Your diabetes top three

Three things that every person with type 2 diabetes should be doing

By Nanette Bultemeier, Pharm.D., BCPS, BC-ADM, CDE, clinical pharmacy specialist and certified diabetes educator, Providence Medical Group

The defining characteristic of type 2 diabetes is elevated blood sugar. Over time, high blood sugar levels can change your blood vessels in ways that increase your risk of heart attack, stroke, and damage to the kidneys, feet and eyes. These complications can threaten your life, or at the very least, the quality of your life. But you can lower your risks by doing three things:

  1. Optimize your ABCs.
  2. Eat to keep things under control.
  3. Move to improve your blood sugar.

1. Optimize your ABCs.

For people with diabetes, the ABCs are more than just letters – they stand for some very important numbers.

A = A1C. This number tells you what your blood sugar levels have been averaging over the last two to three months. That’s an important number, because it’s an indicator of how well your treatment plan is working. We know from large studies that if you can keep the A1C below 7 percent, you can decrease your chances of developing diabetes complications. See your doctor for this blood test every three to six months, and adjust your treatment strategies if you are exceeding the A1C target that you and your doctor are aiming for.

B = blood pressure. High blood pressure increases the risk of heart attack, stroke and kidney disease. When you have type 2 diabetes, you are already at risk for these problems, so you need to be even more aggressive at controlling your blood pressure. While 140/90 is considered the upper limit for healthy blood pressure in the general population, the targets for most people with diabetes are lower. Aim to keep your numbers below 130/80, unless your doctor tells you otherwise.

C = cholesterol. When we look at cholesterol, the number we focus on most is LDL – the “bad” cholesterol that raises heart attack and stroke risks. As with blood pressure numbers, having diabetes means that you need to be more aggressive about keeping your LDL low. The number you want to stay below is 100, unless you already have had a heart attack – in that case, aim to keep your LDL below 70. Talk to your doctor about what your specific LDL goal should be.

D = daily blood sugar. Monitoring your blood sugar numbers daily helps you get to know what causes your spikes and valleys, and how to avoid those. For most people, the goal is for blood sugar to be in the range of 70 to 130 before eating. Two hours after a meal, a blood sugar level below 180 is a good number. As with all of these numbers, talk with your doctor about the range you should be targeting.

Now you know your ABCs. The strategies that follow can help you optimize them.

2. Eat to keep things under control.

A diabetes diagnosis is a wake-up call to reassess what, when and how you eat. The way you eat not only affects your blood sugar on an hour-by-hour basis, but also affects your weight over the long term. When you weigh too much, your diabetes becomes harder to control, which means that your chances of one or more serious complications – a heart attack or stroke, a future on kidney dialysis, the loss of your vision or a foot – go up.

On the flip side, learning a better way to eat will help you reach and maintain a more healthy weight and keep your ABCs under control. Here are the what, when and how of success:

What: About half of what you eat should be vegetables. Yep, you read that right: half. Add moderate amounts of lean protein (not fried), fruit, dairy and whole-grain starches, and you’ve got yourself a nicely balanced diet. Avoid refined carbohydrates, such as white pasta, white rice, flour tortillas, bagels and bakery goodies – they contain little to no fiber and can increase your blood sugar. But don’t toss out all the carbohydrates – they’re still an important part of your diet. You just need to pay more attention to the quantity and quality. Whole-grain carbs such as oatmeal, quinoa, brown rice and whole-wheat pasta are good sources of fiber, which helps offset spikes in blood sugar. Finally, fried, fatty and salty foods don’t do you any good – keep them to a minimum. The same goes for sugary sodas and juices – water is a much better choice.

When: Try to eat three meals a day, plus a snack or two, spaced no more than three to five hours apart. Don’t skip meals. Snacks, like your meals, should be healthy and balanced: some cut up vegetables with Greek yogurt dip, for example, or a small apple with a few unsalted almonds are good choices.

How: The easiest way to change how – and how much – you eat is to adopt the plate method. Start with a smaller, 9- to 10-inch plate, and use this for your main meals. Now imagine dividing the plate in half. Use one half for your favorite non-starchy vegetables, such as steamed broccoli, roasted cauliflower, green beans, or a green salad with cucumbers, carrots and tomatoes. Divide the other side in half again and use one of these smaller sections for lean protein, such as chicken or turkey (without the skin), fish or seafood, lean red meat, an egg-white omelet, or a soy protein such as tofu. Use the remaining section for your starch – this can be a whole-grain product (look for whole-grain breads, cereals, tortillas and pastas), starchy vegetables such as sweet potatoes or green peas, or cooked beans such as black beans, chili or lentils. Next to the plate, you can add a small serving of fresh fruit and a low-fat dairy choice.

While these recommendations work well for many people, there is no set “diabetes diet” that is perfect for everyone. If you are having a hard time finding what works for you, connect with a dietitian or a certified diabetes educator who can help you develop an individualized eating plan that will make progressing toward your goals a pleasure, not a punishment.

3. Move to improve your blood sugar.

Physical activity helps your muscles use sugar for energy more efficiently, helps your body respond better to insulin and improves your ABCs. In addition, getting more activity helps you shed extra pounds, boost your mood, lower your stress and get a better night’s sleep. When combined with healthy eating, it could even reduce your need for medications. These are powerful benefits, and it doesn’t take much to achieve them. A brisk, 30-minute walk – or two quick 15-minute walks – five days a week will get you there.

Start by talking with your doctor about what is safe for you – especially if you have other health conditions or complications. Begin with something slow and easy, and increase the intensity and duration of your activity gradually over several weeks. Work your way up to a moderately intense level of activity that gets you breathing harder, but not gasping for breath – you should be able to talk, but not sing. If walking isn’t your thing, try a bike ride, take up tennis or shoot some hoops. If you have joint pain or mobility issues, swimming and pool exercises can help a lot. Once you’ve established aerobic activity as a regular part of your life, work on adding some strength and flexibility training to balance out your activity plan.

For bonus benefits, look for ways to increase the activity level of your life in general. Sit less and stand more. Walk around while you’re on the phone. Skip the elevator and take the stairs. Park farther away from where you are going. Plant and tend a garden. Play with your kids, your grandchildren or your pet. Mow the lawn. Scrub your house until it sparkles.

Beyond the top three

I’ve focused on the top three things you can do to manage diabetes and avoid complications, but of course, it doesn’t stop there. You also should check your feet every day, visit your dentist regularly, go to the eye doctor at least once a year, take your medications as prescribed, get your immunizations, keep your doctor’s appointments…the to-do list goes on. Just know that changing the way you live your life can save your life.

Here are two excellent sources for more information:
The American Diabetes Association
The National Diabetes Education Program

If all of this seems a little overwhelming at times, remember: your health care team is here to help. Don’t give up in frustration – your health goals are too important. Talk to your team whenever you have questions or need to get back on track. We’ll help you stay on top of things.

One final note

If you are dealing with a chronic disease such as type 2 diabetes and don’t have a primary care physician, or are looking to change providers, consider Providence Medical Group, with more than 90 clinics in Oregon, you can get the care you need right in your neighborhood.