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by Adele H. Hite, M.A.T. and Eric C. Westman, M.D.

Once it develops, diabetes is a lifelong condition that affects an estimated 23.6 million people in the United States—that’s almost 8 percent of the population. It’s considered a disorder of the metabolism, meaning that diabetes affects how the body uses food for growth and energy.

Glucose, Insulin, and Diabetes

In people with diabetes, the body is not able to use glucose normally and blood glucose levels are above normal. Glucose is important because it’s the body’s main source of fuel. Glucose is a form of sugar in the blood; when food is eaten, it’s broken down into glucose and passes into the bloodstream, where it provides energy.

Insulin, a hormone produced by the pancreas, is essential for the body’s process of using fuel, or glucose: blood cells need insulin to take up glucose. In people with diabetes, however, the pancreas produces too little or no insulin or their blood cells do not respond effectively to insulin.

As a result of insufficient insulin production or ineffective use, glucose builds up in the blood and, instead of being used as fuel, is passed out of the body in urine. In other words, the body loses its main source of fuel.

Diabetes Among Women

In addition to gestational diabetes, there are several ways in which diabetes affects women differently from men. Women with diabetes tend to have a more-serious risk of heart disease, and in the event of a heart attack, women have lower survival rates and those who survive have a poorer quality of life. As well, risk of blindness is greater for women with diabetes than men.

Women with diabetes who wish to become pregnant need to make special considerations, as pregnancy can affect insulin levels and diabetes-related eye and kidney problems. Pregnant women need to be especially careful about keeping blood glucose levels as close to normal as possible in order to protect themselves and the baby.

Types of Diabetes

There are three main types of diabetes:

  • Type 1 diabetes
  • Type 2 diabetes
  • Gestational diabetes

What Is Type 1 Diabetes?

Type 1 diabetes is an autoimmune disease. It’s also known as insulin-dependent diabetes. Five to 10 percent of diagnosed diabetes in the United States is type 1.

In autoimmune diseases, the body’s immune system (which normally fights infection) functions abnormally and attacks a part of the body. In type 1 diabetes, the immune system attacks the cells in the pancreas (beta cells) that produce insulin. As a result, a person with type 1 diabetes produces little or no insulin. He or she must take insulin daily to live.

Causes of Type 1 Diabetes

The exact causes of type 1 diabetes are still not known. Researchers suspect that causes include autoimmune, genetic, and environmental factors; viruses may also be involved. Though type 1 diabetes can develop at any age, it most often appears in children and young adults.

Risks for Type 1 Diabetes

Men and women have equal incidence of type 1 diabetes. It can occur at any age, though it most often develops in children. The disease is more common among Whites than among other races.

What Is Type 2 Diabetes?

Type 2 diabetes is the more-common form of the disease; among people with diabetes, nine out of 10 have type 2. In type 2 diabetes, the pancreas makes insulin for some time, but the body can’t use it effectively. Insulin production eventually decreases, at which time glucose builds up in the blood and the body cannot use it for fuel.

Causes of Type 2 Diabetes

Type 2 diabetes most often affects people who are overweight, older, have a family history of diabetes, are physically inactive, or have had gestational diabetes. Certain ethnicities—such as African American, Mexican American, and Pacific Islander—also have a high incidence of type 2 diabetes.

Risks for Type 2 Diabetes

Pre-diabetes. Pre-diabetes refers to a condition where people have blood glucose levels that are higher than normal but not high enough to be considered diabetes. Pre-diabetes can still be a health concern—it raises the risk of developing type 2 diabetes, heart disease, and stroke. Without prevention, a person with pre-diabetes is likely to develop type 2 diabetes within 10 years. Preventive steps include weight loss of 5 to 7 percent through healthy diet and increased physical activity.

Type 2 diabetes is more common among older people, and many who develop it are overweight; in fact, being overweight or obese is the leading risk factor for type 2 diabetes because excess weight can keep the body from using insulin properly. African Americans, American Indians, Native Hawaiians and other Pacific Islanders and Hispanics have a higher incidence than Whites. Older age, impaired glucose tolerance, physical inactivity, a family history of diabetes or a personal history of gestational diabetes are risk factors for type 2 diabetes.

These risk factors increase the likelihood of developing both type 1 and type 2 diabetes:

  • Overweight or obesity
  • A parent, brother, or sister with diabetes
  • High blood pressure of 140/90 or higher
  • Abnormal cholesterol (HDL, or “good” cholesterol, 35 or lower; triglyceride level of 250 or higher)
  • Physical inactivity (less than three days per week of exercise)

Diabetes Testing and Diagnosis

Diabetes is most often diagnosed in children and adults using a fasting blood glucose test. This test is performed when the patient hasn’t eaten for eight hours (in other words, after “fasting”) and measures levels of glucose in the blood. Diabetes may be diagnosed with a fasting blood glucose level of 126 milligrams per deciliter (mg/dL) or higher.

Other tests for diabetes include: 1) the oral glucose tolerance test, where blood glucose levels are measured two hours after drinking 75 grams of glucose dissolved in water; a blood glucose level of 200 me/dL indicates diabetes and 2) a blood glucose level of 200 mg/dL or higher taken at any time of day when other symptoms of diabetes are present.

Who should get tested? People who may want to consider testing include those over 45 years of age, especially if they are overweight, and people younger than 45 who are overweight and have one or more additional risk factors. Find a list of risk factors under “Risks.”

Symptoms of Diabetes

  • Increased thirst
  • More-frequent urination
  • Constant hunger
  • Weight loss
  • Blurred vision
  • Extreme fatigue
  • Very dry skin
  • Sores that are slow to heal
  • More infections that usual
  • Tingling or numbness in hands or feet

Symptoms may develop quickly, but damage to the insulin-producing beta cells in the pancreas may have been going on for some time.

It’s important to know and recognize these symptoms because a person who develops diabetes and is not diagnosed and treated can lapse into a life-threatening diabetic coma. This coma is known as diabetic ketoacidosis.

Treatment of Diabetes

There is no cure for diabetes, but it can be treated, or managed. The main goal in diabetes management is to keep blood glucose levels, cholesterol, and blood pressure as close to normal range as possible. A combination of insulin, physical activity, and healthy diet are the basic tools for treating type 1 diabetes. Type 2 diabetes is managed by healthful eating, regular physical activity, and blood glucose testing to keep track of blood glucose levels. Some people with type 2 diabetes also take medicines (pills, insulin, or other injectable medicine) to help control glucose levels.

Management of diabetes has improved in recent decades. Innovations include quick-acting and long-acting insulins for insulin-dependent (type 1) diabetes, more oral drugs for type 2 diabetes, improved blood glucose monitors, and external insulin pumps to replace daily injections. As well, care for diabetes-related conditions has improved; for example, laser surgery can treat eye disease, and kidney and pancreas transplantation is a possibility for people with organ failure.

Treatment of diabetes is often handled by primary care physicians, though other specialists may be part of the healthcare team. Additional specialists may include an endocrinologist who specializes in diabetes care, a dietician to help with sound food choices, educators certified in diabetes, and a podiatrist and/or ophthalmologist (eye and foot issues are possible complications of diabetes). And, depending on an individual’s overall health, the healthcare team may extend to other specialists—cardiologists for those with heart concerns and obstetricians for pregnant women, for example.

A regular visit to the doctor for someone with diabetes should include:

  • Taking blood pressure
  • Checking feet for sores; a thorough foot exam at least once a year
  • A hemoglobin A1C test at least twice a year (determines blood glucose level for the past two to three months)
  • Checking kidney function at least once a year by testing blood and urine
  • Testing cholesterol levels at least once a year

Complications of Diabetes

Diabetes has a large impact in the United States: it’s been widely recognized as one of the leading causes of death and disability. Cardiovascular disease is a serious risk for people with diabetes, which contributes to the high rate of death among people with diabetes from heart disease or stroke (at least 65 percent). As a result, people with diabetes need to manage their blood glucose levels as well as their blood pressure and cholesterol levels. Healthy diet, physical activity, and medicines prescribed by a doctor can help protect cardiovascular health. Some healthcare providers also recommend regular Aspirin use. Avoiding or quitting smoking is another important part of cardiovascular health.

Serious Health Complications of Diabetes

  • Heart disease
  • Blindness
  • Kidney failure
  • Lower-extremity amputations (due to hardening of the arteries)
  • Nerve damage
  • Problems with blood flow
  • Foot problems (pain, sores, and blisters)

There are other complications related to diabetes that, while not always immediately life-threatening, can become long-term problems. Fortunately, by controlling your blood glucose levels, maintaining a healthy weight, exercising regularly, and managing your blood pressure and cholesterol levels, many of the potential complications of diabetes can be prevented or managed or their onset may be delayed. Learn more about these complications and how to manage them in the next section, “Living with Diabetes and Caring for Yourself.”

Type II Diabetes

Though managing the condition may seem daunting, there is a less complicated dietary solution.

The following made-up scenario represents a situation that is too often repeated in doctors’ examination rooms across the country: Jane Doe, a 54-year-old white female, has her yearly checkup with her family physician, expecting to leave with a clean bill of health. Yes, she has gained some weight in the past few years and is having trouble losing the extra pounds. True, she has been feeling more tired lately, but nothing out of the ordinary. Sure, her blood pressure is up a bit, but she attributes that to her weight gain. When her doctor tells her that she has type 2 diabetes, she is shocked. Her doctor explains to her that type 2 diabetes can be managed through daily insulin therapy, diet, and exercise. Managed? she thinks, But isn’t there a cure?

To answer that question, some understanding of diabetes as a disease is needed. There are three main forms that diabetes can take: type 1 diabetes, often called juvenile-onset or insulin-dependent diabetes; type 2, also called adult-onset or non-insulin-dependent diabetes; and gestational diabetes, which occurs during pregnancy and may later lead to a diagnosis of type 2 diabetes. What all these diseases have in common is a high level of blood glucose due to abnormalities in insulin action, production, or both.

In type 1 diabetes, the pancreas lacks the ability to produce insulin, a glucose- and fat-storing hormone, due to reasons that are not fully understood. Type 2 diabetes is primarily a disease of insulin resistance, which means that the body produces adequate (or even abnormally high) levels of insulin but cannot utilize it to clear the blood of glucose. If the blood glucose levels remain high for many years, diabetes can cause microvascular (small blood vessel) and macrovascular (large blood vessel) disease throughout the body.
Of the three forms of diabetes, type 2 is by far the most common in the United States; around 90 to 95 percent of diabetics have type 2 disease. The direct cause of type 2 diabetes is currently at the center of controversy in the medical and scientific community, but there is one fact upon which everyone agrees: type 2 diabetes is a lifestyle-related disease, associated with obesity, inactivity, high blood pressure, and high cholesterol and/or triglycerides.

Type 2 Diabetes Is Also Known as Carbohydrate Intolerance

If you have just been told that you have type 2 diabetes, this means that your blood glucose is too high and your insulin is not working to clear the blood of glucose. In other words, you have an “intolerance” to the dietary source of glucose: carbohydrates. This intolerance most often results from being overweight or obese as well as eating in excess foods that contain glucose (sugar and starches). If you have lactose intolerance, you are told to cut down or avoid lactose; if you have carbohydrate intolerance, you should cut down or avoid carbohydrates.

Protein, fat, and fiber in the diet do not raise the blood glucose. High-carbohydrate foods such as potatoes or corn, however, will raise the blood glucose just like table sugar. Foods that contain no or very little carbohydrates, including eggs, meat, cheese, and non-starchy vegetables, do not raise the blood glucose very much or at all. If you have diabetes or a tendency toward diabetes, you can help control your blood sugar by limiting your intake of sugar and starchy carbohydrates and eating foods lower in carbohydrates.

If you are overweight or obese, losing weight will improve your intolerance to carbohydrates. Many people will no longer have elevated blood glucose after losing weight and are able to handle carbohydrates in their diets again. Although the exact mechanism of why the fat tissue causes carbohydrate intolerance is not yet understood, it is known that reduction of fat tissue by weight loss can normalize the carbohydrate intolerance.

A Diet Without Sugar or Starch

The most effective way to reduce your blood glucose through diet is to carefully monitor all the carbohydrates in the foods you eat. Start by checking food labels for the “total carbohydrate count.” Good food choices contain 0 grams (g) or less than 1 g of carbohydrates per serving. Food preparation is less important than carbohydrate count when eating to reduce blood glucose, so meals may be cooked in a microwave oven, baked, boiled, stir-fried, sautéed, roasted, fried (without flour or corn meal), or grilled.

To reduce your blood glucose by diet, add foods like beef (hamburger and steak, for example), pork, ham (unglazed), bacon, lamb, veal, poultry (chicken, turkey, and duck), fish and shellfish, and eggs. To add nutrients like vitamins and fiber, include 2 cups of salad greens and 1 cup of nonstarchy vegetables in daily meals. Salad greens may consist of arugula, celery, Chinese cabbage, chives, cucumber, endive, lettuce (all varieties), parsley, spinach, radicchio, radishes, scallions, or sprouts. Nonstarchy vegetables include artichokes, asparagus, beet greens, bok choy, broccoli, Brussels sprouts, cabbage, cauliflower, chard, Chinese cabbage, collard greens, eggplant, green beans, jicama, kale, leeks, mushrooms, turnip and mustard greens, okra, onions, peppers, pumpkin, shallots, snow peas, spinach, string beans, or sugar-snap peas. You may also add small amounts of the following foods: hard cheese, nuts, olives, avocados, lemon juice, cream, soy sauce, mayonnaise, and pickles.

History of Diabetes Treatment

Before insulin or other medications were available, experts recommended a high-fat, low-carbohydrate diet as the only available treatment for diabetes. When insulin became available in the 1920s, the amount of allowable dietary carbohydrates was increased for practical reasons, and insulin was used to “cover” the dietary carbohydrates. Today many people with diabetes are just told to increase the insulin amount to match the carbohydrates in their diet.

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How Nurses Can Promote Healthy Lifestyles for Their Patients

Nurses are undoubtedly an influential force among patients, probably because of their close and frequent contact with patients and wide awareness of population-specific health issues.

Patients who are now taking insulin and choose to reduce their carbohydrate intake must monitor their blood glucose carefully and be ready to reduce insulin use if needed. In our clinic, for example, we would reduce a patient’s insulin by 50 percent on the first day of changing his or her diet. Then, when the blood glucose comes down below 100 milligrams per deciliter (mg/dL), we reduce insulin again. We have had people on 150 units of insulin per day taper off their insulin in eight days. To avoid low blood glucose, however, we recommend that all patients make these adjustments in consultation with an appropriate doctor.

Long-term Effects

Although short-term reduction of dietary carbohydrates can be safely accomplished, concerns exist about reducing carbohydrate intake over a longer period. If dietary carbohydrates are reduced, there is a fear that dietary fat may increase, which may in turn increase cardiovascular risk factors. This fear of dietary fat was apparently the reasoning for the low-fat dietary recommendations of the 1970s, which were designed to reduce cardiovascular risk. Without testing, the same philosophy was then applied to diabetes.

The research community has just begun revisiting this idea of reducing dietary carbohydrates as a treatment for type 2 diabetes. In the longest studies of the low-carbohydrate diet to date (one year), reductions in cardiac risk factors were repeatedly seen. Improvements also included weight loss, reduced insulin and triglyceride levels, increased HDL levels (the “good” cholesterol), and reduced blood pressure. Beyond one year, most of what we know about the long-term effects of a low-sugar and low-starch diet comes from the clinical experience of doctors who have used this approach in their practices and the assumption that keeping the blood glucose low is important for reduction in cardiac risk.

Is a reduced-carbohydrate diet for everyone? The Daily Recommended Intake (DRI) for carbohydrate is set at 130 g per day for adults and children based on the average minimum amount of glucose utilized by the brain. Most Americans eat two to three times that much carbohydrates daily. Unfortunately, the carbohydrates that Americans consume that are not utilized for short-term energy needs are stored in the body as fat, which over time may lead to carbohydrate intolerance. A “no sugar or starch diet” may not be appropriate for everyone, but reducing daily carbohydrate intake to, at the very least, DRI levels (130 g per day) in susceptible populations may help prevent the development of type 2 diabetes and obesity. In the largest lifestyle study to date, a controlled-calorie, 50-percent carbohydrate diet halted the development of diabetes in some people, but the disease still progressed in many. (This study diet contained about 300 g of carbohydrates per day!)

Treating Diabetes with Medication

In some cases carbohydrate intolerance in type 2 diabetes is so severe that medications are needed to control the condition. Medication therapies, which include pills or insulin injections, can have their own side effects, however, as some may lead to an increase in hunger and weight gain, which may then lead to more carbohydrate intolerance. Newer medications, such as metformin (Glucophage,® Glucophage XR,® Glumetza,® Fortamet,® and Riomet®) and Byetta® (exenatide), do not seem to cause the weight gain and the hunger seen with insulin but are associated with other side effects.

Unfortunately, studies have shown that even people with type 2 diabetes who are medically “well controlled” can expect their condition to deteriorate over time. Research has found that blood sugar levels over 140 mg/dL (the American Diabetes Association considers good control to be between 130 mg/dL and 180 mg/dL) will begin to damage blood vessels on the micro- and macrovascular levels and create further burnout of beta cells in the pancreas. Normalization of the blood glucose (between 80 mg/dL and 110 mg/dL) with diet therapy and weight loss is thus critical.

Is There a Cure?

Reducing the amount of sugar and starch that you eat can have a powerful effect on lowering your blood sugar. Although there is no “cure” for type 2 diabetes, a reduced-carbohydrate diet, with weight loss if needed, can allow a person with this disease to enjoy a healthy life.

Living with Diabetes and Caring for Yourself

If you have diabetes, your healthcare team is important, but you make a big difference in your health by the steps you personally take to manage diabetes. Daily management involves keeping blood glucose at target levels (avoiding levels that are too low or too high), knowing how to respond if blood glucose rises or drops, and making healthy choices about diet and exercise. As well, understanding potential common complications of diabetes and how to manage or prevent them will help you stay healthy.

What You Can Do

Maintain healthy blood pressure. Normal blood pressure (less than 130/80) can help prevent damage to eyes, kidneys, and blood vessels among people with diabetes. High blood pressure is common among people with diabetes. Keep blood pressure within a healthy range through healthy diet and physical activity, and in some cases, with medicines prescribed by your doctor.

Maintain healthy cholesterol. High blood cholesterol levels are a potential complication of diabetes and, due to resulting narrowing or clogging of blood vessels, can raise risk for heart disease and stroke (two particularly significant health concerns among people with diabetes) and cause circulation problems. Try to keep blood cholesterol at healthy levels (a total cholesterol of under 200, LDL under 100, HDL above 40 in men and 50 in women, and triglycerides under 150) with a healthy diet, exercise, and possibly medications.

Don’t smoke. Smoking is a health risk for the general population and can be particularly dangerous for people with diabetes. Ill effects include raising blood glucose, blood pressure, and cholesterol levels. As well, tobacco further increases the risk of heart and blood vessel complications among people with diabetes. If you do smoke, quitting has significant health benefits—risk for heart attack and stroke and nerve, kidney, and oral diseases are all lowered.

Get an annual flu shot. Because diabetes can make your immune system more vulnerable to severe cases of the flu, it’s important to protect yourself by getting a flu shot every year, preferably in the fall before flu season begins. Talk your doctor about other vaccinations, like one for pneumonia.

Keep your blood glucose as close to normal as possible. Test your blood glucose regularly (several times a day, as indicated by your healthcare team); doing so can prevent or delay the onset of certain diabetes-related complications. Watch for both low blood glucose and high blood glucose. By keeping track, you’ll better understand how food, physical activity, and diabetes medicines affect blood glucose and, as a result, how to better manage these levels.

Recognize what triggers low blood glucose readings (lower than 70 mg/dL). Eating less than usual, getting more exercise, or taking too much diabetes medicine can cause a drop, and so can drinking beer, wine, or liquor. Your doctor can tell you about ways to treat low blood glucose, including which foods to eat and the right amounts. Examples include fruit juice (1/2 cup), hard candy (three to five pieces), and glucose tablets (three to four).

It’s also important that you tell people around you (friends, family, and coworkers) that you have diabetes and how to respond if your blood glucose falls too low. They should know about foods and medications to give you, including timing and amount or dosage.

High blood glucose (higher than 140 mg/dL) before a meal can damage body organs over time. Blood glucose can be high as a result of too much food, less physical activity than usual, or too little diabetes medicine. You can help prevent levels from becoming too high by maintaining a consistent food and exercise program, drinking enough water, taking diabetes medicine at regular times, and maintaining a healthy weight.

Be prepared for work, school, and travel. When you leave home, plan to follow your regular schedule as closely as possible, including when you eat, test blood glucose, take medicine, and exercise. Take along all necessary supplies, including snacks, water, medicines, and blood glucose testing supplies and wear a form of identification (like a bracelet) to indicate that you have diabetes.

Take proper care of your feet, eyes, and oral health. Get routine exams with appropriate specialists (a podiatrist for feet, and an ophthalmologist for eyes, and a dentist). Prevent injury to your feet by checking them regularly and wearing properly-fitting shoes and cotton socks. Practice good oral hygiene—brush your teeth at least twice a day and floss at least once.

Weight Loss and Exercise

Maintaining a healthy weight (including losing weight, if necessary) and exercising regularly are important factors in all aspects of diabetes-related health.

How does exercise benefit people with diabetes? Exercise can have many good effects among people with diabetes. Being active can help control blood glucose and blood cholesterol (raising “good” HDL and lowering “bad” LDL), keep weight within a healthy range, and help prevent heart and blood flow problems, which reduces risk of heart disease and nerve damage.

How much exercise is needed? For diabetes-related health, and general health, the recommended about of exercise is 30 minutes per day, at least five days per week. Recommended intensity is moderate; walking briskly, mowing the lawn, dancing, swimming, or bicycling are examples of moderate-intensity activities.

What precautions should people with diabetes take when planning an exercise program? Speak with your doctor about the types of activities that are safe for you and the appropriate intensity. Special exercise-related considerations among people with diabetes include heart, foot, and eye problems and high blood pressure. If necessary, your doctor will help you choose activities that accommodate any limitations you may have.

How does exercise affect blood glucose levels? Your doctor can also help you understand how exercise may affect your blood glucose levels and how to take precautions to keep levels in a safe range. For example, exercise may lower blood glucose levels too much, causing hypoglycemia (a condition where symptoms include shakiness, weakness, confusion, irritability, and hunger). The risk of hypoglycemia may be higher in people who take insulin or other oral medications. Hypoglycemia can be prevented by checking blood glucose before exercise—if it’s below 100, eat a small snack.

Your doctor can also talk with you about precautions like bringing food and glucose tablets with you when you exercise and eating properly prior to exercise. He or she can discuss insulin use and exercise, as dosage may need to be changed before beginning an exercise program.

Exercise can also raise blood glucose levels, so it’s important to avoid exercise when levels are high (above 300, or a fasting blood glucose above 250).

Other precautions include wearing cotton socks and properly fitting shoes; checking your feet for sores, blisters, cuts, or other injuries; and drinking enough fluids, as dehydration can affect blood glucose.

Healthy Diet

To make healthy food choices, consider these guidelines:

  • Eat smaller portions.
  • Eat less fat and cook food using lower-fat methods.
  • Limit foods high in saturated fats and trans fats (including fatty meats, fried foods, whole milk, nondairy creamers, stick margarine, shortening, some salad dressings, sweets, and crackers).

Replace less-healthful choices with the following types of foods:

  • Whole grains (including oatmeal and whole-grain rice, breakfast cereal, breads, and tortillas)
  • A variety of fruits and vegetables (fresh or frozen and dried fruit and 100 percent fruit juice)
  • Good vegetable choices include dark green varieties (broccoli, spinach, Brussels sprouts), orange varieties (carrots, sweet potatoes, pumpkin, winter squash), and beans and peas.

Cut back on high-sugar foods like:

  • Fruit-flavored drinks
  • Soda
  • Tea or coffee with sugar

Cut back on salt (in cooking and at the table) and in foods like:

  • Canned and packaged soups
  • Canned vegetables
  • Pickles
  • Processed meats

How to Help Control Type 2 Diabetes

In addition to dietary changes and medication options, there is another critical factor that anyone diagnosed with diabetes should consider: exercise. According to the National Diabetes Information Clearinghouse research has shown that physical activity can have many positive effects:

  • Lower your blood glucose and your blood pressure
  • Lower your bad cholesterol and raise your good cholesterol
  • Improve your body’s ability to use insulin
  • Lower your risk for heart disease and stroke
  • Keep your heart and bones strong
  • Keep your joints flexible
  • Lower your risk of falling
  • Help you lose weight
  • Reduce your body fat
  • Give you more energy
  • Reduce your stress level

By discussing exercise options with your healthcare team, you can work together to decide how best to add physical activity into your daily life—including aerobic exercise, strength training, and stretching. It may be that some forms of exercise are not a good idea, so this dialogue with your doctor is important before you start any program. Once you and your doctor have decided on what type of activity is appropriate, you can move ahead with designing an exercise program, finding friends to keep you company and motivate you, and enjoying the benefits of physical activity.

Gestational Diabetes

Gestational diabetes can occur in pregnant women. It develops late in pregnancy and usually goes away after the baby is born. Gestational diabetes remains a health concern, however, because it raises a woman’s risk of developing type 2 diabetes within five to 10 years by 40 to 60 percent. Women who have had gestational diabetes may be able to help prevent type 2 diabetes by maintaining a healthy body weight and staying physically active.

Other Types of Diabetes

In addition to type 1, type 2, and gestational diabetes, there are other types of diabetes. And sometimes a person exhibits characteristics of more than one type; in type 1.5 diabetes (latent autoimmune diabetes in adults), for example, a person will show signs of both type 1 and type 2. Additional types of diabetes include those caused by genetic defects of the insulin-producing cells in the pancreas, genetic defects of insulin action, damage to the pancreas, excess amounts of certain hormones, and medications that reduce insulin action.


Incidence of diabetes appears to on the rise. The Centers for Disease Control and Prevention (CDC) estimates that one in three people in the United States born in 2000 will be affected by diabetes. And by 2050 the CDC projects that diagnosis of diabetes will have increased by 165 percent.


National Diabetes Education Program

American Diabetes Association

The Centers for Disease Control and Prevention

National Diabetes Information Clearinghouse

American Dietetic Association

American Heart Association


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