New Studies Suggest Advice for Patients With Type 2 Diabetes

From aafp.org

Low-carb Diets, Timing of Exercise May Prove Beneficial

Findings from two new studies can help family physicians counsel their patients with type 2 diabetes about specific diet and lifestyle changes that show positive effects on insulin resistance and haemoglobin A1c levels.

The studies, published in the open access journals Diabetologia and JAMA Network Open, may prove useful in the prevention and treatment of type 2 diabetes.

“The results of these studies will give family physicians added tools to help combat the growing number of Americans with type 2 diabetes,” said Beulette Hooks, M.D., medical director of the family medical clinic at Martin Army Community Hospital in Fort Benning, Ga. “Many patients do not want to use medications to treat diabetes, so this will give them a chance to lower the A1c in a more natural way.”

Timing of Physical Activity Tied to Insulin Resistance

In the first study, researchers analysed the physical activity levels 775 adults who participated in an obesity study. Researchers continuously monitored the participants on four consecutive days and categorized them as being most active in the morning, afternoon or evening, or having an even distribution of moderate to vigorous physical activity throughout the day.

Compared with adults who had an even distribution of physical activity, insulin resistance was reduced by up to 18% in those who were most physically active in the afternoon and up to 25% in those who were most active in the evening. There was only a 3% reduction in insulin resistance among those who were most active in the morning.

Based on these findings, the researchers said “the time of the day when physical activity is performed may be relevant for metabolic health and may be considered during lifestyle advice,” while also acknowledging that the timing of exercise “is a relatively unexplored field in human studies.” While they did not consider whether physical activity later in the day directly reduces the risk of diabetes, they did call for further studies to “assess whether timing of physical activity is indeed important for the occurrence of type 2 diabetes.”

Sustained Low-carb Diet Linked to Lower A1c Levels

In the second study, researchers randomly assigned 150 people with elevated untreated haemoglobin A1c levels of 6% to 6.9% into two groups. One group maintained a usual diet, received written information on dietary advice from the Department of Agriculture and had the option to participate in monthly educational sessions unrelated to diet. The other group participated in a six-month dietary intervention program that targeted a net carbohydrate intake of less than 40 grams per day for the first three months, then less than 60 grams per day for the next three months, with an emphasis on high-fibre carbohydrates. Participants in the intervention group also received behavioural counselling and a handbook with dietary guidelines and recipes.

Compared with a usual diet, participants in the dietary intervention group had significantly larger decreases in A1c levels. This group also had significantly greater decreases in fasting plasma glucose, body weight and systolic blood pressure levels. While adverse event rates were similar among groups, significantly more individuals in the intervention group reported muscle cramps throughout the study period.

Because of the study design, the authors said they could not determine the effects of reducing carbohydrate intake on A1c levels independently of caloric restriction and weight loss. Nevertheless, they suggested that a low-carbohydrate diet “may be an option for people with or at high risk of type 2 diabetes to improve glycaemic and other markers, and should be studied further and over longer time periods in other populations and settings.”

Family Physician Takeaways

Hooks said that the studies offer good information in two areas where family physicians often try to engage patients when they are first diagnosed with prediabetes and early type 2 diabetes.

“Family physicians can let their patients know studies have been done on timing physical activities and how a sustained low-carbohydrate diet can help lower their A1c, thus preventing end-stage organ damage from type 2 diabetes,” she said, adding, “If FPs can help prevent patients being treated for prediabetes, with the results of the two studies we could hopefully prevent them from getting type 2 diabetes.”

https://www.aafp.org/news/health-of-the-public/exercise-time-low-carb-diabetes-studies.html

Obesity and Type 2 Diabetes: What Is the Relationship?

From verywellhealth.com

Obesity and type 2 diabetes often occur together. This is partly because obesity promotes inflammation throughout the body, potentially leading to changes in normal metabolic functions.

For example, these changes can affect the body's sensitivity to insulin (a hormone that helps metabolize food) and glucose metabolism (breaking foods down into sugar). In turn, these changes directly affect a person's risk of developing diabetes.

This article examines the connection between obesity and type 2 diabetes, including how to treat and manage both conditions.

Antonio_Diaz / Getty Images

Connection Between Obesity and Diabetes

Obesity is a condition in which a person carries more body fat than is considered healthy, often increasing their risk for other health conditions. When someone has obesity—especially when excess body fat is carried around the abdomen (belly)—their risk of developing diabetes increases.

Obesity-related inflammation plays a role in developing diabetes, likely by reducing insulin sensitivity and increasing insulin resistance (the body's inability to properly respond to insulin). When this happens, the cells no longer respond well to insulin and have trouble receiving glucose (sugar) from the bloodstream.

In response, the pancreas makes extra insulin, which can lead to higher-than-normal blood sugar levels over time. To counteract the continuously high glucose, the liver then converts sugar into fat and stores it as additional body fat.

Obesity can also raise your risk of developing other chronic health conditions, such as high blood pressure (hypertension), stroke, heart disease, gallbladder disease, certain cancers, inflammatory joint conditions, and acid reflux.

 Risks

While diabetes can affect anyone, the risk of developing it is higher among people with obesity. This is because of the inflammation generally accompanying obesity and its effects on insulin resistance and glucose metabolism. However, having type 2 diabetes does not necessarily increase the risk of obesity.

When obesity and diabetes occur together, there is a risk that one or both of these conditions could get worse, especially if lifestyle changes are not made or prescribed medication is not taken.

However, there is also an opportunity to improve both conditions by making lifestyle changes and following prescribed medical treatment.

Treatment and Management of Obesity With Diabetes

By improving obesity, diabetes can also improve—and vice versa. While diabetes often requires medication, both conditions benefit significantly from making similar lifestyle changes.

The best ways to address obesity include getting regular physical activity and eating a nutrient-dense diet.

Following a nutritious diet means avoiding ultra-processed and pre-packaged foods (which are often high in calories and low in nutrients) and eating plenty of whole plant foods and lean proteins that are naturally high in vitamins, minerals, and fibre and low in added sugar, cholesterol, and saturated fat. This eating plan helps support weight loss and maintenance.

Managing diabetes also involves getting regular exercise and making similar diet changes. It's also helpful to pay attention to portion sizes and eat smaller meals more frequently. These lifestyle habits can help improve insulin sensitivity and manage blood sugar levels. 

Prevention

Type 2 diabetes and obesity are both considered preventable conditions. It's also possible to prevent diabetes from developing if you already have obesity.

Lifestyle Changes

Obesity and type 2 diabetes can often be prevented by making lifestyle changes like incorporating regular exercise into your days to improve blood sugar and help with weight loss.

If you're not already exercising, start small and create a physical activity routine that you enjoy, such as jogging, swimming, biking, yoga, and strength training.

Lifestyle adjustments can also include eating a diet that's based on whole foods rather than ultra-processed or pre-packaged foods (which are often high in added sugar, salt, and saturated fat).

Whole foods include:

• Fruits and vegetables
• Whole grains
• Lean proteins
• Legumes (e.g., beans, peas, lentils)
• Nuts and seeds

Choose water for hydration and leave sugary sodas and juices for once-in-a-while treats. 

Screenings

Preventive screenings are a critical part of your overall health and wellness. At the very least, try to see your healthcare provider once a year for a wellness check—even if you're not having abnormal symptoms. They will do a comprehensive health screening that includes blood work and a physical exam.

Symptoms to Watch For

In addition to weight gain, there are some other signs and symptoms of diabetes you should know.

Some possible symptoms of diabetes include:

• Frequent urination
• Feeling thirstier than usual
• Increased hunger
• Feeling fatigued
• Numbness or tingling in hands and feet
• Getting more frequent infections
• Sores or wounds that are slow to heal
• Blurry vision
• Unintentional weight loss

Speak to your healthcare provider if you notice any of these symptoms.

Summary

Obesity can lead to the development of related health conditions, including diabetes. Obesity commonly triggers inflammation in the body, which can interfere with metabolic functions like normal insulin sensitivity and glucose control.

Having obesity and diabetes at the same time is challenging because the conditions can affect one another negatively. However, they can also be improved with medication management and lifestyle changes.

A Word From Verywell

Both obesity and type 2 diabetes are common conditions. While it can be overwhelming to be diagnosed with either or both, there are many things you can do to manage and treat these conditions.

https://www.verywellhealth.com/obesity-and-diabetes-6823190 

Is it possible to get type 2 diabetes by not consuming sugar?

From hindustantimes.com

Doctors address the popular myth and spill the beans on whether it possible to get diabetes by not consuming sugar

Diabetes can be caused by a variety of lifestyle factors, including the amount of sugar that a person consumes, the type of sugar and the autoimmune condition of the person. Eating lots of sugar can increase the risk of developing diabetes but it's not the only thing that can cause the disease.

In an interview with HT Lifestyle, Dr A Sharda, Consultant - Endocrinologist and Diabetologist at Manipal Hospital on Millers Road shared, “Type 2 Diabetes is more closely linked to genetic predisposition than to dietary habits like the consumption of sugar. So, if a person has a genetic predisposition (a family history) of diabetes and consumes excess sugar in their daily food intake, resulting in obesity, they have a higher risk of developing type 2 diabetes at an earlier stage than others. However, we can delay the onset of type 2 diabetes by many years even if we have a family history by adopting a few lifestyle measures that include regular exercise, a healthy diet and weight maintenance.”

According to Dr Sandeep Reddy, Senior Endocrinologist at Kamineni Hospitals in Hyderabad, many people believe that it is possible to get diabetes by not consuming sugar, but this is not true. He explained, “People with diabetes also have a higher risk of developing other autoimmune conditions, such as Crohn's disease or lupus. Consuming sugar indirectly through the foods that you eat can also increase your risk of developing diabetes. For example, eating processed foods that are loaded with sugar can increase your risk of developing diabetes.”

Highlighting that prediabetes is a condition in which you have higher blood sugar levels but no symptoms of diabetes, he cautioned, “If you have prediabetes, you're at an increased risk of developing diabetes later on. Time is the key factor in whether or not you'll develop diabetes. If you have prediabetes, your blood sugar levels may stay high for a long time without causing any symptoms. This means that it may take a long time for your blood sugar levels to reach the level that's considered to be a sign of diabetes.”

He elaborated, “Natural sugars are found in food sources like fruits, vegetables, and milk. These sugars are broken down by the body and used as energy. Large amounts of added sugars are sugars that are added to foods and drinks outside of the natural sources. These sugars can increase your blood sugar levels quickly. Piece, puzzle. It's possible to get diabetes by not consuming sugar, but it's not easy. Previous research has shown that people who don't consume sugar are at a higher risk of getting type 2 diabetes. Levels of sugar consumption can have an impact on your risk of developing diabetes. A wider population is needed to accurately assess the risks associated with sugar consumption. Total calorie and alcohol consumption are also important factors to consider when assessing your risk of developing diabetes.”

He revealed that there is a particular type of sugar that is associated with a higher risk of developing diabetes and said, “High fructose corn syrup is the name of this kind of sugar. Studies suggest that people who consume high fructose corn syrup are at a higher risk of developing diabetes. A lot of people are consuming high fructose corn syrup without knowing it. This is because fructose corn syrup is found in many processed foods. If you are not consuming sugar on a regular basis, then it is possible to get diabetes by not consuming sugar. However, it is important to be aware of the risks that come with not consuming sugar. This includes the risk of developing hypoglycaemia and hyperglycaemia. If you are not able to balance your food intake, then you are at a higher risk of developing these conditions. Certain diabetes medications can also increase your susceptibility to developing diabetes.”

https://www.hindustantimes.com/lifestyle/health/is-it-possible-to-get-diabetes-by-not-consuming-sugar-101669544311292.html

How to detect uncontrolled diabetes

From diabetes.co.uk

Individuals with uncontrolled diabetes present a range of identifiable symptoms. An early diagnosis of uncontrolled diabetes is key as it can combat other health problems from developing.

Here are 10 symptoms that are linked to uncontrolled diabetes:

High blood glucose

The clearest sign of uncontrolled diabetes is high blood glucose levels.

According to the Centers for Disease Control and Prevention, a human’s glucose levels should be 80 – 130 milligrams per decilitre (mg/dL) before eating and below 180 mg/dL two hours after a meal.

To maintain a healthy blood glucose level, people should follow a healthy lifestyle and use the correct diabetes medication. 

People who regularly have high blood pressure should speak to their doctor immediately.

Regular infections

Having high blood sugar levels can trigger the development of infections, such as cystitis, thrush, foot ulcers, cellulitis, the flu and gastrointestinal infections.

People with high blood sugar are especially at risk of having regular yeast infections as it is known to feed on sugar.

Individuals with diabetes take longer to recover from an infection and are at risk of it worsening.

By delaying treating an infection, people with diabetes are at risk of developing sepsis or requiring an amputation. 

People who detect any changes to their skin should speak to their doctor immediately.

Urinating more

 A typical symptom of uncontrolled type 1 and type 2 diabetes is regular urination.

A normal person usually releases around one to three quarts of urine every day. However, an individual with diabetes can release up to 20 quarts of urine per day because their bodies have to clear the blood of extra glucose.

In addition, high blood glucose causes people to drink more regularly, resulting in them weeing more.

Feeling thirsty

Feeling extremely thirsty is a common sign of uncontrolled type 1 and type 2 diabetes.

Symptoms include:

• Dizziness
• An overpowering need for water
• A really dry mouth

Feeling extremely thirsty is most likely to happen when an individual’s blood glucose levels are higher than 250 mg/dL.

Being dehydrated can also trigger diabetic ketoacidosis (DKA) – a serious complication which develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy.

Signs of DKA are:

• A loss of consciousness
• Confusion
• Stomach pain
• Fruity-smelling breath
• Dizziness

People who experience symptoms of DKA should seek hospital treatment immediately.

Increased hunger levels

People with uncontrolled diabetes will feel hungrier as their cells struggle to access glucose because of a lack of insulin production. It can also happen when the body do not know how to use the insulin correctly.

Individuals with uncontrolled diabetes are not likely to put weight on even though they are more likely to overeat due to an increased appetite. This indicates that their body is not receiving the right amount of energy it needs.

Losing weight

Being unable to absorb glucose can trigger weight loss. Frequent urination also causes somebody to lose weight.

People should speak to their doctor immediately if they are eating lots of food but losing weight.

Fruity-smelling breath

High blood glucose levels can make an individual's breath smell sweeter.

The body breaks down fat when it is unable to get to the glucose. This process produces a chemical called acetone, which is known for having a fruity odour.

Kidney complications

High blood sugar levels can destroy the blood vessels, especially the ones located in the kidneys. This can trigger the development of kidney disease.

Signs of kidney disease include:

• Dark urine
• Bloody urine
• UTIs
• Lower back pain
• Frothy urine

In most cases, symptoms of kidney disease are only identifiable when damage has already occurred.

Heart complications

Having uncontrolled diabetes increases a person’s risk of developing cardiovascular disease. People with diabetes are also at risk of developing a stroke. 

Symptoms of these conditions include abnormal heart rhythms, high blood pressure and chest pain.

Numb and tingling feelings

Having high blood glucose levels for a long period of time can cause severe nerve damage, especially in the hands and feet.

This can cause the damaged area to feel numb and tingly. Nerve damage in people with diabetes is known as diabetic neuropathy.

People should speak to their doctor immediately if they experience these symptoms.

https://www.diabetes.co.uk/news/2022/nov/how-to-detect-uncontrolled-diabetes.html 

Can People with Diabetes Eat Cheese?

From eatingwell.com

Find out from a nutrition expert if cheese can help you better manage your blood sugar and maintain a healthy weight 

Cheese is one of those foods many people say they can't imagine living without. But for those with special dietary needs, knowing whether or not cheese is safe to eat can be critical for their health. While some nutrition experts are split on whether cheese and dairy should be included in a diabetes diet, science shows that it is OK to eat cheese if you have diabetes—but some types are better than others. So whether it's Cheddar, mozzarella, Parmesan or vegan cheese, read on to learn which kinds of cheese can help people with diabetes better manage their condition.

How Cheese Affects Your Blood Sugar

People who are living with diabetes must pay close attention to their food's glycaemic index and carb content. GI is a numbered scale ranging from 0 to 100 that represents how quickly a particular food causes blood sugar to rise. The higher the number, the more rapidly that food increases blood sugar.

Foods with a high glycaemic index tend to be high in carbohydrates. Fortunately, most cheeses contain little to no carbohydrates and rank low on the GI scale. That's good news for people with diabetes who love cheese, since low-GI foods have been shown to help people manage their type 2 diabetes and maintain a healthy weight, a significant risk factor for diabetes, per the Harvard T.H. Chan School of Public Health.

However, GI is not the only thing that you should take into account. Kelsey Lorencz, RDN, a registered dietitian nutritionist and nutrition advisor for Fin vs. Fin, tells EatingWell, "Cheese is a great source of protein and fat, both of which can help slow down the digestion of carbohydrates and lead to a more steady rise and fall in blood sugar."

Benefits of Eating Cheese

Can Help Lower Your Risk of Type 2 Diabetes

According to a 2018 meta-analysis published in PLOS Medicine, several studies have shown that consuming dairy products like cheese and yogurt may help reduce the risk of type 2 diabetes. However, many kinds of cheese are high in saturated fat, and high amounts may increase your risk of heart disease. That's why it's important to opt for low-saturated-fat cheeses when possible and eat the ones with high saturated fat in moderation.

"Replacing high-fat cheese with lower-fat options like Swiss, mozzarella, provolone and ricotta could help reduce diabetes risk," states Lorencz.

Can Help You Prevent Blood Sugar Spikes

Protein is involved in many critical bodily functions, such as muscle growth, immune health and tissue repair. Additionally, protein intake can also help regulate your blood sugar and prevent spikes by blunting the absorption of carbohydrates. In addition, protein is highly satiating and helps curb your appetite, so you're less likely to overeat or crave sugary and low-nutrient foods.

Like saturated fat, the protein content of cheese varies widely. For example, 1 ounce of Parmesan cheese provides 10 grams of protein and 4.2 grams of saturated fat, while 1 ounce of sharp Cheddar cheese contains 6.7 grams of protein and 5.4 grams of saturated fat.

What to Consider

Saturated Fat and Sodium

It's known that eating high amounts of saturated fats can lead to cardiovascular disease, for which people with diabetes are at higher risk. The American Diabetes Association recommends keeping your saturated fat intake to less than 10% of your daily calories for good health, which is about 20 grams daily based on a 2,000-calorie diet. While cheese may be higher in saturated fat and sodium than many other foods, the good news is that there are several kinds of cheese lower in saturated fat that are best for people with diabetes, such as cottage cheese, ricotta and low-fat Cheddar.

Another ingredient to watch out for in cheese is sodium. Sodium should be limited in a diabetes diet since it can also lead to heart disease. Like saturated fat, the sodium content of cheese varies greatly. Be a conscious consumer and read the Nutrition Facts label to ensure you're buying cheese that's low in sodium. The American Heart Association recommends keeping your sodium intake to less than 2,300 milligrams daily, and ideally less than 1,500 mg—especially if you're at higher risk of CVD.

Dairy Allergies or Intolerances

According to the National Institutes of Health, approximately 36% of U.S. adults have lactose intolerance, meaning they don't absorb lactose (a sugar found in dairy) properly. Fortunately, there are plenty of non-dairy cheese substitutes available. For example, nuts, seeds and nutritional yeast can replace cheese since they're high in protein and healthy fats and low in saturated fat and sodium. Additionally, you can find soy-based vegan cheeses at most grocery stores that are dairy-free and similar in taste and protein content.

Choosing the Best Cheese for Diabetes

When it comes down to choosing one cheese over another, it's all about heart health. People with diabetes are twice as likely to develop heart disease than people who don't have diabetes, according to the Centers for Disease Control and Prevention.

"Heart health is vital for people with diabetes, as high blood sugar levels can damage blood vessels and increase the risk of heart disease," says Lorencz. "Lower-fat cheeses like Swiss, mozzarella, provolone and ricotta are better options for people with diabetes."

Tips to Include Cheese in a Healthy Diabetes Diet

If you have diabetes, an excellent way to include cheese in your diet is to combine low-fat, low-sodium cheeses with healthy foods, such as fruit and whole grains. Cheese has a minimal impact on your blood sugar, so it can be paired with higher-carb foods for a good balance. However, cheese should be consumed in moderation since it's higher in calories.

"Low-fat cheese paired with a carbohydrate like apples or crackers makes for a great balanced snack that can keep you full and regulate the digestion of carbohydrates for sustained energy and balanced blood sugar," advises Lorencz.

The Bottom Line

Cheese can be included as part of a healthy, balanced diet if you have diabetes. However, people with diabetes should opt for cheeses that are low in saturated fat and sodium while high in protein. If you have diabetes, combine higher-GI foods with cheese to help regulate blood sugar and prevent spiking. In addition, like any other food, enjoy cheese in moderation to maintain a healthy balanced diet.

https://www.eatingwell.com/article/8014237/can-people-with-diabetes-eat-cheese/