MUCH OF what is discussed below is not only for the person who suffers from diabetes, but should be noted by every-one who wants to remain healthy and safe from diseases such as diabetes! Following on from my first article, here I will talk about control and treatment.
Controlling blood sugar is essential to feeling healthy and avoiding the long-term complications of diabetes. Some people are able to control their blood sugar with diet and exercise alone; others may need to use insulin or other medication in addition to lifestyle changes.
Several factors affect blood sugar levels:
Food
Food raises the blood sugar levels, which are at their highest one to two hours after a meal.Controlling when you eat and how much you eat can influence the peaks in blood sugar levels that arise after eating, and the lows that occur when you haven’t eaten for a while. Being consistent in the timing and amount of food you eat each day will help you keep your blood sugar within your target range.
Exercise and physical activity
In general, the more active someone is the lower their blood sugar, as cells spend sugar to produce energy. Aerobic exercises such as brisk walking, jogging or cycling are especially good, but gardening, housework and even just being on the go all day can also lower blood sugar.
Medication
Insulin and oral antidiabetic medication deliberately work to lower blood sugar, but medication taken for other medical conditions may also affect the glucose levels. Corticosteroids may raise blood sugar levels as well as some drugs which are used to control high blood pressure and cholesterol – two medical conditions which, in diabetic patients, are even more important to keep under control.
Illness
As a defence to the cold or other illnesses, the body raises the blood sugar levels, which helps to promote healing, but for a diabetic this can be a problem. Fever increases the rate at how quickly sugar is used, making the control of insulin treatment more difficult.
Alcohol
Alcohol disrupts the liver’s normal production of sugar. While your liver is busy metabolising the alcohol you’ve consumed, it doesn’t release its stored sugar when the blood sugar level starts to drop. Your blood sugar can then drop too low. Even a small amount of alcohol can cause blood sugar levels to fall, due to the fact that normally when your blood sugar starts to drop, your liver steps in – changing stored carbohydrate into glucose that goes into the blood – helping to avoid, or slow down, a low blood sugar reaction. Alcohol is a toxin and your body reacts to it like a poison. The liver wants to clear it from the blood as quickly as possible, and it will not release any glucose until it has removed the alcohol. Alcohol should be taken in moderation, not forgetting that it can cause the opposite reaction, driving up your blood sugar because of the added calorie consumption.
Watch what you drink
If you do drink, select drinks that are lower in sugar. If you have mixed drinks, use mixers that are sugar free, such as diet soda, tonic water, club soda or seltzer. And choose alcohol with fewer carbohydrates, such as light beer. If you have diabetes related complications, such as nerve damage or retinopathy, don’t drink at all. Alcohol can worsen the damage. Ask your doctor if it’s safe for you to drink any alcohol.
Fluctuation in hormone levels
The female hormone, oestrogen, makes cells more responsive to insulin, and progesterone makes cells more resistant. These two hormones fluctuate throughout the menstrual cycle and before menopause, producing variations of blood sugar levels, but most women can control any symptoms with additional exercise and changes in their diet. After menopause, many women with diabetes require about 20 per cent less medication for diabetes, because their cells become more sensitive to insulin.
The main treatment tools for diabetes are diet, weight management and exercise, and, in some cases, medication.
Diabetes management starts first and foremost with diet, and that can be the most difficult thing to manage. Having diabetes does not mean eating only boring foods or being hungry all the time! It means that more fruit, vegetables and whole grain foods should be eaten, which are high in nutrition and low in fat and calories, with fewer carbohydrates and sweets. In other words, basically the same diet all of us should follow!
Exercise is also very important, and the good news is that the same exercises that are good for the heart and lungs also help lower blood sugar levels. First of all, every-one should check with their doctor before beginning any exercise programme. There should be approximately 30 minutes of aerobic exercise, such as walking, cycling, tennis and swimming, most days. Diabetics have to be aware that exercise induces the body to use up glucose for extra energy, and adjust their diet or medication accordingly.
Being overweight is the greatest risk factor for type 2 diabetes, because fat makes your cells more resistant to insulin. But when you lose weight the process reverses, and for some people weight loss is all that is needed to restore blood sugar to normal.
When diet, exercise and maintaining a healthy weight are not enough, then medication may be required.
Everyone with type 1diabetes and some people with type 2 must take insulin every day to replace what their pancreas is unable to produce. Unfortunately, insulin cannot be taken in pill form because enzymes in the stomach break it down so it becomes ineffective. For this reason, insulin has to be injected using a syringe, insulin pen injector or insulin pump, which provides a continuous supply of insulin. The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but manufactured in a laboratory.
For people who have type 2 diabetes, there is a variety of oral medication that can be taken to control this disease and these work on the body in different ways. By combining drugs from different classes, blood sugar may be controlled in several different ways. Newer medications are now being produced that combine different drugs in a single tablet.
In recent years, researchers have focused increasingly on transplantation for people with type 1 diabetes. Unfortunately, pancreas transplantations aren’t always successful and they can be more dangerous to health than diabetes, so it is not considered unless the diabetes cannot be controlled, or there are serious complications.
Islet cell transplantation (pancreas cells that produce insulin) is still considered an experimental procedure but offers a less invasive, less expensive and less risky option for people with diabetes.
It will be some time before the majority of the world’s 130 million people with diabetes can reap the benefits of the current research into transplantation. Once that happens, a miracle will have occurred!
This is in the future, and while caution is the watchword for now, that future is a great deal brighter than before.
Niki Medlock
Luzdoc Practice Nurse
Diabetic Clinic Nurse
