Proper management of diabetes can prove effective in preventing amputations, loss of sight and other diabetes related complications."- Margarett Best, Minister of Health Promotion
So you have been diagnosed with Diabetes and are looking at how to live with this disease. The important thing for you to remember at all times is that if your blood glucose isn’t controlled — that is, kept between 70 and 139 mg/dl after eating or under 100 mg/dl fasting — damage can occur to your body. The damage can be divided into three categories: irritations, short-term complications, and long-term complications.
Taking control of Your Lifestyle
Diabetes is just one part of your life and it can affect the rest of your lifestyle. However, you can alter your lifestyle to the benefit of your health and your diabetes. Try making these changes to your lifestyle one suggestion at a time, and when you think you have that one under control, move on to the next.
Drinking alcohol safely
A glass of wine is a pleasant addition to dinner, and studies show that alcohol in moderation can lower the risk of a heart attack. For a diabetic, it is especially important that food accompany the wine because alcohol reduces blood glucose; a complication called hypoglycemia may occur. Never drink alcohol without food, especially when you are taking glucose lowering medication.
The following people should not drink alcohol at all:
- Pregnant women
- Women who are breastfeeding
- Children and adolescents
- People who take medications that interact with alcohol
- People with medical conditions that are worsened by alcohol, such as liver disease and certain diseases of the pancreas
The amount of wine that is safe on a daily basis is a maximum of two 4-ounce glasses for a man or one 4-ounce glass for a woman. Men metabolize alcohol more rapidly than women, so they can drink more. But you should drink no more than a maximum of five days out of seven.
In terms of alcohol content, 11⁄2 ounces of hard liquor, such as gin, rum, vodka, or whisky, or 12 ounces of light beer are the equivalent of a 4-ounce glass of wine.
Alcohol adds calories without any nutrition. Alcohol has no vitamins or minerals, but you do have to account for the calories in your diet. If you stop drinking alcohol, you may lose a significant amount of weight. For example, a person who has been drinking three drinks a night and stops will lose 26 pounds in a year.
Alcohol can cause cirrhosis of the liver and raises blood pressure. It also worsens diabetic neuropathy. Do you need any more reasons not to drink alcohol?
In addition to drinking alcohol in moderation, here are major ways you can improve the rest of your lifestyle:
- Avoid tobacco in any form. It is the number-one killer.
- Avoid illicit drugs.
- Drive safely.
- Benefit from relationships.
- Maintain your sense of humor.
Working Toward a Healthy Weight
Like many adults, you may be trying to lose some weight or keep unwanted pounds from creeping up on the scale. If so, focus on good nutrition and physical activity as the basis for your own "can do" healthy living plan.
Get Real About Your Goals
Evaluate your weight. One way is to check your Body Mass Index (BMI). BMI scores weight in relation to height. A BMI between 19 to 25 is a healthy range for most people. At higher BMI levels, some health problems may increase.
If you're at a healthy weight, keep up the good work. Be sure to continue with a healthy living plan that includes a balanced diet and regular physical activity. If your BMI is 25 or higher:
- First put the brakes on gaining additional pounds. Use the tips below to help you get on track.
- Then try to lose some weight. Losing even 5% to 10% of your body weight may result in improved blood pressure, cholesterol and blood sugar control (if you have or are at risk for diabetes).
- Work with your doctor or a registered dietitian to set personalized weight goals.
- Aim for a loss of one to two pounds per week.
A Healthful Eating Plan
What we eat over time influences our health and may affect our risk for some diseases. While there is no one "right way" to eat, healthy eating plans include some tried and true principles. Start by following Canada’s Food Guide recommendations and the tips below.
- Make sure you get appropriate amounts of carbohydrates, protein and fat since all are an important part of a balanced diet. Following the Food Guide generally will provide you with suitable amounts of all three. Choose the appropriate number of servings from each food group based on your age and gender and watch your portion sizes.
- On average, most adults should be getting between 25 to 30 grams of fibre per day. Make sure to eat the recommended amount of fibre daily. A fibre-rich diet (e.g. vegetables, fruits, whole-grain foods, legumes) helps in the management of diabetes and may help reduce the risk of heart disease. Fibre also helps to reduce hunger by keeping you feeling full longer.
- Eat plenty of vegetables and fruit. Aim for at least seven servings per day, especially dark green and orange vegetables. Enjoy them steam, baked or stir-fried. Raw fruits and veggies make delicious snacks.
- Get adequate amounts of calcium. For most people, the goal is two to three servings of milk products each day. Choose low fat milk or fortified soy milk, yogurt or cheese. Tofu with calcium and dark green vegetables can also be calcium-rich sources.
- Eat sensible portions. Get to know your food and what is in it. Check out the serving size on product packages and read menu descriptions when eating out. Don’t give in to great "super-sizing" deals. When preparing food at home, try using measuring cups and spoons to help you visualize portion sizes.
- Eat slowly and listen to your body's signals for hunger and fullness. Eating while multi-tasking often means you're not paying attention to what or how much you eat. Busy lifestyles often means reaching for high-fat and sugary snacks. As a result, you may end up eating too many calories and not getting the nutrients you need from missed food groups.
- Save calories by trying “no”, “low” or “reduced” calorie versions of foods, but be sure to stick to the serving size. Just because they may be lighter in calories or fat does not mean that you should overindulge!
Move a little more everyday. Challenge yourself:
- Buy a pedometer and try to add 2000 steps to your daily routine. Aim to eventually take 10 000 steps everyday.
- Add an additional 5 minutes to your usual activity duration.
- Park farther away from the office or store and make a commitment to use the stairs.
- Walk around while you are talking on the phone.
- Take a quick walk around your building, office or neighborhood after lunch.
- Take the long route to the washroom, copier or mailbox.
- Walk over to coworkers instead of using email or the phone.
Small changes in activity can create a significant calorie deficit over time. The more small changes you make, the easier regular activity will become to fit into your usual schedule and lifestyle plan. 10 minute spurts here and there all contribute to the recommended 60 minutes per day you should be aiming for.
Medication: Type 1 diabetes always requires daily injections of insulin. Type 2 diabetes is controlled through exercise and meal planning and may require medications and/or insulin to help the body make or use insulin more effectively.
Lifestyle Management: Learning to reduce stress levels in day-to-day life can help people with diabetes better manage their disease. Stress busters you might try are: spending quality time with friends and family, relaxing bubble baths or a day at the spa getting a massage.
Diabetes and Depression
Depression is serious mental health concern that goes far beyond general unhappiness. According to the Centre of Addiction and Mental Health (CAMH), depression is the leading cause of disability globally. Those with severe depression find it difficult to function in their everyday lives, and fifty per cent of those diagnosed with clinical depression will experience a relapse at some point in their lives.
When you have diabetes, your risk of depression increases. The Canadian Diabetes Association (CDA) says depression is twice as common for individuals with diabetes, as compared to the general population. And, major depression is found in at least 15% of people with diabetes.
If you or someone you know has diabetes, be alert to the signs and symptoms of depression. To help you learn more about depression and the treatment options available, KRAFT Living Well with Diabetes recently spoke with Claudia Tindall, an advanced practice mental health clinician and registered social worker with more than 25 years of experience.
Just as diabetes must be carefully managed on an ongoing basis, the same goes for depression. If left alone, it can get worse. But when treated properly, you can regain the quality of life you once enjoyed.
Signs and symptoms of depression
For a number of reasons, depression often goes undiagnosed and untreated. Depressed individuals may feel ashamed or embarrassed to talk about their problems. They might think things will improve on their own. Or, they might be in a state of denial and not even realize they're suffering from depression.
Unfortunately, if depression is left untreated, it can fester for many years and take a heavy toll on an individual's personal and professional life. When someone experiences five or more of the following symptoms, it can be a sign of depression:
- Feelings of sadness and despair that are present almost every day, last throughout the day
- Impaired performance at school, work or in social relationships
- Changes in appetite or weight
- Problems sleeping
- Loss of interest in work, hobbies, people or sex
- Withdrawal from family members and friends
- Feelings of uselessness, hopelessness, guilt, pessimism or low self-esteem
- Feelings of agitation, sluggishness or fatigue
- Difficulty concentrating, remembering things or making decisions
- Crying easily, or feeling the urge to cry but not being able to
- Having thoughts of suicide (these should always be taken seriously)
- Feeling out of touch with reality – this may include hearing voice or having strange ideas
While the signs and symptoms of depression can vary widely from person to person, the onset of a depression often coincides with a major life change. For example, receiving a diabetes diagnosis, or adjusting to the major lifestyle changes associated with diabetes, can be enough to trigger periods of depression.
The good news is that professional help is available, so you don't have to deal with depression alone.
The earlier a person is treated for depression, the more positive the outcome. If you or someone you know is experiencing any signs of depression, there's no time like the present to seek help. A number of resources are available – including mental health professionals who can provide effective forms of therapy, support groups and self-help strategies.
Start with your family doctor
General practitioners can make referrals to mental health professionals – including psychiatrists, psychologists and psychotherapists – who in turn can verify the diagnosis and offer counseling to help develop coping strategies. Depending on the severity of the depression, your family doctor or a psychiatrist may also prescribe antidepressant medication to help you cope with the symptoms.
If someone other than your main healthcare provider is treating you for depression, it's important to ensure they're in regular communication with one another. This is especially important for people with diabetes since depression is associated with poorer blood glucose management, health complications and a decreased quality of life.
It's also important to note that if you're taking antidepressant medication, you should always follow your doctor's instructions. If it appears your symptoms are lifting, that doesn't mean stopping your medication. Rather, it could be a sign the medication is working. The same goes for any medication you may be taking. Always consult a healthcare provider before stopping a medication. Otherwise, you could jeopardize your health and risk a relapse. Three effective forms of therapy
Cognitive Behavioural Therapy (CBT)
CBT is a form of psychotherapy that helps people deal with depression by showing them how negative thought patterns can contribute to feelings of sadness and despair. Over time, individuals learn how to turn negative thoughts into more balanced ones.
Interpersonal Therapy (IPT)
IPT looks at depression from an interpersonal perspective. Personal experiences – such as the loss of a loved one or a change in role, such as retirement – can alter a person's support system and trigger a depression. IPT aims to treat the depression by finding ways to cope with and improve interpersonal relationships.
This form of therapy helps people stay mentally healthy after they've recovered from an episode of depression. Unlike CBT, mindfulness meditation does not attempt to change thought patterns. Instead, it helps individuals focus on the here and now, and accept their feelings without judgment. Support groups for individuals and families
Research shows when a depressed person has positive family support, they're less likely to experience a relapse. Yet, often families simply don't know what they can do to help the depressed individual. They're afraid of saying or doing the wrong thing for fear of making the situation even worse.
Learning about depression, and the issues surrounding it, can help family members be more supportive. Many mental health organizations offer education groups and programs that teach families about depression, what they can do in a crisis situation and how to effectively communicate with a depressed individual.
Ways you can help yourself
Just as you plan your meals, it can help to plan your day in much the same way. Making time for activities – like exercise, hobbies and socializing – can add important structure to your day and help you find enjoyment where there wasn't any before.
Many individuals find it helpful to discuss their problems in a safe environment with others who are experiencing similar emotions. That's the premise of self-help groups. They remind you that you're not alone. The Canadian Mental Health Association (CMHA) lists local chapters across the country with programs and services to help those in need.
What to do in a crisis
If you have suicidal thoughts, or someone you know has talked about suicide or self-harm, it's extremely important to seek help quickly. The Centre for Suicide Prevention lists crisis centres across Canada and people can also access the closest emergency room of their local hospital.
Look for books on depression in the General Health section of your local bookshop. Plus, these online resources can help you learn more about depression and what you can do about it:
CAMH (Centre for Addiction and Mental Health)
Canada's leading addiction and mental health teaching hospital aims to help those affected by addiction and mental illnesses, such as depression.
Confidential Depression-Screening Test
This quick, easy and anonymous questionnaire can determine if you're experiencing signs of clinical depression.
Mood Disorders Society of Canada
This national, non-profit organization is committed to improving the quality of life for those affected by mood disorders, such as depression.
This quarterly Canadian publication aims to improve quality of life for individuals who suffer from mood disorders and mental illnesses
What follows are 10 Myths About diabetes from the American Diabetes Association:
Myth #1 You can catch diabetes from someone else.
No. Although we don’t know exactly why some people develop diabetes, we know diabetes is not contagious. It can’t be caught like a cold or flu. There seems to be some genetic link in diabetes, particularly type 2 diabetes. Lifestyle factors also play a part.
Myth #2 People with diabetes can't eat sweets or chocolate.
If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. They are no more “off limits” to people with diabetes, than they are to people without diabetes.
Myth #3 Eating too much sugar causes diabetes.
No. Diabetes is caused by a combination of genetic and lifestyle factors. However, being overweight does increase your risk for developing type 2 diabetes. If you have a history of diabetes in your family, eating a healthy meal plan and regular exercise are recommended to manage your weight.
Myth #4 People with diabetes should eat special diabetic foods.
A healthy meal plan for people with diabetes is the same as that for everyone – low in fat (especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain foods, vegetables and fruit. Diabetic and “dietetic” versions of sugar-containing foods offer no special benefit. They still raise blood glucose levels, are usually more expensive and can also have a laxative effect if they contain sugar alcohols.
Myth #5 If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta.
Starchy foods are part of a healthy meal plan. What is important is the portion size. Whole grain breads, cereals, pasta, rice and starchy vegetables like potatoes, yams, peas and corn can be included in your meals and snacks. The key is portions. For most people with diabetes, having 3-4 servings of carbohydrate-containing foods is about right. Whole grain starchy foods are also a good source of fiber, which helps keep your gut healthy.
Myth #6 People with diabetes are more likely to get colds and other illnesses.
No. You are no more likely to get a cold or another illness if you have diabetes. However, people with diabetes are advised to get flu shots. This is because any infection interferes with your blood glucose management, putting you at risk of high blood glucose levels and, for those with type 1 diabetes, an increased risk of ketoacidosis.
Myth #7 Insulin causes atherosclerosis (hardening of the arteries) and high blood pressure.
No, insulin does not cause atherosclerosis. In the laboratory, there is evidence that insulin can initiate some of the early processes associated with atherosclerosis. Therefore, some physicians were fearful that insulin might aggravate the development of high blood pressure and hardening of the arteries. But it doesn’t.
Myth #8 Insulin causes weight gain, and because obesity is bad for you, insulin should not be taken.
Both the UKPDS (United Kingdom Prospective Diabetes Study) and the DCCT (Diabetes Control & Complications Trial) have shown that the benefit of glucose management with insulin far outweighs (no pun intended) the risk of weight gain.
Myth #9 Fruit is a healthy food. Therefore, it is ok to eat as much of it as you wish.
Fruit is a healthy food. It contains fiber and lots of vitamins and minerals. Because fruit contains carbohydrate, it needs to be included in your meal plan. Talk to your dietitian about the amount, frequency and types of fruits you should eat.
Myth #10 You don’t need to change your diabetes regimen unless your A1C is greater than 8 percent.
The better your glucose control, the less likely you are to develop complications of diabetes. An A1C in the sevens (7s), however, does not represent good control. The ADA goal is less than 7 percent. The closer your A1C is to the normal range (less than 6 percent), the lower your chances of complications. However, you increase your risk of hypoglycemia, especially if you have type 1 diabetes. Talk with your health care provider about the best goal for you.