The majority of our dialysis patients lose kidney function completely – in other words they no longer urinate. So imagine what happens when they eat salty foods (not salt) – they get thirsty and drink – Then the dialysis treatment must try (only try) to remove the fluid they accumulate. It is true that high blood sugar also causes thirst – which I must keep in mind. I have many patients who rely on their PCP for advice with their insulin. They take the same amount of insulin regardless of their blood sugar – and the A1C remains elevated – I can’t change how they administer the insulin – but only recommend asking for a referral to an endocrinologist.
You can talk to your diabetes health care team about making any necessary meal or medication adjustments when you exercise. They'll offer specific suggestions to help you get ready for exercise or join a sport and give you written instructions to help you respond to any diabetes problems that may happen during exercise, like hypoglycemia (low blood sugar), or hyperglycemia (high blood sugar).
The problem, of course, has not been solved – the sugar bowl is still overflowing. You’ve only moved sugar from the blood (where you could see it) into the body (where you couldn’t see it). So, the very next time you eat, the exact same thing happens. Sugar comes in, spills out into the blood and you take metformin to cram the sugar back into the body. This works for a while, but eventually, the body fills up with sugar, too. Now, that same dose of metformin cannot force any more sugar into the body.
The result of his hard work? He lost 160 pounds in two years, normalized his high blood pressure and high cholesterol, has an A1C of 5.6, and no longer takes metformin and glyburide. His advice to others with type 2: "You need to have a plan, and you need to be consistent," he says. "[Diet and exercise are] something you need to do to survive and control it. Look at it as the same thing as taking a pill or insulin."
Diabetes mellitus (DM) was first recognized as a disease around 3000 years ago by the ancient Egyptians and Indians, illustrating some clinical features very similar to what we now know as diabetes.1 DM is a combination of two words, “diabetes” Greek word derivative, means siphon - to pass through and the Latin word “mellitus” means honeyed or sweet. In 1776, excess sugar in blood and urine was first confirmed in Great Britain.2,3 With the passage of time, a widespread knowledge of diabetes along with detailed etiology and pathogenesis has been achieved. DM is defined as “a metabolic disorder characterized by hyperglycemia resulting from either the deficiency in insulin secretion or the action of insulin.” The poorly controlled DM can lead to damage various organs, especially the eyes, kidney, nerves, and cardiovascular system.4 DM can be of three major types, based on etiology and clinical features. These are DM type 1 (T1DM), DM type 2 (T2DM), and gestational DM (GDM). In T1DM, there is absolute insulin deficiency due to the destruction of β cells in the pancreas by a cellular mediated autoimmune process. In T2DM, there is insulin resistance and relative insulin deficiency. GDM is any degree of glucose intolerance that is recognized during pregnancy. DM can arise from other diseases or due to drugs such as genetic syndromes, surgery, malnutrition, infections, and corticosteroids intake.5-7
Metformin is likely effective for as long as 10 years, based on long-term follow-up of patients in the Diabetes Prevention Program (DPP). In this trial, investigators randomized 3234 at-risk patients to 3 groups: metformin 850 mg twice daily; lifestyle modification (7% weight loss, 150 minutes of physical activity per week, and a one-to-one 16-lesson curriculum covering diet, exercise, and behavior modification); or placebo.4 At a mean 2.8-year follow-up, the incidence of diabetes was 31% lower in the metformin group (95% confidence interval [CI], 17%-43%) and 58% lower in the lifestyle modification group than in the placebo group (95% CI, 48%-66%; P<.001 for both comparisons).
Combining the Nurses’ Health Study results with those from seven other studies found a similar link between sugary beverage consumption and type 2 diabetes: For every additional 12-ounce serving of sugary beverage that people drank each day, their risk of type 2 diabetes rose 25 percent. (27) Studies also suggest that fruit drinks— Kool Aid, fortified fruit drinks, or juices—are not the healthy choice that food advertisements often portray them to be: Women in the Black Women’s Health study who drank two or more servings of fruit drinks a day had a 31 percent higher risk of type 2 diabetes, compared to women who drank less than one serving a month. (28)
Eventually, even though the pancreas is working at its best to produce more and more insulin, the body tissues (for example, muscle and fat cells) do not respond and become insensitive to the insulin. At this point, overt diabetes occurs as the body is no longer able to effectively use its insulin to maintain normal blood sugar levels. Over time, these high levels of sugar result in the complications we see all too often in patients with diabetes.

Salmon is a type 2 diabetes superfood because salmon is a great source of anti-inflammatory omega-3 fatty acids. There are differences in the fatty acids in wild vs. farmed salmon. This is because of what the fish eat. Wild salmon eat smaller fish and live in colder waters, which causes them to develop a higher ratio of anti-inflammatory omega-3s to saturated fats in their meat. Farmed fish are up to 10 times higher in persistent organic pollutants, antibiotics, and other contaminants. These harmful chemicals are pro-inflammatory and have been associated with increased risk of cancer and heart disease.
Designed to support positive behaviour change, the program helps eligible participants plan and action small lifestyle changes that have long term health benefits. The program involves six sessions overs six months and is delivered by qualified health professionals. Participants have the choice of group sessions or phone coaching options. Group sessions in local areas work well for people who enjoy social interaction and learning from others’ experiences while phone coaching appeals to those whose work or life situation make it difficult for them to commit to set days and times.
According to American Diabetes Association (ADA) recommendations, it may be appropriate for people with type 2 diabetes whose A1Cs are close to target to manage diabetes with lifestyle changes alone for three to six months—provided their doctor deems them "highly motivated." If that doesn't work, metformin is typically the first in a long list of type 2 blood glucose–lowering medications to add to the diet and exercise plan.

Talk to your friends and family beforehand about your reasons for eating healthy. Tell them it's important to your long-term health that you stay on your healthy eating plan and ask them not to encourage you to eat things that aren't good for you. Friends and family are often just trying to demonstrate their love by wanting you to enjoy a dessert, however mistaken that is. Help them understand they can best help you by not making it more difficult to stay on track and by supporting you in your efforts to take good care of yourself.
Sometimes life happens and we don’t always have time to prepare breakfast in the morning, pack a nutritious lunch, have healthy snacks readily available,and cook a balanced meal for dinner. If you find yourself unexpectedly stopping at a restaurant for a quick meal, a celebration dinner or to take a break from cooking, go in with motivation to make healthy choices. Try these meal modifications to stay within your daily calorie intake and still feel satisfied. Appetizers Choose an item… Continue reading »
Our Shopping List for Diabetics is based on the Pritikin Eating Plan, regarded worldwide as among the healthiest diets on earth. The Pritikin Program has been documented in more than 100 studies in peer-reviewed medical journals to prevent and control many of our nation’s leading killers – heart disease, high blood pressure, stroke, metabolic syndrome, and obesity as well as type 2 diabetes.
Control portions and eat smaller meals. Consuming generous portions and large meals requires your pancreas to work harder to secrete the needed insulin to bring your blood sugar down. The extra calories consumed due to sizeable portions and large meals also makes it harder for you to lose weight which is usually necessary for better blood sugar control.
Combining the Nurses’ Health Study results with those from seven other studies found a similar link between sugary beverage consumption and type 2 diabetes: For every additional 12-ounce serving of sugary beverage that people drank each day, their risk of type 2 diabetes rose 25 percent. (27) Studies also suggest that fruit drinks— Kool Aid, fortified fruit drinks, or juices—are not the healthy choice that food advertisements often portray them to be: Women in the Black Women’s Health study who drank two or more servings of fruit drinks a day had a 31 percent higher risk of type 2 diabetes, compared to women who drank less than one serving a month. (28)
Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might combine drugs from different classes to help you control your blood sugar in several different ways.
At Stanford Medical Center in California, while working as a clinical dietitian, I teamed up with a clinical research dietitian who specialized in diabetes.Our goal was to help women reach a weight recommended for their actual height. What resulted was a book Help! My Underwear is Shrinking: One woman’s story of how to eat right, lose weight, and win the battle against diabetes.The book tells the story of one woman as she struggles with her daily routine and responsibilities while trying to follow the plan and lose weight. The character provides humorous insight and methods she used for achieving her goal.
Contrary to popular belief, not all carbs are off-limits if you’re managing diabetes. In fact, the ADA recommends vitamin-rich whole grains in a healthy diabetes diet. These foods contain fiber, which is beneficial for digestive health. Fiber can also promote feelings of fullness, preventing you from reaching for unhealthy snacks, and it can help slow the rise of blood sugar. Plus, whole grains contain healthy vitamins, minerals, and phytochemicals that are healthy for anyone, regardless of whether they have diabetes or not.
Often, people with type 2 diabetes start using insulin with one long-acting shot at night, such as insulin glargine (Lantus) or insulin detemir (Levemir). Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health.
You can talk to your diabetes health care team about making any necessary meal or medication adjustments when you exercise. They'll offer specific suggestions to help you get ready for exercise or join a sport and give you written instructions to help you respond to any diabetes problems that may happen during exercise, like hypoglycemia (low blood sugar), or hyperglycemia (high blood sugar).
Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about  Facts about Diabetes, take our self assessment quiz when you have completed this section.  The quiz is multiple choice. Please choose the single best answer to each question. At the end of the quiz, your score will display. If your score is over 70% correct, you are doing very well. If your score is less than 70%, you can return to this section and review the information.
High blood pressure may also be present with your diabetes. Limiting how much salt you eat can help keep your blood pressure low. Decrease the amount of salt you add during cooking and reduce salt in recipes, before adding salt at the table, taste first, try seasoning your food with (salt-free) herbs, spices, and garlic. Lemon juice brings out the natural saltiness of foods. Avoid processed foods that are high in salt (sodium chloride) such as canned or packaged foods and condiments such as mustard, watch for “Na” (sodium) on food labels. Chips, pretzels, and other such snacks are very high in salt, and check with your physician before using salt substitutes.
The American Diabetes Association (ADA) recommends lean proteins low in saturated fat for people with diabetes. If you’re following a vegan or vegetarian diet, getting enough and the right balance of protein may be more challenging, but you can rely on foods like beans, nuts, and tofu to get your fix. Just be sure to keep portion size in mind when snacking on nuts, as they are also high in fat and calories.
Getting to—and staying at—a healthy weight: Being overweight (BMI greater than 25 kg/m2) increases your risk of developing type 2 diabetes, so if you’re overweight, you should take steps to lose weight. By losing 5% to 10% of your body weight, you can reduce your risk. You can do this by eating smaller portions and being more physically active, which, conveniently enough, are two other ways to prevent type 2 diabetes.
Most people with diabetes find that it is quite helpful to sit down with a dietitian or nutritionist for a consult about what is the best diet for them and how many daily calories they need. It is quite important for diabetics to understand the principles of carbohydrate counting and how to help control blood sugar levels through proper diet. Below are some general principles about the diabetic diet.
Not necessarily. If you can lose weight, change your diet, increase your activity level, or change your medications you may be able to reduce or stop insulin therapy. Under certain circumstances, you may only need insulin temporarily – such as during pregnancy, acute illness, after surgery or when treated with drugs that increase their body’s resistance to the action of insulin (such as prednisone or steroids). Often the insulin therapy can be stopped after the event or stress is over.
But contrary to a tossed-about diabetes myth, a lack of motivation isn't always a factor behind a person's need for medication. Type 2 diabetes is a progressive disease, and it's not always possible for people to control their blood glucose levels with diet and exercise alone over time. People with prediabetes or type 2, however, are encouraged to embark on lifestyle changes such as losing at least 5 to 7 percent of their body weight, exercising more, and choosing healthier foods with fewer calories.

People who have hypertension may follow a similar dietary plan to those who have diabetes. However, people with hypertension should also reduce sodium and caffeine intake. Individuals with both diabetes and hypertension should look for foods with low sodium counts, avoid coffee or caffeinated beverages, and avoid foods high in saturated and trans fats.

In fact, the CDC notes that losing just 5 to 7 percent of your body weight can help lower your risk of developing type 2 diabetes. So, if you’re 200 pounds, aiming to lose about 10 to 14 pounds might help you prevent prediabetes from progressing to full-blown type 2 diabetes or help halt the advancement of type 2 diabetes if you’ve already been diagnosed.
In this country, we tend to over- do it on those. Most people do not enjoy measuring their foods or counting carbs. My favorite way to estimate portion sizes is to use the “Create Your Plate” method created by the America Diabetes Association. Simply use a disposable plate divided into three sections (one half-plate section and two quarter plate sections). The large, half plate section should be used for non-starchy vegetables, things like carrots, broccoli, or cauliflower. Place your lean meat or protein in one quarter-plate section, and your carbohydrate in the other quarter-plate section. You can practice designing your meal using this method on their website: http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/
Random blood sugar test. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a blood sample showing that your blood sugar level is 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially if you also have signs and symptoms of diabetes, such as frequent urination and extreme thirst.
The types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes. (39) Trans fats do just the opposite. (8, 40) These bad fats are found in many margarines, packaged baked goods, fried foods in most fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. Eating polyunsaturated fats from fish—also known as “long chain omega 3” or “marine omega 3” fats—does not protect against diabetes, even though there is much evidence that these marine omega 3 fats help prevent heart disease. (41) If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease. (42)
And finally, behavioral changes that set up environments for success are extremely helpful. These may include daily food/beverage/activity/glucose logging, and food-proofing environments. Logging can now be completed easily with electronic applications and website support, such as www.choosemyplate.gov . Food-proofing takes more doing and family/significant other assistance. Environments to review may include home, shopping, work, driving, and social. Review foods in each environment that sabotage efforts to manage blood glucose, and develop strategies to cope. For instance, when driving, bring a planned carb-controlled snack (e.g. small apple, 3 graham cracker squares, sparkling calorie-free water), in case travels extend past expected times; and check driving patterns, since some automatic routes may go past a favorite fast food place that magically pulls the car in!
Up your soluble fiber intake: There are two types of fiber – the type that does not dissolve in water (insoluble fiber) and the kind that does (soluble fiber). Insoluble fiber can help manage weight and prevent constipation by moving quickly through the digestive tract and adding bulk to stool. Soluble fiber, on the other hand, absorbs water and turns into a gel-like consistency during digestion. This process slows down digestion and nutrient absorption. Soluble fiber can also lower blood sugar and cholesterol levels: because it isn’t well absorbed, it doesn’t contribute to blood sugar spikes and can help manage type 2 diabetes.
If you choose to drink alcohol, remember: To drink with your meal or snack (not on an empty stomach!), to drink slowly or dilute with water or diet soda, that liqueurs, sweet wines and dessert wines have a lot of sugar, to wear your Medic Alert (Alcohol can cause hypoglycemia/low blood glucose), reducing alcohol can promote weight loss and help you lower your blood pressure. 
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