Diabetes is a serious disease that affects a staggering number of Americans. Last week, I shared these stats, which illustrate just how common the disease is becoming: Newly diagnosed cases of diabetes increased by 90 percent from the mid-1990s to the mid-2000s. And the number of Americans with diabetes has tripled from 1980 through 2006. (As many as 95 percent of diabetes cases are type 2 diabetes, the type that, in many cases, is a result of obesity; type 1 is usually caused by an autoimmune disease. See the box below for more on the different types of diabetes.)If you're one of the people affected by diabetes, you might be feeling frustrated, overwhelmed, even fearful about what your diagnosis means for you. Fortunately, you have a lot of control over how well you fare. If you take your medications and monitor your blood sugar level, and make a few important lifestyle changes, such as the ones I mention below (and which I discuss, along with my co-authors endocrinologist John J. "Jack" Merendino, Jr., M,D., and Best life lead nutritionist Janis Jibrin, M.S., R.D., in more detail in The Best Life Guide to Managing Pre-Diabetes and Diabetes), you can stay healthy, ward off complications of the disease and improve your quality of life.Try these three key strategies to keep your diabetes under control. • Control your carb intake. Your body uses carbohydrates as its main source of energy. When you eat a carbohydrate-rich food, like cereal, bread or fruit, the body breaks down the starch and sugar in these foods into glucose—the glucose is then transported through the bloodstream, and with the help of the hormone insulin, it makes its way into all the body's cells, where it's used as fuel. At least, that's how it’s supposed to work. When you have diabetes, the body either doesn't produce enough insulin or the cells aren't responsive to the insulin. That means if you eat a meal containing carbohydrates, you'll end up with an excess of glucose in your bloodstream—not in your cells, which need the fuel to pump your heart, expand your lungs, and keep nerve cells firing in the brain. Long term, that excess glucose causes damage to your eyes, kidney and nerves, and increases your risk for heart disease. Obviously, you need carbs for energy, so the key is finding the right amount, both in terms of blood sugar and calories. (There are some helpful charts in the book as well as the online program to help you figure this out.) Once you determine just how many carbs you can handle, you can then spread them out between your meals and snacks so you keep your blood sugar as stable as possible throughout the day. • Maintain a healthy weight. The connection between weight and diabetes is well-established. Ideally, you should try to bring your body mass index, a ratio of height to weight, into the healthy category; a BMI of less than 25 is considered healthy. (To find out your BMI, use the National Heart, Blood and Lung Institute's BMI calculator.) But even losing a small amount of weight—about 10 percent, according to studies—can help you control your disease. To drop pounds or maintain, you'll need to follow a calorie-controlled balanced diet, such as the one in our meal plans. Exercise is also important; see below for more on this. • Exercise regularly. Exercise protects against diabetes in a number of ways. First, it can help you shed pounds, thus reducing your risk for the disease. It also helps you lose dangerous abdominal fat (also called visceral fat), which puts you at risk not only for pre-diabetes and type 2 diabetes but also for heart disease and other illnesses. And finally, it reduces insulin resistance (meaning it makes insulin more effective at transporting glucose into all the body's cells). The result: Better blood sugar control and improved overall health. Check out the videos and articles in our Library for great workouts, tips and motivation.The Different Types of DiabetesType 1 diabetes is usually caused by an autoimmune condition that affects the insulin-producing cells in the pancreas (called beta cells). It can also be caused by severe pancreatitis or removal of the pancreas. People with type 1 must take insulin because the body produces little to none. About five to 10 percent of all diabetes cases are type 1.Pre-diabetes is a condition in which your blood sugar levels are elevated above normal, but aren't high enough to meet the criteria for diabetes. (Normal blood sugar is under 100 mg/dL; pre-diabetes is a blood sugar between 100 and 125; diabetes is a blood sugar of 126 or higher.) People with pre-diabetes usually produce enough insulin, but the body does not respond to the hormone as well as it should (a condition called insulin resistance, which has been linked to obesity and abdominal fat). In fact, people with pre-diabetes often produce very high levels of insulin—that's what it takes to combat the insulin resistance and get glucose (fuel used for energy) into cells. The condition doesn't always progress to type 2 diabetes—lifestyle changes can reverse the condition.Type 2 diabetes is, many times, simply a worsening of pre-diabetes. As with pre-diabetes, a person with type 2 may have a lot of insulin circulating in their bloodstream, but his insulin resistance has worsened to a point where even high levels of the hormone can't get enough glucose into cells. And after a while, insulin production itself may diminish—one theory is that the pancreas simply wears out from years of manufacturing the hormone at such a high rate. Type 2 accounts for about 90 to 95 percent of all diabetes cases.Gestational diabetes is a form of diabetes that women can develop when they're pregnant. It usually develops in the second half of pregnancy (doctors typically test for it around the 22nd week of pregnancy), and can put your health as well as the health of the fetus at risk.For more on diabetes management, check out The Best Life Guide to Managing Diabetes and Pre-Diabetes. http://www.thebestlife.com
