Diabetes : Diabetes Diagnosis and Changing Your Habits

Victor R. Martinez, El Paso Times, Texas

Josefina has Type 2 diabetes.

She was diagnosed three days after Thanksgiving, during her annual checkup.

The diagnosis left her dumbfounded.

"I was shocked; I really thought I took care of myself," she said. "Nobody in my family has diabetes. I never had any of the symptoms. I walked about a mile to a mile and a half every day and I ate the right foods, and my cholesterol was under control."

Her doctor has given her three months to manage the diabetes through exercise and diet. If that doesn't work, she will go on medication.

"I'm walking from five to six miles a day now and I'm trying to learn about how to eat properly," said Josefina, who attended a diabetes management course sponsored by the El Paso Diabetes Association. "It could hit anybody. I'm really going to try my best to beat this without having to go on medication."

Nearly 18 million people in the United States are diagnosed with diabetes, according to the American Diabetes Association. Most have Type 2 diabetes, in which the body doesn't effectively use the insulin it creates. Insulin is a hormone that takes sugar from the blood to the cells.

"The problem with diabetes is it's silent, it's chronic, and it doesn't have a cure," said Irma Herrejon, a diabetes specialist with the El Paso Diabetes Association. "People ignore it because it is silent. When you don't make the change in your lifestyle, you will have complications -- and those complications are the worst part."

The risk of developing Type 2 diabetes varies from person to person, depending on such factors as family history, ethnicity, weight and age.

Several complications can develop if diabetes is not treated.

"There could be retinopathy, which could lead to blindness; kidney disease, which could lead to death; neuropathy, which affects all the nerves in your body and could lead to amputation," Herrejon said.

She said the next step after being diagnosed is simple, in theory. "Change your life; change the way you live," she said. "You need to educate yourself. When you know what you are eating or doing is not healthy and can lead to complications, you'll choose the right way to live."

Herrejon, who herself has had diabetes for 22 years, understands that a change in lifestyle can be difficult. "The treatment for diabetes is in the change in your life style," she said. "The doctor can give you the medicine, but if you are still living like you used to, the medicine will be insufficient." She wakes up at 5 every morning to exercise.

"If you're not used to exercise or eating right -- and I see it in every ethnic group -- it's going to be very difficult to change," she said.

The diabetes management class at the El Paso Diabetes Association is six hours of instruction, in which newly diagnosed diabetics learn the basics of diabetes treatment, complications, management, portion control in meals, and the role of exercise. Las Palmas LifeCare Center also has a diabetes treatment center, which provides meal planning, a personalized exercise regimen and other services.

"We'll make sure that we put them on a program where diet and exercise is covered just for the patient," said Mike Flores, the director of Las Palmas LifeCare Center, 3333 N. Mesa. "Our doctor will also talk to the patient about stress and everything else that involves diabetes."

The diabetes patient will sit down with a dietitian and a certified strength and conditioning specialist to detail a plan.

"That is the difference," Flores said. "We do a little bit of what they do in the doctor's office, but we do a whole lot of the complementary stuff that surrounds it. Here, it's a slow-down version. The diet and exercise really makes the difference for people to improve their health."

Maria Prieto, 54, found out she is a borderline diabetic at her annual physical a few weeks ago.

"My blood-sugar readings came back too high at my last physical," she said. "My mom and my sister have diabetes, and I want to learn how to eat better."

Prieto also attended the diabetes management course sponsored by the El Paso Diabetes Association.

"I don't want to get diabetes. That's why I'm here, trying to learn all I can," she said. "I do a lot of walking, a lot of exercising. I'm just really worried I might have it. I feel like I'm in good health."

Diabetes education is key, even for parents of children with diabetes.

Carmen Enriquez's 10-year-old son, Richie Gomez, has had Type 1 diabetes -- in which the body does not produce insulin -- since he was 3 years old. Enriquez, whose parents have Type 2 diabetes, recognized the symptoms right away.

"It was a shock at first, but I knew I had to get as much education and information as I could for my son," she said. "We have to do this together. I taught him to check his glucose when he was 3."

As Enriquez is learning, so is Richie.

"He has to learn what I learn," she said. "I try to explain to him the importance of taking care of himself. He needs to do it for himself, because Mommy is not always going to be here."

Enriquez said it was difficult at first for Richie to understand why the other children could eat frosting and drink soft drinks.

"I let him be a kid, but at the same time I tell him he can't have two or three pieces of pizza anymore," she said. "He knows he should just have one slice. When we go to birthday parties, he knows to take off the frosting from the cake."

She said the El Paso Diabetes Association has been a blessing for providing camps for children with diabetes.

"I know a lot of moms want to put a shield around their children, and I was doing that, too," Enriquez said. "I learned through the association about teaching them their independence, and the camps he attends does wonders for his self esteem."

Richie would feel different around other children before going to the camps. "He saw that he wasn't the only one who had to poke his fingers," Enriquez said. "He was just like everybody else."

Diabetes and diet There is no such thing as a "diabetes diet." The foods recommended for a diabetic are good for everyone. For people with diabetes, carbohydrates must be monitored. Carbohydrates have the greatest influence on blood sugar levels. A dietitian can provide nutrition education to develop a meal plan that fits your lifestyle and activity level, and meets your medical needs. The following are the basics of a healthy diabetes diet, courtesy of diabetes.webmd.com. --Eat a variety of foods.

--Eat the right amount of calories to maintain a healthy weight.

--Choose foods high in fiber. You need 25 to 35 grams of fiber a day. Studies suggest that people with Type 2 diabetes who eat a high-fiber diet can improve blood sugar and cholesterol.

--Do not skip meals.

--Eat meals and snacks at regular times every day. If taking a diabetes medicine, eat meals and take medicine at the same times each day.

--Small amounts of sugar are fine.

--Read food labels. Learn how to determine how much sugar or carbohydrates are in the foods that you eat.

--Substitute, don't add. When you eat a sugary food, substitute it for another carbohydrate that you would have eaten that day.

--Sugary foods can be fattening. Many foods that have a lot of table sugar are very high in calories and fat. Eat in moderation.

--Check your blood sugar after eating sugary foods and talk to your health-care provider about how to adjust your insulin if needed.

Diabetes and exercise The American Diabetes Association offers these exercise guidelines for those with diabetes: --Start slowly; gradually increase your endurance. --Choose an activity you enjoy.

--Exercise at least three or four times a week for 20 to 40 minutes each session. An exercise program should include a five- to 10-minute warm-up and at least 15 to 30 minutes of continuous aerobic exercise or muscle-stretching exercises.

--Drink water before, during and after exercise.

--Do not ignore pain. Stop any exercise if it causes unexpected pain.

--Discuss with your doctor appropriate types of exercise.

--Do not exercise if your blood sugar is greater than 250 mg/dL (milligrams per deciliter) and your ketones are positive. This is a sign you already may have a lack of insulin; exercise will only cause a greater rise in blood sugar.

--Learn the effects of various exercises on your blood sugar.

--Eat carbohydrates after exercise. Add carbohydrates to your meals before exercising; adjust insulin appropriately before. Types of exercise

--The latest findings show that strength training has a profound effect on managing diabetes. In a recent study of Hispanic men and women, 16 weeks of strength training produced improvements in sugar control comparable to taking medication.

--Aerobic fitness helps decrease the risk of Type 2 diabetes and helps manage blood sugar levels.

Victor R. Martinez may be reached at vmartinez@elpasotimes.com; 546-6128.

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Copyright © 2010, El Paso Times, Texas

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