Lifestyle Changes to Manage Type 1 Diabetes
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What and how much you eat and how much you exercise are two major factors in diabetes management that you can control. It is important for you to learn how to eat a ]]>healthy diet]]> and to incorporate ]]>regular exercise]]> into your daily life.
The dietary guidelines for managing diabetes can seem complicated. However, you'll see that the recommendations are the same as those for general good health, and you can eat the same foods as everyone else. A nutritionist can help you make sense of these guidelines and help you develop healthful eating patterns that will work for you. Ask your doctor for a referral to a certified diabetes educator (CDE) registered nutritionist.
The basic eating guidelines for people with type 1 diabetes are:
Follow a Routine
Eat three meals, and don't skip meals. Try to eat meals at the same time each day, and be sure each meal should contain about the same amount of carbohydrate, protein, and fat as the same meal the day before. In case a meal is delayed, keep snacks with you at all times.
Your blood sugar rises and falls in response to your eating patterns. Therefore, by eating about the same amount and types of food at the same times each day, you can easily predict when your blood sugar level will rise. This makes it easier to match your insulin dose with these rises in blood sugar.
Eat a Varied, Healthy Diet
Follow the Food Guide Pyramid, which is the US government's recommendations for healthful eating. Avoiding concentrated sweets like fruit juice, regular cola, and sugary and calorie dense foods should be avoided. For people with type 1 diabetes, there are a few modifications:
- Starchy vegetables, like green peas, corn, and potatoes are considered part of the "Grains" group. They contain significant amount of carbohydrate.
- Cheese is not part of the milk group, but instead is found in the "Meat & Others" group.
Following the Food Guide Pyramid will also help you to eat a low-fat, high-fiber diet. Having type 1 diabetes puts you at risk of developing heart disease. A high-fat diet also increases your risk. Choose a diet that is low in saturated fat and cholesterol to help protect your heart.
Fiber can help lower blood cholesterol and blood pressure. It is also thought to help your body use insulin better. Slowly increase your fiber intake with the goal of 20-35 grams of fiber per day. Good sources of fiber include whole grains, some fruits, vegetables, and legumes. Be sure to increase your fluid intake with your fiber or you will be constipated.
The Food Guide Pyramid provides a range of servings in each food group. A registered dietitian can help you determine where you fall in these ranges.
Both sugar (glucose) and starch are carbohydrates. Your body reacts to any type of carbohydrate in the same way, so the total amount of carbohydrate you eat is more important for blood sugar control than the source.
A dietitian can help you determine how many grams you should eat per day. This amount should be dispersed evenly throughout your meals and snacks. Many foods contain carbohydrates. White grain products, citrus fruits, and milk products contain highest amounts.
Keep a Record
Keep a record of your meals, include the time you ate, what you ate, and how much. Include this information with your blood sugar levels and insulin dosages. This information is very helpful for your doctor and registered dietitian.
Methods of Dietary Planning
There are two main methods for planning your meals: the exchange system and carbohydrate counting. Meet with a registered dietitian to determine which of these systems will work for you and to learn the details of using it.
This system divides all food into six groups—starch, fruit, milk, vegetable, meat, and fat. Within each of these groups, are defined servings or "exchanges" of food items. Each exchange within a given group has the same calories and grams of fat, protein, and carbohydrate as every other exchange in that category.
For example, each of the following counts as one starch exchange:
- ½ cup of cooked pasta
- 1 slice of bread
- 1 small (3 oz.) baked potato
- 1 ounce of dry cereal
You can use these (and other starch exchanges) interchangeably when your meal plan calls for one starch.
In the exchange meal planning system, your dietitian will determine the number of calories you need each day and translate them into exchanges from each of the six food categories. Then, he or she will work with you to distribute these exchanges across your meals and snacks for the day.
Carbohydrate counting is based on the fact that carbohydrate has the strongest effect on blood sugar level, as compared with fat and protein. Your doctor and/or dietitian will determine how many grams of carbohydrate you need each day. Then, these grams are distributed evenly across your meals and snacks. You can choose foods based on the amount of carbohydrate they contain.
Carbohydrates differ in the degree and rapidity with which they raise blood sugar. Whole grains and certain other “complex carbohydrates” raise blood sugar less than simple carbohydrates, such as sugar, white rice, or potatoes. These complex carbohydrates are said to have a low glycemic index, and their consumption has been shown in some studies to improve control of diabetes without increasing risk for hypoglycemia.
Regular exercise is essential for everyone to ensure better health. And for people with diabetes, it offers extra benefits, including:
- Lowering blood sugar and improving the body's ability to use glucose—In some cases, regular exercise can decrease the amount of insulin necessary for blood glucose control.
- Lowering risk factors for heart disease, which is a common complication of diabetes
Talk with your doctor about your exercise program. Since exercise causes your blood sugar to drop, you may need to make some modifications in your insulin dose and schedule and your eating plan. Moreover, have your doctor screen you for any diabetic complication(s) especially heart disease, which may be worsened by exercise.
Smoking may negatively affect your ability to control your diabetes. ]]>Quitting smoking]]> can also reduce your risk of numerous conditions, like heart disease, lung disease, and certain types of cancer. Talk to your doctor about strategies to quit.
When to Contact Your Doctor
- If you have any questions about your eating plan
- If you feel that your eating plan is too difficult to follow
- When you want to start up an exercise program or make significant changes in your present program
- If you have any symptoms of hypoglycemia after exercising (Symptoms include: shakiness, dizziness, extreme sweating, hunger, headache, and pale skin color.)
American Diabetes Association. American Diabetes Association guidelines: nutrition principles and recommendations in diabetes. Diabetes Care. 2004;27:S36-46.
American Diabetes Association. American Diabetes Association guidelines: physical activity/exercise and diabetes. Diabetes Care. 2004;27:S58-62.
American Diabetes Association. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American Diabetes Association. Diabetes Care. 2004;27:2266-2271.
American Diabetes Association website. Available at: http://www.diabetes.org/home.jsp .
Joslin Diabetes Center website. Available at: http://www.joslin.org/ .
Juvenile Diabetes Research Foundation International website. Available at: http://www.jdrf.org/ .
National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://www.niddk.nih.gov/ .
3/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Hofer SE, Rosenbauer J, Grulick-Henn J, et al. Smoking and metabolic control in adolescents with type 1 diabetes. J Pediatr. 2009;154(1):20-23.e1.
Last reviewed December 2009 by ]]>B. Gabriel Smolarz, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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