Diabetes Mellitus: A Practical Handbook

by Sue K. Milchovich, Barbara Dunn-Long

Overview

Updated to include the latest developments in medicine and practices for diabetes treatment, as well as the most current information on new medication delivery methods, this comprehensive guide covers every aspect of living with diabetes. This user-friendly book takes a look at both the medical and nutritional sides of the disease and teaches diabetics how to balance diet, medication, and exercise for optimal health from the start. The diet and exercise plans that are included feature portion sizes and sample meal plans along with low-impact workout routines and have been revised to reflect new food pyramid guidelines and current minimum exercise suggestions. While an absolute cure for diabetes has not yet been discovered, this health manual makes living with the disease manageable.

Product Details

ISBN-13:	9781933503639
Publisher:	Bull Publishing Company
Publication date:	04/01/2011
Edition description:	Tenth Edition, 10th edition
Pages:	240
Product dimensions:	6.00(w) x 8.90(h) x 0.70(d)

About the Author

Sue K. Milchovich, RN, BSN, CDE, is a member of the American Diabetes Association and has been a certified diabetes educator for more than 25 years. She lives in Covina, California. Barbara Dunn-Long, RD, is in private practice and is a member of the American Diabetes Association. She lives in Villa Park, California.

Read an Excerpt

Diabetes Mellitus

A Practical Handbook

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By Sue K. Milchovich, Barbara Dunn-Long

Bull Publishing Company

Copyright © 2011 S.K. Milchovich and B. Dunn-Long
All rights reserved.
ISBN: 978-1-936693-10-8

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CHAPTER 1

Diabetes Mellitus

Diabetes mellitus has been known to man since about 2000–3000 B.C. The Greeks and Romans gave diabetes its name:

DIABETES = SIPHON (frequent urination)

MELLITUS = HONEY (sugar in the urine)

At the present time, diabetes affects about 21 million Americans. As long as more and more people become overweight, and as we live longer, we will continue to see an increase in the number of people with diabetes. It is estimated that for every person who is known to have diabetes there is one person who does not know.

HEREDITY

Diabetes is not a contagious disease. You cannot catch it from or give it to anyone. Heredity plays a very important role in its occurrence. It is believed that the susceptibility to diabetes is passed from generation to generation via genes, but not in any specific pattern. Heredity plays a stronger role in Type 2 diabetes (non-insulin-dependent) than in Type 1 diabetes (insulin-dependent) (see pages 4–5), but the nature of these genetic factors and how they are inherited are not yet understood. You may or may not know of other family members who have diabetes.

VIRUSES AND THE IMMUNE SYSTEM

Understanding the way the human body's immune system works may someday answer a lot of questions about the cause of Type 1 diabetes (insulin-dependent). The immune system normally works to protect the body from harmful viruses and bacteria, but, for reasons not completely understood, in some people this protective system fails. It begins to destroy the cells of the pancreas that make insulin, so the body can no longer produce its own insulin.

There is also a seasonal factor in Type 1 diabetes — a greater number of people are diagnosed with it during the flu and virus season.

NUTRITION AND OBESITY

There is a direct connection between being overweight and having Type 2 diabetes (non-insulin-dependent). The pancreas of a person with Type 2 diabetes produces insulin, but the excess weight prevents the body cells or tissues from using it. We call this INSULIN RESISTANCE. Many times a person will also have high blood pressure and high cholesterols forming what is called the "Insulin Resistance Syndrome." Losing weight and exercising can result in the body's cells or tissues once again being able to use the insulin made by the pancreas. Blood sugars, blood pressure, and cholesterol all drop to healthier levels.

Currently there is a rapid rise in the number of people in the world with Type 2 diabetes, including teenagers and children. This type of diabetes occurs more often in people who:

* Have family members with diabetes

* Are overweight

* Have high blood pressure

* Have high cholesterols, especially high triglycerides and low HDL (see page 187)

* Are Hispanic American

* Are African American

* Are Native American

* Are Asian/Pacific Islander American

* Have had diabetes during pregnancy (gestational diabetes)

* Have had large babies (over nine pounds)

These are called the risk factors for diabetes. How many do you have? How many do your family members have?

TYPES OF DIABETES

Type 1 Diabetes (Insulin-Dependent)

* Formerly called juvenile diabetes

* Usually occurs before age 20 but can occur at any age

* Affects 10% of the total diabetes population

* No insulin production in the pancreas

* Has some connection to heredity

* Affects males and females equally

* Rapid weight loss

* Many symptoms plus ketones

* Seasonal: more often diagnosed during flu season

* Treatment:

Insulin: learning how to adjust insulin for changes in eating, exercise, illness, or pregnancy

Personal plan of meals and snacks to allow "usual" or ethnic foods

Good nutrition meeting needs for growth or pregnancy (and breastfeeding)

Exercise

Education

Type 2 Diabetes (Non-Insulin-Dependent)

* Formerly called maturity onset diabetes

* Occurs in adults and children

* Affects 90% of the total diabetes population

* Insulin is made by pancreas, but there is not enough or the body cannot use it correctly

* Has strong connection to heredity and being overweight

* Is slow to develop

* Majority are overweight, few are normal weight

* Has no seasonal connection

* Treatment: Weight loss (if overweight)

Maintain weight (if weight is good)

Personal plan of meals and/or snacks to:

Include "usual" or ethnic foods

Adjusted for work, school, activities

Work for target blood sugars

Work for normal levels of blood fats (cholesterol and triglycerides)

Work for normal blood pressure

Exercise

Oral medication and/or insulin if needed

Education

At Risk for Diabetes

* Also known as Impaired Fasting Glucose or Impaired Glucose Tolerance

* Formerly called borderline diabetes

* Have fasting blood sugars over 100 but under 126 mg/dl

* In a glucose tolerance test, have a 2 hour blood sugar between 140–199 mg/dl

* Have a Hemoglobin A1c result 5.7%–6.4%

* Are usually overweight

* Have insulin resistance

* Treatment: Healthy eating for weight loss

normal blood sugars

normal blood fats (cholesterol and triglycerides)

normal blood pressure

Exercise

Education

Gestational Diabetes

* Occurs during pregnancy, in the last trimester

* Have insulin resistance

* Many pregnant women are tested between 24 and 28 weeks of pregnancy

* Treatment: diet and sometimes insulin

* Good control of blood sugars is an absolute must to protect the baby

* Blood sugars usually return to normal once the baby is born.

* Many women develop diabetes later

* It is important to maintain normal weight

GLUCOSE AND INSULIN

In order to control your blood sugar, you must understand glucose and insulin.

* Glucose, or sugar -> comes from the food you eat raises blood sugar

* Insulin -> is made by the pancreas helps the liver, muscle, and fat cells use glucose must have enough of it and it must be working correctly

Let's Start with GLUCOSE

All the foods we eat consist of CARBOHYDRATES, PROTEINS, and FATS.

* CARBOHYDRATES (see pages 43–55) include:

Foods high in sugar — "sweets," honey, syrup, sugar, etc.

Starches — cereals, bread, potatoes, rice, pasta, corn, peas, beans, etc.

Fruits

Milk, yogurt

* PROTEINS (see pages 57–63) include:

Meat — poultry, beef, fish, etc.

Eggs

Cheese, cottage cheese

Peanut butter

Tofu

* FATS (see pages 63–65) include:

Oils

Margarine and butter

Salad dressing

Mayonnaise

Bacon

Avocado

Nuts and seeds

The stomach and intestines break down 100% of all the CARBOHYDRATES you eat to glucose. This glucose enters the blood, causing your blood sugar to rise. Be aware of the TOTAL AMOUNT of carbohydrate foods you eat at any one time.

Eat a large amount of carbohydrate foods. [right arrow] Blood sugar rises too high.

Eat little or no carbohydrate foods. [right arrow] Blood sugar may drop too low.

Your blood sugar will remain more stable if you keep the TOTAL AMOUNT of carbohydrate foods eaten from meal to meal constant and balance them with some protein, fat, and vegetables. Do not focus on the sugar content of foods — look at the TOTAL CARBOHYDRATE amount (see nutrition label on page 83).

Vegetables contain carbohydrates, but because they have so few calories and little carbohydrate, they do not affect blood sugar unless eaten in large amounts.

PROTEIN does not affect blood sugar. The type and amount of protein foods you choose to eat depend on what you need to do about your weight (lose, gain, or maintain) and whether your cholesterol is high or normal. INCLUDE A SMALL AMOUNT OF PROTEIN WITH EACH MEAL to help control the rise in blood sugar that occurs after eating and help you go 4 to 5 hours between meals.

FAT does not cause blood sugar to rise. The type and amount of fat you choose to eat depend on what you need to do about your weight (lose, gain, or maintain) and whether your cholesterol is high or normal. A meal that is high in fat (for example, pizza) will keep your blood sugar [up longer.

The "perfect meal" is made up of small amounts of foods from [all the groups.

AMOUNT IS THE KEY!1

Insulin

INSULIN is a hormone made in the pancreas, which is located behind and below the stomach.

When the blood sugar rises, insulin is released into the blood. Both insulin and glucose travel all over the body via the blood.

In the MUSCLES, glucose is turned into ENERGY.

The LIVER stores glucose for future use (especially if blood sugar drops too low).

FAT cells take and store all the excess glucose as fat.

For glucose to enter a cell and do its work, INSULIN must be present to act as a transporter. Think of it as glucose coming upon a locked door, and insulin as the key that opens the door.

When you have diabetes, there is a problem with insulin:

* Type I diabetes [right arrow] No insulin is produced.

The cell in the pancreas that make insulin have been destroyed by the body, so no insulin is made.

* Type 2 diabetes [right arrow] Too little insulin is produced and/or

insulin is made, but it does not work very well

Type 2 diabetes

In someone who is thin or of normal weight, the cells of the pancreas do not make enough insulin.

In those who are overweight, a lot of insulin is made at first but will decrease over time. Also the insulin does not work correctly. It cannot get into the muscle and fat cells to do its work. This is called insulin resistance.

There are 2 ways to break the insulin resistance and get the body to use the insulin:

* LOSE WEIGHT — 10 to 20 pounds is the "key" amount.

* EXERCISE : See exercise on pages 147–158.

Presently, the exact cause of diabetes (Type 1 and Type 2) is unknown, and there is no cure. Once you have diabetes, you have it for the rest of your life.

You will learn how to keep your blood sugars as close to normal as possible by balancing food, body weight, medication, and exercise. The best way to do this is to work with several people (no one person can teach you all you need to know) known as your "diabetes team."

You must be the center of the team. The other members may include any or all of the following people:

[ILLUSTRATION OMITTED]

With good planning and habits, you will be able to feel your best and be in control of the diabetes, rather than having the diabetes control you.

CHAPTER 2

Hyperglycemia

One problem you may have if your food, medication, and activity balance is disturbed is too much sugar in the blood. This is called HYPERGLYCEMIA.

HYPERGLYCEMIA can occur

* If you forget or reduce your insulin or oral medication

* If you eat too much, especially carbohydrate foods and meals high in fat

* If you have a fever, cold, flu, infection, surgery, or other illness or emotional stress

* From "bad" medication — medication that is out of date or no longer working, or insulin that has been frozen or stored at too high a temperature

* From inactivity

The classic symptoms of hyperglycemia are

* Unusual thirst

* Frequent urination

* Fatigue, extreme tiredness

* Persistent infections

Hyperglycemia occurs slowly, and your blood sugar can rise to a fairly high level (about 300 mg/dl) before you feel these symptoms. Keep track of your blood sugars through blood and urine sugar tests.

For those of you with Type 1 diabetes, as your blood sugar rises you may also form ketones, which show up in your blood and urine (explanations of ketones, acidosis, and diabetic coma are on pages 115–117).

When the ketones form you begin to feel symptoms such as

* Weight loss

* Nausea and vomiting

* Abdominal cramps

* Deep, rapid breathing

* Fruity" breath

Other names you might hear for hyperglycemia or high blood sugar are DIABETIC KETO-ACIDOSIS and DIABETIC COMA.

CHAPTER 3

Hypoglycemia

Your food, medication, and exercise must be balanced to keep the amount of sugar in your blood as close to normal as possible. If the balance is not maintained, you may have either too much or too little sugar, which could lead to serious trouble.

HYPOGLYCEMIA, INSULIN REACTION, and INSULIN SHOCK are all names for too little sugar in the bloodstream. This occurs when the blood sugar drops below 70 mg/dl or drops rapidly from a higher level to a lower level. (How to measure blood sugars is explained on pages 107–114.)

HYPOGLYCEMIA can occur

* If you take too much or are on too much insulin or oral medication

* If you eat too little or skip or delay meals and snacks

* From excessive or unplanned exercise or the timing of exercise

Hypoglycemia can occur at night while you are sleeping, especially if you take insulin. You may actually sleep through it and not awaken.

Clues to nighttime hypoglycemia are

* Bed clothes and sheets wet from sweat

* Headache on awakening

* Nightmares, restless sleeping

* Extreme fatigue on awakening

* High (fasting) blood sugars in the morning

Hypoglycemia can occur in people taking insulin or oral medications. Those who control their diabetes by diet alone usually do not develop hypoglycemia.

When you have an insulin reaction or become hypoglycemic, the symptoms will come on SUDDENLY. Some of the first symptoms are

* Cold sweats, clammy feeling

* Shakiness, dizziness, or weakness

* Irritability, crankiness, or impatience

* Heart pounding or beating faster

* Nervousness

* Hunger

When the brain senses that your blood sugar is low you may also feel

* Headache

* Numbness or tingling in the fingertips or lips

* Blurred or double vision

* Confused thinking

* Slurred speech

* Personality change

* Seizure

* Unconsciousness

If you are hypoglycemic, you usually will have 2, 3, or 4 of these symptoms. Any one alone probably will not mean low blood sugar. If possible, test your blood sugar immediately, as soon as you feel any of the symptoms, and see if your sugar is indeed low. Regardless of how severe or numerous they may be,

TAKE HEED OF THE EARLY WARNING SYMPTOMS,

and do not wait to see if they will go away. Call your doctor when you are having repeated or severe hypoglycemic reactions.

When you experience low blood sugar, do the following:

1. Check your blood sugar immediately.

2. Take some kind of "Fast Sugar Food" immediately. You need 10–15 grams of glucose or carbohydrate to put sugar into your bloodstream quickly.

3. Limit your activity at once. Lie or sit down.

4. If possible, tell someone.

5. Once you have eaten the Fast Sugar Food, the symptoms should begin to fade (within 10 or 15 minutes). If you do not begin to feel better, repeat the Fast Sugar Food.

6. Once you are feeling normal again, it is wise to follow up with a snack, especially if more than ½ hour will pass before the next meal. If it is close to meal time, ½ hour or so, just go ahead and have your regular meal.

Examples of Fast Sugar Foods containing 10–15 grams of glucose or carbohydrate include

5–7 Lifesavers
4–6 ounces of orange juice or apple juice
2 ounces of grape juice
4–6 ounces of regular soda (not diet)
6 jelly beans
10 gumdrops
2 lumps (or teaspoons) of sugar
2 level teaspoons of honey or maple syrup
8 ounces of fat-free milk

There are also several glucose tablets and gels you can use:

Cake-decorating gel available in grocery stores
1 tube = 10 grams glucose

Insta Glucose available in pharmacies
1 tube = 30 grams glucose

Glutose available in pharmacies
1 tube = 15 grams of glucose
1 multidose tube = 45 grams of glucose

Glucose tablets available in pharmacies
1 tablet = 4 grams glucose
10 tablets/tube

GlucoBurst Gel available in pharmacies
1 pouch = 15 grams of glucose
3 pouches/box

Dex Glucose Gel available in pharmacies
1 tube = 17 grams of glucose
3 tubes/package

Liquid Shot available in pharmacies
1 bottle = 15 grams of glucose

Glucose Rapid Spray available in pharmacies
5–10 sprays
100 sprays/bottle

(Continues...)

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Excerpted from Diabetes Mellitus by Sue K. Milchovich, Barbara Dunn-Long. Copyright © 2011 S.K. Milchovich and B. Dunn-Long. Excerpted by permission of Bull Publishing Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Contents

Acknowledgment,
Preface,
About the Authors,
Survival Skills,
The Circle of Good Diabetes Control,
CHAPTER 1 Diabetes Mellitus,
CHAPTER 2 Hyperglycemia,
CHAPTER 3 Hypoglycemia,
CHAPTER 4 IDEAS — Understanding Your Blood Sugar,
CHAPTER 5 Diet,
CHAPTER 6 Home Blood Sugar Testing,
CHAPTER 7 Ketones and Keto-Acidosis,
CHAPTER 8 Medicines to Treat Diabetes,
CHAPTER 9 Laboratory Tests,
CHAPTER 10 Exercise,
CHAPTER 11 Sick Days,
CHAPTER 12 Personal Hygiene,
CHAPTER 13 Medical Identification,
CHAPTER 14 Stress,
CHAPTER 15 Emotions — They Are a Part of Us,
CHAPTER 16 Traveling with Diabetes,
CHAPTER 17 Complications of Diabetes,
CHAPTER 18 Research on Diabetes,
CHAPTER 19 Organizations and Resources,
APPENDIX A Answers to Quiz on Hyperglycemia and Hypoglycemia,
APPENDIX B Meal Planning Forms,
APPENDIX C Bibliography,
Index,