There are three potentially dangerous acute effects of diabetes needing medical attention: hypoglycemia, hyperglycemia, and wounds. And diabetics need a doctor's care in certain circumstances when they have the flu. Here's what the experts say.
Hypoglycemia occurs when blood sugar drops too low. You can treat mild symptoms yourself (See "Sidelight: Self-Treatment for Mild Hypoglycemia"). Severe symptoms include headache, confusion, combative behavior, or unconsciousness. Get to a hospital emergency room immediately, where a doctor will give you intravenous glucose. "If you're having frequent hypoglycemic reactions," says Karl Sussman, M.D., American Diabetes Association past president, "see your doctor because you may need to change your regimen."
Hyperglycemia is when blood sugar rises too high. Its mild symptoms are excess urination, excess appetite or thirst, blurred vision, or dizziness. "You can be hyperglycemic and not have any symptoms, so you won't even know unless you're monitoring your blood glucose," Dr. Sussman says. Severe hyperglycemic symptoms include loss of appetite, stomach cramps, nausea and vomiting, dehydration, fatigue, deep rapid breathing, and coma.
Wounds and sores, especially on the feet and legs, get infected easily in a person with diabetes. Have them treated by a doctor.
When you think you have the flu, call your doctor right away; or get to a hospital emergency room if:
You're vomiting or having abdominal pain.
You have large amounts of sugar and acetone in your urine.
Your blood sugar levels are above 200 milligrams.
Your temperature is 100 F or more.
Face the fats
The ADA wants you to cut the fat out of your diet budget. Calories from fat should account for no more than 30 percent of your calories. Each gram of fat produces 9 calories. Every chance you get, replace artery-clogging saturated fat with polyunsaturated or, better yet, monounsaturated fat, or with complex carbohydrates, Franz says.
Eat food with fiber
Natural fiber in food has been found to have a host of beneficial effects for everyone. That goes double for people with diabetes. The ADA advises you to gradually head for 40 grams a day. Whole wheat products, barley, oats, legumes, vegetables, and fruit are the best sources of fiber, as well as essential nutrients.
One possible benefit fiber provides diabetics is lower cholesterol levels. "The water-soluble fibers found in legumes, oats, barley, and fruit, when eaten in a low- fat diet, have been shown to lower blood fat levels," Franz says. "Because they form a gel in the gastrointestinal tract," they may also cause the energy (sugar) in food to be absorbed at a slower rate, giving your insulin a chance to keep your blood sugar on a more even keel.
Fiber also helps keep you from feeling hungry. "I think one of the main benefits of fiber is that it adds bulk to the diet," Franz says. "For Type II people who are trying to control their weight and so are on restricted calories, bulk lets people feel fuller."
Besides giving you that pleasantly satiated feeling, fiber foods are good for you. "They're often high in important vitamins and minerals," Franz says.
Cut your cholesterol
The ADA recommendation is that you should eat no more than 300 milligrams of cholesterol daily. This means cutting way down on organ meat and egg yolks and restraining yourself when it comes to meat and dairy fats. It also means adding fiber to your diet. (For more information, double-click here to go to the Cholesterol article.)
Substitute For Sugar
Research shows that sucrose and table sugar, when used in equal amounts with starches, doesn't hike blood sugar levels any more than other starches, such as potatoes and wheat. Thus the ADA says you can have modest amounts of refined sugars if your diabetes is under control and you're not too overweight. But otherwise, check out alternative sweeteners. "They're certainly safe to use," Franz says. The ADA has approved noncaloric sweeteners, like aspartame and saccharin, and sweeteners with calories, like fructose and sorbitol.
Eat Smaller Meals More Often
The diabetic body can handle smaller meals more easily because the smaller the meal, the less insulin is needed to handle the glucose influx from each meal, Franz says. Less glucose equals less insulin equals more constant blood sugar levels. Some diabetes meal plans call for three meals a day or three small meals plus one or two small snacks between meals. Franz says she favors more actual meals because "often if people go too long between meals they get so hungry they can't control what they eat at the next meal." She also recommends snacks like a piece of fruit or a couple of crackers between meals.
Treat Booze Like Fat
Exchange alcohol calories for fat calories, the ADA says, because alcohol is high in calories per gram and because it's metabolized like fat
Lose Weight
"Weight loss is the number one priority," Dr. Mirsky says. Eighty percent of Type II diabetics are overweight. They tend to live a sedentary life and eat a lot. Obesity may obliterate insulin receptors so sugar can't enter the cells and remains in your blood. If you're overweight, diet and exercise will almost certainly help you lose some weight and get your blood sugar back to normal, and that may be all you need, Dr. Mirsky says. "Sometimes, all you have to lose is 5 or 10 pounds and you're fine."
The benefits of regular exercise for everybody, diabetic or not, are well recognized. But diabetics have even more reason to get their arms and legs moving and their hearts pumping. Exercise strengthens the heartbeat, helps control blood sugar levels, and increases circulation to the body's extremities. Exercise can cut the level of cholesterol and triglycerides while raising the level of high-density lipoproteins (the "good" cholesterol that protects against heart disease). It helps you control your weight, increases your stamina, and lets you sleep more soundly. And it really helps shore up your emotional fortitude. "Regular exercise has been shown to have beneficial effects on mood, especially for depression," says health psychologist Paula Hartman-Stein, Ph.D., of the Akron General Medical Center in Ohio.
There's also some evidence that exercise increases the number of insulin receptors on cell surfaces, which means insulin can find a place to put glucose where it's needed inside the cells. In fact, to a person with diabetes, exercise is like a dose of insulin.
Repetitive, rhythmic movements involving your large muscles arms and legs are best for diabetics. That means walking, jogging, swimming, rowing, or bicycling. You have to exercise regularly and at least three times a week for 20 to 30 minutes, the experts say. Your doctor may even prescribe exercise five to seven times a week. Studies show that even a two- or three-day layoff from exercise reverses its beneficial effects in diabetics
Check With Your Doctor
If your diabetes isn't under control or you have complications, exercise can make it worse. If you have high blood pressure, that also needs to be controlled first. Your doctor may want you to take a stress test. He'll want to judge the effects of any medication you're taking.
--------------------------------------------------------- Excerpted from Doctors Book of Home Remedies Copyright 1994 Rodale Press, Inc.
