1. FAMILY HOME REMEDIES By Nadeem Y. MuftiDIABETES - 14 Ways to Live Well with DiabetesEach day, millions of diabetics walk a tightrope between too little sugar in thebloodstream and too much. Too little--which may come from a complication ofmedication--and they may quickly be overcome by dizziness, fatigue, headache,sweating, trembling, and, in severe cases, loss of consciousness and coma. Too much--which can happen after eating too much, especially if the person is older andoverweight--and the person may experience weakness, fatigue, excessive thirst, laboredbreathing, and loss of consciousness. Left untreated, the picture is bleak: Blindness,kidney disease, blood vessel damage, infection, heart disease, nerve damage, high bloodpressure, stroke, limb amputation, and coma may result. Because the initial symptoms(fatigue, weakness, frequent urination) are usually mild, half of all diabetics do notrealize that they have the disease. And thats a real shame, because with early diagnosisand treatment, the chances of living a long and productive life are higher than if thedisease creeps along undetected until irreversible problems set in. If youd like someproof that diabetes is clearly a disease you can live with, take a look at these prolificdiabetics: jazz musician Dizzy Gillespie, singer Ella Fitzgerald, actress Mary TylerMoore, baseball Hall of Fame great Jim (Catfish) Hunter. Even before treatment was assophisticated as it is today, author Ernest Hemingway and inventor Thomas Edison, bothof whom were diabetic, managed to leave their marks on history. If you are one of thelucky ones whose diabetes has been diagnosed by a doctor, you have an idea of what hasgone awry in your body. The disorder stems from the way your body processescarbohydrates, which you take in through food. Normally, these foods are converted intoa form of sugar called glucose, which floats along in the bloodstream until the pancreas, alarge gland located behind the stomach, goes into action. The pancreas produces insulin,a hormone that signals body cells to soak up the glucose. Once inside the cell, the glucoseis either used to produce heat or energy or is stored as fat. A person with diabetesproduces little or no insulin or else becomes resistant to the hormones action and cantcompensate. Either way, the glucose cant get into the cells; it accumulates in the bloodand is later expelled in the urine. In short, blood sugar rises while cells starve. Onlyabout one-tenth of all diabetics have the severe form of the disease, called Type I, whichusually affects children and young adults and requires daily injections of insulin. Mosthave what doctors refer to as Type II, or adult-onset diabetes. While about one-third ofType II diabetics do require insulin to control blood sugar, and another one-third usemedications to increase insulin production, the remaining Type II diabetics rely onnonmedical measures (such as diet, weight loss, and exercise) alone to control theirdisease. No matter which group you fall into, you can benefit from taking an active rolein your treatment. But dont make a move without consulting your doctor first. He or shewill call the shots; then its up to you to carry through. Heres how: Dish up a special diet."The goal of dietary intervention for Type I diabetes is to help minimize short- and long-term complications by normalizing blood sugar levels. The goal of dietary intervention inType II diabetes is to help the patient achieve and maintain normal body weight," says
2. John Buse, M.D., Ph.D., assistant professor in the Department of Medicine, Section ofEndocrinology, at the University of Chicago and director of the Endocrinology Clinic atthe University of Chicago Medical Center. Both Type I and Type II diabetics shouldfollow the guidelines offered by the American Diabetes Association (ADA), which wererevised in 1986 based on new research findings. (See Extra! Extra! - "Choose One fromColumn A . . .")Know your carbohydrates. The traditional dogma for diabetics was this:Avoid simple carbohydrates, or simple sugars (such as table sugar), because they raiseblood sugar quickly, and choose complex carbohydrates (such as the starches and fiberfound in grains, potatoes, beans, and peas), because they raise blood sugar more slowly.But this dogma has given way recently to newer rules, which really arent rules at all inthe strictest sense. "Diabetic meal planning must account for many factors," says HaroldE. Lebovitz, M.D., professor of medicine, chief of the Division of Endo-crinology andDiabetes, and director of the Clinical Research Center at State University of New YorkHealth Science Center at Brooklyn. "A food eaten alone may affect blood sugardifferently than when it is eaten with another food. The same variations can be noted withcooked foods versus raw foods and even with different brands of foods. And not least,different foods affect blood sugar differently in different people." Consequently, whilecomplex carbohydrates like lentils, soy beans, peanuts, and kidney beans are still best forcausing the slowest and lowest rise in blood sugar after a meal, present evidence suggeststhat sucrose (table sugar) may not be "off limits" for Type II diabetics if blood glucoselevels stay normal after their ingestion. "Experimenting with forbidden foods may bepossible with a doctors consent," says Lebovitz. "But before you start bingeing onbonbons, its important to be prepared to see what happens in terms of the blood-glucoseresponse."Get fond of fiber. The key to the effectiveness of complex carbohydrates maylie in the fiber content. "While the cause and effect of fiber in control of Type II diabeteshas yet to be established, we do know that such foods are very satiating and can helpenormously toward weight loss and maintenance," says Buse.Understand "sweet" talk.Actually, there are a number of different kinds of sugar, and each has a potentiallydifferent effect on blood sugar levels. "The most basic form of sugar is glucose, ordextrose, which will raise blood sugar levels faster than any other kind when swallowed,"says Ira J. Laufer, M.D., clinical associate professor of medicine at New York UniversitySchool of Medicine and medical director of The New York Eye and Ear InfirmaryDiabetes Treatment Center in New York. "Sucrose also tends to raise blood sugar almostas quickly as dextrose. But fructose, sometimes called fruit sugar, generally has a verymild effect on blood sugar. If your diabetes is in good control, dietetic desserts andcandies sweetened with pure fructose are not likely to raise your blood sugar levels verymuch," he adds. On the other hand, fructose provides as many calories as other sugars, soit may not be the wisest choice for diabetics who need to lose weight.Reduce your risks.To emphasize the fact that excess weight is a Type II diabetics most serious problem,experts on diabetes are fond of saying that if you want to find out if theres a possibilityof getting diabetes, just keep on eating and get fat. You can do other things, too, but themain thing is get fat. An estimated 80 percent of those with Type II diabetes are obesewhen diagnosed with the disease. Added weight can both accelerate the diabetes andbring on its complications, especially cardiovascular disease and stroke. In contrast, evena modest weight loss can have dramatic effects: High insulin levels drop, the liver beginsto secrete less glucose into the blood, and peripheral muscle tissues begin to respond to
3. insulin and take up glucose better. Just as obesity leads to insulin resistance, so weightloss reverses the condition. When persons with Type II diabetes lose weight, theyfrequently are no longer diabetic. "Type II diabetics may only need to get and stay at anideal body weight," says Buse. "And unless they do that, nothing else will work verywell." (See Extra! Extra! - "Changing Your Ways" for weight-loss tips.)Dont "crash."Too rapid weight loss rarely works in the long run and is potentially dangerous ifundertaken without a doctors advice. Sometimes, a doctor will, in fact, prescribe a very-low-calorie diet to initiate weight loss, but only for a very short period of time. Generally,the best approach is to lose weight gradually with a low-fat, lower-calorie, nutritionallybalanced diet combined with increased activity. Avoid the use of over-the-counterappetite suppressants that contain phenylpropanolamine (PPA).Graze. Many expertsbelieve that a Type II diabetic may more easily achieve normal blood sugar levels by notoverloading with too much food at one time. "Three smaller meals a day--breakfast,lunch, and dinner--plus two or three snack-type meals in between is easier for the diabeticpersons insulin to handle. Just be sure that you dont overshoot your calorie limit,however," advises Lebovitz.Get a firm foothold. Neuropathy, damage to the nerves, is acommon problem for diabetics. It occurs most often in the feet and legs, and its signsinclude repeated burning, pain, or numbness. "Neuropathy can be dangerous if it causes aloss of feeling, because then even a minor foot injury may go undiscovered--leading toserious infection, gangrene, and even amputation of the limb," says Joseph C. DAmico,D.P.M., a podiatrist in private practice in New York. Diabetics, therefore, need to bediligent about foot care. (See Extra! Extra! - "Foot Notes for Diabetics.")Be a sport.Regular exercise provides many benefits. It tones up the heart and other muscles,strengthens bones, lowers blood pressure, strengthens the respiratory system, helps raiseHDL (good cholesterol), gives a sense of well-being, decreases tension, aids in weightcontrol, enhances work capacity, and confers a sense of achievement. "For those withdiabetes," says Laufer, "exercise bestows additional benefits. It promotes the movementof sugar from the bloodstream into cells, where it is burned for energy, and it improvesthe cells ability to respond to insulin, thus decreasing their need for the hormone." Notall exercises are for every diabetic person. If blood sugar is high, exercise will lower it; ifits low, exercise will lower it further. Those on medication must work with a doctor tomake necessary adjustments. Because of the potential for neuropathy, diabetics need toprotect the nerve endings in the feet and so may need to avoid high-impact activities suchas jogging. Another consideration is that diabetics are particularly sensitive todehydration. Also, intense exercise could endanger capillaries in the eyes alreadyweakened by diabetes, leading to rupture, vision problems, and even blindness. So youwill need to choose your exercise program carefully with the aid of your doctor. And,especially if you are over 40 years old, you will need to undergo a general medicalexamination, including a cardiovascular screening test and exercise test, beforeproceeding with your exercise program. Once your doctor gives you the go-ahead tobegin a program of regular exercise, you need to set up realistic goals in order to avoidtoo-high or too-low blood sugar levels and other problems that could result from doingtoo much too soon. "Someone who has not spent much time engaged in physical activitywho is also overweight should not be thinking in terms of running races," advises Laufer.Swimming, bicycle riding, and brisk walking are all recommended. Indeed, walking isthe one activity that all medical experts agree is ideal for a diabetic patient. "The average
4. Type II diabetic patient is over 50, overweight, and underactive," says Laufer. Walking isa kinder, gentler activity for such individuals. Remember, however, that the positiveeffects of exercise last for only a day or two, so your goal should be to exercise at leastevery other day.Watch your mouth. Diabetics must be extra careful about their teeth."Good dental hygiene is important for everyone," says Andrew Baron, D.D.S., a dentistand clinical associate professor at Lenox Hill Hospital in New York. "Because they are atincreased risk for infection, diabetics should be super cautious about preventing toothdecay and periodontal disease." Keep a supply of toothbrushes so you wont have to dealwith old, worn brushing aids. Brush and floss without fail after every meal and beforebedtime. And see your dentist regularly for checkups and cleaning.Check your dentures.Ill-fitting dentures or permanent bridgework cause frustration for anyone who has to livewith them. For a diabetic, the consequences go far beyond annoyance. "Dentures thatmove around in your mouth can cause sores that dont heal," cautions Baron. "Its a shameto suffer with such problems, especially when they are so easily remedied by a dentist." Ifyou notice sore spots in your mouth or find that your dentures are moving or slipping, seeyour dentist to have the problem corrected.Take charge. How do you psych yourself upfor a game that has no timeouts and that never ends? Thats the question diabetics faceevery day. One way is to learn all you can about your illness so that you can bettercontrol it. "Diabetics are constantly learning and relearning lifestyle changes andbehavior adjustments. Its like studying for a masters degree in diabetes--and, in thiscase, there is no graduation and no vacation," says Laufer. Its a given that even in adiabetic whose disease appears to be totally under control, there will be occasional rapidand even violent swings in blood sugar levels, brought on by emotional or physicalstresses, meals, medications, or even the time of day. But if they are anticipated andaccepted, these episodes can be viewed as simply a bump in the road rather than a majordetour.Do something nice for yourself. While its important to learn as much as you canabout your diabetes and stay with your treatment regimen, you also need to keep things inperspective. "It is a rare individual who takes time to stop and smell the roses, as itwere," notes Laufer. "This is especially true for diabetics, who often get so caught up intheir disease that it is difficult for them to focus on other, more-positive aspects of life."Make a list of all the things you would like to do if you had the time--and then make thetime to do at least some of them. Obviously, finishing a box of chocolates should notappear on this list. While staring into space may be an ideal uplifter for one person, andnapping the afternoon away does the same for another, straightening out a messy closetmay do the trick for a third.Do something nice for someone else. Its hard to think of yourown problems when you are engaged in making another persons life more pleasant. Inany city or town in the country, there are those who are less well-off, with more-severeproblems. "You can call your local hospital or library to inquire about volunteers," saysLaufer. "Or you can knock on the door of an elderly, housebound neighbor who mightappreciate a visit."