Diabetes: A Quick Look Into the Disease

Chapter 1: An Overview of the Disease

Chapter 2: What are the Types of Diabetes?

Chapter 3: What are the Symptoms of Diabetes?

Chapter 4: What are the Causes of the Two Major Types of

Diabetes?

Chapter 5: Diabetes Comorbidities and Complications

Chapter 6: What is Diabetic Neuropathy?

Chapter 7: The Diabetic Pregnant Woman and Her

Offspring

Chapter 8: Treatments for Diabetes

Chapter 9: The Diabetic Diet: Carbohydrates and Glycemic

Index

Chapter 10: Other Things that Could Help a Diabetic Person

Chapter 11: Diabetes Myths and Truths 2

 Chapter 1: An Overview of the Disease
The Case of Millie. Millie, an elderly obese
woman went to her doctor due to her complaints of
low energy and fatigue, blurry vision, dizziness,
and pain in her ankles and knees. She also
informed her doctor that lately, she felt hungry all
the time and had to eat a lot because she could
not be satiated. Plus, Millie claimed that she
urinated several times throughout the day even
when she had less water intake. When she peered
closely, she also noticed that her urine seemed to
have tiny bubbles in them. Considering all of
Millies complaints, her doctor
recommended an array of tests for her. These
included testing for blood sugar and creatinine.
The laboratory also tested if Millies thyroid and
liver were functioning adequately. When Millies
test results came back, everything was normal
except for her blood sugar, which was 70 130
mg/dl even when she did not have breakfast prior
to being checked. When it was checked again two
hours after she had her first meal, her blood sugar
level was 170 - 200 mg/dl.
3
 Chapter 1: An Overview of the Disease
So what happened to Millie? An individuals
glucose or sugar level normally rises up after
food intake. Usually, the ceiling limit of such
sugar level is 140 mg/dl. However, the
situation is different for individuals who have
diabetes. Their glucose levels range from 70
130 mg/dl even when they have fasted before
being tested and up to 180 mg/dl immediately
following a meal. Millie had a glucose level
that was way over 180 mg/dl; she had 200
mg/dl. Because she had very high glucose
levels, Millies doctor diagnosed her as
suffering from diabetes.
So what is diabetes? Diabetes is a chronic
and noncommunicable disease that is
characterized by a deficiency in insulin. Insulin
is a hormone that is created by the beta cells
that are located in the pancreas and is
released by the same organ. The purpose of
such release is for nutrient and glucose to be
absorbed into the bodys tissues. However,
there are instances wherein the person does
not have enough insulin and instances
wherein the persons body has become
immune to insulin. When this happens, the
person is diagnosed with diabetes.
4
 Chapter 1: An Overview of
the Disease
How prevalent is diabetes? Statistically, the problem of
diabetes has been growing over the years. In 2012 alone
millions of Americans, regardless of their developmental
stage, suffered from diabetes. Specifically, around 29.1
million Americans have the disease, with 1.4 million more
being diagnosed annually since 2012. The diagnosis seems
to increase with age, with many of the Americans who suffer
from diabetes being in their late adulthood. In terms of pre-
diabetic condition, the age range is wider and individuals as
young as 20 years old can be predisposed to developing the
disease. In terms of race, diabetes is highest among
American Indians (15.9%) and lowest among non-Hispanic
white individuals (7.6%). In addition, approximately 13.2%
non-Hispanic blacks, 12.8% Hispanics, and 9.0% Asian
Americans suffer from diabetes. However, the above
statistics are true only for Americans. Worldwide, the
numbers are even higher. The World Health Organization
reports that between 1980 and 2014 the number of people
who have diabetes has reached hundreds of millions (i.e.
422 million). Globally, untreated diabetes is now considered
a major cause of stroke, blindness, kidney failure, and lower
5
 Chapter 1: An Overview of the Disease
In terms of socioeconomic status,
diabetes is more prevalent among
individuals from the lower middle-
class and upper middle-class status. It
is lower among people from low-
income households and high-income
households. It should be noted,
though, that such picture of diabetes
as being more common in the middle
class is correlational rather than
causal. Hence, in terms of
socioeconomic status, the statistics
are not conclusive. What experts do
know about diabetes is that as of
today, the percentage of people
suffering from diabetes continues to
rise. In fact, there are projections
indicating that by 2050, for every
three adults, particularly those in the
United States, one will be diagnosed
with the disease. Given the
aforementioned context, it is not
impossible for diabetes to become the
predicted by the World Health
Organization. If people do not do
anything to alleviate the
consequences of diabetes, it will be
considered as an epidemic sometime
in the future.
How is a person tested for
diabetes? People are screened for
diabetes through initially testing their
blood sugar. The test, which is known
as Glycated haemoglobin (A1C) test,
measures blood sugar percentage in
the haemoglobin. When two separate
A1C tests show levels that are 6.5% or
higher, the person is diagnosed with
diabetes. Aside from the A1C test,
there are also other options for
screening people who might have the
disease. These options include
random blood sugar testing, fasting
blood sugar testing (FBS), and oral
glucose tolerance test. For random
when the person last consumed food.
On the other hand, in fasting blood
sugar test, the person would have to
fast overnight for at least 8 hours prior
to being tested. When the person is
subjected to FBS, even water intake is
not allowed as water may alter the
result of the test. In oral glucose
tolerance test, the person has to fast
overnight too for the initial testing.
Then the person is asked to drink a
sugary liquid and the persons blood
sugar is tested periodically for the
next two periods. This is done to
check for changes in glucose levels
within the time of the sugary liquid
intake.
7
 Chapter 1: An Overview of the Disease
The Economic Impact of Diabetes. Diabetes does not only affect physical health; it
also has implications on the economy of the country. Unfortunately, the rising number
of people who have been affected by the disease has an inverted effect on global
economic conditions. For instance, productivity is reduced as people with the diagnosis
withdraw from the labor force due to complications brought about by the disease. In
the event that these individuals could not work, they are put on disability
compensation to help them alleviate the financial strain that the disease could cause.
This puts a dent on the economic resources of the nation and not just on them. In
addition, if individuals suffering from diabetes do not completely withdraw from their
jobs, they may still be absent many times from their duty hours. This is because they
have to set doctor appointments and medical check-ups when their symptoms are
painful or when they have to undergo regular checking or monitoring.

However, the preceding statements only discuss the indirect costs of diabetes.
In terms of direct costs, diabetes has forced the global economy to spend around $827
billion. In 2012, in the United States, the medical and health sectors spent a total of
$245 billion on diabetes-related expenses. On average, the money that the United
States has spent on individuals who have been diagnosed with diabetes is more than
double compared to the money that the country has spent on those who have not
been diagnosed with the disease.
8
Chapter 2: What are the Types of Diabetes
Type 1 Diabetes. Type 1 diabetes, which is
otherwise known as insulin-dependent diabetes
mellitus or juvenile diabetes, is due to a lack of
insulin in the persons body. This hormonal lack is
the result of what can be colloquially called a
mistaken identity attack. Normally, the persons
immune system only attacks germs and foreign
substances to keep the person healthy. However,
some people have immune systems that
mistakenly attack the beta cells in the pancreas,
thereby
For destroying
the body the bodys
to function capacity
properly, to produce
it is crucial for the
insulin. and the bloodstream to have insulin, since
tissues
the hormone is responsible for preventing the tissue
structure from deteriorating uncontrollably. In the
absence of insulin, the tissues cannot maintain their
structure and will break down into simple
compounds. When they are broken down into simple
compounds, they become part of the bodys by-
products. Eventually they leave the body through
urination. If this happens all the time, the ensuing
result is diabetes type 1.

9
Chapter 2: What are the Types of Diabetes
Because insulin is deficient in
people with juvenile diabetes, it
is not surprising to find high
levels of sugar and broken down
protein and fat products in their
bloodstream as well as in their
urine. When these products stay
in the bloodstream for long
periods of time, it is likely for the
bodys organs and blood vessels
to be destroyed. In addition, this
insulin deficiency prevents the
cells composing the body organs
to get the nutrition and energy
they need from glucose. To
prevent this from happening,
people with type 1 diabetes rely
on regular monitoring of their
glucose levels as well as daily
injection shots of insulin.
Type 1 diabetes is further divided
into two categories. The first is
idiopathic type 1 diabetes, which
is very rare and has an unknown
cause. The second is immune-
mediated type 1 diabetes, which
is more common. Because it is a
lot more common, most of the
information that experts know
about type 1 diabetes mellitus is
about immune-mediated type 1
diabetes. Regardless of these
categories, though, the disease
usually onsets when the person
is young, even during childhood.
10
Chapter 2: What are the Types of Diabetes

Type 2 Diabetes. Otherwise termed as non-insulin-dependent diabetes mellitus,

the second type of diabetes occurs when the body cannot properly use insulin to sustain
the functions of body tissues. It can also occur when the body cannot produce enough
insulin for the same purpose. Type 2 diabetes is considered as a metabolic disorder that
usually onsets when the person is older and is preceded by pre-diabetes conditions brought
about by weight problems and a sedentary lifestyle.

It should be noted, though, that it is natural for the pancreas ability to produce
insulin to decline as people grow older. But despite this decline, the insulin produced by a
normal individual is adequate for the body tissues. However, this is not the case for
individuals with type 2 diabetes. In the absence of sufficient insulin production and
utilization, the tissues of a person with this type of diabetes cannot transmit blood sugar
into the cells, thereby causing diabetic symptoms in the person.

Unfortunately, regardless of the type of diabetes that the person is suffering from,
there is no known cure for this disease despite its prevalence. Even so, with treatment and
healthy lifestyle changes, the symptoms of diabetes can be manageable.

11
Chapter 2: What are the Types of Diabetes

Another Disease that Seems Like Diabetes Mellitus but is

Actually Unrelated to It. Whereas the major types of diabetes
are both known as diabetes mellitus because of their sweet
effect on the urine of the person with the disease, there is what
experts call as diabetes insipidus. People who suffer from the
disease urinate just as much and as frequently as their mellitus
affected peers (polyduria). Usually, they urinate as much as 15
litres of urine a day, which is more than three times the normal
litres of urine excreted by individuals without the diagnosis. Their
urine appears diluted or watery and colourless; hence the
adjective that is used to describe it is insipid. Furthermore, people
who have the diagnosis suffer from polydipsia. This is
characterized by intense and exaggerated feelings of thirst, even
if the person has already consumed several glasses of liquid.

12
 Chapter 2: What are the Types of Diabetes

However, aside from the above mentioned features, diabetes insipidus does not share the same hormonal problems of
diabetes mellitus. Rather than being caused by an insulin deficiency, it is caused by a problem in arginine vasopressin (AVP), which
is otherwise referred to as an antidiuretic hormone. AVP, which is responsible for maintaining normal urine volume and
concentration, can become problematic when there are damages to the kidney, the hypothalamus, or the pituitary gland. Normally,
the hypothalamus creates AVP and stores it in the pituitary gland. The only time that this anti-diuretic hormone is released into the
bloodstream is when the body becomes dehydrated. Upon dehydration, the hormone is released in the bloodstream, concentrates
urine and triggers the kidneys tubules to release water into the bloodstream instead of excreting most of it into the urinary
system. But when this mechanism malfunctions, the result is a large volume of diluted or watery urine exiting the body more than
the usual.

Depending on which part of the abovementioned mechanism is disrupted, people could suffer from specific types of
diabetes insipidus. The first is called central diabetes insipidus, which is caused by a problem in the production, storage, and
release of vasopressin. Such disruption is brought about by a tumour or meningitis or an inflammation in the pituitary gland or
hypothalamus. The second type is nephrogenic diabetes insipidus, which happens when the kidney has problematic tubules.
Defects on the kidney tubules could be due to drugs such as antiviral medications and lithium, or it could be due to a chronic
kidney disease. The third type of diabetes insipidus is primary polydipsia or dipsogenic diabetes, which is caused by unhealthy and
prolonged water intake. The brain has a thirst-regulating mechanism that signals to the person when he should take in water or
other forms of liquid. When such mechanism malfunctions, the result is the persons inability to correctly perceive real thirst,
pushing him to constantly drink. The last type of diabetes insipidus is gestational diabetes. A rare type of diabetes, this affects only
women who are pregnant. For women with gestational diabetes, their placenta creates an enzyme that destroys their vasopressin,
thereby resulting in the condition.
13
 Chapter 3: What are the Symptoms of Diabetes?

People who are diagnosed with

diabetes manifest varying symptoms
of the disease. When their diagnosis is
comorbid with other illnesses, the
symptoms could become all the more
varied, sometimes even to the point of
being confusing. But diabetes does
have common symptoms that are
manifested by many diagnosed
individuals.

Urination and Feelings of Being

Thirsty. Typically, the most common
symptoms of diabetes are thirst and
frequent urination, which goes on and
on as an endless cycle. People who
have diabetes urinate more often than
whats regular, and the result is
dehydration. When they are
dehydrated, they feel thirsty hence
they need to drink again. Afterward, 14
 Chapter 3: What are the Symptoms of Diabetes?
The reason why diabetic individuals urinate more
is that their body cannot reabsorb glucose that
passes through their kidneys. Normally, glucose
is reabsorbed into the bodys tissues with the
help of insulin. Because this is not possible, the
body tries to get rid of the extra glucose in the
kidney through creating more urine, which in
effect uses up the bodys fluids. When the fluids
are used, the person becomes thirsty. Hence, the
more a person creates urine, the more they
urinate, and the thirstier they become.
Feelings of Hunger. People are not usually
alarmed with the idea of having to alter
drinking liquids and urinating many times in
one day. After all, urine is an ordinary waste
and body by-product. On the other hand, the
dehydration that occurs because of frequent
urination can cause a loss in nutrients that
would have been absorbed into the cells if
only insulin was readily and properly available
in the blood stream. In effect, this loss of
nutrients results to feelings of hunger.
Itchy Skin, Dry Mouth and Skin Rash. Since
most of the body fluids of individuals with
diabetes go to the production of urine, they have
less body fluid for other bodily functions and
body parts. For instance, their skin ends up
having less moisture and may feel dry due to the
diminished fluid. The dry skin results in itchy
sensations, which when scratched can worsen
the rash. Even the mouths of individuals with
diabetes feel dry and parched, and the skin
Loss of Weight.
surrounding The
the mouth weight
could loss that occurs
feel cracked.
among people with diabetes is a result of the
bodys inability to create energy from the glucose
that comes from the food that they eat. Due to
this inability, the body starts looking for other
means to get its much needed energy. Usually,
this energy comes from muscle and fat burning,
which ultimately results in weight loss.
15
 Chapter 3: What are the Symptoms of Diabetes?

Constant Exhaustion and Fatigue. Connected

Sudden Blurry Vision. When glucose passes
to hunger, people suffering from diabetes do not
by the eye tissues, it can cause swelling in the
have a lot of energy and are fatigued most of the
lenses of the eyes. When this happens, the eyes
time. Experts explain this as stemming from the
may suddenly lose their capacity to focus, hence
insulin deficiency that is involved in absorbing
causing fluctuating and varying degrees of
glucose into the cells so that the cells could
vision blurriness. Sometimes, instead of only
create energy from it. When people are tired,
blurred vision, people may end up becoming
they also feel drowsy and sleepy, which explains
blinded because of their diabetes.
the constant urge to sleep experienced by
diabetic patients.
Yeast Infections. When glucose remains high for
Dizziness and Weakness. In addition to prolonged periods of time, people with type 2
exhaustion, dehydration can cause dizziness. diabetes can experience yeast infections. Because
With the constant dehydration that occurs in yeast lives on glucose and individuals with
people with diabetes, it is likely that they diabetes have an abundant amount of this, it is
would also feel constant dizziness and would possible for infections to grow in parts of their
be weak many times. bodies that are moist and warm. Usually these
parts include areas under the breasts, around the
penis or the vagina, and between the fingers and
the toes. This particular symptom is more common
among individuals with type 2 diabetes.
16
 Chapter 3: What are the Symptoms of Diabetes?

Feeling Nauseous and Vomiting. When the body burns fat instead of glucose, ketones are produced. Ketones are organic
compounds, and makes the blood acidic. The increased acidity leads to stomach discomfort, which results to nausea and vomiting.
If ketone levels are high, this may also lead to a condition known as diabetic ketoacidosis (DKA). Because DKA can be life
threatening, individuals with diabetes are urged to monitor their blood ketone levels and to seek medical attention if and when it
becomes necessary. The buildup of ketones is more common among people with type 2 diabetes.

Wounds that Resist Healing. Another symptom that is associated with type 2 diabetes is slow healing of wounds. High blood
sugar levels tend to narrow down blood vessels. The narrowed blood vessels slow down the flow of blood and oxygen to the
wounds, making it difficult for the wounds to heal. Also, the sugar levels affect the red blood cells and prevent them from bringing
the essential nutrients to tissues that are involved in the healing process. Without the nutrients carried by the red blood cells, the
white blood cells in the tissues find it hard to fight wound infections. So, the wounds cannot heal as quickly.

Pain associated with complications of diabetes. Sometimes, the symptoms of diabetes cannot be felt by those who have the
disease. In fact, some experts believe that out of four individuals who might be suspected as suffering from the disease, one of
them would most likely not experience any of the symptoms. However, there are other health complications that could spring from
diabetes (e.g. neuropathy, stroke, and heart attacks). Along with these complications are various forms of physical pain that can
affect any part of the persons body. Some of these afflicted areas include the lower extremities of those suffering with diabetes,
such as their legs and their feet.

Irritability and Mood Changes. Although it may be unknown to most people, individuals with diabetes can experience irritability
and mood swings. These changes in mood are said to be a result of the rapid changes in blood sugar levels. Whether blood sugar is
high or low, some people with diabetes can feel irritable or sad. Sometimes the mood changes are not caused by the change in
body chemistry; they result from the strains and stress that come with having to deal with other symptoms and having to manage
their conditions.
17
 Chapter 4: What are the Causes of the Two Major Types of
Diabetes
Possible Causes of Type 1
Diabetes. For type 1 diabetes,
the definitive causes are not
really known. However, experts
and researchers claim that there
are individuals who are
predisposed to developing type 1
diabetes. One of the things that
could set the stage for the
development of this disease is
their genetic makeup. Individuals
who tend to develop type 1
diabetes are those who have a
specific human leukocyte antigen
(HLA) complex on their number 6
chromosome . This is said to elicit
an immune system response in
the body when a viral infection
occurs.
HLA and Viral Infections. The thing
with viral infections is that the
immune systems T cells produce
antibodies that will help fight a
virus. But when the infection carries
a virus that contains the same
antigen as the beta cells, or the
insulin producing cells in the
pancreas, the T cells mistakenly
perceive the beta cells as part of the
virus and end up creating antibodies
that attack the beta cells. Similarly,
when a virus infects the beta cells
HLA, causing an alteration in the
beta cells immunological
appearance, the T cells become
autoreactive, causing the
destruction of the infected beta
cells. When the beta cells are
destroyed, the insulin in the body is
significantly reduced. Some of the
viruses that are said to trigger onset
of type 1 diabetes are mumps,18
 Chapter 4: What are the Causes of the Two
Major Types of Diabetes

Cows Milk and T Cells. Another possible cause of diabetes 1 is the protein that can
be found in the milk of cows. According to researchers Vaarala, Knip and Akerblom
(1999), a certain type of protein that has similar characteristics with glycodelin, a
protein that regulates the production of T cells, is attacked by the babys body when
the baby is fed cows milk. But because of the similarities that it shares with
glycodelin, the babys body also unintentionally attacks glycodelin. This increases the
production of T cells. Unfortunately, an increase in the production of T cells
inadvertently destroys the beta cells in the babys body. The researchers also claim
that bovine insulin, which is found in the cows milk, reacts with human insulin.
Among children with already existing diabetes-associated autoantibodies, this
reaction of bovine insulin can later on lead to insulin resistance, which can trigger
type 1 diabetes . Although the study of Vaarala and colleagues is empirical and
systematic, the plausibility of cows milk as a cause of type 1 diabetes remains
controversial in the scientific community.
19
 Chapter 4: What are the Causes of the Two Major Types of
Diabetes
Possible Causes of Type 2 Diabetes. As with type 1 diabetes, the definitive causes of
type 2 diabetes mellitus are unknown. Unlike type 1, though, the risk factors associated
with the development of this type are clearer.

Genetics and Heredity. Type 2 seems to be genetic or hereditary. Time and again,
studies have shown that individuals with relatives and family members who have
diabetes have higher chances of being diagnosed with the disease. The risk is also
higher for those who have at least one parent who is diabetic.

Developmental Stage. Age is another risk factor of type 2 diabetes. Statistics

show that as people grow older, the possibility that they would be diagnosed with type 2
diabetes also increases. Those who are more than 45 years old seem to be diagnosed
more compared to those who are younger. Medical professionals assume that this is
probably connected to peoples inclination to become less active and a lot heavier when
they are older. Still, this assumption may not hold water in all cases because in recent
years, more and more young people are diagnosed with type 2 diabetes.

Weight and Obesity. As indicated in the preceding paragraph, weight has

something to do with being diabetic. People who are overweight or obese or those with
a body mass index of over 30 tend to develop the disease. It even becomes more
problematic when much of the weight is found in the abdomen area. Since the abdomen
is close to the heart, the chemical released by fat buildup in the abdomen puts the
cardiovascular and metabolic system of the body in danger. Heart attacks, stroke, and
other conditions relevant to diabetes could result from this.
20
Chapter 4: What are the Causes of the Two Major Types of Diabetes
An Inactive Lifestyle. Inactivity also
puts the person at risk of developing
the condition. People who spend their
time avoiding exercise deprive
themselves of the opportunity to
control their weight. The inactivity can
lead to increase in weight, which as
previously mentioned, also increases
the risk of diabetes.
Pre-diabetes Condition. People who
also have a pre-diabetes condition are
at risk of developing the disease. A
pre-diabetes condition exists when
the person has a blood glucose level
that is higher than the average but
not high enough to be considered as
indicative of diabetes. Otherwise
known as impaired glucose tolerance,
a prediabetic condition can turn into
type 2 diabetes unless something is
done about it. Not surprisingly, people
who are obese also have higher
Existing Health Conditions Other than Pre-diabetes.
Women who developed gestational diabetes when
they were pregnant in the past and women who
have polycystic ovarian syndrome are at higher risk
of developing type 2 diabetes compared to other
women who have neither concerns.
Race and Ethnicity. Finally, a diabetes risk factor
that may be startling to some people is race and
ethnicity. How this particular risk is possible remains
unclear. However, in various studies, it is apparent
that individuals who are African-Caribbean, South
Asian and Chinese, and those who are African are
predisposed to developing the disease. In fact,
compared to the general UK population, those who
are from South Asian communities have six times
better chances of being diagnosed with the
condition. Those who have African and African-
Caribbean roots have lesser chances of developing
the disease compared to the Asian group. However,
they are still three times at higher risk compared to
the general UK population. Likewise, compared to
white people, Hispanics, Asian-Americans, and 21
 Chapter 5: Diabetes Comorbidities and Complications

People who have diabetes often also suffer from other health complications. This article discusses some examples of comorbidities
of diabetes and health complications that arise from the condition.

Hypertension. Oftentimes people with diabetes also have high blood pressure or hypertension. Approximately 67% of people with
type 2 diabetes will also have these symptoms. Hypertension happens when blood pressure is higher than 140/90 (systolic
reading/diastolic reading) mmHg. For people with diabetes, an additional diagnosis of hypertension further endangers them and
puts them at risk for the development of macrovascular and microvascular diseases. Specifically, when not treated, the blood
pressure of people suffering from diabetes can lead to stroke, heart failure, or heart attack.

Non-alcoholic Fatty Liver Disease (NAFLD). This disease is a common comorbidity of type 2 diabetes mellitus, although it can
also be present in those with type 1 diabetes. In NAFLD, there is an increase in the circulation of free fatty acid in the body, which
means that fatty acids can also reach the liver. When this happens there is then an excess of triglycerides (TGs) in the liver, which
in turn increase resistance to insulin. Coupled with diabetes, obese individuals who have untreated NAFLD can ultimately be
diagnosed with cirrhosis.

22
Chapter 5: Diabetes Comorbidities and Complications
Dyslipidemia. Also known as hyperlipidaemia, is a rise in the plasma
cholesterol or triglycerides (TGs) of the body. At times both the levels
of plasma cholesterol and triglycerides are both higher than normal. It
may also be indicated by decreased levels of high-density lipoprotein
(HDL). People with type 2 diabetes are likely to have developed an
atherogenic combination of high TGs, low HDL, as well as elevated
levels of low density lipoproteins (LDL). Diabetic dyslipidemia, when
coupled with a sedentary lifestyle and high caloric intake, increases the
possibility that affected people could have cardiac arrest. Studies have
shown that this possibility is higher among women, although the
reasons as to why this occurs are not yet well explored. Dyslipidemia is
also believed to be caused by problems in the action of insulin among
people with diabetes together with hyperglycaemia, or the excess
levels of glucose in the bloodstream. However, in some clinical cases of
individuals suffering from type 2 diabetes, the connection of insulin
resistance to dyslipidemia is much clearer compared to
hyperglycaemias connection to the disease.

Kidney Disease. Approximately 40% of individuals with diabetes also

suffer from chronic kidney problems. Chronic Kidney Disease (CKD)
may or may not exist before the diagnosis of diabetes. A primary issue
revolving around CKD is that when it is severe, it increases the
possibility of hypoglycaemia occurring in people with the diagnosis
because it affects the way that insulin moves within the body 23
(pharmacokinetics). Hence, for people who have both diabetes and
Chapter 5: Diabetes Comorbidities and Complications

Cardiovascular Disease (CVD)

People who have been recently hospitalized due to their diabetes and a coronary, vascular, or carotid
concern are at high risk of having coronary artery conditions (CAD) and coronary heart disease (CHD). When
they possess this particular risk, they also have a higher likelihood of developing CVD. Some additional
factors that could contribute to the development of the disease are cholesterol levels, hypertension,
cigarette smoking, and medical history of CAD in the family, obesity, PCOS, high uric acid content, and
elevated lipoproteins. There is a need to manage symptoms that may be associated with cardiovascular
disease because it is one of the leading causes of death among those with diabetes. However, CVD can be
prevented; medical doctors recommend a change in lifestyle, along with taking low dosages of aspirin (for
those
Sleepwith lower risks) to high dosages of aspirin (for those with higher risks).
Disorders

Not having enough hours of sleep at night leads to health concerns like obstructive sleep apnea. Apnea is
a condition wherein people stop breathing while asleep so they end up suddenly jerking awake to catch
their breath. Catching their breath allows them to resume the flow of oxygen to their bodies and their
brains. Because sleep is interrupted many times throughout the night, sufferers end up being deprived of
the adequate rest that they need to function well during the day; hence they are usually sleepy and tired.
Unfortunately, sleep apnea is common among adult individuals with diabetes, affecting 2 out of 3
patients. Usually it affects diabetic individuals who are over the age of 65 rather than those who are
younger, although the possibility is still there.

24
 Chapter 5: Diabetes Comorbidities and Complications

Sleep Disorders

Apnea can be treated through the use of a continuous positive airway pressure or CPAP machine. The
machine, which is used while the person is asleep, blows air into the throat through a hose and mask. The
air pressure prevents the throat from closing up and allows oxygen to flow continuously. People who use the
machine are less sleepy during daytime and have better blood pressure. People who suffer from the
disorder but who do not wish to use the machine are advised to lose 10% of their body weight to alleviate
themselves of their symptoms. They are also advised to not sleep on their back as it predisposes their
throat to close up more. Rather, they are encouraged to shift sleeping on their side and on their stomach.

Another sleeping problem that people with diabetes suffer from is restless legs syndrome (RLS), a
neurological disorder wherein people have uncomfortable sensations in their legs. These sensations, which
usually occur at night when people are supposed to be resting, can increase in intensity and can become
very painful. Sometimes they manifest in such a way that it would seem as if there is a surge of electricity
passing through the legs, while other times they manifest in twitching, throbbing, or creeping sensations.
Restless leg syndrome occurs more for diabetic individuals who also have kidney problems and neuropathy.
RLS is said to be related to a disruption in the function of the basal ganglia circuits of the brain. The basal
ganglia circuits utilize dopamine, which is an essential neurotransmitter that controls muscle movement
and activity. When its dopamine pathway is disrupted, involuntary muscle movements occur like the ones
during an RLS episode.

Doctors recommend exercising and stretching legs before going to sleep as a way to treat RLS. Similarly,
they encourage diabetic individuals to lessen their use of tobacco and reduce their caffeine and alcohol 25
 Chapter 5: Diabetes Comorbidities and Complications

Stress and Psychological Disorders

People with diabetes feel stressed out due to its symptoms. Stress is only the tip of the iceberg, and
individuals with diabetes are likely to experience other more serious psychological concerns, such as
depression. In fact, people with either type of diabetes suffer from depression two times more than the
average population. Moulton, Pickup & Ismail (2015) found out that type 2 diabetes and depression have a
shared mechanism, which can possibly explain their comorbidity. Both can increase activation of a
patient's innate immunity, which eventually results to a cytokine-mediated inflammatory response and
the dysregulation of the hypothalamic-pituitary-adrenal axis. This physiological occurrence can increase
resistance to insulin and can lead to depression, even resulting in high mortality levels. For type 1 diabetes,
though, there is less evidence of its specific physiological connection to depression, although correlations
between the two are significant.

Furthermore, statistics on the comorbidity of diabetes with other psychological disorders show that
the relationship between them is bi-directional. For instance, the two conditions could be independent
diseases, existing together because of their shared pathogenic pathways. It is also possible that diabetes
complicates an existing psychiatric disorder, or it could be the other way around, such as when medications
for a psychiatric disorder leads to an impaired glucose tolerance, resulting in diabetes. It is also possible for
both to overlap in terms of their manifestation, such as during panic attacks.

The previously mentioned comorbidities and complications of diabetes have to be treated.

Treatment depends on the type of comorbidity, the persons disposition, and the persons existing medical
history. It is advisable to know more about patients and their history before prescribing treatment or 26
Chapter 6: What is Diabetic Neuropathy?
Diabetic Neuropathy in a Nutshell. When a person has
diabetes, the possibility of having other health concerns is
also high. In fact, some patients who suffer from diabetes
also end up having diabetic neuropathy, which is a type of
nerve damage commonly associated with high sugar
content in the blood.When blood sugar is high, the bodys
nerve fibers can be damaged.

Symptoms Associated with Diabetic Neuropathy. So

how would people suffering from diabetes know if they have
diabetic neuropathy? There are common symptoms
associated with the disease and unfortunately, depending
on which nerves are affected, these symptoms can manifest
in different parts of the body. The pain brought about by the
symptoms, which may have varying severity, can be felt by
diabetic people not only in their lower extremities (i.e. leg
and feet) but also in their digestive system and their urinary
tract. Sometimes, such pain can affect the patients blood
vessels and heart.

The symptoms of diabetic neuropathy are also contingent

on the type of neuropathy that the person is suffering from.
Basically there are four types of neuropathy: peripheral,
autonomic, radiculoplexus and mononeuropathy.

27
Chapter 6: What is Diabetic Neuropathy?

Peripheral Neuropathy. People who have peripheral neuropathy usually experience

numbness and muscle weakness. They also report having sharp and painful cramps along
with tingling and burning sensations in their extremities. Sometimes, there is a loss of
balance and coordination coupled with a loss of reflexes, particularly reflexes relevant to
ankle movement. Foot problems (e.g. bone and joint pain, infections, deformities and
ulcers) are also often experienced by people with this diabetic complication. The symptoms
of peripheral neuropathy commonly affect the legs and the feet first, moving later on to the
hands and the arms. They also manifest in increasing severity throughout the day and are
often worse during night time.

Autonomic Neuropathy. When the nerves that are commonly associated with daily body
functioning are damaged, autonomic neuropathy might occur. If the disease affects the
stomach and the intestine, the symptoms usually include feeling nauseated after eating
and vomiting of undigested food, early satiety and difficulty with bowel movements such as
diarrhea or constipation. If the persons heart and lungs are affected, the symptoms may
include an abnormal heart rate, blood pressure problems and shortness of breath. If the
persons bladder system is affected, the symptoms may include incontinence or leaking of
urine, difficulty urinating and feeling that the bladder still has urine even after having
urinated. Other uncategorized symptoms of autonomic neuropathy include unintentional
weight loss, vaginal dryness, erection concerns, irregular perspiration and heat intolerance.

28
 Chapter 6: What is Diabetic Neuropathy?
Radiculoplexus Neuropathy. Otherwise
known as diabetic amyotrophy,
radiculoplexus neuropathy usually affects
nerves located on the hips, thighs, legs
and buttocks. Its symptoms are weight
loss, swelling of the abdomen, difficulty
rising or getting up once the person is
seated, intense and sudden pain in the
thigh and hips or in the buttock, and
atrophy of thigh muscles. A diabetic
patient who experiences this type of
neuropathy can gradually get better
although the symptoms have a tendency
to intensify before finally lessening.
Mononeuropathy. The last type of
neuropathy is mononeuropathy, which is
also referred to as focal neuropathy. The
term indicates that for this type of
neuropathy, the damage is focused on a
specific nerve. It is very painful, albeit, it
has better prognosis compared to the
other three types. The nerve that is
affected by mononeuropathy is usually
located in the face, the leg or the torso.
foot or the shin, pain in the front part of
the thigh, pain in the persons pelvis or
lower back, or pain in the persons chest or
abdomen area. People with this kind of
neuropathy may also suffer from Bells
palsy or paralysis on either the left or the
right side of the face. Their vision may also
be affected and they may find it hard to
focus their eyes particularly when there is
aching behind one eye. Sometimes also,
because eye focus is difficult, they may
have double vision.
If mononeuropathy is caused by a
compacted nerve, diabetic people may
develop carpal tunnel syndrome.
Individuals who suffer from this condition
complain of a tingling sensation in their
fingers, or if not their fingers, in their hand.
It is also possible that instead of the
tingling sensation, they may complain of
fingers or hand numbness. In general, their
hand would feel feeble and they would be
inclined to dropping things due to the
weakness. They would then find it difficult
29
 Chapter 6: What is Diabetic Neuropathy?

Factors Contributing to Diabetic Neuropathy. As earlier mentioned, nerves can be damaged when the person has high blood
sugar. Although it is unclear as to how this happens, experts have proposed the idea that the sugar content disrupts the nerves
from their signal transmission function. At the same time, such sugar content weakens capillary walls, cutting the flow of oxygen
and essential nutrients to the nerves.

But aside from the above, the extent of damage on the nerves is determined by risk factors such as a kidney disease, smoking and
the length of time the person has had diabetes and the persons ability to monitor and regulate blood sugar. With regards to the
first risk factor, if the persons kidney is damaged because of diabetes, toxins enter the persons blood thereby increasing the
possibility of nerve damage. Similarly, when the person smokes, the arteries become hardened and narrow. The more the person
smokes, the higher is the likelihood that the narrowing and hardening would occur. This occurrence eventually reduces the capacity
of the blood to retain a regular and undisrupted flow all throughout the persons body. When blood does not flow well, the flow of
oxygen is also compromised. Ultimately, the peripheral nerves become damaged and the person suffers from diabetic neuropathy.
Moreover, the longer the person has had diabetes, the higher is the possibility of developing neuropathy. When this risk factor is
added to the persons possible unhealthy practices in terms of blood sugar control, the end result is a diabetic disaster.

Signs that the Person Has to Take Action and Seek for Medical Help. If people suffer from diabetes and they want to
prevent, or at least decrease, the possibility of developing neuropathy, they should constantly monitor changes in their body. If for
example, they could not sleep because of a burning or tingling sensation in their hands and feet, or if they experience dizziness any
time of the day, it is advisable for them to visit their doctor. If they experience changes in sexual functions, urination routine and
digestion activities, they should also consider making an appointment with their doctor. Likewise, a wound that is taking long to
heal or a wound that is not healing at all can be another tell-tale sign that would indicate the need to seek for medical help.
(National Institute of Diabetes and Digestive and Kidney Diseases).

Although it is possible that any of the above mentioned signs do not immediately point to diabetic neuropathy, finding out earlier
about the truth is better than finding out later about it. As with other diseases, prevention is always better than the cure.

30
 Chapter 7: The Diabetic Pregnant Woman and Her Children

When the Mother-to-Be Has Type 1 or Type 2 Diabetes. It is best to regulate blood sugar prior to getting pregnant
because high blood sugar levels could be harmful to the baby during first few weeks in the womb. Keeping blood sugar in
control includes engaging in physical activities, eating healthy and planning dietary intake, as well as taking
maintenance medicines that are not harmful to the foetus.
But how does diabetes affect the pregnant woman and the child she is carrying? On
the babys end, it is possible for the baby to have very low blood sugar immediately
after birth. During pregnancy, glucose from the mother passes through the
umbilical cord to the baby. This means that the baby could also have high glucose
level while inside the womb. But this glucose level can drop quickly once the baby
is born because the source is cut-off. The sudden drop can result to very low
glucose levels, which is unhealthy.

Similarly, the brain, heart, lungs and other organs of the baby develop during the
first 2 months of pregnancy. During this period, glucose is absorbed by the babys
cells to become fuel for the cell. But the cells can only absorb a certain amount of
glucose at a time, leaving excess glucose free to cross-link with proteins and fats.
change
When gene
the expression
cross-link and cause
becomes deformities,
permanent, such glycation
advanced as a cleft end
palate. In other
product cases the effect can cause life threatening
or AGE
conditions such as disrupted blood flow, a malfunctioning immune system
is created. Unfortunately, AGE has negative effects on the development of the baby defects in neural tube development and
abnormally
because shaped red blood cells. The mother may also develop preeclampsia during the second half of her pregnancy.
it can
This can induce hypertension and would cause an excess of protein to be present in her urine, which is a sign of possible
kidney damage. Preeclampsia can be life threatening for the mother and the baby and the only solution is for the mother
to give birth to her baby prematurely. This in turn can cause other health complications.

31
 Chapter 7: The Diabetic Pregnant Woman and Her Children

When the Mother-to-Be Develops Gestational Diabetes. Sometimes, the woman only develops diabetes during the
later phase of her pregnancy. This condition is known as gestational diabetes and usually happens when the woman cannot
produce adequate insulin while she is pregnant. Usually, the detection window of the condition is between the 24 th and 28th week of
pregnancy.

A woman who is overweight has a higher tendency of suffering from gestational diabetes a likelihood that is further
increased if the woman had already given birth to a baby who weighed over 9 pounds. If the woman has a parent or a sibling with
type 2 diabetes, if she has been diagnosed with polycystic ovary syndrome or if she herself suffers from pre-diabetes, she also has
higher chances of being diagnosed with gestational diabetes.

Gestational diabetes affects the baby in several ways. First, the baby may be born bigger than the average because the
extra glucose that the mother transfers to the baby is stored in the babys body as fat. Even when the babys pancreas creates
extra insulin to regulate the high glucose level, the ratio of the two is still imbalanced. Second, the baby might suffer from
hypoglycaemia after birth, similar to the child of the mother with type 1 or type 2 diabetes . Third, the baby may be born with
jaundice, which is characterized by the yellowing of the skin and the whites of the eyes. The babys jaundice eventually goes away
but not without needing extra care and attention from medical professionals and the mother. Fourth, the baby might be born with
respiratory distress syndrome, a condition wherein the alveoli in the babys lungs do not stay open because of the absence of
surfactant, which is the coating of the alveoli. When the alveoli close up, air cannot pass through the lungs and breathing becomes
hard. Babies who have respiratory distress syndrome appear blue (cyanosis) because the presence of oxygen in their blood is
insufficient. This can be characterized by the nostrils flaring out and grunting when they exhale. To help babies breathe, a
ventilator has to be attached to them and surfactant can be provided to them through their windpipe. If babies with the diagnosis
do not receive proper treatment, they can suffocate, or if they do live, they can suffer with damages in their brain and other
organs. Fifth, the baby of a mother with gestational diabetes will likely grow up overweight and suffer from type 2 diabetes.
32
Chapter 7: The Diabetic Pregnant Woman and Her Children
What Should a Pregnant Woman with Diabetes Do to Keep Herself and Her Baby
Healthy?
A pregnant woman who suffers from diabetes should be given extra tests to help her throughout her
pregnancy. Her prenatal check-ups should include ultrasound exams to monitor the rate of her babys
growth. Kick counts should also be monitored to check the time in between her babys movement. The
babys heart rate should also be monitored to make sure that it matches expected heart rates of babies
when they are active inside the womb.

Regardless of the type of diabetes that she has, a woman who is pregnant should monitor her glucose
levels. Her doctor can help her set glucose level targets throughout her pregnancy. She can stick to these
target levels if she is wise with her food choices. She should ask her dietician and doctor to help her plan
her daily meals and snacks because she cannot risk suffering from hypoglycaemia due to not having the
right amount and type of food. If the pregnant woman suffers from hypoglycaemia, she is advised to
immediately take 3 or 4 glucose tablets or drink cup of any fruit juice or 1 cup of milk or eat 5 to 6 pieces
of candy. After 15 minutes, she should check if her blood glucose has increased to normal levels. If it is still
low, she is advised to have another serving of the aforementioned food until her blood sugar reaches a
normal level.

It would also be good for the pregnant diabetic woman to keep herself active throughout her pregnancy
since exercising can prevent glucose levels from shooting up. The most common form of exercise for a
pregnant woman is walking but there are other forms of exercise that may be beneficial to her. Naturally,
she has to ask her doctor prior to engaging in specific types of exercise to make sure that she does not put
herself or her baby in any risk.

If it becomes necessary, the pregnant woman can take insulin shots or medication for diabetes. However,
because medicine can interact with the type of food that people consume and the time that they consume
33
 Chapter 8: Treatments for Diabetes
Treatments for Type 1 Diabetes. The treatments needed by individuals with type 1 diabetes normally span their
entire lives. The main purpose of these treatments is to help them maintain their blood sugar levels within specific
ranges. Similar to people with type 2 diabetes, regular exercise and proper diet can help those with type 1
diabetes but they also need additional precautionary
measures such as the following:

Regular Insulin Shots. Insulin shots (e.g. rapid-acting,

intermediate and long-acting) are crucial rather than
optional for sufferers of type 1 diabetes. Aside from insulin,
people with type 1 diabetes may also take Symlin, which
prevents a rapid increase in glucose levels that can
happen after eating. They may also take medicines that
prevent blood pressure and cholesterol from rising and
medicines that provide protection to the heart.

Regular Monitoring of Glucose. Patients are also required

to monitor their blood sugar at least four times on a daily
basis because anything could cause a sudden glucose
spike or drop. For instance, skipping a meal after taking an
insulin shot will result in low blood sugar levels or
hypoglycaemia. Likewise, they are required to avoid
smoking and drinking alcoholic beverages altogether
because either of these can complicate their sugar levels 34
and their condition.
 Chapter 8: Treatments for Diabetes

IV Fluids. Since, individuals who suffer from type 1 There is another innovative possible cure for type 1
diabetes may also suffer from diabetic ketoacidosis, diabetes. A research on small molecule therapy
they may also need intravenous fluids to keep their suggests that type 1 diabetes can be prevented if the
electrolytes stable and prevent dehydration from destruction process that eliminates beta cells in the
occurring. body could be understood more. Through the therapy,
the size of the beta cells may increase thereby
Surgery and Transplantation. There are studies that leading to an increased production of insulin. At the
illustrate the possibility of treating type 1 diabetes same time, the test is expected to stimulate existing
through surgery and transplantation. An example of beta cells to generate new ones through the process
this is replacing the pancreas of patients with a of cell division. However, conclusive findings on such
healthier one. Unfortunately, not everyones body projects have not been established.
will accept a transplanted organ, so patients who
undergo this procedure need immuno-suppressant
drugs to accommodate the transplant. Instead of
transplanting the pancreas, Dr. Joseph Lancman
suggests transplanting beta cells. If beta cells are
transplanted, the individual with type 1 diabetes
would no longer need insulin and might even be
cured of his condition. Despite the promises brought
about by this procedure, it shares the problems of
pancreas transplantation in terms of possible
infection and the host body rejecting the transplant.
35
 Chapter 8: Treatments for Diabetes
Treatments for Type 2 Diabetes. Many times, for individuals with type 2 diabetes, doctors would primarily
recommend careful planning of food intake and exercising. Doctors highlight the need for these two ways of treatment
because type 2 diabetes is usually associated with a sedentarylifestyle
and and excess weight.

Dietary Intake. In the past, individuals with type 2 diabetes

were advised to not consume food types that were sweet
but they were not asked to restrict eating food that
contained carbohydrates (e.g. potatoes, beans, pasta,
bread, yogurt and cereals). This was ill advised because
carbohydrates typically contain starch and sugar
molecules which can raise blood sugar levels. Nowadays,
medical professionals encourage patients to have low-
carbohydrate diets because they can significantly help in
reducing weight of people with the condition. This is
supported by research, which has shown that individuals
with diabetes who controlled their carbohydrate intake
were able to lose more weight compared to those who
were advised to undergo low-fat diets. In fact, the low
carbohydrate diet of these patients did not only result to a
decrease in weight but also to a decrease in bad
cholesterol levels and an increase in high-density
lipoprotein. Davis and colleagues had similar results when
they studied 105 individuals who were diagnosed with type
2 diabetes. In their year-long study, those who were under
a low carbohydrate diet lost weight faster compared to
36
those who were under a low-fat diet, although patients
Chapter 8: Treatments for Diabetes

Regular Exercise. Exercise is encouraged among individuals with type 2 diabetes

because of its many benefits. Patients find it easier to maintain their weight loss if they
exercise. Through being physically active, patients are also able to maintain their blood
glucose levels at a normal range, particularly because glucose is utilized during the
muscles activity. The American Diabetes Association even emphasizes that when people
are engaged in physical activities, their cells become more sensitive to insulin so the
body could utilize the substance well. Likewise, when patients exercise, their cells
remove glucose from the blood thereby resulting to lower blood sugar levels. Lowered
blood sugar and better use of insulin are not the only advantages that patients get from
exercising. Overall, regular physical activity helps them deal with stress that is
associated to their condition and eliminates their depressive symptoms. It also helps
them have good sleeping habits and maintain their energy throughout the day, achieve
better physical balance and diminishes experiences of painful sensations from their
joints, bones and muscles, and improves the flow of blood throughout the body.

37
 Chapter 8: Treatments for Diabetes

Medications. There are also medications prescribed for people with type 2 diabetes and these may be taken orally or
injected directly into them such as when they wish to have insulin shots. These medicines have varying effects,
depending on their content and purpose. Some of these medicines are the following:

Alpha-glucosidase Inhibitors Biguanides (e.g.

(Acarbose and Militol). The glucovance, actoplus
purpose of these medicines is and avandamet). These
to help patients break down help muscles absorb
the starch and sugar glucose and prevent the
components of their food to liver from producing too
prevent their blood glucose much sugar.
Incretin mimetics (e.g. Byeta,
from going up. Because of Tanzeum and Victoza). Patients
this, doctors recommend that may also take incretin mimetics or
these medicines be taken glucagon-like peptides, which can
DPP-4
priorinhibitors (e.g.
to eating. increase growth of b-cells hence
Kazano, Onglyza, Nesina
assisting in insulin production and
and Janumet). These
use. These drugs also decrease
assist the pancreas in
rate of stomach emptying, thus
the production of insulin,
preventing individuals from too
thereby allowing the
much food intake.
body to efficiently
38
absorb glucose.
 Chapter 9: The Diabetic Diet:
Carbohydrates and Glycaemic Index

People with diabetes have to eat healthy so that they could control a sudden spike or
drop in their glucose levels. They also have to count how much carbohydrates they
have consumed. However, this does not mean that they could no longer enjoy mouth-
watering food. In fact, there are plenty of low-carbohydrate, low-calorie and low-sugar
meals that people with diabetes could enjoy while counting carbs at the same time.

39
 Chapter 9: The Diabetic Diet: Carbohydrates and
Glycaemic Index
Do People Need Carbs?
The body utilizes carbs and prefers it as
a source of energy. Even the brain needs
the broken down version of these carbs
(glucose) in order for it to function
properly. When people need extra
glucose, the body retrieves glycogen
(stored glucose) from the liver. If there is
no glycogen and the supply of glucose is
restricted because of a low-carb diet, the
body utilizes fat for its energy need.
Gender Differences in Carb
Needs.
The amount of carbs needed by people differ due to their activity level, lifestyle,
weight and health needs. But according to experts from the Academy of Nutrition
and Dietetics, peoples gender also determines the amount of carbohydrate that
they need daily. Women generally need 45g to 60g of carbs for every meal they
take and 15g of carbs for snacks. Men on the other hand need between 60g to
75g of carbs per meal and 15g to 30g of carbs per snack. As a rule snacks are only
allowed if they are essential. Patients can ask their dietician to help them
determine if they need snacks throughout their day and if they do, these can be
included in their meal plans.
40
Chapter 9: The Diabetic Diet: Carbohydrates and Glycaemic Index
What Can Carbohydrates do to a Persons
Blood Sugar? Any type of carbohydrate,
whether it is from desserts, sandwiches or bread
can raise sugar. When counting carbohydrates,
patients should remember that so long as the
amount of carbohydrates are equal for two food
products that belong to separate food groups,
they are bound to have the same impact on their
glucose levels. So if patients eat one gram of ice
cream, it has the same effect as one gram of a
hoagie or pasta. Still, when choosing one source
of carbohydrates over another, patients may
want to look into other ingredients of their item
because these have different effects on the
patients health.
Why Count Carbs? One benefit of counting
carbs is that it allows patients the freedom to
choose the amount of carbohydrates they want
to consume per meal so long as these are within
their daily limit. This prevents patients from
feeling as if they do not have control over their
food choices. Another benefit of counting carbs
is that it helps patients see that they can choose
from several food groups, even from those that
they initially might have thought as taboo for
people with their condition. Finally, counting
carbs is also a means to remind patients that
they need to test their glucose levels at least
three times a day, or once before each meal.
41
 Chapter 9: The Diabetic Diet: Carbohydrates and Glycaemic Index
How is Counting Carbs Done? Before even attempting to count carbs, the Joslin Diabetes Center advises patients
to invest on a guide on the amount of carbs they should eat daily. Then, they should have a list of food and their
carbohydrate content. They can use this list when deciding
on their next food intake. Patients may also use nutrition labels of
food as their basis for counting carbs so to do this they must know
how to read these. Similarly, they need to understand that
portions are not equal to carb content. Sometimes what they may
take as a small portion may already have three times the amount
of carbs in it than what they originally anticipated. When patients
have learned the basics of counting carbs, they would have to
purchase measuring cups and a weighing scale to measure the
exact amount of carbohydrates in a specific item. Patients can
also use their hands to estimate how much food they need to eat
to keep up with their carb requirement. (Constance et al., 2015).
For instance the thumb is equal to a tablespoon, which is
approximately 1 serving of low fat mayonnaise. The tip of the
thumb is equal to a teaspoon or 1 serving of regular mayonnaise.
As for the hand, a palm (excluding the fingers) is approximately to
3 ounces of boneless meat while the fist is equal to 30 grams or a
cup of cereal when it is cooked.

42
 Chapter 9: The Diabetic Diet: Carbohydrates and Glycaemic Index

Can Diabetic Individuals Still Count Carbs when They Eat Out? Eating out poses a concern for people with diabetes because
many times the food that restaurants offer, even those that seem to be healthy, are laden with sodium and fat. However, patients can
still eat out and count carbs at the same time so long as they try to remember some key points. For instance, they have to remember
to review all the items in the menu before deciding on what they should eat. This can help them check which items will make them go
overboard and which wont. They could also try looking for restaurants that do have healthier options. In the event that they dont find
any, they can ask restaurants to serve them half of the meals portion while the rest can be to-go or they can share the other half with
their friends or family they are out with. Restaurants are usually happy to oblige their customers so those with diabetes can request
for their orders to be cooked in a specific way such as if they want to have less salt or less sugar, or if they want their salad dressing
to be served on the side rather than to be mixed in with the salad.

The Low Glycemic Diet. Glycemic index (GI) is referred to as a measure of how much carbohydrates in food affect blood glucose
levels. Since carbohydrates ultimately break down to simple sugar, it is logical for individuals with diabetes to monitor the GI of their
food. For this reason, some medical doctors recommend a low glycemic diet for those with diabetes. Many vegetables have low GI
such as cauliflower, green beans, lettuce, asparagus, eggplant, peppers, celery, snow peas and cucumber. There are also fruits with
low GI such as banana, oranges, plums, kiwifruit, grapes and cherries. Multigrain bread, wheat kernel, all bran, macaroni and sweet
potato also have low GI. Sweets on the other hand are high on GI so patients should refrain from consuming too much of these.

So Which Low Glycemic Index Food Should Individuals with Diabetes Choose? Whether their choice is bread or pasta, diabetic
patients would benefit more if they choose to eat food that is made of whole grain rather than refined grain. If this is their choice, they
would not miss out on flavor either because whole grain products are more flavorful compared to refined grain products. Raw fruits
and vegetables are also better options compared to those that have been processed and canned. There are also low GI recipes (e.g.
Spinach Pesto Pasta, Baked Potato topping, Spinach Chutney, Teriyaki Chicken Nibbles and Carnitas Bites) found online or in books so
patients do not have to feel as if they can only eat limited food varieties.
43
 Chapter 10: Things that Could Help a
Diabetic Person

Actively seeking help from medical professionals is one of the many things that
people suffering from diabetes would have to do in order to resolve their concerns.
Although medication may be a primary need, people suffering from diabetes would
also have to do lifestyle changes and maintain these for the rest of their lives. To ease
the transition for them, their family members could play a significant role in the
process. The personality that they are born with could also help them as they
continue living their lives as diabetic people. This article discusses in detail some of
the things that could benefit people with diabetes.

44
Chapter 10: Things that Could Help a Diabetic Person
The Effect of Self-Determination.
Along with self-efficacy, the idea of
determination sets the stage for the
successful management of diabetes.
Peoples self-determination springs from
their source of motivation. Ryan and
Decis Self-determination Theory states
that, at any given point in time, people
could either be intrinsically or
extrinsically motivated. For example,
they may strive hard to do well in their
work because they like the rewards that
come with good performance. People
suffering from diabetes are likely to
follow the same mechanism. They may
be punctual with their medication
because they like the idea of being
rewarded with good health. It is also
possible that they are motivated to take
steps towards exercising because they
value exercise as a form to combat
sudden sugar spikes. People who have
diabetes should be aware of their
motivation orientation so that they may
follow through with positive changes in
The Power of Self-efficacy and
Believing in Ones Self.
While it is true that being diagnosed with
the disease could hit people really hard,
when they believe that they can actually
overcome this ordeal, a positive long
term change in theirlives stands very
possible. Psychological studies state that
when people have self-efficacy or they
believe that they have the capability to
find solution to problems or challenges
affecting them, it createsa positive
attitude towards things. This positive
attitude can motivate them to
accomplish anything. In the case of
individuals with diabetes,if they are able
to motivate themselves to be positive
despite their condition, they are also able
to achieve specific outcomes. For
instance, they reduce their stress and
lower their chances of becoming
depressed over the disease. Furthermore,
they increase theirchances of
succeeding over diabetes.
45
The Persons Goals.
The aid given by self-efficacy and
determination will not persist if it is not
coupled with the actual setting of
personal goals. Goals can give people
suffering from diabetes the direction that
they need so that any action they take,
which may affect their condition, would
not have drastic and negative effects on
them. For instance, people with diabetes
who need to lose weight might want to
incorporate exercising in their daily
regime. In the event that they falter and
end up skipping one day of exercise, the
goal that they have set is there to guide
them back. Naturally, personal goals
have to be realistic or they would only
leave people frustrated and angry. So, if
people with diabetes haveto lose 60
pounds, they should not be setting
themselves up for failure by saying that
they will do their best to lose the 60
pounds in one month. Not only would this
goal be unhealthy, it would also be
impossible.
The Decision to Have a Lifestyle
Change.
Medication can help the person with
diabetes. Still, medication cannot solve
everything. The person has to make a
lifestyle change and this does not only
mean losing weight or exercising as
mentioned above. Rather, there is really
a need to turn things around. For
example, smoking is known to complicate
the condition of someone with diabetes.
It puts the person at risk for more health
complications such as blindness and
kidney failure and this is due to the
nicotine in cigarettes. Hence, the diabetic
person would have to quit smoking.
46
 An Empathic and Genuine Support from Supportive and Understanding Family
Health Professionals. Members.

As with medical professionals, it is recommended for

Aside from recommending medical interventions, it
the significant others of diabetic patients to give them
would be good for doctors and other medical
the support that they need. Studies have shown that
professionals to listen to the stories of diabetic
the social support given by family members of
patients with empathic ears and genuine hearts. When
diabetic patients to them buffer the latters experience
people are diagnosed with diabetes, they may have
of stress associated with the condition. Similarly,
varied reactions. Sometimes the patient may react
supportive behaviours from these people help diabetic
with disbelief, sometimes with anger and still other
patients adhere to their medication and regulate their
times with confusion. Doctors, nurses and other health
self-care efforts. In addition, when significant others,
professionals, who have worked with patients for a
especially spouses of diabetic patients, are aware of
number of years, may become saturated listening to
their needs, patients find it easier to monitor their
descriptions of pain and other challenges that their
blood sugar levels, remember their appointments with
patients share with them. Sometimes because of this
their doctor and engage in exercise. But support in the
saturation, albeit unintentional, they might take lightly
form of awareness is not enough. Patients find it more
such stories to a point wherein they would appear as if
motivating to make lifestyle changes if their family
they are insincere and uncaring towards their patients.
members would join them in their efforts. This means
Of course, it is very possible that the stress and the
that if dietary restrictions have to be made, this action
concerns that they have to face at work may make
should not only be isolated to the patient. Rather the
them appear this way. Still, patients need all the
family will have to make adjustments to their own
support that they could be given particularly if they do
dietary intake. As indicated in the preceding
not thoroughly understand their situation. Being
paragraphs, there are several things that could be
empathic towards patients does not essentially mean
beneficial to the diabetic patient. Currently, there are
that their attending doctors would no longer be
arguments over which of these can give a better and
objective in terms of properly doing their job. Rather it
more positive contribution to the life of someone
means that as doctors, they would help their patients
suffering from the disease. However, this article
understand their situations objectively and at the
believes that there is no need for such argument to
same time maintain their compassion for them. When
continue because a combined impact of all the factors
doctors are empathic towards their patients, patients
will surely be more beneficial to the patient.
find it easier to deal with their pain, with their 47
symptoms and with their feelings about their situation.
 Chapter 11: Diabetes Myths and Truths
Despite the advancements in research and medicine, people still believe things that are neither true nor accurate
about diabetes. Unfortunately, these beliefs can possibly lead to more harm than good to individuals with diabetes
and to those who are at risk of developing the disease. This article discusses ten of these myths and the truth
that corresponds to them.

Number 1: Only desserts can give people

diabetes. Many patients with diabetes mellitus think
that the only reason why their sugar is high is
because of theyve eaten too many cakes, pastries
and ice cream. The truth is any food that is high in
carbohydrates can increase glucose levels. This is
because carbohydrates in its simplest form, is a
sugar. Although sugar is good for the body, an excess
of it, especially in the bloodstream, is not. In addition,
type 1 diabetes is not at all caused by eating sugary
food. The truth is that type 1 diabetes is mostly
caused by genetic makeup, rather than lifestyle
choices and that it develops because beta cells are
mistakenly attacked by the immune system of
someone who has type 1 diabetes.

48
Chapter 11: Diabetes Myths and Truths

Number 2: People who suffer from diabetes can no longer be physically active.
Contrary to this belief, many studies illustrate that people with the condition can still lead
active lives. For instance, studies have shown that when individuals who are at risk of
developing type 2 diabetes engage in regular exercise, there is a decrease in their glucose
levels and an increase in the possibility of preventing onset of the disease. For those with
the diagnosis, exercise helps them lose weight, achieve better cardiovascular functioning
and lower mortality. An earlier study corroborates these findings. They recommend
resistance exercise three time a week for individuals with diabetes in order to reduce their
chances of developing cardiovascular diseases. Similarly, a study done this year yielded the
same findings on exercise. The researchers found out that many patients could decrease
their glycated hemoglobin level, systolic blood pressure, waist circumference, blood
glucose, body fat percentage, resistance to insulin, weight, and diastolic blood pressure
after only 12 weeks of continuous exercise, as well as increasing their muscular strength
and cardiorespiratory fitness.

Number 3: For Type 2 Diabetes, weight is all that matters. Because correlations
between type 2 diabetes and obesity are high, many people have this false impression that
the disease could only happen to those who are overweight, if not obese. However, the
National Institutes of Health has reported that just because someone is of normal weight,
this does not mean that the person could no longer suffer from type 2 diabetes. In fact
approximately 20% of people suffering from type 2 diabetes have normal body weight.
49
 Chapter 11: Diabetes Myths and Truths

Number 4: Fruits are always healthy. Diabetic individuals should eat fruits to satiate their sweet tooth. This raises a
red flag because in reality the sugar content of some fruits is still too high to not risk affecting blood sugar. Mangoes, for instance,
can make blood glucose levels shoot up and should be eaten in smaller quantities. The best way to know whether a fruit has low,
moderate or high sugar content is for patients to discuss this with their dieticians.
Number 5: Patients find insulin shots painful but addictive. Both of these claims are not factual. First, insulin shots utilize
syringe needles that are thin and small. So whatever pain may be present during an insulin shot would be negligible, especially for
the benefits of the insulin. Some patients even find it more painful when their blood sugar is monitored using a finger stick.

Why people think insulin is addictive is not difficult to understand. After all, it is usually injected into the body, much like morphine.
However, insulin is not a drug and is not addictive. It is a substance that the body naturally creates and uses to regulate glucose in
the bloodstream. Whereas drugs make people crave for them, insulin does not have the same effect.

Number 6: Type 1 Diabetes is more life threatening than type 2 diabetes. Regardless of the type, diabetes is a serious
diagnosis. It is a major cause of death in the world and has persisted in its growth and prevalence. When diabetes is left untreated,
it will lead to other problems like renal failure, heart attack, stroke and blindness. Depending on the severity of its complications,
diabetes can be life threatening.
Number 7: Type 1 diabetes is for children while type 2 diabetes is for adults. While it is true that the onset of type 2
diabetes commonly starts during adulthood, it could also be diagnosed when the person is young. It is unfortunate to note that the
combination of unhealthy lifestyle and genetic factors has put children at risk of developing type 2 diabetes. Likewise, type 1
diabetes can affect both adults and children and the symptoms may suddenly occur at any age group.

50
 Chapter 11: Diabetes Myths and Truths

Number 10: Diabetic women should not get

Number 8: Being borderline diabetes is
okay. Otherwise known as prediabetes,
borderline diabetes poses a risk for people to
actually have the full-blown diagnosis. So it is
not okay for individuals to say that they do not
have anything to worry about. Rather they
should take care of themselves and monitor
their lifestyle to avoid suffering from diabetes.
pregnant if they do not want to risk their lives. It
is true that a pregnant woman who also suffers from
diabetes can experience concerns throughout the
duration of nine months. However, there are specialists
who can help the pregnant woman and there are
precautionary measures that she could take to avoid
harming herself and her baby. She can keep herself
active, monitor the babys movement, test her sugar
and choose healthy food. So long as the woman is
capable of safeguarding her health and the babys
health, there is no reason for the diabetic woman to
not have children if she wishes to have them.

Number 9: Diabetes symptoms always manifest. Although

symptoms do appear most of the time in people with diabetes, there are
cases wherein symptoms are absent. Sometimes, symptoms can be
missed easily because they seem to be natural i.e. being thirsty,
frequent urination, insatiable hunger. Because of this possibility, it is
always good for people who may display factors that could predict
diabetes (e.g. presence of the disease in the family, weight concerns
and a sedentary lifestyle) to have themselves tested for the disease.

51