During my years in practice as a primary care physician, I discovered that a lot of patients recently been diagnosed or who have been living with diabetes for quite some time had a lot of questions about their disease and do not have the resources with sufficient clarity that they truly `get it'. With the number of people with diabetes expected to double to 44 million in the next 25 years in the United States, now more than ever, we need to become more aware of measures to prevent or treat early diabetes. In my experience, a typical 15 minute office visit is not enough time to answer all the questions; especially questions that relate to how to live with the knowledge needed to move them forward. As the saying goes, `knowledge is power'. I have written in a simple and yet illustrative phrases. I have set the book out explaining the different aspects of diabetes care using each letter of the alphabet. By empowering people with knowledge, they are able to make better informed and healthier decisions. In addition to being a physician, I am also trained as a life coach. My goal in this manual is to focus more on wellness than disease. My assertion is that being diagnosed with diabetes does not mean that you cannot live a life that focuses on being healthy and doing things to support your wellbeing. In fact on the contrary it is a call to embrace a wellness lifestyle with enthusiasm and an optimistic attitude.
Dr. Eno's Guide to Living Powerfully with Diabetes
By Eno Nsima-ObotAuthorHouse
Copyright © 2011 Eno Nsima-Obot
All right reserved.ISBN: 978-1-4567-3540-1Contents
Dedication........................................................................vForeword..........................................................................xiAcknowledgments...................................................................xiiiWhat Is Diabetes?.................................................................1The Relationship between Diabetes and Insulin.....................................2How Is Diabetes Diagnosed?........................................................3What Is Borderline Diabetes?......................................................4Long-Term Complications of Type II Diabetes.......................................4A—Acceptance................................................................7Journal Entry.....................................................................9B—Believe that You Can Live with Diabetes...................................10Journal Entry.....................................................................12C—Commit to Change..........................................................13The Stages of Change..............................................................13The Benefits of Being Aware of the Stages of Change...............................16D—Drugs.....................................................................17What Are the Best Sites to Inject Insulin?........................................22Some Important Tips...............................................................23Action Steps......................................................................24E—Exercise..................................................................25Starting an Exercise Program......................................................26Examples of Moderate Physical Activity............................................27Tips on Starting an Exercise Program..............................................29Action Steps......................................................................33F—Foot Care.................................................................34G—Glycosylated Hemoglobin...................................................36Action Steps......................................................................38H—Heart Health and Hypertension.............................................39Some factors that can affect the progression of heart disease.....................39Action Steps......................................................................42I—Immunizations.............................................................44Action Steps......................................................................46J—Journal...................................................................47Action Steps......................................................................49K—Kindred History...........................................................50Action Steps......................................................................52L—Lipid Levels..............................................................57Action Steps......................................................................60M—Microalbumin and Kidney Function..........................................61N—Nutrition.................................................................631. Create Your Plate..............................................................642. The Diabetes Food Pyramid......................................................653. Carbohydrate Counting..........................................................674. Glycemic Index.................................................................68Some Final Guidelines.............................................................68Restaurant Eating as a Diabetic...................................................69Action Plan.......................................................................70O—Observe...................................................................72Action Plan.......................................................................73P—Persistence...............................................................74Action Plan.......................................................................76Q—Questions.................................................................77Action Plan.......................................................................79R—Referrals.................................................................80Action Plan.......................................................................82S—Supplements...............................................................83Action Plan.......................................................................87T—Treat Promptly............................................................88U—Utilize a Support System..................................................89V—Vacation..................................................................91Practical Tips for Travel.........................................................91Action Plan.......................................................................93W—Well-Being and Wellness...................................................94Wellness..........................................................................95eXcellence........................................................................96Y—Yes, You Can!.............................................................97Z—Zero in with Zest!........................................................98Appendix..........................................................................99Instructions for Checking Blood Sugars:...........................................100Worksheet.........................................................................102Resource List.....................................................................105
Chapter One
What Is Diabetes?
You have just left your doctor's office, and you have just been informed that you have diabetes. You've heard of diabetes before, and you have a rough idea of what it means. You probably know a few people who have diabetes—some may even be relatives—but you never thought that it could happen to you!
Diabetes is a disorder in which the body is no longer able to handle blood sugar. Blood sugars are regulated by a hormone called insulin, which is released from an organ called the pancreas. When there is a defect in the way that insulin is released or any problem with the action of insulin with the cells of the body, the sugars remain in the bloodstream. This is called hyperglycemia (high blood sugar).
There are two main types of diabetes—type I and type II diabetes.
Type I diabetes is also called Insulin-dependent diabetes. It usually is genetic and is typically diagnosed at a very young age.
Type II diabetes is more common than type I diabetes, and it is commonly called non-insulin-dependent diabetes. It usually occurs at an older age. However, with the current obesity epidemic, and due to changes in our dietary habits, individuals are being diagnosed at a much younger age, sometimes even in the teenage years.
This manual is mainly for people with type II diabetes. No doubt those with type I can learn a lot about how to manage their diabetes, but my broad audience is type II diabetes patients.
The Relationship between Diabetes and Insulin
Insulin is a hormone produced in the pancreas by the beta cells. It is responsible for a variety of functions, most importantly coordinating the use of sugars and fats in order to produce an energy source for the body. Insulin secretion is dependent on a balance between blood sugar levels in the fasting state and after eating. When one is fasting, insulin stimulates the release of stored fat as a form of fuel for the body to function. After one eats (post-prandial state), insulin secretion is increased by the increased amount of glucose. This promotes the storage of excess sugars as triglycerides in the fat cells.
With time the body's cells become resistant to the effects of insulin. A condition called insulin resistance. The pancreas is doing what it normally does, releasing insulin, but the insulin is unable to be taken into the cells where it acts to break down sugars.
I like to compare this to "the landlord" changing the "door lock" (the cell receptors) on the tenant (the insulin). Insulin no longer works as well as it used to. The body's cells send a message back to the pancreas requesting that it release more insulin, and still, the locks stay "jammed" (insulin resistance).
In the end, we have a downward spiral of high blood sugar levels, high levels of insulin circulating in the bloodstream, and starving cells! Next, the liver gets a message that there is not enough sugar for the cells, and now the liver cells start to send out more sugar by the breaking down sugar stores called glycogen.
If this continues for a long time, the undetected blood sugars rise so high that a person may begin to develop symptoms.
Common symptoms of diabetes include the following:
• Extreme thirst
• Extreme hunger
• Frequent urination
• Blurred vision
• Extreme fatigue
• Weight loss
Other more subtle symptoms that may act as a warning of pre-diabetes include the following:
• Frequent yeast infections in women
• Frequent boils or abscesses
• Dark velvety areas over the creases of the skin called "acanthosis nigricans"
At times, the diagnosis of diabetes may be made quite early with the help of a blood test, and so the symptoms above may not have time to develop. Usually by the time that you begin to develop the symptoms listed above, you may have had diabetes for up to five years!
How Is Diabetes Diagnosed?
Diabetes is detected with a fasting blood sugar test. This could be done as part of an annual physical examination or a health screening. To obtain an accurate result, the blood test should be performed after an eight-to-twelve-hour fast. Normal fasting blood sugar levels should be less than 99 mg/dl. If the readings are above 100 mg/dl but less than 140 mg/dl, then this is called impaired fasting glucose.
When the fasting blood sugar levels are above 126 mg/dl, your doctor may recommend an oral glucose tolerance test. This test is performed over a two-hour period. You are required to fast for at least eight to twelve hours prior to the test. When you arrive at the lab, a fasting blood test is performed, and then you are given 75G of glucose (sucrose) to drink. After two hours, a repeat blood test is done. If the level is more than 200 mg/dl, then you are diagnosed with diabetes.
In my clinical practice, I used this test to diagnose borderline and frank diabetes even at mildly elevated fasting levels.
The current recommendations by the American Diabetes Association are that there be at least another repeat test, such as an elevated fasting sugar, on a separate day to confirm the diagnosis of diabetes. This may be a finger stick fasting glucose test done while you are at your doctor's office. It does not have to be a repeat of the oral glucose tolerance test.
What Is Borderline Diabetes?
Pre-diabetes or "borderline diabetes" is when the oral glucose tolerance test shows blood sugar levels less than 200 mg/dl but over 140 mg/dl. This indicates that there is a high likelihood that you could develop diabetes if you do not make some changes to your lifestyle.
Most recently, the American Diabetes Association approved the use of the A1C test to screen for diabetes. For more information about the A1C test, please refer to the chapter on "G-Glycosylated Hemoglobin."
Long-Term Complications of Type II Diabetes
There are two major types of complications associated with type II diabetes. They are divided into macrovascular complications and also microvascular complications.
It is beyond the scope of this manual to go into a description of the complications associated with diabetes; however, I believe it is also important to know what they are.
Macrovascular complications affect the major vessel beds of the body, including the following:
• The heart vessels, causing coronary artery disease
• The brain, causing cerebrovasular disease
• The peripheral circulation, causing peripheral vascular disease
The common reason for the development of these complications is atherosclerosis, which is the buildup of cholesterol plaques in the blood vessels.
Atherosclerosis begins earlier, and plaque builds up faster than it does in people without diabetes.
There are other associated diseases and conditions called "risk factors" that increase the risk for macrovascular complications:
• Hypertension
• Obesity (particularly central obesity, which is fat around the belly)
• Smoking
• Inadequate exercise
Microvascular complications associated with diabetes affect smaller vessels and include the following:
• Diabetic Retinopathy (eye disease)
• Diabetic Nephropathy (kidney disease)
• Diabetic Neuropathy (nerve diseases)
Diabetes and its associated complications are the fourth leading cause of death and disability in the United States.
The good news is that research shows that by controlling the blood sugars and keeping them within the recommended range, microvascular complications can be reduced.
So now that we know all this let's dive into the Diabetic Alphabet soup and learn how you too can live a more powerful life with Diabetes. Enjoy!
Chapter Two
A—Acceptance
For a lot of people, being diagnosed with diabetes is a life-changing and mind-altering experience. It may also come with a sense of loss of what was felt like to be "healthy." All of a sudden, you are labeled with a medical disease, and now you have to start seeing a doctor on a regular basis to stay healthy. You may also experience a sense of loss because now you have to make certain dietary changes.
Either way, loss is hard to deal with and requires acceptance.
Without acceptance, all the other steps outlined in this manual are worthless. They just remain words on paper without relevance. It is only when action is attached to awareness and education that personal growth occurs.
With acceptance that you have diabetes, you can then arm yourself with the willpower to move forward (awareness). You can empower yourself with the knowledge that you need to make healthier decisions for yourself (action).
With acceptance comes self-love and also self-responsibility. Self-love means that you choose to embrace yourself as complete and resourceful and whole just as you are right now. It means that you have the right answers inside of you and all you need to do is commit to finding what works best for you. Self-responsibility (response-ability) means that you have the capacity to respond in a way that will make your life better. In other words, you make choices that cause better outcomes for you. When self-love and self-responsibility are combined together, they create a powerful catalyst for change.
By accepting that you have diabetes, you are giving yourself a choice to make decisions early enough to alter any potential for a bad outcome.
Acceptance now becomes a chance at a new lease on life!
With acceptance, you are ready to stretch and grow in new directions that you had never thought possible. You become a walking question mark ready to search for the right answers and situations that work for you.
Journal Entry
Exercise 1 (a lesson in acceptance)
Look in a mirror for this exercise. Place your hands over your heart and say the following out loud: "I am the perfect expression of myself! There is no one else like me, and so I accept full responsibility for being me!"
Now write in your journal or the space below:
"Being diagnosed with diabetes means _________ to me."
Chapter Three
B—Believe that You Can Live with Diabetes
Once you accept the diagnosis of diabetes, the next step is to begin to take action to begin living with diabetes.
The rest of this manual will only be useful to you if you have embraced acceptance and belief. Without acceptance and a strong unshakeable belief that you can make the changes in your lifestyle and move forward, then the rest of what I write about in this manual is only theoretical and words on a page with no relevance to your life.
In my years of practice, I have come across a number of patients who were under the misguided impression that if they accepted that they had diabetes, they were laying claim to a disease that would only have a negative impact on their lives. I have seen countless individuals take that attitude and return years later in a worse state than they were in when they were initially diagnosed.
This is simply because they were not willing to accept and then act!
I have also been fortunate to take care of patients who accepted their diagnosis and then partnered with me to find ways that could make them better.
By partnering with your health-care provider (and several other resources outlined under the chapter S—Support), you move yourself toward a higher level of well-being, which is the ultimate goal of this manual.
Journal Entry
Exercise 2 (declaration on belief)
Take a clean sheet of paper and write out the following declaration: "I live a full and healthy life with diabetes!"
Post this in several places that you can see and read this statement back to yourself several times a day.
This is a declaration, and it is a powerful tool that is designed to give your subconscious mind the permission to accept what it is that you are focusing on and now work to provide you with the tools to live a better life.
Denial is not healthy and uses up too much negative energy.
Believe that you can live a full and rewarding life despite the fact that you have been diagnosed with diabetes. Believe that the energies of the universe will align themselves with your soul. Then you open yourself to so much more potential and possibility in your life.
Chapter Four
C—Commit to Change
Once you have accepted and believe that you can live a healthy life with diabetes, the next step is to commit to living that lifestyle.
As humans, our nature is to jump straight into action, oftentimes without adequate preparation. This is why we end up "falling off the wagon" despite our best efforts and never committing to lasting change.
There are several stages involved in making lasting lifestyle changes. It may be helpful to have a working knowledge of these stages so that you do not get discouraged if at first you do not succeed.
This is a brief outline of the different stages in the change process.
The Stages of Change
Pre-contemplation
The first stage of change is a stage called pre-contemplation. Simply put, change is not even on your radar screen. You may have thought about it very briefly—you may have decided not to eat too many sweets—but it's not something that you truly have any intention of going though with.
The next stage of the change process is called contemplation.
A typical example of this stage is when you have been to the doctor and you've been informed that your blood sugar levels are running outside of the target range. You are beginning to think that maybe you do need to make changes to your lifestyle, but you are nowhere near action; however, the thoughts of making healthier lifestyle choices are on your "radar screen," so to speak.
Preparation
After the contemplation stage is the stage of preparation. In this stage, you are getting ready for action by putting things in place. For instance, you may decide that you will no longer have cookies and ice cream for dessert but want to find other healthy replacements that will satisfy your sweet tooth. This is a good stage in the change process to make a list of things that you intend to do. An important thing that we fail to realize is that without a road map that clearly marks our destination, there is a chance that we just may not reach the destination.
It is worthwhile for you to spend a considerable amount of time in preparation so that you can come up with a concrete plan that is unique for you rather than adapt a cookie-cutter approach or follow what another person may have told you worked well for them.
Preparation lays the solid foundation for the next stage—action.
Action
Action is the stage that we are all very familiar with. Action makes us feel we are accomplishing a goal. However, when the proper steps have not been taken prior to action, then the action steps may not be as effective and may not produce lasting change. A common reason why people tend to fail- despite their heartfelt intentions to live a healthy lifestyle- is that they did not spend enough time in the contemplation and preparation phase but just jumped straight into action.
Relapse
Relapse is a stage to be aware of. Relapse is not unusual, and it happens. It can occur even to the well-prepared. A lot of people simply stop trying because they feel that they have failed when they go back to an old habit. That fear of failure stops them in their tracks, and they do not try again. Relapse can happen more than once.
We see striking examples of this happening in a person who is attempting to quit smoking. Remember that it is okay to fall, get back up on your feet, and try again. But it is important to be aware of the triggers that caused the relapse.
One of the most challenging times during the year comes around the holiday season from Halloween all the way to New Year's Day. This is a time of the year when there is such an abundance of sweets, candies, and rich desserts adorning almost every dining table or gathering. Even for people who are not diabetic, the holidays are a time where a lot of people gain a few pounds in weight.
There are lessons to be learned even in the relapse phase. For instance, if you tend to relapse during the holidays and eat more desert and sweets at holiday parties, perhaps you could come up with measures to counter that urge. A good example would be making a commitment to increase the amount of exercise.
(Continues...)
Excerpted from Dr. Eno's Guide to Living Powerfully with Diabetesby Eno Nsima-Obot Copyright © 2011 by Eno Nsima-Obot. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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