Minority Health Month: Control type 2 diabetes with healthy diet, exercise

BY VICKI HAYWOOD DOE | Special to the Metro Monthly

Diabetes mellitus – characterized by elevated blood glucose – has become a growing health problem in this country.

Diabetes leads to serious health complications and is one of the leading causes of death and disability in the United States. Complications, due to damage to nerves and blood vessels, include: kidney disease, peripheral vascular disease, atherosclerosis, and hypertension. Studies have shown that adults with diabetes have heart disease and stroke death rates two to four times higher than non-diabetics. The American Diabetes Association (ADA) estimates that the health-care cost for the treatment of diabetes and related complications run about $174 billion annually.

According to the Centers for Disease Control (CDC), approximately 24 million Americans suffer from the disease. Between 90 and 95 percent are type 2 diabetes. Type 2 is characterized by the cells becoming resistant to insulin and is associated with lifestyle habits and genetics. Type2 diabetics tend to be sedentary, overweight or obese, and have excessive body fat in the abdominal area.

Other risk factors include family history, age (45 years or older), high blood pressure, pre-diabetic, abnormal cholesterol (lipid) levels, and being an ethnic minority. African-Americans and Hispanics are twice as likely to develop type 2 diabetes. The CDC reports that approximately 4.9 million African-Americans have this disease. The highest rate of type 2 diabetes is seen in adults 60 years or older. However, the U.S. Department of Health and Human Services (HHS) states that the prevalence of type 2 diabetes is increasing alarmingly among children. This trend seems to be related to increased childhood obesity.

The first step in controlling diabetes-associated health complications is knowing if you have the disease. Diagnosis is essential. Unfortunately, 5.5 million people are unaware that they are diabetic. An important step in managing diabetes is for individuals to take full responsibility in “knowing their numbers.” It’s important to know/keep blood glucose levels, blood pressure and cholesterol levels within the normal target range. The National Diabetes Education Program recommends the target range for reducing heart disease and stroke for most diabetics to be:

A1C (blood glucose): less than 7 percent (checked at least twice a year);

Blood pressure: less than 130/80 mmHg (checked every doctor’s visit);

Cholesterol (LDL): less than 100 mg/dl (checked once a year).

Successful target-level management can be achieved by eating healthy and staying active. (Research has shown that exercise is an effective way in preventing and treating type 2 diabetes.) Type 2 diabetics who participate in regular exercise experienced lower fasting blood glucose concentrations, improved insulin sensitivity, weight loss, improved lipid levels, reduction in blood pressure, and lower risk for cardiovascular disease. Type 2 diabetics should participate in an exercise program that includes both aerobic and resistance training, unless they have significant limitations or complications. The American College of Sports Medicine (ACSM) recommends:

Aerobic training

Burn at least 1,000 calories/week; accumulate at least 150 minutes/week. When possible, add additional minutes/week. This helps overweight and obese individuals to achieve weight loss.

Frequency: three to seven days/week.

Intensity: 50 to 80 percent Heart Rate Reserve (HRR). Moderate intensity is recommended, activities at higher intensity (greater than 60 percent HRR) depends on the individual’s fitness level and tolerance.

Time: Start with at least 10 minute sessions accumulating at 30 to 60 minutes each day.

Type: Rhythmic, using large muscle groups. Mode of exercise should fit the individual’s abilities and needs. Walking is common. For those with orthopedic and peripheral nerve damage, there’s swimming, water aerobics, stationary bikes, non-weight bearing equipment and low-impact activities.

Resistance training

Resistance training maintains and increases muscle mass, which helps with glucose tolerance and insulin sensitivity. It also increases resting metabolic rate, which helps with overall weight loss and control.

Frequency: two to three non-consecutive days.

Intensity: two to three sets of eight to 12 repetitions. Lifts should be low to moderate intensity.

Time: Focus on major muscle groups. Eight-10 complex (multi-joint) exercises using the upper and lower body.

Type: Based on individual needs and tolerance. Use weight machines, body weight, resistance bands, and free weights. Avoid increases in blood pressure; avoid sustained gripping; avoid Valsalva maneuver; holding breath.

Allow five to 10 minutes of warm-up and five to 10 minutes of cool down to prevent injuries. Any successful exercise program should progress slowly, have realistic, manageable goals, and a supportive network for encouragement. Before undertaking any exercise programs, individuals should consult their physician or health-care provider. Follow necessary precautions to make sure exercise is safe and fun. Monitor blood glucose levels to help avoid hypoglycemic events (drop in blood glucose levels). (Tests should be taken before and 15 minutes after exercise.) Drink water before, during and after exercise. Wear proper fitting shoes and clothing.

Eating a healthy well-balanced diet and making healthy food choices is essential for managing and controlling type 2 diabetes and successful weight loss. The USDA Food Guide and the American Dietetic Association recommends:

Eat a balanced diet complete with nutrient- dense whole foods and beverages; eat more fiber-rich whole grains, fruits and vegetables, fat-free dairy products, and lean meats (chicken, turkey, fish); reduce sodium intake; reduce fats (no more than 30 percent of the diet; with less than 10 percent coming from saturated fats; stay away from processed foods, processed sugars and sugary beverages; drink plenty of water at least 6-8 glasses a day; stay away from high-calorie low-nutrient foods; decrease portion size and number of portions consumed.

Consult with a registered dietitian to learn how to count carbohydrates, understand the glycemic index and design appropriate meals.

Living with diabetes can be challenging. However, this disease can be controlled through rigorous self-management, combined with healthy eating, regular exercise and proper medications to maintain optimal target levels. Communicating with your physician, dietitian, exercise specialist, and other health care professionals and keeping connected with a supportive community is essential.

Vicki doe circle 4-14ABOUT THE WRITER – Vicki Haywood Doe PhD, ACSM-HFS, is president and health fitness director for Haywood Doe Consulting Co., LLC/Vicki Doe Fitness, a health and wellness consulting company based in Niles, Ohio. Visit http://www.vickidoefitness.com for more information.


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