Possible diabetes? Fasting glucose question

Below is a question I recently received from FOODPICKER.org

Susan D. asks: My fasting glucose number was 127.  Does this sound like pre-diabetes or diabetes?  What should I do to control by blood sugar?

Answer:  Diabetes is usually diagnosed if your blood glucose level exceeds 125 mg/dL during a fasting plasma glucose test. This test is usually conducted on more than one occasion to confirm the diagnosis. Three types of blood tests are to diagnose diabetes: 

• A Fasting plasma glucose test measures your blood glucose after fasting (not eating anything) for at least 8 hours. 
  
  
• An oral glucose tolerance test also starts with you in the fasted state, then you drink a glucose-containing beverage and your blood glucose levels are monitored for 2 hours afterwards.
  
  
• A random (or casual) plasma glucose test measures blood glucose at any point in time, without regard to when you last ate. 

Here is some more information regarding diabetes diagnosis from the NIH's National Diabetes Informational Clearinghouse. Since a blood glucose of 127 mg/dL is just above the cutoff, your doctor will likely repeat the fasting test or have you complete an oral glucose tolerance test before officially diagnosing you.

If your diagnosis of diabetes is confirmed, you should speak to your doctor regarding treatment. Generally, this involves blood glucose monitoring, oral medications, exercise and diet changes. Most notably, you will need to take care to spread carbohydrates evenly throughout the day. This may seem overwhelming, but there is a lot of help available! Often the best way to get started is by attending a diabetes education class or making an appointment with a Certified Diabetes Educator or Registered Dietitian. Check out this post from a few weeks ago for some more ideas in finding help. 

Send your questions to diabetes@foodpicker.org or directly to me at jjznutrition@gmail.com

Prediabetes, weight loss and fruits & vegetables

Here is a question I recently received from FOODPICKER.org:

Bob R.: I have pre-diabetes and am trying to lose weight.  How many servings of fruit and veggies should I have each day?

Answer: Prediabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. It's great that you have already decided to take the first step to better health! According to the American Diabetes Association losing as little as 5-10% of your body weight (approximately 10-15lbs), along with engaging in regular activity, may help you delay or prevent the development of type 2 diabetes.

In general, adults should consume about 3 cups of vegetables and 2 cups of fruit everyday.  But what counts as a cup? This may be confusing. In general, 1 cup of raw or cooked vegetables or 2 cups of raw leafy greens should be considered 1 cup of vegetables. For fruits, 1 cup of chopped fruit or ½ cup of dried fruit can be considered 1 cup. Here is a handy vegetable chart and a handy fruit chart from MyPyramid.gov that should help clear things up a bit.

You'll notice that both vegetable juices and fruit juices are also on the MyPyramid charts. In terms of watching your blood glucose levels, juices have two major strikes against them: they contain little to no fiber, and are a concentrated source of sugars. Drink juices in moderation! Also be sure to look out for starchy vegetables like potatoes, corn and peas. Starchy vegetables are much higher in carbohydrate than their non-starchy or cruciferous counterparts. Go for vegetables like broccoli, kale, lettuce, cabbage, cauliflower, chard, bok choy and bell peppers. Check out http://www.choosemyplate.gov/  for menu planning tips and to track and assess your food intake. Also visit FruitsandVeggiesMoreMatters.org for recipe ideas.

Don't forget that regular, moderate exercise is an important part of a healthy lifestyle. You don't have to join a gym - try walking for 30 minutes, 5 days a week. It will make a difference.

New Type 2? Think there's nothing to eat?

Question of the week from FOODPICKER.org:

Susan A.: I was diagnosed with type 2 diabetes last month.  I’m having difficulty understanding how many carbs and sugar I can have each day.  I’m finding that nearly everything contains carbs and sugar!  Can you help me with this?
 
Answer: Asking for help is the first step in learning diabetes self-management. You might start by asking your endocrinologist or primary care doctor to refer you any classes in your area. Also please refer to last week's question & answer for help in finding a Certified Diabetes Educator (CDE) or Registered Dietitian (RD) to work with you. For newly diagnosed persons, I highly recommend personalized sessions with a CDE or RD. It will be very helpful in starting you off on the right track to great diabetes self-care and good long-term health.

There are 2 main meal planning methods taught to people with diabetes: carbohydrate counting and the exchange system.  I find carb counting a much easier method to learn and teach, but you may find you like exchanges better. Be sure to ask about these two methods so you can discover which will work better for you.

In general, the body needs a minimum of 130 grams of carbohydrate each day. Carbohydrates are not the enemy here - your body runs on carbohydrate and needs adequate amounts to survive! For someone with diabetes, the issue is that the body cannot handle a large amount of carbohydrate at one time. It is important for you to spread carbohydrates throughout the day. You will find it easier to do this (and easier to maintain blood glucose control) if you eat several smaller meals and snacks instead of only 2 or 3 meals per day.

For example, say you are aiming for approximately 150 - 160g of carbohydrate per day. You could divide as follows:

• Breakfast: 25 -30g
• Snack: 15 - 20g
• Lunch: 30 - 45g
• Snack: 15 - 20g
• Dinner: 30 - 45g
• Snack: 15g

This type of breakdown of grams/carb per meal is typical in the carb counting method of meal planning.

When reading food labels, the "Total Carbohydrate" amount is the most important one to consider (sugar is included in the "Total Carbohydrate" amount). For foods without labels (the best type to eat!), you can try searching the USDA's nutrient database or FOODPICKER.org. You can also track and assess your diet for free with USDA's SuperTracker.

In general, the faster your blood glucose rises, the higher it is likely go. You'll want to concentrate on carbohydrates that take longer to digest. This includes carbohydrate choices with lots of naturally-occurring fiber: whole grains (brown rice, quinoa), whole fruits (not fruit juices) and non-starchy vegetables (broccoli, lettuce, spinach, green beans, peppers, tomatoes, etc.).

There are a few common starchy vegetables to look out for: corn, peas, white potatoes and sweet potatoes. While nutritious, these veggies are more concentrated sources of carbohydrates. Enjoy them in smaller portions than you would non-starchy vegetables. Low-fat dairy products (milk & yogurt) are also nutritious carbohydrate choices, but be sure to check the "Total Carbohydrate" amount, especially on fruit-flavored yogurts. Some are loaded with added sugars, which will drastically increase the amount of total carbohydrate. 

Do you know someone with diabetes?  They can send their questions to: diabetes@foodpicker.org

Diabetes Education Help

Question of the week from FOODPICKER.org

Nancy M. asks: "I am trying to find a class for our grandson. He is 19 and has a part-time job but no insurance. He just found out last week that he is a type 1 diabetes after losing a lot of weight and his blood sugar was 523. He is on insulin but needs to go to a class to manage his diabetes without going hungry. Where do we start? Any suggestions would help us a lot."

Answer: Learning you or someone you love has diabetes can turn your world upside-down, but know that help is available and you are not alone! There are many resources to check, even without medical insurance. Diabetes cannot be cured, but it can be managed. People with diabetes can enjoy healthy, long life filled with delicious foods - but education is the first step. It is extremely important for your grandson to start taking an active role in his health right away.

First, where was your grandson diagnosed? I would check with the doctor, healthcare provider or clinic that actually made the diagnosis. Also check with other other local hospitals and clinics. It is very likely they have many resources already in place for people just like your grandson.

Second, your best bet would be to find a certified diabetes educator in your area. You can locate a diabetes educator through the American Association of Diabetes Educators. A certified diabetes educator (CDE) is a healthcare professional with additional training and specialized knowledge in diabetes self-management education. A variety of healthcare professionals may also be CDEs - doctors, nurses, registered dietitians, pharmacists, etc.

Another resource is the American Dietetic Association, through which you can find a registered dietitian (RD) in your area. Registered dietitians are food and nutrition experts. An RD will assess your grandson's nutritional needs, work with him to provide knowledge and facilitate lifestyle changes that fit within his current work schedule and activity level.

Note that both websites above will generate a list of providers, from there you can contact the individual diabetes educator or registered dietitan to see what s/he offers in terms of classes, one-on-one education sessions, and find out about cost. Some RDs and CDEs work alone, some are part of a larger healthcare facility or network of facilities.

Also, be sure to check out the American Diabetes Association for more resources and information on diabetes basics, lifestyle and events.  Finally, you might also want to tell your grandson to check your state Department of Health's website. For example, New York State DOH has a diabetes page filled with information and available resources.

Good luck!