Nutrition Column – Diet and Exercise: Cornerstones of Diabetes Management

November is National Diabetes Awareness Month. In the United States, one in 14 people live with diabetes. Nearly as many people suffer from impaired glucose tolerance, a condition that frequently progresses to diabetes. Moreover, the incidence of diabetes is on the rise among both adults and children. Many factors have played into this rise, including genetics, an aging population and better tools of diagnosis. A major factor, though, has been the epidemic rise in obesity in the U.S.

Diabetes is the common term used for a collection of diseases and conditions in which the body doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugars to build up in the body. The Centers for Disease Control and Prevention categorizes the various forms of diabetes into four general categories: type 1, type 2, gestational diabetes and other specific types.

Type 1 diabetes, formerly labeled as insulin-dependent or juvenile-onset diabetes, accounts for only 5 percent to 10 percent of all diagnosed cases. While this type most often begins in childhood and is always insulin-dependent, these labels were abandoned by the CDC in favor of the less descriptive "type 1" term because the disease also may develop in adults, and any form of diabetes can become dependent on insulin. People with type 1 diabetes are usually not overweight. Risk factors, though not well defined, are thought to include genetic, autoimmune and environmental factors.

Type 2 diabetes is the most common form of diabetes, accounting for 90 percent to 95 percent of all cases. This form also has gone by other names, including non-insulin-dependent and adult-onset diabetes. However, like type 1, type 2 may be insulin-dependent and may develop in childhood. Risk factors for type 2 diabetes include obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, older age, physical inactivity and race/ethnicity. African Americans, Hispanic/Latino Americans, Native Americans and some Asian Americans and Pacific Islanders tend to be at higher risk for type 2 diabetes.  

Gestational diabetes develops in 2 percent to 5 percent of all pregnancies. While it usually disappears when the pregnancy is over, nearly 40 percent develop type 2 diabetes at some point in the future. Risk factors for gestational diabetes include family history of diabetes and obesity.

The "other specific types of diabetes" category is reserved for diabetes that results from specific genetic syndromes, surgery, drugs, malnutrition, infections or other illnesses. Such types of diabetes account for only 1 percent to 2 percent of all diagnosed cases.

Because of the availability of insulin, diabetes is not the dreaded disease it was in the early part of this century. Still, people with diabetes are at higher risk of developing major health complications, including coronary heart disease, hypertension, kidney disease, gangrene, cataracts and retina damage leading to blindness. They also are at higher risk of long-term complications from such common ailments as the flu and a bout of food-borne illness.

The good news is that people with diabetes can enjoy long and productive lives if they follow good diet, exercise and health care practices. If you have diabetes, healthy eating is an important step in taking care of your diabetes. The basic diet recommended for people with diabetes is the same low saturated fat, high fiber, calorie-controlled diet that’s recommended for all healthy Americans. The one major difference is a greater emphasis on the timing of food intake. Eating meals and snacks on a regular schedule is a healthy practice for all, but is especially important for people with diabetes. Skipping meals and snacks has a tendency to cause large swings in blood glucose levels and subsequent insulin reactions.

Another important step is regular exercise. Researchers have long known that engaging in vigorous exercises like running, racket sports and cross-country skiing can help keep diabetes under control. However, recent studies have shown that less vigorous activities such as walking briskly for 30 minutes a day can provide similar benefits. The key seems to be exercising regularly (four to five times per week) for at least 20 to 30 minutes at a time.

by Pat Kendall, Ph.D., R.D., Food Science and Human Nutrition Specialist, Colorado State University, Cooperative Extension