Live Well with Type 2 Diabetes

A diagnosis of diabetes can be a life-altering experience. You may suddenly find yourself needing to pay scrupulous attention to your food intake, your exercise schedule, and your previously ignored blood glucose levels.

Meeting the challenge

Tending to your body’s new, evolving needs can be overwhelming for both type 1 diabetics who no longer produce insulin and type 2 diabetics whose cells no longer respond to insulin.

Switching up dietary and lifestyle habits can take serious commitment and most of all, practice, practice, practice! Situations that present challenges to the new diabetic, such as eating out and travelling, require advance planning and extra preparation the first time around. A bit of diabetes savoir faire will go a long way toward easing the transition into this new way of life.

Dining decisions

Many menu options contain hidden (or blatantly obvious) sources of saturated fats and carbohydrates. Eating out while sticking to your dietary recommendations may seem like an impossible task at first. Simplify your selection process by perusing online menus before going out. Look for high-fibre, low-fat options, and bypass anything that is breaded, battered, or fried.

Substitutions are possible in most restaurants, allowing you to replace side dishes such as white rice, potatoes, and corn with lower glycemic options. Skip carbo-loaded soups, sauces, and gravies, and keep the temptations of the breadbasket out of reach.

Dodge saturated and trans fats by choosing flavoured vinegars or lemon juice over creamy dressings and opting for skinless poultry, baked fish, or legumes. If you’re planning a small but sweet indulgence for dessert, cut the carbs in your main course to compensate.

Portion control can be difficult when you aren’t filling your own plate. Share a meal with a friend, or ask for a take-home container and remove excess food before starting your meal. Give the all-you-can-eat buffet a wide berth, and inquire whether lunchtime or half-sized meals can be ordered.

Alcohol consumption

If your diabetes is well controlled, alcohol may be appropriate for you in moderate amounts, meaning one daily drink for women and no more than two drinks per day for men. Dry wines, light beers, and spirits (with sugar-free mixes) have lower carbohydrate contents than other options. Drink with caution if you are taking insulin for your diabetes, being aware of the increased risk of hypoglycemic (low blood sugar) episodes with alcohol use.

The challenges of physiology

Even the most attentive diabetics may notice periodic elevations in their blood sugar levels that seem unrelated to dietary and exercise practices. Physiological changes such as illness and hormonal fluctuations will affect glucose metabolism and may require adjustment of management strategies.

Illness

In times of stress, glucose is released into the bloodstream to provide extra fuel for the body. This same response occurs during the stress of illness, prompting increases in blood sugar that may precede other symptoms. Changes in eating habits on sick days along with decreased exercise also contribute to fluctuations in glucose measurements. While newly diagnosed diabetics may compensate unconsciously for these changes, others will see significant fluctuations in their glucose levels.

If you use diabetic medications to manage your blood sugar, consult with your doctor about sick-day strategies before you get sick. Whether drug-based strategies are used or not, blood sugar measurements should be taken every two to four hours during an illness. Steer clear of sugar-containing cough syrups and lozenges and take in plenty of fluids to stave off dehydration-associated hyperglycemia.

Menstruation

The menstrual cycle may be responsible for other, more predictable shifts in blood glucose. Monthly variations in estrogen, progesterone, and other hormones govern the reproductive system, influencing other body systems at the same time. In the postovulatory phase of the cycle, blood sugar levels may increase as a result of increases in insulin resistance and the acceleration of food passage through the stomach.

Research shows that this effect is by no means consistent among all women and may not pose significant risk. To understand the role of hormonal fluctuations in your own body, correlate your blood sugar measurements with your menstrual cycle over several months. If your glucose is consistently elevated during the latter part of your cycle, you may wish to discuss proactive strategies for management with your health care practitioner.

Menopause

The years leading up to complete cessation of menses are characterized by hormonal fluctuations and menstrual cycles of varying lengths. During this time, blood sugar levels may be equally unpredictable and should be measured regularly. In addition, quarterly visits with your health care practitioner to measure your hemoglobin A1c (HbA1c) levels will help to determine how well your current treatments are managing your glucose levels overall.

Menopause presents additional challenges that are specific to diabetic women. Sleep disturbance, common during the menopausal transition, may hinder blood sugar regulation. Symptoms of hot flashes or daytime fatigue may be mistaken for hypoglycemic episodes, resulting in unnecessary carbohydrate intake.

The risk of some health concerns, such as urinary tract infections and cardiovascular disease, are independently increased by both menopause and diabetes. Diabetic women entering menopause should watch for changes to blood sugar levels and undergo regular screening for cardiovascular risk factors and infections.

Health care helpers

Alongside cardiovascular disease, diabetics of all ages are at greater risk of kidney failure, blindness, and periodontal disease. Regular follow-ups with specific health care practitioners will ensure early detection and treatment of concerns.

Primary care

The Canadian Diabetes Association recommends diabetic-focused visits with a primary health care practitioner every three months to assess treatment efficacy. In these sessions, HbA1c levels, showing glucose control over the previous three months, should be discussed. Cholesterol, blood pressure, and kidney function should be evaluated regularly.

Optometrist or ophthalmologist

Poor glucose control impairs the blood vessels nourishing the eye. Vision loss (diabetic retinopathy) can result, causing blindness. As damage may occur before any changes in your vision, annual eye exams are recommended and may be covered by your provincial health care plan.

Dentist or dental hygienist

High blood sugar levels increase the risk of oral fungal infections, gum disease, and tooth loss. In addition, periodontal disease may contribute independently to poor blood glucose control: recent research suggests improved glucose levels in diabetics receiving treatment for gum disease. Professional cleanings may be required as often as four times per year.

Depression and diabetes

Although the association is not fully understood, diabetics are also at increased risk for major depressive episodes. Depression is seen in 15 to 20 percent of diabetics, compared with just 3 to 7 percent in the general population, making it a significant concern for many diabetics. Depression is also a risk factor for poor glycemic control, making it doubly important to treat mood issues without delay.

Exercise

Many options exist to treat depression, ranging from counselling and lifestyle changes to pharmaceutical options. Physical activity has documented antidepressant effects, and a regular exercise routine may improve mood significantly. Exercise-based therapy is particularly appropriate to diabetics thanks to its profound positive impact on fasting blood glucose, triglyceride, and HbA1c levels. (See our article on fitness for diabetics on page 95.)

Fish oils

Fish oil supplementation also has the potential for wide-reaching benefit in diabetics with depression. Fish oils high in eicosapentaenoic acid (EPA) may improve depression, especially when EPA exceeds docosahexaenoic acid (DHA) content by 200 to 2,200 mg per day. EPA should make up more than 60 percent of the total EPA and DHA. EPA may also improve cholesterol measurements, assist in blood sugar regulation, and protect against diabetic retinopathy.

Cautions

Some commonly used antidepressant supplements such as St. John’s wort should be used cautiously, given the potential for interaction with diabetic medications. If symptoms of depression are of concern to you, seek support from your health care team rather than trying to tackle this problem alone.

Keeping it Zen

While stress is an unfortunate reality for most of us, chronic or long-term stress is particularly harmful to diabetics. Stress can increase blood pressure, heightening cardiovascular risk. Stress-related increases in blood sugar pose a serious challenge to glucose management.

Many people are accustomed to operating in a state of stress without really feeling its effect on their bodies. In order to reduce chronic stress, we need to tune in to its presence within us. Simply rating stress levels throughout the day may provide some valuable insights. Sitting quietly from time to time, and checking in with breathing patterns, heart rate, and state of mind can also build this awareness.

The most effective stress-reduction techniques vary tremendously between individuals, and may include exercise, journalling, and taking time out for rest, relaxation, and personal interests. Cognitive behavioural therapy and other professionally guided sessions can provide immense, immediate benefit. Many informational and support resources are available both online and in person (see sidebar on previous page).

A diagnosis of diabetes can require significant changes to many aspects of daily life. Learning to navigate new situations, addressing associated risks, and accessing necessary resources will assist the transition into a health-supporting lifestyle.

4 ways to support a loved one with diabetes

1. Learn about diabetes

Understand the disease and the challenges that its treatment may present. Refer to the resources in the accompanying sidebar for information on diabetes.

2. Ask how you can help

The needs of people with diabetes are individual; avoid making assumptions and open a dialogue instead. Is there anything that you could be doing differently?

3. Don’t nag

Avoid becoming the diabetes “police.” Instead of criticism (however well intentioned), focus on encouragement and support.

4. Find out how they are coping

Encourage discussion about feelings and provide support for their emotional process. Share your experience of their diagnosis as well.

Diabetes and smoking

Smoking and high blood sugar both cause significant damage to blood vessels. Diabetics who smoke are three times more likely to have a heart attack than their nonsmoking counterparts. It may take several attempts to overcome this powerful addiction. Here are a few tips to help you kick the habit.

• Before attempting to quit, list the reasons why this decision is important to you. Remind yourself of these reasons throughout the process.
• Share your plans with a friend who will support you, and discuss the ways in which she may be of assistance.
• Access the numerous online resources for smokers including the Canadian Cancer Society’s Smokers’ Helpline (smokershelpline.ca). You can speak to a quit coach toll-free.
• Read publications such as the Canadian Cancer Society’s One Step at a Time (available at cancer.ca).
• Ask your health care practitioner for assistance. Smoking cessation medications, acupuncture, and counselling may all assist you in achieving your goal.

Resources and support groups for diabetics

Travel tips for diabetics

• Discuss the timing of meals and medications with your health care practitioner if you are crossing numerous time zones.
• Obtain a letter from your doctor listing your medications and the reason for their prescription. A medical certificate is recommended in order to travel with medical devices such as syringes. Before leaving, inquire about additional documentation that may be required at your destination.
• Carry your medications and glucometer with you during travel to guard against loss or mishandling. Pack more supplies and medication than you think you may need, separate them in a clear plastic bag for easy inspection, and always have some snacks on hand. If travelling with insulin, protect it from temperature extremes with a well-insulated carrying bag.
• A medical identification bracelet or necklace may be a lifesaving tool should you require medical care while unconscious.