belgium waffle.Use blood glucose monitoring to find out whether your diet and exercise approach is working; make a note in your diary of the changes you made and learn from experience. The most informative times to test are first thing in the morning, before eating and 1-2 hours after your meal.

  • Learn about different food types and eat a healthy, nutritious diet
  • Consider what you eat and how it might affect your blood glucose level. Learn about the effects of different types and amounts of food on your blood glucose level using blood glucose monitoring
  • Use a calorie counter, or similar book, to assess the carbohydrate, fat and protein content of foods
  • Scrutinize food labels
  • Use the Glycemic Index only as one tool among others when determining which foods to consume
  • Cut down on saturated fats
  • Cut down on alcohol and salt, particularly if you have high blood pressure
  • Increase your level of activity, being careful to adjust insulin dosing and food intake as needed. Consult your doctor whenever you change your exercise routine

A three-pronged attack can help you to control your blood glucose levels:

  • Increase your daily level of activity - this can help to reduce Insulin Resistance and the amount of insulin your body needs
  • Reduce your daily calorie intake and try to lose some weight - this helps to reduce Insulin Resistance
  • Reduce your carbohydrate intake and choose carbohydrate foods that are digested more slowly and rich in fiber, such as vegetables.

IMPORTANT ADVICE IF YOU TAKE CERTAIN TABLETS OR INJECT INSULIN

An arrangement of fruit.An additional role of diet in managing diabetes is preventing low blood glucose levels (hypoglycemia). This is particularly important if you take tablets to help decrease blood glucose levels because the oral medications work via different mechanisms.

Some insulin and tablet regimens require you to have snacks in between meals in order to prevent hypoglycemia. Snacks are not always necessary, however, so check with your doctor or dietician to see if you need to snack between meals.

Delayed or missed meals are probably the most common cause of hypoglycemia. Take steps to avoid low blood glucose levels if you know that you are not going to be able to eat your usual meal. Have an extra snack to keep you going and keep an eye on your blood glucose level.

Snacks are important before exercising, especially if the activity does not form part of your regular daily routine. This is to prevent exercise-induced hypoglycemia.

 

(1) The effect of physical exercise on the dynamics of glucose and insulin.
Derouich M, Boutayeb A., J Biomech. 2002 Jul;35(7):911-7.

Understanding Diabetes, H. Peter Chase, M.D. McKesson Provider Technologies Copyright 2005

The Healing Handbook for Persons with Diabetes, Ruth E. Lundstrom, R.N. and Aldo A. Rossini, M.D. Copyright 1995-1997

Exercise therapy for the aged diabetics. Oshida Y, Ishiguro T. Nippon Rinsho. 2006 Jan;64(1):81-6.

Exercise, glucose transport, and insulin sensitivity. Goodyear LJ, Kahn BB. Annu Rev Med. 1998;49:235-61.

(2) A low-carbohydrate as compared with a low-fat diet in severe obesity. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L. N Engl J Med. 2003 May 22;348(21):2074-81.

Comparison of a very low-carbohydrate and low-fat diet on fasting lipids, LDL subclasses, insulin resistance, and postprandial lipemic responses in overweight women., Volek JS, Sharman MJ, Gomez AL, DiPasquale C, Roti M, Pumerantz A, Kraemer WJ., J Am Coll Nutr. 2004 Apr;23(2):177-84.

Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Ann Intern Med. 2005 Mar 15;142(6):403-11. Summary for patients in: Ann Intern Med. 2005 Mar 15;142(6):I44.

(3) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.
American Heart Association Nutrition Committee Circulation. 2006 Jul 4;114(1):82-96. Epub 2006 Jun 19.

Management of behavioral risk factors for cardiovascular disease (CVD)., Kottmann W, Ahmad N, Bachmann U Ther Umsch. 2005 Sep;62(9):583-9.

(4) Nutritional aspects of hypertension. Paillard F. Presse Med. 2006 Jun;35(6 Pt 2):1077-80.

Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials.
Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA. J Hypertens. 2006 Feb;24(2):215-33.

(5) Thematic review series: patient-oriented research. Nutritional determinants of insulin resistance. McKauley K, Mann J. J Lipid Res. 2006 Aug;47(8):1668-76. Epub 2006 May 23.

Fast food, central nervous system insulin resistance, and obesity. Isganaitis E, Lustig RH., Arterioscler Thromb Vasc Biol. 2005 Dec;25(12):2451-62. Epub 2005 Sep 15.

 

Read about diabetes and pregnancy.

 

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"I have been using the Insulite System for about 6 months. I have noticed that my eating habits seem to have transitioned very naturally.... no starvation or denial, I don't crave junk food or sweets anymore!! I have been able to lose about 20 pounds, slowly, safely, and permanently. This is a "for life" program..."
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