Diabetes

Diabetes

When the ants went marching, ancient doctors watched with keen interest. They knew that ants were instinctively attracted to the unusually sweet urine of people who had a mysterious disease that caused intense thirst and dehydration. So if ants scurried toward a person’s urine, it was a good bet that that person had a serious ailment we now know as diabetes.

But while diagnosis was simple, treatment was a nightmare. For thousands of years, doctors tried crude treatments like bleedings, blisterings, and drastically restricted diets consisting of 400 to 600 calories a day. Nothing worked. It wasn’t until insulin was discovered in the 1920s that scientists truly began to understand how to control the disease.

“Diabetes is an eminently treatable condition these days,” says Alan Krasner, M.D., assistant professor of endocrinology at Johns Hopkins University School of Medicine in Baltimore. “With the advances we’ve made, people who are diagnosed with diabetes today certainly can look forward to living healthier lives than others did in the past.”

It’s not surprising that insulin was the key to treatment, because that’s the most important factor in the diabetes equation. People who have diabetes have trouble either producing or using insulin, which is an essential hormone that your cells need in order to nourish themselves. Normally, digestion breaks down some foods into glucose, a blood sugar that is your body’s main source of fuel. As glucose circulates through the bloodstream, it is carried to cells throughout your body. Insulin, which is manufactured in the pancreas, is the gatekeeper. It helps glucose enter your body’s cells so it can be used as fuel for growth and energy.

Without insulin—or without the ability to use it well—the cells are deprived of glucose. They’ll begin to weaken. Meanwhile, glucose continues to pour into the bloodstream, building up to abnormal levels.

Diabetes becomes more prevalent with age. About half of all cases are diagnosed after 55. Nearly 6.3 million seniors—one in every five people over age 65—may have diabetes, according to Linda Morrow, M.D., medical director of Alexian Brothers Senior Health Center in San Jose, California. And another 6 million seniors who have impaired glucose tolerance are at high risk of developing the disease.

Two types of diabetes can affect seniors. Type I diabetes occurs when the body’s immune system, for some yet undiscovered reason, mistakenly attacks and destroys the cells in the pancreas that are responsible for making insulin. Without insulin, blood sugars pile up and diabetes sets in. This form of the disease, which affects 5 to 10 percent of older Americans, requires insulin injections to keep blood sugars under control, Dr. Morrow says.

But 90 percent of the time when an older person gets the disease, it is Type II diabetes, says Dr. Krasner. If you have Type II, your pancreas is still doing its job. The catch is that it either isn’t producing enough insulin or it is making plenty of insulin but your body has developed what is known as insulin resistance. Insulin resistance occurs when your cells snub the hormone, making it impossible for blood sugar to enter cells and be used as fuel.

Although diabetes is a chronic disease that has no cure, there are plenty of things you can do to augment the care you receive from your doctor, says Dr. Krasner.

Try This First

Know your foe. Learn as much as you can about diabetes, Dr. Morrow urges. The better you understand the disease, the more likely you are to be able to control it. Ask your doctor to recommend a certified diabetes educator in your area, or contact your local chapter of the American Diabetes Association (ADA). Books such as the American Diabetes Association Complete Guide to Diabetes also are terrific resources.

“Ninety-nine percent of the care and management of diabetes is in the patient’s hands,” says Christine Beebe, R.D., certified diabetes educator and spokesperson for the American Diabetes Association. “We can’t move in with you, prepare your meals, and monitor your blood sugars for you. You have to know what to do and when to do it. And you can’t do it if you don’t have the knowledge and skills.”

Other Wise Ways

Identify yourself. Wear or carry identification that will let others know that you have diabetes. If you are incapacitated, prominently displayed identification will help emergency personnel make the appropriate decisions that can save your life, Dr. Krasner says. Emergency identification tags, cards, bracelets, and necklaces are available at many pharmacies.

Step lively. Regular exercise is a vital part of any diabetes management plan, according to Dr. Morrow. Just taking a 15-minute walk every day can help lower blood sugar and can help your body use insulin more efficiently.

Some activities such as weight lifting may not be safe for you, particularly if you have high blood pressure or diabetic eye disease (retinopathy). So talk with your doctor before beginning any regular workouts, advises Dr. Morrow.

Follow your dietary blueprint. No single diet can possibly meet the unique needs of every person who has diabetes, Beebe says. So you should consult with a registered dietitian who has experience working with people who have diabetes. Jot down everything you eat and record your blood sugar readings for two to three days prior to your initial meeting with your dietitian. It will help her assess your current diet and develop a meal plan that is right for you.

“Many older people who discover that they have diabetes have very good eating habits. A lot of times, we just need to tweak the diet somewhat,” Beebe says. Once your meal plan is established, meet with your dietitian at least twice a year to fine-tune it, she suggests.

Follow the pyramid. Even if you have a dietary plan specifically designed to control your diabetes, certain basics apply to everyone, says Beebe. She recommends the U.S. Department of Agriculture’s Food Guide Pyramid for people who are 50-plus as an excellent starting point for any senior who has diabetes. These guidelines give you a general eating program that balances your consumption of fats, proteins, and carbohydrates in a way that should provide good nutrition. Here are the daily recommendations and some examples of servings.

• 6 to 11 servings of cereals and grains (examples: ½ bagel, ½cup of cooked noodles, 2 to 3 graham crackers)

• 2 to 4 servings of fruits (examples: one orange, one banana, 1 cup of strawberries)

• 3 to 5 servings of vegetables (examples: ½ cup of corn, ¾cup of vegetable juice, 1½ cup of mashed potatoes)

• 2 to 3 servings of lean meat, poultry, eggs, dry beans, or nuts (examples: ½ cup of tuna, two ounces of meatloaf, four tablespoons of peanut butter)

• 2 to 3 servings of dairy products (examples: 1 cup of reduced-fat milk, 1 cup of low-fat yogurt, or 1½ cups of low-fat ice cream)

Fats like olive oil, mayonnaise, butter, margarine, and salad dressing should be used sparingly, notes Beebe.

Although the pyramid can help you cope with many of the dietary challenges of having diabetes, remember that you should still consult with a dietitian before beginning any meal plan to control this disease. Your individual meal plan, an exercise plan, and medication can help keep your blood sugar under control most of the time, Beebe adds.

Graze. Spread your calories, especially those that come from carbohydrates, throughout the day in order to keep your blood sugar levels at optimal levels, Beebe says. So instead of two large meals, you may want to eat five or six smaller meals like half a sandwich and an orange.

Don’t forget fiber. Food high in water-soluble fiber like beans, oat bran, fruits, and nuts can help people with diabetes control their blood sugar, Beebe says. Soluble fiber slows the absorption of carbohydrates, so your blood sugar level may not rise as quickly. Try eating at least 20 grams of fiber a day. For example, start your day with a bowl of oatmeal for breakfast. Then have a peach for a mid-morning snack, a bowl of chili for lunch, and lentil bean soup along with your dinner. You’ll be well on your way to reaching your goal.

Treat yourself. In the past, people with diabetes were told that they could not eat certain foods, namely, refined carbohydrates like sugar, cookies, or sweets. But more than 30 research studies have shown that all carbohydrates have similar effects on blood sugar. That means a cookie elevates blood sugar about as much as a slice of bread or piece of fruit, Beebe says.

“For the most part, there is no reason why a person with diabetes can’t include a cookie or other dessert item in a healthy meal plan,” Beebe says. “It’s simply unrealistic to expect that somebody is never going to eat sugar. It’s the total amount of carbohydrates you eat each day that is really important.”

Moderation is the key, she adds. Try to keep your simple-sugar intake down to 10 percent of your total calories each day. If you eat 2,000 calories a day, for example, you can allocate about 200 calories—that’s about one scoop of ice cream or one or two brownies—to your sweet tooth.

Pay heed to your feet. Inspect your feet and between your toes every day, Dr. Krasner says. Diabetes can damage nerve endings in your feet and toes, making it difficult for you to feel sores, blisters, and other injuries. Look for cuts, breaks in the skin, or swollen, red areas. Consult your doctor or podiatrist about any infections, puncture wounds, or open sores on your feet.

Keep your feet clean and dry. Bathe your feet with warm water and mild soap every day. Dry them carefully, especially between the toes. Apply a thin coat of moisturizing lotion if the skin on your feet feels unusually dry. Wear clean socks and comfortable, well-fitting shoes. Never go barefoot. You’re more likely to injure your feet if you do, Dr. Krasner warns.

Get a green light to drive. If you use insulin or diabetes pills and have a history of low blood sugar (hypoglycemia), test your blood sugar level before you begin driving, Dr. Krasner says. If your blood sugar is below 100 milligrams, don’t get behind the wheel until you’ve stabilized your blood sugar to over 100 milligrams. Hypoglycemia can cause loss of conscious while driving, he says. If you are driving and feel symptoms of hypoglycemia, such as extreme confusion, fatigue, or irritability, pull to a stop by the side of the road and treat yourself for it immediately.