Suddenly, food was the enemy. Everything that went in your mouth had the potential to cause you to have your feet amputated and go blind. Sounds a bit extreme now, but at the time, that’s what went through my mind every time I picked up a fork.

Many people will try to tell you what you can and can’t eat as a diabetic. Most will be well-meaning. Most won’t have a clue. Including, apparently, the American Diabetes Association.  The ADA is still recommending a low-fat diet high in complex carbohydrates.

I’ve yet to meet, or hear of, a Type 2 diabetic that could maintain good control on that type of diet.

Rather than compounding the problem by telling you what you should or should not eat, I’d recommend a simpler method: eat by your meter.

Eating By Your Meter

It’s simple really. At diagnosis, the most important thing in your life is (or should be) getting your blood sugar under control. Everyone reacts differently to food. What spikes glucose levels through the roof for one person might only cause a mild rise in another.

The only way to know for sure it to test. Test your blood sugar before every meal. Take it again 2 hours after eating. Try to keep your meals simple to begin with, the less types of things you eat at a meal, the easier it is to pinpoint which item had the greatest impact on your blood sugar.

From there, it’s a process of elimination. If something spikes your blood sugar to unacceptable levels, take it off the menu. At the very least, try it again, but eat less of it.

It means a lot of testing. A lot. But it’s the only way to truly know for sure whether a particular food item is OK for you to eat.

Without getting into a big philosophical debate of low vs high carb, you’ll probably find that a diet lower in carbs is easier for you to maintain control on than one high in carbs. Personally, I can’t eat bread, pasta or potatoes. Whole grain, multi-grain – doesn’t matter.

I generally eat eggs or cottage cheese for breakfast. A chicken salad or chicken breast with veggies for lunch and lean meat and veggies for dinner.  It ends up being fairly low carb, but when was the last time you saw a “study” that said that lean meat and veggies were bad for you? If you take out all the hyperbole from the various diet advocates, the bottom line is that they pretty much all would be on board for a lean meat and veggies diet as being healthy.

I’m not a vegatarian. I’d imagine it would be quite a bit tougher to be a vegatarian and a Type 2. Not impossible, just harder.

Bottom line: eat by your meter and develop your diet based on your body’s reactions to food. The meter doesn’t lie.

Personally, I use the Life Scan One Touch Ultra 2 glucometer. Results are fast, accurate and the strips are easy to find. You can purchase one from Amazon below, or it may be covered by your medical insurance.

You can also order extra strips from for this meter from Amazon, which is handy if your doctor won’t write you a prescription for more than a couple of tests a day. I’ll order an extra box once a quarter or so just so I have extra on hand. ONE TOUCH Ultra Fast Draw Test Strips-100CT by Lifescan

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]]> http://www.t2faq.com/type-2-diabetes/supplements/diabetic-supplements.html/feed 0 http://www.t2faq.com/type-2-diabetes/monitoring/diabetes-medical-alerts.html http://www.t2faq.com/type-2-diabetes/monitoring/diabetes-medical-alerts.html#comments Fri, 24 Aug 2007 14:43:00 +0000 admin http://www.t2faq.com/type-2-diabetes/monitoring/diabetes-medical-alerts.html Without question, Type 1 Diabetics should wear some sort of medical alert bracelet or necklace at all times. Type 2′s on insulin should as well. The dangers of going low, or hypo, are just too great and you see news stories all the time of hypo diabetics being confused for a drunk and not given the medical attention that is so important during a hypo.

Non insulin-using Type 2′s however often feel they don’t need to wear a medical alert.

I wear a dog-tag style necklace identifying myself as a diabetic for a couple of reasons:

1.) I frequently travel alone. If I were mugged and knocked unconscious in a distant city, it could literally be days (or never) before I was identified and a family member familiar with my medical history could be contacted.

2.) You don’t need to be a med student to know that the very FIRST thing they will do if you are taken to a hospital is insert…. a glucose IV.

Now, they are probably going to insert a glucose IV even if you are conscious and ask them not to, it’s just what they do. If you are very persuasive and have a competent ER doc, you might be able to convince them to use a saline IV instead. If you are unconscious, they will definitely use a glucose drip.

Without a medical ID, the hospital staff would have no way of knowing that they need to monitor your blood glucuse and possibly administer insulin. If you’re out for a few hours, it will probably be “no harm done”. But what if said mugger whacked you over the head hard enough to put you in a coma for a day, or two, or a week? Or you broke your jaw in a car accident and couldn’t talk or… fill in your worst case scenario here.

Bottom line, if you’re diabetic you need to wear some sort of ID. A wallet card isn’t enough.

You can find reasonably priced and attractive medical alerts options at American Medical ID

Frozen shoulder is a condition in which adhesions in your body’s joints (typically the shoulder) cause severe pain and restrictive movement.

Prior to my diagnosis, I spent several years with limited range of motion in my shoulder and a burning pain sensation that rarely, if ever, went away. It was never actually diagnosed as frozen shoulder, but looking back, that’s undoubtably what it was.

The shoulder tends to eventually “unfreeze” and the pain goes away (to some extent at least), but people have been known to suffer from frozen shoulder for up to five years.

For me, anti-inflammatory drugs helped as did massage therapy and chiropractor visits. The pain radiated so much and was vague enough in its presentation that my family doctor was never able to diagnose it.

Additional Resources:

Wikipedia Entry on Frozen Shoulder 

Diabetic Frozen Shoulder

Diabetes In Control: Frozen Shoulder

The HbA1c test is used to monitor your diabetes. It is an average of your blood glucose levels over time and gives you a good idea of how well you are controlling your diabetes.

The A1c is a blood test. Blood is drawn and (usually) sent to the lab for the test. Some doctor offices now have ”instant A1c” test equipment in their offices.

The basic science behind the A1c works something like this: the red blood cells in your body pick up glucose that is flowing in your blood. This is normal and happens to everyone. If you have high levels of glucose in your blood, your red blood cells pick up more glucose than normal. The shorthand “HbA1c” stands for glycosylated hemoglobin. 

Red blood cells live for around 3 months in your body. At any time, old red cells are dying and new ones are being formed. The older red blood cells have “picked up” more glucose molecules over their life than the younger red blood cells. By drawing blood and examining the amount of glucose bound to the red blood cells, the lab can come up with an average of how much glucose has been available in your blood for the red blood cells to “pick up” and bind to over the previous three months or so. This is why most endocrinologists will schedule A1c’s quarterly.  

Non-diabetic people have A1c levels around or under 5.0. The American Diabetes Association recommends that diabetics keep their A1c under 7%. I personally think this is too high. There are studies that suggest that levels under 5.5 are best to reduce complications from diabetes developing.

I’m shooting for an A1c of around 5.5 or lower.

A few things to keep in mind:

Normal lab measurements can vary from lab to lab, so it’s important to know if your samples have been tested by the same lab each time.

A1c’s are averages. If you tend to have really high blood sugar, followed by really low blood sugar, your A1c might average out to a good number, but the highs are doing damage. It’s the same theory that if you have one foot in boiling water and one foot in freezing water you are, on average, comfortable.

While it’s not perfect, the A1c is a very important number in the diabetic’s life and it’s vital that you know your A1c, understand what it represents, and have a new one done on a regular basis. If you have a history of being in good control, your doctor may not order an A1c every quarter, but I would recommend having one done twice a year at a minimum.

The classic symptoms are: extreme thirst, frequent urination, extreme weight loss and fatigue. These can come on quite quickly in a type 1 diabetic, but can develop slowly in a type 2.

The thirst and urination are obviously tied together – this is your body’s attempt to get rid of the excess glucose. If glucose levels are high enough, the glucose will begin to “spill” into your urine. This can result in your urine leaving a “sticky” residue (more likely to be noticed if you are a man, for obvious reasons.) The weight loss and fatigue are similarly tied together. As your systems for processing glucose break down, your body has increasing difficulty getting the food energy it needs, and will resort to breaking down itself for energy.

Constant hunger. As stated above, if you are an undiagnosed diabetic your body’s cells are probably starving for nutrition and signaling that they need food, even if you’ve just eaten. As a type 2, you’re probably producing an excess amount of insulin, which is triggering hunger symptoms.

Itchy skin, especially after high intake of carbohydrates. I literally felt itchy everywhere after drinking Gatorade, prior to diagnosis. It got to the point where I thought I was allergic to it. Turns out it was just the high level of high fructose corn syrup that it contains.

Flushing/sweating after eating. This is a common reaction to high blood glucose level spikes that follow eating a meal.

Diabetic ketoacidosis – this is a potentially fatal situation resulting from the body breaking down fat/muscle. More common in Type 1′s it can occur in type 2′s as well. Symptoms include abdominal pain and rapid, shallow breathing. Immediate treatment at a hospital is required.

Other symptoms are actually signs that complications may have developed:

- Wounds that are slow to heal. High glucose levels impedes the body’s repair mechanisms.

- Infections. These are common in undiagnosed/uncontrolled diabetics. The high glucose levels create ideal conditions for opportunistic infections on/under the skin and throughout the body. Boils and carbuncles are common. Respiratory infections (bronchitis, pneumonia) can be persistent and take longer to clear up. For women, yeast infections can be a chronic problem.

- Blurry vision. Diabetes affects the small blood vessels in the body first. Your eyes have many very small blood vessels.

- Foot Pain. More properly called diabetic neuropathy. The blood vessels in your feet/toes are small and the furthest from your heart, so they frequently show signs of damage first. Ultimately, this can lead to amputations as the blood vessels and tissues in the feet and legs become damaged and begin to die. Neuropathy can feel like pins and needles in your feet or numbness in the toes/feet.

- Erectile dysfunction. Damage to small blood vessels can also affect the nerves which control sexual function and erectile dysfunction is fairly common in men.

Of course, the gold standard for whether you have diabetes is your blood glucose levels as determined using a blood glucose meter or having an A1c test done at a laboratory.  Fasting levels above 126, post meal levels of greater than 180 or an A1c test above 6% are some common guidelines for a diagnosis of diabetes.

If you suspect you might be diabetic, schedule an appointment with your doctor and specify that you would like to have an A1c test performed as well as having your fasting blood glucose checked. If you have experienced any of the symptoms above, make sure you discuss them with your doctor. There may be many reasons/causes for these symptoms (frequent urination might be caused by taking a diuretic for high blood pressure, for instance) but it’s better to be safe and mention everything, even if you think you know what’s causing it.  

Unless you are taking insulin, you’re going to have to watch what you eat closely. “Eating by your meter” is what a lot of Type 2′s call it. If what you ate causes you to have blood glucose readings over 140 two hours after your meal, you better reconsider whether that is a food you can eat.

I generally eat breakfast at home and dinner seems to be easier if you’re eating out. I generally have eggs,  cottage cheese, or bacon for breakfast. Dinner just seems to be easy as well: a lean meat and some veggies, hold the potatoes. Most restaurants will let you substitute the veggie of the day for the potato.

Lunch, on the other hand, is harder. I’ve never been one to pack my lunch and I rarely take a full hour for lunch, so I was in the habit of hitting the fast food places for lunch. When you are a Type 2, you begin to notice that very few menu items at fast food joints don’t include bread, potatoes, fries, pasta or some combination of the above.

Your meter will tell you if you can tolerate any of the above, but if you are like me, you most likely need to avoid those types of food choices.  

Over time, I’ve come to learn a few things I can do to allow me to still grab a quick lunch at a fast food place.

1.) Salad – learn to love ‘em. I’ve yet to see a fast food place that doesn’t offer some sort of salad. Usually you can get grilled chicken with them as well. Granted, some of those fast food salads can be a little nasty, but they are generally safe. Just watch the dressings! Some dressings contain ridiculous amount of sugar. I tend to stick to ranch, blue cheese or vinaigrettes, as they tend to low carb.

2.) Skip the Fries, ditch the bun. Wendy’s will allow you to substitute a side salad or chili or fruit for the fries in the combo meals. I’d watch the fruit, it usually comes in a syrup (another word for SUGAR!). Sometimes, I’ll order a double with cheese and a side salad. I’ll eat my salad first and then lose the bun, put the remains of my burger in my salad bowl and use my fork to eat it. It’s low carb and it’s a whole lot easier to eat a bunless burger out of a bowl rather than to try and eat it with your fingers. Lot less messy too.

3.) Give the Colonel a try. KFC might not be known as a health food place, and lord knows I wouldn’t recommend a mashed potato bowl to a Type 2 diabetic, but you CAN eat at a KFC, I do it all the time. Order an original recipe chicken breast one piece meal. You get two side dish choices with that, I get grean beans for both of them as the other alternative aren’t good for me (mac and cheese, potato wedges, cole slaw -it has a fair amount of sugar added or corn.) The corn isn’t too terrible, but I try to avoid it. Ask them to skip the biscuit and you take the skin off the chicken. Voila! A lean chicken breast with veggies.

4.) Hit the deli counter at you local grocery store. Many grocery stores still have salad bars. Load yourself up with healthy choices and hit the road.

5.) Chili – You can get chili at many fast food places. You’ll need to test to find out how good a choice chili is for you. The beans have a decent amount of carbs, but are also high in fiber so they might OK for you. The biggest problem with chili is that some recipes will add a lot of…. you guessed it, sugar.

That pretty much sums up the lunch options I’ve discovered so far. If you have a favorite Type 2 friendly fast food lunch you’d like to share, leave a comment below.

How often should I check? At first, pretty much all the time. The only way to come to grips with your diabetes is to learn, as soon as possible, how well your medications are working and what effect various foods have on your blood sugar. If you are a Type 2 Diabetic, your doctor may only write a prescription for testing 2 times a day. I’d recommend more, at least at first. If you have to, pay cash for extra strips.

A good plan for someone recently diagnosed would be to check your blood glucose:

1. First thing in the morning – Before you brush your teeth or have anything to drink, preferably.
2. Two hours after you took your first bite of food for the day.
3. Immediately before lunch.
4. Two hours after your first bite of lunch
5. Immediately before your evening meal
6. Two hours after your first bite of your evening meal
7. Last thing you do before you go to bed

Why test so much?

Testing before your meals will give you a baseline from which to judge how the food you eat affects your blood sugar. I’d recommend eating simple meals of only a few items at first. This will allow you to pinpoint which foods are creating the increase in blood glucose.

Testing 2 hours after your meal (called postprandial testing) will show you how your body is reacting to food. 

Blood sugar spikes in everyone immediately after eating a meal, it’s the way we’re designed. In a normal person, insulin kicks in and delivers the glucose to your muscles and tissues, so after the immediate spike, blood glucose drops quickly. A normal person’s blood glucose might spike up to 180 (or even higher) an hour after a meal, but then falls quickly to under 140 at two hours. A second stage release of insulin “mops up” whatever is left and the normal person’s blood glucose falls back into a range of 80 to 120 (or so) after the meal.

A Type 2 diabetic will spike just like everyone else. In most Type 2′s, those who have a fully functioning pancreas, insulin will also be released to deliver all that glucose. Here’s where things go awry for the Type 2 Diabetic. Insulin resistance causes the insulin to struggle to deliver the glucose.  Glucose remains in the bloodstream and levels will remain high for hours. In general, the higher the number of carbohydrates consumed, the greater the release of glucose and the higher your blood glucose will stay.

Testing prior to bed will give you a good baseline to determine what’s going on in your body overnight. Most people’s blood glucose will fall throughout the night or remain steady. Your body, specifically your liver, will attempt to produce glucose over the course of the evening to keep your blood sugar somewhat stable throughout the night.

Toward morning, our bodies tend to gear up just prior to waking. Hormones begin kicking in to prepare the body for the coming day. The liver will dump its store of glucose to get things started. That’s a normal process in most people. 

Many Type 2 Diabetics will notice very high fasting (morning) blood glucose numbers. This is the result of the liver producing/dumping glucose into their system at some point in the night. Once again, the insulin resistance works against you, so that glucose remains hanging out in your bloodstream in the morning instead of feeding your body’s cells. This high morning, fasting blood glucose is referred to as the Dawn Phenomenon, and can be very frustrating.

Normally when you go to the doctor to have blood work done, they have you do it first thing in the morning in a fasted state. For many Type 2 Diabetics, fasting blood sugar is the last thing “to go”. An undiagnosed Type 2 Diabetic might have extremely high post meal numbers for years, but if their fasting blood glucose remains steady, they will go undiagnosed.

By following this testing schedule, you will begin to see patterns. I’d recommend charting your glucose numbers along with what you ate. This will allow you to see how various foods affect your blood sugar. Over time, you’ll learn which foods will cause unacceptable spikes and learn to avoid those things. Or, you will learn that a “little bit” of certain foods will be OK, but no more than that.

It’s a lot to track, it takes time, its an annoyance, and it’s very, very important that you take the time to do it. Everyone reacts differently to different kinds of foods. I could tell you what foods I have to avoid, but it might be very different from the list you come up with by testing your body’s reaction to foods.

 Once you get a grip on your numbers and your diet, you can probably begin to scale back your testing. I pretty much always do a fasting (first thing in the morning) test. I’ll test again once or twice throughout the day, varying the tests from before and after meals, sometimes testing at lunch, sometimes before or after dinner and occassionally before bed.

Before you can scale back to this “old timer’s” schedule however, you have to put in the work and learn how food affects your blood glucose, and the only way to do that is to test, test, test and record the results.

Personally, I use the Life Scan One Touch Ultra 2 glucometer. Results are fast, accurate and the strips are easy to find. You can purchase one from Amazon below, or it may be covered by your medical insurance.

You can also order extra strips from for this meter from Amazon, which is handy if your doctor won’t write you a prescription for more than a couple of tests a day. I’ll order an extra box once a quarter or so just so I have extra on hand. ONE TOUCH Ultra Fast Draw Test Strips-100CT by Lifescan

Often considered the “last resort”, insulin is always an option. Sometimes a doctor will prescribe insulin for a newly diagnosed Type 2 diabetic in order to get dangerously high levels down to a more normal range before trying pills or other injected medicines. Hypos, dangerously low blood sugar, are always a concern when injecting insulin. If a patient doesn’t respond to oral medications or oral medications stop being effective, many type 2 diabetics will “progress” to injecting insulin. An inhalable version has been developed, but it is still most commonly injected.

For oral medications there are several different types: Biguanides, Meglitinides, Sulfonylureas, Thiazolidinediones, Alpha-glucosidase inhibitors, DPP-4 inhibitors and incretin mimetics. I’m not going to get into the science behind them, but a general overview as well as some brand names are below. At the end of the article are some links to various sites that have good descriptions of the science behind these drugs.

Biguanides – These drugs reduce the production of glucose by the liver and may help with insulin resistance. Glucophage is the brand name, but it is commonly sold as a generic, Metformin. Metfomin also comes in a variety of extended release versions and is commonly included with some of the other drugs below for a combination therapy.

Meglitinides – These drugs work by stimulating the pancreas to release more insulin. Common drug names include: Prandin and Starlix.  Due to the way these drugs work, hypoglycemia is a concern.

 Sulfonylureas- These drugs work by causing the pancreas to release more insulin. Common names include glypizide (Glucotrol), glyburide (Micronase) and glimepiride (Amaryl).  Again, due to the way these drugs work, hypoglycemia is a concern, and the user should monitor their carb intake and talk to their doctor about diet modifications.

 Thiazolidinediones- These drugs increase insulin uptake and reduce the amount glucose produced by the liver. Common drug names include Avandia and Actos. There have always been warnings concerning these drugs and liver damage, and there has been recent concern (particularly with Avandia) about heart damage. This class of drugs can also cause edema (retention of fluid) in the feet and legs, which can be dangerous for people with heart conditions and may be reason for the recent concerns.

Alpha-glucosidase inhibitors – These drugs work in the intestines, blocking the break down and absorption of starches in the digestive track. Common names are Precose and Glyset.

Incretin mimetics – This is a newer class of drugs. The first developed is Exenatide (Byetta). This drug was actually first discovered by examining the saliva of Gila monsters (a member of the lizard family). Byetta is an injected medication. Byetta works by slowing digestion, signalling the pancreas to release the correct amount of insulin and keeping the liver from producing and releasing too much glucose. Some users experience nausea when first starting Byetta.

DPP-4 Inhibitors - Sitagliptin (Januvia) is another new class of drugs that work by reducing a specifc protein in the body, allowing the insulin your body produces to work more effectively.

Additional Resources

Wikipedia: Anti-Diabetic Drugs

American Diabetes Association

Dr. Bernstein’s Diabetes Solution

Mayo Clinic

Consumer Reports – Type 2 Diabetes Drugs (pdf)

There is a prevailing opinion that fat people get Type 2 Diabetes *because* they are fat.

At the same time, there’s plenty of evidence that Type 2 Diabetes is an inherited genetic disorder of the metabolic system that is progressive.

Why is it so hard to believe that the bad genes came first and *caused* the weight gain? Hmm, a person with an inherited genetic disorder of the metabolism system is putting on weight…go figure.

Maybe, just maybe, the disease came first. Slowly impeding the processing of glucose in the body. Slowly causing ever increasing amounts of insulin to be released in order to deal with all that glucose. Slowly increasing the insulin resistance, allowing that excess insulin do the second part of its job- store fat.

Is it really so hard to believe that maybe Type 2 Diabetics tend to be fat *because* they have a disease, instead of vice-versa?

I’ve yet to see a good study that conclusively points one way or the other. There’s no doubt that the vast majority of people with Type 2 are fat.

Maybe there’s a reason for that?