Type 2 diabetes mellitus is where the body can't utilize its insulin properly. Insulin helps your cells convert glucose (a sugar found in your blood from the food you eat) into energy, but when your cells don’t use insulin effectively, the pancreas is unable to keep up which leads to a buildup of sugar in the blood. This is why we see high blood sugars. Related to this, insulin resistance (or the resistance of the body to use the insulin it makes) is when cells in your muscles, fat, and liver don't respond well to insulin, and can't easily take up the glucose/sugar from your blood. As a result, the pancreas makes even more insulin to help the glucose along to go into your cells. Type 2 differs from type 1 diabetes, which is an autoimmune condition where the pancreas no longer makes enough insulin by itself (or at all), so blood sugars go high with no insulin to help the cells take in the excess sugar in the bloodstream.
Type 2 diabetes can be caused by a variety of factors, such as a family history that includes diabetes, high blood pressure, high triglycerides, low HDL or the good kind of cholesterol, impaired liver function, being 40 years of age or older, a past medical history that includes gestational diabetes, excess visceral fat or obesity, not getting enough exercise, or Asian, Black, or Indigenous origin.
Some signs and symptoms to watch out for include unexplained weight gain or loss, extreme thirst or hunger, patches of darkened skin on the arms or neck, vision problems, itchiness around the genital area, multiple yeast infections, numbness in the hands or feet, frequent urination, and any wounds that seem slow to heal or that are non-healing. If undiagnosed, or untreated, there can be deadly consequences. People with type 2 diabetes need to regularly check blood sugars, typically take an oral or injectable medication, and make some lifestyle changes including a healthier diet and more exercise.
Type 2 diabetes doesn't go away, but can be properly managed to a point where daily meds and finger-pricking are a thing of the past. However, uncontrolled blood sugars lead to an increased risk of infections, skin conditions, kidney disease, heart disease, stroke, high blood pressure, atherosclerosis, hearing loss, dementia, mental illness, and neuropathy, which can itself result in amputations of the feet, legs, arms, hands, and other body parts due to nerve damage and improperly healing wounds and infections.
Medical nutrition therapy for type 2 diabetes includes many lifestyle changes. These include carbohydrate counting, awareness and utilization of serving sizes and portion control, and the ongoing monitoring of blood sugars. Keeping blood sugar in check is WAY easier said than done, as there are 42 separate factors that can affect how the body manages blood sugars. These include, but are not limited to, medications, stress, illness, exercise, and many other variables besides food intake. It's also important to have a good support system with friends, family, and your healthcare providers who can collaborate on the best plan of care for you.
With checking your blood sugars, I advise people to do it right away when you wake up, before eating anything. This gives you a fasting blood glucose reading, which are typically lower as you likely haven't eaten anything for awhile, so that can be more encouraging compared to checking randomly throughout the day and the reading being quite high. I also highly recommend an adjustable lancing device and using the smallest needles possible for the most comfortable experience. The little needles typically come in anywhere from 33 gauge though I believe the most common is 30g. As part of my training, I had to prick my fingers multiple times, including once per day for an entire month, and I can say from experience the lancing devices that do not let you adjust the depth REALLY hurt. Here are a few examples of what I mean by adjustable: CareTouch FreeStyle Microlet Next OnCall OneTouch Auvon Genteel
As mentioned before, there are other lifestyle changes to incorporate besides diet and controlling blood sugars. Make sure to get in some regular movement; the best exercise is one you can keep doing because you enjoy it - make it a sustainable habit! Again, diabetes is a lifelong condition. You also need to properly manage stress, as that is one big factor that can really hinder your ability to keep blood sugars within range. Once again, easier said than done, I know.
I also recommend a variety of fresh food, adequate portion control, and awareness of carbohydrate amounts. I won't go into too much detail here - that's what your appointments are for! - but take a look at the brief nutrition label reading graphic above. Start becoming more aware of carb counts, serving sizes and portion sizes by reading the nutrition label for what you want to eat, and use measuring cups and spoons to serve your food onto your plate. Keep in mind: portion size and serving size aren’t always the same amount! Using the above graphic as an example, the serving size for this bread is 2 slices, whereas another label might say it's for 1 slice. The portion size is the amount you're going to eat - so if you want a sandwich, you'll likely use 2 slices of bread. Another example: if you're having rice, you will probably have a cup of it, or 2/3 if you want to be precise and measure out a bit onto your plate - but the carb count & serving size for rice is 15 grams per 1/3 cup - so if you measure out a cup of rice, your portion is actually 45 grams of carbs.
A super-easy way that is more basic and visual is to use the plate method: mentally divide your plate in half. Fill half of the plate with non-starchy vegetables - most veggies are good here, but exclude things such as corn, peas, and potatoes. Those go into the carb section, which is one quarter of the plate, or 50% of the half-section that is left. The last quarter section is for your protein foods, which don't affect blood sugar.
Another way to measure portions is to use your hand! With this handy guide, you’ll always have a way to estimate portion size at your fingertips - get it? I have bolded the most important ones:
3 ounces (protein): palm of hand - no fingers; think the size of a deck of cards
1 ounce of meat or cheese: thumb (tip to base)
1 cup, or 1 medium piece of fruit: fist
1–2 ounces of nuts or pretzels: cupped hand
1 tablespoon: humb tip (tip to 1st joint)
1 teaspoon: fingertip (tip to 1st joint)
Another thing: as a dietitian, I get to talk to a lot of newly-diagnosed diabetics and people that have been living with diabetes for decades. My favorite tip is what I call "the pairing trick" - to keep your blood sugars more stable, think about what you like to eat for meals and snacks, particularly snacks; carbohydrates are typically the majority or sole macronutrient source of nutrition. Now think about what you could add to that food. What could you pair it with?
I have always loved apples, and while apples themselves are great - nutritious, hydrating, arguably a very healthy snack option - if I eat an apple, my blood sugar will go up. That's ok! I am not diabetic and each time we consume anything with carbs, diabetes or no diabetes, our blood sugar will rise. But if I was a diabetic, my blood sugars would probably remain too high, maybe for a bit too long, and I can't let that go on consistently for years without not-so-nice things happening. So... what could I pair with the apple to make a more balanced snack? I could slice it up and dip into peanut butter, that would give me some satiating fat and protein. Or I could add some jerky or string cheese so I can have a little protein boost to my snack break. You know, I really like berries too... I could have some nuts with my berries to make a bit more of a balanced snack. I also like mac & cheese. I REALLY like mac & cheese with some broccoli and protein thrown in to make it more delicious, nutritious, and carb-conscious!
Pairing the carb source (an apple, pasta, whatever) with protein and/or fat (nuts, cheese, etc) will help balance out blood sugars and keep them from rapidly rising or crashing - not fun. We want nice, steady, moderate rises in blood sugar and a gradual descent back into normal range. A lovely little leisurely trip up a mountain then back down, not the dreadful rollercoaster drop (I do use wild gestures when I talk about this, but it's not the same in writing). The point is that our blood sugar is supposed to rise and fall, regardless of diabetes, but what we want to avoid is the "sugar high" and subsequent "sugar crash" - plus, using the addition mindset feels less restrictive, so you're more likely to keep it up!
You can also use general meal planning to get into a healthy eating routine so you don't go too long without eating, which can also mess with blood sugars. Proper timing of meals can help blood sugars stay within range. Click here to read a Research Roundup article that goes further into depth on what to eat first and last during meals to help manage blood sugars.
Last but not least, if you would like assistance developing a meal plan that incorporates your preferences but also takes into account consistent carbohydrates, you can purchase a ready-made or individualized meal plan that focuses on whole foods, vegetables, fruits, lean proteins, and healthy fats. We encourage variety while honoring your preferences - this creates a realistic goal that promotes a balanced approach to healthy eating. We can help you pick nutrient-dense foods, manage your macronutrient balance, and make sustainable lifestyle changes. Learn more about our approach here!
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