Lifestyle Tips to Control Blood Sugar
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To Stay Well, Mix and Match a Healthy Lifestyle and Medicines
Research now shows that to stay healthy year in and year out with type 2 diabetes, you've got to get and keep your blood sugar, lipids (cholesterol), and blood pressure in control. That's goal No. 1. The best recipe to tackle this? A healthy lifestyle matched with the correct mix of blood glucose-lowering medications for you at the time.
The Science: Newer studies show that by the time most people are diagnosed with type 2 diabetes (yes, diagnosed!), they have lost at least half of their insulin-making beta cells. For this reason, the big push today is to treat type 2 aggressively from day one. To achieve the recommended target glucose goals, the American Diabetes Association (ADA) suggests that most people with type 2 diabetes start on a glucose-lowering medication right out of the starting gate.
In the Trenches: Yes, it's human nature to delay starting more medications, but too many people and their health care providers are too slow to act. "Healthy eating and being physically active always help make the job of getting and keeping your glucose, lipids, and blood pressure in control easier and may help you have fewer pills to pop," says Claudia Shwide-Slavin, RD, CDE, a dietitian and diabetes educator in New York City.
Monitor Your Meter to Check Your Efforts
Your blood sugar monitoring results can help you paint the picture of your progress with lifestyle changes and meds. Know your targets for fasting glucose and after-meal testing.
The Science: For most people, the ADA suggests a fasting goal of 70-130 mg/dl and an after-meal (one to two hours after the start of a meal) goal of under 180 mg/dl. Compare these with your A1C results. The ADA recommends a goal of 7 percent or less for most people. If your results are in the zone, great! Keep on truckin'.
In the Trenches: If your glucose results aren't regularly hitting your targets despite your best efforts to eat healthfully and take your blood glucose-lowering medications as directed, then it's time to talk with your provider about how to progress your management so you can achieve your targets and stay healthy over time. This might mean taking more of one medication or adding another. It's important to realize there are more new types of blood glucose-lowering medications that act just where they're needed for type 2. And most of these newer medications do not cause low blood glucose (hypoglycemia) or weight gain.
Curb Added Sugars with No-Calorie Drinks
Iced tea, fruit punch, sports drinks, energy drinks -- they might sound like healthy, thirst-quenching choices, but most are far from it. Research shows that American adults consume an average of 22 teaspoons of added sugars a day (about 15 percent of daily calories!). That's no surprise; a 20-ounce bottle of regular soda contains 15 teaspoons of added sugars. These teaspoons aren't just coming from regular soda -- loads of added sugars lurk inside many beverages such as sweetened iced tea and fruit punch. With few calories to spare, why waste them on added sugars that offer you no nutrition?
Why it works: Once ingested, caffeine causes the body to release the hormone adrenaline, which is known to raise blood sugar levels. Scientists also surmise that caffeine may interfere with the process for transporting glucose from the blood to other cells to be used as fuel.
The Science: The latest iteration of the Dietary Guidelines for Americans strongly advises cutting back on foods and drinks with added sugars. Top on the list is "drink few or no regular sodas, sports drinks, and fruit drinks."
In the Trenches: To quench your thirst, think water first. If you want a bottled drink, read the Nutrition Facts label. Make sure the drink contains zero calories, carbohydrate, and sugars (on the Nutrition Facts label, sugars means all naturally occurring sugars as well as added sugars). If you choose a beverage with calories and carbohydrate, such as a fruit or vegetable juice, be aware of the serving size. Some bottles and cans hold two or more servings (a serving for beverages is most often 8 ounces). Make sure you count these calories and carbohydrate grams in your eating plan.
Portion Control, Please
One surefire way to cut calories and be able to tighten your belt is to control your portions. In translation, this means to continue to eat most of the foods you enjoy -- just a bit less of some, such as meats (protein), fats and oils, and desserts and sweets. Fill your plate with more fruits and vegetables.
The Science: Research shows that people don't follow rigid diets or meal plans for long. Deprivation doesn't work! Plus, as shown in the National Institutes of Health-funded POUNDS LOST weight loss study, even when people tried to dramatically change their diets, over time they gravitated back to their usual ways of eating, including cultural foods and eating habits.
In the Trenches: To trim weight for good, start with limiting portions. For meats, seafood, and poultry, weigh your servings for a while to help your eyes zero in on a 3-ounce cooked portion. Eat fewer desserts and sweets. Set personal goals based on your current habits and desires. There's no need to do without -- that's deprivation. Another strategy to control portions is to eat off a 9-inch plate. "Silly, but true," says Kate Cornell, PWD type 2. "It has definitely helped me control my portions." And don't have seconds; if you're still hungry, wait 15 minutes before eating more. Final tip: Don't eat in front of the TV -- it will distract you from hearing your body's fullness signals.
Snack Smart and Healthy
To snack or not to snack with diabetes? The once widely given advice that people with diabetes need to eat three small meals and three snacks each day is no longer true. That advice dates back to older medications and the potential for hypoglycemia.
The Science: Research shows that some people can control their calories better with between-meal snacks, yet other studies find that frequent snacking can lead to excess calories. If your glucose is running too low, talk with your provider about a medication change rather than continuing to snack or overeat to prevent lows. Bottom line: Whether or not you fit snacks into your eating plan should be based on how you can best follow a healthy eating plan.
In the Trenches: If you choose to snack once, twice, or three times a day, make your snacks healthy, and see that they help you fill in your nutrition gaps. Snack on cut-up or ready-to-go vegetables. Dip these in a low-fat salad dressing or yogurt with herbs. Try a piece of fruit or a no-sugar-added fruit snack pack. A handful of nuts or a piece of part-skim cheese with whole grain crackers might suit your fancy. Smart snacking requires you to plan ahead to have snacks on hand where and when you need them. Keep the portion size small. When PWD type 2 Patty Gilliam is on the road, she likes to take "snack bags of preportioned nuts or celery sticks filled with peanut butter."
Put Your Body in Motion to Gain Big Benefits
Moving more does way more than aid weight loss. It can lower blood sugar and contribute to other health benefits.
The Science: Research shows that being active has many benefits, especially for people with type 2 diabetes. Exercise has been shown to aid weight loss, but even more importantly, it helps you keep lost pounds off. It improves insulin sensitivity, which in turn can lower blood sugar. Being active has heart-health benefits, improves joint mobility, and even improves sleep quality. ADA recommendations suggest you do aerobic activities (such as walking or swimming to get your heart rate going) as well as resistance training (muscle strengthening with free weights, resistance bands, or weight machines). How much? At least 150 minutes per week of moderate-intensity aerobic activity, and resistance training twice a week.
In the Trenches: Routine screening to make sure you are fit for activity is no longer recommended by the ADA. What is recommended? Increasing your activity gradually. "I find fitting in one good walk a day and doing stretching exercises helps lower my blood sugar," says Carol Rosser, PWD type 2. If you are at high risk for heart and other health problems or you haven't been exercising, the ADA suggests that you start with short periods of a low-intensity activity and increase as you can. If you have concerns, talk with your health care provider.
Lose a Few Pounds at Diagnosis
True, most people with prediabetes or type 2 diabetes carry around excess pounds. But you don't need to lose a lot of weight to lower your blood sugar and improve your cholesterol and blood pressure levels.
The Science: Type 2 diabetes, particularly at the outset, is a disease of insulin resistance, and your pancreas can't produce enough insulin to cover your body's needs if you carry extra pounds. With insulin resistance, your body makes some insulin but doesn't use it well. Studies routinely show that dropping 5-7 percent of your body weight can significantly reduce insulin resistance and lower your blood sugar levels. Minimal weight loss carries numerous other benefits, including improved cholesterol and lower blood pressure.
In the Trenches: The best way to lose weight is to eat less of some foods. Slow and steady wins the race. Sustainable changes in your eating will benefit you more than a fad diet. Start by just eating a few bites less at each meal. Keep eating less by monitoring portion sizes until you're losing one to two pounds a week. Tackle losing a few pounds and most importantly keeping them off by putting a long-range plan into action. Set out to change your eating habits forever. Keep food records for a few days. Be honest! Set a few reasonable goals based on which of your not-so-healthy habits will be easiest to change.
Stress can be a surprisingly powerful driver of your blood glucose levels. Most people see stress raise their blood sugar while others can see stress lower it.
Why it works: Of the components of the food you eat, fiber is the only one that doesn't break down and get absorbed into your system. There are two types of fiber: insoluble, which whisks material through your digestive system, and soluble, which slows the absorption of glucose. Experts recommend a high-fiber diet to people who have and are at risk for developing type 2 diabetes.
The Science: "Stress reliably worsens long-term blood glucose control for most people," says William H. Polonsky, Ph.D., CDE, director of the Behavioral Diabetes Institute in San Diego. For some people, emotional or mental stress causes a release of adrenaline that raises blood sugar. But for others, the effect is behavior-driven, meaning that with stress in their lives, they let diabetes management slip. Polonsky says stressed-out people don't "give their diabetes the close attention it deserves, and presto -- A1Cs rise."
In the Trenches: Try to manage your stress. Limit the stresses you can. Also, work to change your attitude toward the stresses you can't change. Reach out to others with diabetes to learn what works for them. There are many ways to reduce stress, including taking a walk, reading a book, watching a good movie, pausing for a few minutes to take several deep breaths, and playing with pets or children. Perhaps most important is to focus on the things that are going well with your diabetes and in your life.
Do you sleep well? And long enough?
The Science: "Numerous studies suggest that not getting enough sleep and/or having interrupted sleep may worsen control of diabetes and increase overeating," says Carol Touma, M.D., an endocrinologist who focuses on sleep research and metabolism at the University of Chicago. In recent years, a connection has been drawn between people who are overweight and have prediabetes or type 2 diabetes and sleep apnea. "Three-quarters of people with type 2 diabetes have sleep apnea," which causes brief interruptions in breathing during sleep that disturb sleep patterns.
In the Trenches: Work on getting a sufficient amount of deep sleep to feel rested. This may require you to think about your routine and how you unwind and ready your body for sleep. If you consistently wake up feeling tired and just don't feel you are getting good sleep, talk to your health care provider about being tested for sleep apnea. Two healthy lifestyle actions can improve your sleep quality: moving more and losing a few pounds.
Explore and Learn from Past Actions
Ate too much, missed your walk, or didn't check your blood sugar? With countless diabetes to-dos, it's easy to slip up. Rather than beating yourself up for yesterday's mishaps, misadventures, or didn't-dos, take the opportunity to learn from your past actions as you seek to change your ways for the future.
The Science: Animals learn quickly. A rat presses a button with its nose and gets a shock. The rat's solution? Don't press the button again. Humans don't learn so quickly and aren't so simplistic in our actions and reactions.
In the Trenches:It's so easy to beat yourself up. That's negative and unconstructive. Instead, turn mishaps into learning experiences. Ask yourself: How can I handle that situation better? What actions can I take to avoid that situation again? For example, did you find that you overate the high-fat macaroni and cheese that you prepared for your family? Give some thought to finding a healthier mac and cheese recipe the whole family will enjoy. Did you miss your walk because you simply got busy? Try an early-morning or lunchtime walk instead.
Don't Resist Medications
Think back to the mid-1990s and years prior. The big message for people just diagnosed with type 2 diabetes was to follow a meal plan and exercise. Today's message is quite different due to discoveries about why type 2 develops and new treatments added to your health care provider's medicine chest.
The Science: Studies conducted over the past few decades have shown that by the time most people are diagnosed with type 2 diabetes, they are insulin-resistant and don't have enough insulin made in the pancreas to cover their needs. The push is on to treat type 2 aggressively from day one. For this reason, the ADA and a growing crowd of experts now suggest that people with type 2 diabetes start on a blood glucose-lowering medication when diagnosed. Medications lower blood glucose by treating the insulin resistance or supplementing lower-than-desired amounts of gut hormones.
In the Trenches: When your provider suggests blood glucose-lowering medication for diabetes, work with your provider to select one or more medications to help you hit your glucose targets. Remember, what's most important is keeping these numbers in their target zones and keeping you healthy for the long run.
William "Lee" Dubois contributed to this article.