Type 2 Diabetes Information

What is type 2 diabetes? 
The two hormones that control the metabolism of carbohydrates are insulin and glucagon. After consuming a meal containing carbohydrates, insulin is required to transport glucose from the bloodstream into cells for storage or energy. If blood glucose drops, glucagon breaks down stored carbohydrates into simple glucose for energy. These two hormones work together to keep blood glucose levels stable. 

Type 2 diabetes is a condition where the body’s cells do not respond to insulin very well. This condition is known as insulin resistance. As a result, high levels of glucose accumulate in the blood, but the cells are starved of energy, which can lead to cravings for more food an hour or two after eating. This metabolic imbalance is detrimental and can lead to more serious health complications. 

Risk factors, Symptoms, and Diagnosis of diabetes 
• Being overweight or obese can increase insulin resistance. 
• Type 2 diabetes can be affected by family history, genetics, and older age. 
• Other risk factors: 
o Older than 45 years. 
o Low HDL cholesterol (<35 mg/dL), high triglycerides (>250 mg/dL) 
o High blood pressure 
o Have had gestational diabetes in the past 
o Are African American, Hispanic, Native American 
Many people have few symptoms of diabetes, and they may include: 
o Blurry vision 
o Fatigue 
o Frequent urination and increased thirst 
o Tiredness or fatigue 
o Increased hunger 
o Weight loss 
o Wounds that do not heal quickly 
o Numbness in hands and feet

Diabetes is formally diagnosed: 
o If fasting blood glucose (FBG) is greater than 126 mg/dL 
o Hemoglobin A1c is greater than 6.5%. HbA1c is indicative of how well blood glucose is being controlled. Normal levels should be less than 5.7%. An A1c between 5.8% and 6.4% indicates pre-diabetes or insulin resistance. 
o Oral glucose tolerance test- if glucose is greater than 200 mg/dL 2 hours after glucose load is given. 
o Non-fasting glucose-if blood glucose is higher than 200 mg/dL at any time, with symptoms of diabetes above. Confirm with fasting glucose test or A1c.

How do I manage diabetes? 
Type 2 diabetes can be managed through proper diet, exercise, and medication. Blood glucose can be controlled by eating a balanced diet, (with particular care to carbohydrates) daily physical activity, and through weight loss. Work with your doctor, dietitian, and other health care providers to find the best way to manage your diabetes. 

Diet and Weight 
The goal of a diet tailored for diabetics focuses on maintaining balanced calorie and carbohydrate intake throughout the day (50-60% of daily calories). Following a diet for diabetes does not mean eating the same foods every day. For type 2 diabetes, the type of diet that should be used needs to focus on weight control, since typically many patients who develop type 2 diabetes are overweight. Eating healthy, consistent meals and snacks everyday can help curb blood sugar levels from rising or falling too fast, and can also minimize insulin and medication use. See handout on carbohydrate counting and portion control for additional information.

Focusing on low glycemic foods will help stabilize blood sugar levels. Foods with a low glycemic index (GI) will breakdown slower than high GI foods. For instance, processed and highly refined foods like cookies and soda will spike blood glucose levels, leaving you hungry shortly after consuming them. Follow this link for a list of 100 food items and where they are located on the glycemic index: 
http://www.health.harvard.edu/newsweek/Glycemic_index_and_glycemic_load_for_100_foods.htm

It is important to know how to distribute the amount of carbohydrates or starches you eat every day over the course of the day. 
 Foods that are carbohydrate rich include breads, cereals, beans, starchy vegetables (potatoes, peas, corn), and sweets. These foods raise blood sugar levels fastest. Consume smaller portions of these foods over the course of the day. 
 It is important to incorporate foods from a variety of food groups. Non-starchy vegetables and fruits are high in vitamins, minerals, and fiber and have very few calories and carbohydrates. 
 Milk and milk products can be good sources of protein and calcium. Choose fat free or low-fat milk and yogurt, and choose low-fat cheeses. Be careful: Fruited and flavored yogurts, may contain added sugar. 
 Choose lean sources of protein-from lean cuts of meat and chicken, eggs, nuts, and legumes, and use lower fat cooking methods such as grilling or stir-frying.