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Wednesday, September 13, 2017

Calculating Carbohydrates — Precursors of Glucose

When you eat a meal, the immediate source of glucose in your blood comes
from the carbohydrates in that meal. One group of carbohydrates is the
starches, such as cereals, grains, pastas, breads, crackers, starchy vegetables,
beans, peas, and lentils. Fruits make up a second major source of
carbohydrate. Milk and milk products contain not only carbohydrate but
also protein and a variable amount of fat, depending on whether the milk is
whole, lowfat, or fat-free. Other sources of carbohydrate include cakes, cookies,
candies, sweetened beverages, and ice cream. These foods also contain a
variable amount of fat.

To determine what else is found in food, check a source such as The
Official Pocket Guide to Diabetic Exchanges, published by the American
Diabetes Association and the American Dietetic Association, or The Diabetes
Carbohydrate and Fat Gram Guide, published by the American Diabetes

Determining the amount of carbohydrate

How much carbohydrate should you have in your diet? The current recommendation
is between 40 to 65 percent of daily calories. In our experience,
those who keep their carbohydrate intake on the lower side of that range
have less trouble controlling their blood glucose levels and maintaining
lower levels of blood fats. Your registered dietitian may recommend more.
We wouldn’t argue as long as you can maintain satisfactory blood glucose
levels while not increasing the level of triglyceride, a blood fat.

Considering a Vegetarian Diet

The evidence for the benefits of vegetarian eating for your health is growing.
There are several degrees of vegetarian eating:

✓ Vegan leaves out all animal meats and products including dairy.

✓ Lacto-ovo vegetarian includes eggs, milk, and milk products.

✓ Pesco-vegetarian includes fish with eggs, milk, and milk products.

A study in the May 2009 issue of Diabetes Care compared the eating patterns
in Seventh Day Adventists, a group in whom there were different patterns of
vegetarianism. The study found that the group that followed a vegan diet had
the lowest average body mass index (BMI), 23.6, while lacto-ovo vegetarians
had a BMI of 25.7, pesco-vegetarians had a BMI of 26.3, and nonvegetarians
had an average BMI of 28.8. The prevalence of diabetes increased from 2.9
percent in vegans to 7.6 percent in nonvegetarians.

A second key study in the March 2007 issue of The Archives of Internal
Medicine looked at 322,263 men and 223,390 women who provided detailed
histories of their diet and other habits including smoking, exercise, alcohol
consumption, education, weight, and family history of cancer. Over the
course of ten years, 47,976 men and 23,276 women died. Their meat consumption
varied from 1 ounce to 4 ounces a day and processed meat (like
hot dogs, salami, etc.) ranged from once a week to one and one half ounces a
day. The number of excess deaths attributed to high meat consumption was
large. The authors drew the following conclusions:

✓ If these groups are representative of all Americans, over the course of a
decade, the deaths of 1 million men and half a million women could be
prevented by eating less red and processed meats.

✓ People should eat a hamburger only once or twice a week maximum.

✓ People should eat steak only once a week maximum.

✓ People should eat processed meats less than once in six weeks

Controlling Your Blood Pressure

Keeping your blood pressure in check is particularly important in preventing
the macrovascular complications of diabetes. But elevated blood pressure
also plays a role in bringing on eye disease, kidney disease, and neuropathy.
You should have your blood pressure tested every time you see your doctor.
The goal is to keep your blood pressure under 130/80. (See Dr. Rubin’s book
High Blood Pressure For Dummies, 2nd edition, published by Wiley, for a complete
explanation of the meaning of these numbers.) You may want to get
your own blood pressure monitor so that you can check it at home yourself.
The statistics about diabetes and high blood pressure are daunting. Seventyone
percent of diabetics have high blood pressure, but almost a third are
unaware of it. Almost half of them weren’t being treated for high blood pressure.
Among the treated patients, less than half were treated in a way that
reduced their pressure to lower than 130/80.
You can do plenty of things to lower your blood pressure, including losing
weight, avoiding salt, eating more fruits and vegetables, and, of course, exercising.
But if all else fails, your doctor may prescribe medication. Many blood
pressure medicines are available, and one or two will be exactly right for you.
See High Blood Pressure For Dummies, 2nd Edition, for an extensive discussion
of the large number of blood pressure medications.
One class of drugs in particular is very useful for people with diabetes with high
blood pressure: angiotensin converting enzyme inhibitors (ACE inhibitors),
which are especially protective of your kidneys. If kidney damage is detected
early, ACE inhibitors can reverse the damage. Some experts believe that all
diabetics should take ACE inhibitors. We believe that if there’s no evidence of
kidney damage and the diabetes is well controlled, this isn’t necessary.

Treating diabetes

Treatment of diabetes involves three essential elements:

✓ Diet: If you follow the recommendations in this book, you can lower
your average blood glucose by as much as 30 to 50 mg/dl. Doing so can
reduce the complication rate by as much as 33 percent.

✓ Exercise: We touch on exercise in Chapter 3 and cover it more extensively
in Diabetes For Dummies, 3rd Edition (Wiley).

✓ Medication: Diabetes medications abound — there are far too many to
discuss here, but you can find out about them in Diabetes For Dummies,
3rd Edition

Consequences of Diabetes

If your blood glucose isn’t controlled — that is, kept between 70 and 139 mg/
dl after eating or under 100 mg/dl fasting — damage can occur to your body.
The damage can be divided into three categories: irritations, short-term complications,
and long-term complications.


Irritations are mild and reversible but still unpleasant results of high blood
glucose levels. The levels aren’t so high that the person is in immediate lifethreatening
danger. The most important of these irritations are the following:

✓ Blurred vision
✓ Fatigue
✓ Frequent urination and thirst
✓ Genital itching, especially in females
✓ Gum and urinary tract infections
✓ Obesity
✓ Slow healing of the skin

 Short-term complications

These complications can be very serious and lead to death if not treated.
They’re associated with very high levels of blood glucose — in the 400s and
above. The three main short-term complications are the following:

✓ Ketoacidosis: This complication is found mostly in type 1 diabetes. It
is a severe acid condition of the blood that results from lack of insulin,
the hormone that is missing. The patient becomes very sick and will die
if not treated with large volumes of fluids and large amounts of insulin.
After the situation is reversed, however, the patient is fine.

✓ Hyperosmolar syndrome: This condition is often seen in neglected
older people. Their blood glucose rises due to severe dehydration and
the fact that the kidneys of the older population can’t get rid of glucose
the way younger kidneys can. The blood becomes like thick syrup. The
person can die if large amounts of fluids aren’t restored. They don’t
need that much insulin to recover. After the condition is reversed, these
people can return to a normal state.

✓ Hypoglycemia or low blood glucose: This complication happens when
the patient is on a drug like insulin or a pill that drives the glucose down
but isn’t getting enough food or is getting too much exercise. After it
falls below 70 mg/dl, the patient begins to feel bad. Typical symptoms
include sweating, rapid heartbeat, hunger, nervousness, confusion, and
coma if the low glucose is prolonged. Glucose by mouth, or by venous
injection if the person is unconscious, is the usual treatment. This complication
usually causes no permanent damage.

Long-term complications

These problems occur after ten or more years of poorly controlled diabetes
or, in the case of the macrovascular complications, after years of prediabetes
or diabetes. They have a substantial impact on quality of life. After these
complications become established, reversing them is hard, but treatment is
available for them early in their course, so watch for them five years after
your initial diagnosis of diabetes. See Dr. Rubin’s book Diabetes For Dummies,
3rd Edition (Wiley), for information on screening for these complications.
The long-term complications are divided into two groups: microvascular,
which are due at least in part to small blood vessel damage, and macrovascular,
associated with damage to large blood vessels.

Microvascular complications include the following:

✓ Diabetic retinopathy: Eye damage that leads to blindness if untreated.
✓ Diabetic nephropathy: Kidney damage that can lead to kidney failure

Types of diabetes

The following list describes the three main types of diabetes:

✓ Type 1 diabetes: This used to be called juvenile diabetes or insulindependent
diabetes. It mostly begins in childhood and results from the
body’s self-destruction of its own pancreas. The pancreas is an organ of
the body that sits behind the stomach and makes insulin, the chemical
or “hormone” that gets glucose into cells where it can be used. You can’t
live without insulin, so people with type 1 diabetes must take insulin
shots. Of the 24 million Americans with diabetes, about 10 percent have
type 1.

✓ Type 2 diabetes: Once called adult-onset diabetes, type 2 used to begin
around the age of 40, but it is occurring more often in children, many of
whom are getting heavier and heavier and exercising less and less. The
problem in type 2 diabetes is not a total lack of insulin, as occurs in type
1, but a resistance to the insulin, so that the glucose still doesn’t get into
cells but remains in the blood.

✓ Gestational diabetes: This type of diabetes is like type 2 diabetes but
occurs in women during pregnancy, when a lot of chemicals in the mother’s
blood oppose the action of insulin. About 4 percent of all pregnancies are
complicated by gestational diabetes. If the mother isn’t treated to lower
the blood glucose, the glucose gets into the baby’s bloodstream. The baby
produces plenty of insulin and begins to store the excess glucose as fat in
all the wrong places. If this happens, the baby may be larger than usual and
therefore may be hard to deliver. When the baby is born, he is cut off from
the large sugar supply but is still making lots of insulin, so his blood glucose
can drop severely after birth. The mother is at risk of gestational diabetes in
later pregnancies and of type 2 diabetes as she gets older.

✓ Other types: A small group of people with diabetes suffer from one of
these much less common varieties of diabetes:

• Latent autoimmune diabetes on adults (LADA), which has characteristics
of both type 1 and type 2 diabetes
• Genetic defects of the beta cell, which makes insulin
• Medications that affect insulin action like cortisol or prednisone
• Diseases or conditions that damage the pancreas like pancreatitis
or cystic fibrosis
• Genetic defects in insulin action

Recognizing Diabetes

With so much diabetes around these days, you may think that recognizing it
should be easy. The truth is that it’s not easy, because diabetes is defined by
blood tests. You can’t just look at someone and know the level of glucose —
blood sugar — in his or her blood

The level of glucose that means you have diabetes is as follows:

✓ A casual blood glucose of 200 milligrams per deciliter (mg/dl) or more at
any time of day or night, along with symptoms such as fatigue, frequent
urination and thirst, slow healing of skin, urinary infections, and vaginal
itching in women. A normal casual blood glucose should be between 70
and 139 mg/dl.

✓ A fasting blood glucose of 126 mg/dl or more after no food for at least
eight hours. A normal fasting blood glucose should be less than 100 mg/dl.

✓ A blood glucose of 200 mg/dl or greater two hours after consuming 75
grams of glucose.

A diagnosis of diabetes requires at least two abnormal levels on two different
occasions. Don’t accept a lifelong diagnosis of diabetes on the basis of a
single test.

A fasting blood glucose between 100 and 125 mg/dl or casual blood glucose
between 140 and 199 mg/dl is prediabetes. See Dr. Rubin’s book Prediabetes
For Dummies (Wiley). Most people with prediabetes will develop diabetes
within ten years. Although people with prediabetes don’t usually develop
small blood vessel complications of diabetes like blindness, kidney failure,
and nerve damage, they’re more prone to large vessel disease like heart
attacks and strokes, so you want to get that level of glucose down. Sixty
million people in the United States have prediabetes

Knowing When to Call a Doctor

You may find it hard not to worry about the slightest sniffle your little darling
gets, but more often than not it’s nothing serious. However, you do need to
call a doctor if:

Your baby under 3 months old has a fever – this must always be
regarded as potentially serious.

Your child’s listless or miserable even after you’ve brought down her

Your child’s breathing is rapid or laboured.

Your child’s colour changes from pink or red to mauve or blue.

Your child has a convulsion (fit).

Your child loses consciousness.

Your child has blood in her urine, vomit, or stools.

Keep in mind that young children can develop dangerous symptoms quite
rapidly. If your child’s poorly, keep a close eye on her and call your doctor if
you’re in any doubt.

Spotting the Signs That Something’s Wrong

Even if you do everything right, your child’ll get ill – and probably quite frequently.
This isn’t a bad thing: Your child’s body needs to come into contact
with bacteria and viruses in order to build up a good resistance to the germs.
In fact, some research shows that the more illnesses your child gets in the
first few years of life, the healthier she’s likely to be later.

Of course, you won’t welcome every cold and tummy bug your child falls
victim to. After all, caring for an ill child can be extremely worrying, especially
when you can’t quite work out what’s wrong. Try to keep things in perspective:
All children get ill, and in the vast majority of cases the illnesses
aren’t serious and don’t pose any threat to your child’s long-term health.
However, if you’re at all concerned about your child, get her checked out by a
doctor. And try to be aware of the signs of diseases such as meningitis, which
need urgent medical treatment

The person who can tell better than anyone else whether your child is ill is
you. Follow your instincts: You’re likely to be able to spot when something’s
not quite right. Signs that your child has a bug include the following:

A fever: The presence of a fever almost always means an infection.
Fever itself is not dangerous – it’s the body’s normal reaction to the
presence of foreign organisms – but you need to bring down your child’s
temperature to avoid overheating, which can cause a febrile convulsion.

Irritability or lethargy: Your child’s behaviour may be influenced by a
fever. The raised temperature may make her irritable, drowsy, or lethargic
Coughing: This is a common sign that your child has an infection.

Vomiting and diarrhoea: Symptoms like these are usually associated
with problems directly involving the tummy or bowel, such as gastroenteritis
or food poisoning, although sometimes they occur for other reasons.
Some children vomit if they have a high temperature; others vomit
if they’re emotionally upset.

Yes, diarrhoea really can be a cause for celebration! If your child is suffering
from diarrhoea as well as vomiting, she probably has a tummy
bug, which usually settles on its own with no ill effects.

 Vomiting without diarrhoea, especially if
accompanied by fever, may have a different cause such as a urine infection.
If you’re in doubt, ring NHS Direct (0845-4647) or speak to your GP
or health visitor.

A rash: Rashes often suggests a viral infection. The presence of a rash
doesn’t usually make the illness any more serious – in fact, it can help
your doctor diagnose illnesses such as German measles and chickenpox.
But if your child has a rash, ask your doctor to check it out to ensure that
she’s not displayinga symptom of meningitis or another dangerous illness.
The easiest way to test for meningitis is the ‘glass test’. Press the bottom of
a glass on to your child’s rash. If the rash fades or disappears, it is almost
certainly not meningitis; if the rash remains, your child may have meningococcal
septicaemia (blood poisoning) – so call an ambulance immediately.
The list above is a very general description of a few of the most common
childhood symptoms. More detailed info on what to look out for appears
elsewhere in the book. If you’re caring for an infant, head to Chapters 7 and 8,
which are devoted to infant healthcare. For older children

Keeping Your Child Healthy

Illness is one of the things we fear most for our children. It’s impossible – and
unnecessary – to shield your child from every bug out there, but you can
help to boost her health and vitality, making her stronger and better able to
fight off illnesses efficiently.

Eat, drink, and be healthy

If you want your child to eat healthily, you need to serve her a wide variety of
nutritious foods for energy, growth, and development. This means giving
processed and junk foods a wide berth – but it doesn’t mean not being flexible.
Food isn’t worth arguing over, and if your child insists on eating curly
cheesy crisps, that’s fine – as long as they don’t form her staple diet. If most
of the food your child eats is nutritious, you’ll be keeping her in tip-top condition.
Try doing the following to make sure that she eats well:

Give your child at least five helpings of fruit and vegetables a day –
fresh, frozen, canned, dried, or juiced. You’re probably already aware
of this important point, but there’s no harm in stressing it again. Fruit
and veg contain the crucial nutrients needed to maintain a healthy
digestive system, create new body tissue, fight infections, and a lot
more. Try to offer your child at least one orange and one green fruit or
vegetable every day, as they are known to be particularly beneficial and
may help to prevent cancer and other serious diseases.

Fruit or vegetable juice only makes up one of her daily portions of fruit
and vegetables, no matter how much she drinks. That’s because other
goodies in the flesh are not included in juice, and digesting whole fruit
and vegetables benefits her system.

Make sure that your child eats breakfast. Studies show that if your child
eats breakfast, she’s far less likely to become obese in later life. Skipping
breakfast can cause blood-sugar problems and make your child’s metabolism
sluggish, which is bad for the digestive system. Most experts say
that breakfast’s the most important meal of the day: Breakfast eaters are
less likely to contract diabetes or have high cholesterol, which is a
known risk factor for heart disease.

Maintain your own healthy diet. You’re important too! Eating healthy
food yourself is one of the best ways of getting your child into good
habits, so make sure that you tuck in to your greens. Studies also show
that children who have regular family mealtimes are more likely to have
healthier diets than those who don’t. Snacking in front of the telly is a
definite no-no.

Offer as much unprocessed food as possible, and get into the habit of
reading labels on the foods you serve. Check for things such as hidden
fats, sugars, additives, and salt. Foods with lots of preservatives and
added flavourings are often deficient in essential nutrients and high in
unhealthy (and unnecessary) chemicals. Salt’s a particular danger – it
can cause health problems, including high blood pressure and heart
conditions. And sugar (and sugar substitutes), additives, and colourings
have been linked with everything from behavioural problems to physical

Get your child to drink six to eight glasses of water a day. Drinking
enough fluids is vital. Water’s the best drink by far – try to keep sugary
drinks and juices to a minimum, and don’t serve them at all between
meals because they are lethal to tiny teeth. The British medical profession
has been telling us for many years that most children aren’t drinking
enough. Dehydration leads to many short-term and long-term health
problems: Lack of water can cause headaches, constipation, and poor
concentration, to name but a few things.

A good way to tell whether your child’s dehydrated is to check the
colour of her urine. Her urine should be a pale straw colour: If it’s dark
yellow, she may well be dehydrated. A sunken fontanelle (the soft spot
on a baby’s head) can also indicate dehydration.

A moving story

Exercise is vital for everyone – especially your child. Whether your child’s
dancing around the living room or entering a swimming gala, getting active is
all good stuff. Exercise boosts circulation and helps infection-fighting lymphatic
fluid to move throughout the body. Exercise is great for your child’s
emotional health too: When your child exercises, her brain releases chemicals
called endorphins, the body’s natural feel-good chemicals. Your active
child develops stronger muscles and bones, is less likely to become overweight,
has a reduced risk of developing type 2 diabetes, and has lower blood
pressure and cholesterol levels compared with inactive children. For more
details on the benefits of exercise and for suggestions for keeping your child

Breathing easy

In the UK, around 17,000 children under the age of 5 years are admitted to
hospital every year with illnesses related to passive smoking. Not smoking
around your child is a crucial way of safeguarding her health. Scientists have
shown that passive smoking has a lasting impact on the long-term health and
respiratory system of children. Inhaling cigarette smoke increases the risk of
asthma and other acute respiratory conditions and contributes to many
childhood illnesses, including bronchitis, pneumonia, asthma, middle-ear
infections, cot death, and possibly even autism. If your child inhales cigarette
smoke, she’s also at increased risk of developing certain kinds of cancer,
including lung cancer. Research has even found a link between lower IQ levels
and exposure to cigarette smoke.

Going outside the house to smoke doesn’t fully protect your child – although
of course outside is far better than smoking indoors. Research shows that poisonous
chemicals from cigarette smoke cling to your clothes and hair and are
released back into the air – and then inhaled by your child. When researchers
measured toxic chemicals in the blood of children whose parents smoked outdoors,
they found the levels of chemicals to be far higher than in children
whose parents never smoked at all, inside or out.

All you need is . . .

. . . love! To thrive, your child needs lots of cuddles and human contact, particularly
with her main carers. Studies show that lack of love and affection is
as damaging to children as food deprivation: Adequately nourished babies
deprived of human relationships become impeded in their development in
both mind and body.

We cannot overemphasise the importance of touch – human contact is critical
for development and well-being. Babies who are held cry less than those
who aren’t, and those who’re cuddled and massaged frequently tend to have
better immune systems and handle stress more efficiently than those who
aren’t. The need for touch continues into childhood and beyond. One study
showed that when children were massaged regularly for a month, blood glucose
levels dropped dramatically in diabetic children and the children were
able to reduce their medication, while asthmatic children had fewer asthma
attacks. Massage also reduced the symptoms in children with autism, severe
burns, cancer, and arthritis.

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