Diabetes › download › 0003 › 8360 › 50 › L-G-0… · vi Diabetes For Dummies Chapter 3: Recognizing the Various Types of Diabetes . . . . . . . . . . . .33 Getting to Know

Diabetes

5th Edition

by Alan L. Rubin, MD

Diabetes For Dummies ® , 5th Edition

Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030‐5774, www.wiley.com

Copyright © 2015 by John Wiley & Sons, Inc., Hoboken, New Jersey

Published simultaneously in Canada

No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except as permit-ted under Sections 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the Publisher. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permissions .

Trademarks: Wiley, For Dummies, the Dummies Man logo, Dummies.com, Making Everything Easier, and related trade dress are trademarks or registered trademarks of John Wiley & Sons, Inc., and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc., is not associated with any product or vendor mentioned in this book.

LIMIT OF LIABILITY/DISCLAIMER OF WARRANTY : THE CONTENTS OF THIS WORK ARE INTENDED TO FURTHER GENERAL SCIENTIFIC RESEARCH, UNDERSTANDING, AND DISCUSSION ONLY AND ARE NOT INTENDED AND SHOULD NOT BE RELIED UPON AS RECOMMENDING OR PROMOTING A SPECIFIC METHOD, DIAGNOSIS, OR TREATMENT BY PHYSICIANS FOR ANY PARTICULAR PATIENT. THE PUBLISHER AND THE AUTHOR MAKE NO REPRESENTATIONS OR WARRANTIES WITH RESPECT TO THE ACCURACY OR COMPLETENESS OF THE CONTENTS OF THIS WORK AND SPECIFICALLY DISCLAIM ALL WARRANTIES, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE. IN VIEW OF ONGOING RESEARCH, EQUIPMENT MODIFICATIONS, CHANGES IN GOVERNMENTAL REGULATIONS, AND THE CONSTANT FLOW OF INFORMATION, THE READER IS URGED TO REVIEW AND EVALUATE THE INFORMATION PROVIDED IN THE PACKAGE INSERT OR INSTRUCTIONS FOR EACH MEDICINE, EQUIPMENT, OR DEVICE FOR, AMONG OTHER THINGS, ANY CHANGES IN THE INSTRUCTIONS OR INDICATION OF USAGE AND FOR ADDED WARNINGS AND PRECAUTIONS. READERS SHOULD CONSULT WITH A SPECIALIST WHERE APPROPRIATE. NEITHER THE PUBLISHER NOR THE AUTHOR SHALL BE LIABLE FOR ANY DAMAGES ARISING HEREFROM.

For general information on our other products and services, please contact our Customer Care Department within the U.S. at 877‐762‐2974, outside the U.S. at 317‐572‐3993, or fax 317‐572‐4002. For technical support, please visit www.wiley.com/techsupport .

Wiley publishes in a variety of print and electronic formats and by print‐on‐demand. Some material included with standard print versions of this book may not be included in e‐books or in print‐on‐demand. If this book refers to media such as a CD or DVD that is not included in the version you purchased, you may download this material at http://booksupport.wiley.com . For more information about Wiley products, visit www.wiley.com .

Library of Congress Control Number: 2015945230

ISBN 978‐1‐119‐09072‐4 (pbk); ISBN 978‐1‐119‐09076‐2 (ebk); ISBN 978‐1‐119‐09077‐9 (ebk)

Manufactured in the United States of America

10 9 8 7 6 5 4 3 2 1

Contents at a GlanceIntroduction ................................................................ 1

Part I: Getting Started with Diabetes ............................ 7Chapter 1: Dealing with Diabetes ..................................................................................... 9

Chapter 2: Making the Diagnosis with the Glucose and Hemoglobin A1c ................ 19

Chapter 3: Recognizing the Various Types of Diabetes .............................................. 33

Part II: Knowing How Uncontrolled Diabetes Affects Your Body ...................................................... 51Chapter 4: Avoiding Short‐Term Complications .......................................................... 53

Chapter 5: Warding Off Long‐Term Complications ..................................................... 67

Chapter 6: Preserving Sexual Function and Protecting Pregnancy ......................... 101

Part III: Managing Diabetes: The “Thriving with Diabetes” Lifestyle Plan ................................... 121Chapter 7: Self‐Testing for Glucose and Other Key Tests ........................................ 123

Chapter 8: Tackling What You Eat: Healthful Nutrition ............................................ 155

Chapter 9: Metabolic Surgery: A Possible Cure for Type 2 Diabetes ...................... 181

Chapter 10: Creating Your Exercise Plan .................................................................... 209

Chapter 11: Medications: What You Should Know .................................................... 231

Chapter 12: Assembling Your Diabetes Team ............................................................ 267

Part IV: Special Considerations for Living with Diabetes .......................................................... 277Chapter 13: Managing Diabetes in Children ............................................................... 279

Chapter 14: Diabetes and the Elderly .......................................................................... 295

Chapter 15: Dealing With Occupational and Insurance Problems .......................... 305

Chapter 16: Eyeing What’s New in Diabetes Care ...................................................... 317

Chapter 17: Discovering What Doesn’t Work When You Treat Diabetes ............... 325

Part V: The Part of Tens ........................................... 335Chapter 18: Ten Commandments for Excellent Diabetes Care ................................ 337

Chapter 19: Ten Myths about Diabetes That You Can Forget ................................. 343

Chapter 20: Ten Ways to Get Others to Help You ..................................................... 349

Appendix: Mini‐Cookbook ......................................... 355

Index ...................................................................... 391

Table of ContentsIntroduction ................................................................. 1

About This Book .............................................................................................. 2Foolish Assumptions ....................................................................................... 3Icons Used in This Book ................................................................................. 4Beyond This Book ........................................................................................... 4Where to Go from Here ................................................................................... 5

Part I: Getting Started with Diabetes ............................. 7

Chapter 1: Dealing with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Achieving Anything . . . Or Everything! ....................................................... 10

Keeping good company ....................................................................... 10Realizing your potential ...................................................................... 11

Reacting to Your Diagnosis .......................................................................... 11Experiencing denial ............................................................................. 11Feeling anger ........................................................................................ 12Bargaining for more time and feeling depressed ............................. 12Moving on ............................................................................................. 13

Maintaining a High Quality of Life ............................................................... 14Exercising regularly ............................................................................. 15Factoring in the (minimal) impact of insulin treatments ................ 15Managing stress ................................................................................... 16Considering other key quality‐of‐life factors .................................... 17

Chapter 2: Making the Diagnosis with Glucose and Hemoglobin A1c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Realizing the Role of Glucose ....................................................................... 19Understanding the Hemoglobin A1c ........................................................... 21Getting a Wake‐Up Call from Prediabetes .................................................. 22

Knowing whether you should get tested .......................................... 22Testing for prediabetes ....................................................................... 23

Detecting Diabetes ........................................................................................ 24Diagnosing diabetes through testing ................................................ 24Examining the symptoms of diabetes ............................................... 26

Tracing the History of Diabetes Treatment ............................................... 27Explaining the Obesity (and Diabetes) Epidemic ...................................... 29Putting Faces to the Numbers: Sharing Some Real Patient Stories ......... 30

vi Diabetes For Dummies

Chapter 3: Recognizing the Various Types of Diabetes . . . . . . . . . . . .33Getting to Know Your Pancreas and Its Role in Diabetes ........................ 34

Examining your pancreas ................................................................... 34Understanding insulin ......................................................................... 35

Understanding Type 1 Diabetes and You ................................................... 36Identifying symptoms of type 1 diabetes .......................................... 36Investigating the causes of type 1 diabetes ...................................... 37Getting type 1 diabetes ....................................................................... 38Preventing type 1 diabetes ................................................................. 39

Having Type 2 Diabetes ................................................................................ 39Identifying symptoms of type 2 diabetes .......................................... 40Investigating what causes (and what doesn’t cause)

type 2 diabetes ................................................................................. 42Getting type 2 diabetes ....................................................................... 43Preventing the causes of type 2 diabetes ......................................... 44Recognizing variants of type 1 and 2 diabetes ................................. 46

Dealing with Gestational Diabetes ............................................................... 48Recognizing Other Types of Diabetes ......................................................... 48

Part II: Knowing How Uncontrolled Diabetes Affects Your Body ...................................................... 51

Chapter 4: Avoiding Short‐Term Complications . . . . . . . . . . . . . . . . . . .53Solving (and Steering Clear of) Short‐Term Complications ..................... 53Dropping Too Low: Hypoglycemia .............................................................. 54

Identifying the signs of hypoglycemia............................................... 55Categorizing levels of hypoglycemia ................................................. 57Managing the causes of hypoglycemia ............................................. 57Understanding the risks of hypoglycemia in special situations .... 60Treating hypoglycemia ....................................................................... 61

Combating Ketoacidosis ............................................................................... 62Managing Hyperosmolar Syndrome ............................................................ 63

Heeding the symptoms of hyperosmolar syndrome ....................... 64Finding the cause ................................................................................. 64Treating hyperosmolar syndrome ..................................................... 65

Chapter 5: Warding Off Long‐Term Complications . . . . . . . . . . . . . . . .67Knowing How Long‐Term Complications Develop

and How to Avoid Them ........................................................................... 68Kidney Disease ............................................................................................... 68

The impact of diabetes on your kidneys .......................................... 70Early indications of kidney disease ................................................... 70

vii Table of Contents

Progressive changes in the kidneys .................................................. 71Treatment for diabetic nephropathy ................................................ 73

Eye Disease ..................................................................................................... 76Noting common eye problems in diabetics ...................................... 76Eyeing the risks of retinopathy .......................................................... 78Resources for the blind and visually impaired ................................ 80

Nerve Disease, Also Known as Neuropathy ............................................... 80Examining the basics of neuropathy ................................................. 81Recognizing disorders of sensation .................................................. 82Comprehending disorders of movement .......................................... 84Recognizing disorders of automatic (autonomic) nerves .............. 85Entrapment neuropathies ................................................................... 86

Heart Disease ................................................................................................. 87Identifying risks of heart disease to diabetic patients .................... 88Metabolic syndrome ............................................................................ 90Cardiac autonomic neuropathy ......................................................... 92Cardiomyopathy .................................................................................. 92

Diabetic Blood Vessel Disease Away from the Heart ................................ 93Peripheral vascular disease ............................................................... 93Cerebrovascular disease..................................................................... 95

Diabetic Foot Disease .................................................................................... 95Skin Disease in Diabetes ............................................................................... 97Gum Disease in Diabetes .............................................................................. 98Sleep Apnea .................................................................................................... 98Other Conditions Associated with Diabetes

That You Should Know.............................................................................. 99

Chapter 6: Preserving Sexual Function and Protecting Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101

Examining Erection Problems .................................................................... 101Reviewing the erection process ....................................................... 102Discussing ED with your doctor ...................................................... 103Treating for ED ................................................................................... 103

Facing Female Sexual Problems ................................................................. 106Striving for a Healthy Pregnancy ............................................................... 107

Realizing the body’s reaction to pregnancy ................................... 107Being proactive before and during pregnancy .............................. 108Diagnosing gestational diabetes ...................................................... 109Recognizing risks to mother and baby ........................................... 110Treating diabetes during pregnancy ............................................... 112Maintaining your health after pregnancy ....................................... 115Focusing on your baby’s health ....................................................... 117

Dealing with Polycystic Ovarian Syndrome ............................................. 118

viii Diabetes For Dummies

Part III: Managing Diabetes: The “Thriving with Diabetes” Lifestyle Plan .................................... 121

Chapter 7: Self‐Testing for Glucose and Other Key Tests. . . . . . . . . .123Testing, Testing: Tests You Need to Stay Healthy .................................. 124Monitoring Blood Glucose: It’s a Must ...................................................... 126

How often should you test? .............................................................. 127How do you use a lancet? ................................................................. 128How do you perform the test?.......................................................... 129

Choosing a Blood Glucose Meter .............................................................. 130Factors that may infl uence your purchase ..................................... 130Profi les of different meters ............................................................... 131

Tracking Your Glucose over Time: Hemoglobin A1c .............................. 141Testing for Kidney Damage: Moderately Increased Albumin (MIA) ..... 143Checking for Eye Problems ........................................................................ 144Examining Your Feet ................................................................................... 144Tracking Cholesterol and Other Fats ........................................................ 146Measuring Blood Pressure ......................................................................... 149Checking Your Weight and BMI ................................................................. 151Testing for Ketones ..................................................................................... 152Testing the C‐Reactive Protein .................................................................. 152Checking the TSH ........................................................................................ 153Evaluating Testosterone in Men with Type 2 Diabetes .......................... 153Checking Vitamin D ..................................................................................... 154

Chapter 8: Tackling What You Eat: Healthful Nutrition. . . . . . . . . . . .155Considering Total Calories First ................................................................ 156

Consuming the right amount of carbohydrates............................. 159Portioning proteins ............................................................................ 163Filling the fat requirement ................................................................ 164

Getting Enough Vitamins, Minerals, and Water ....................................... 166Counting Alcohol as Part of Your Diet ...................................................... 168Using Sugar Substitutes .............................................................................. 169Eating Well for Type 1 Diabetes ................................................................. 171Reducing Your Weight ................................................................................ 171

Types of nutritional plans (NP)........................................................ 172Vegetarian plans ................................................................................ 174Mediterranean NP .............................................................................. 174Metabolic surgery for diabetes ........................................................ 175Behavior modifi cation ....................................................................... 176

Coping with Eating Disorders .................................................................... 177The dangers of anorexia and bulimia .............................................. 178Sources of help ................................................................................... 179

ix Table of Contents

Chapter 9: Metabolic Surgery: A Possible Cure for Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181

Realizing the Benefi ts of Metabolic Surgery ............................................. 182Comparing surgery versus medical weight loss ............................ 183Considering costs .............................................................................. 183Contemplating the other benefi ts .................................................... 184

Considering Surgery over Traditional Diabetes Care ............................. 185Realizing that surgery is a safe option ............................................ 185Comparing metabolic surgery and usual care ............................... 185Focusing on metabolic surgery and intensive care ....................... 186

Getting Familiar with Guidelines for Surgical Candidates ...................... 187Eyeing medical determinants ........................................................... 188Noting psychological determinants ................................................ 188Knowing who shouldn’t have surgery ............................................. 189

Choosing the Operation .............................................................................. 189Adjustable gastric banding (AGB) ................................................... 190Roux‐en‐Y gastric bypass (RYGB).................................................... 191Vertical sleeve gastrectomy (VSG) .................................................. 192How the surgery works ..................................................................... 193

Preparing for Surgery .................................................................................. 193Finding the right surgeon.................................................................. 193Getting ready for surgery .................................................................. 194

Identifying Short‐Term and Long‐Term Complications of Surgery ....... 195Managing your medications after surgery ...................................... 195Listing short‐term problems............................................................. 196Noting long‐term problems............................................................... 196

Eating Properly and Exercising after Surgery .......................................... 198Focusing on nutrition after surgery ................................................. 198Comprehending why you may gain weight .................................... 198Exercising before and after surgery ................................................ 199

Hearing from Real Patients ......................................................................... 202Patient GM .......................................................................................... 202Patient MS ........................................................................................... 203Patient MP ........................................................................................... 205

Considering New Guidelines for Surgery .................................................. 206

Chapter 10: Creating Your Exercise Plan. . . . . . . . . . . . . . . . . . . . . . . .209Getting Off the Couch: Why Exercise Is Essential ................................... 210

Preventing macrovascular disease .................................................. 211Providing other benefi ts ................................................................... 211Taking charge of your health ........................................................... 212Understanding your body mechanics during exercise ................. 212Reaping the benefi ts .......................................................................... 213

Exercising When You Have Diabetes ........................................................ 214Working out with type 1 diabetes .................................................... 215Working out with type 2 diabetes .................................................... 215

x Diabetes For Dummies

Determining How Much Exercise to Do .................................................... 216Exerting enough effort ....................................................................... 216Devoting an hour a day ..................................................................... 217Making moderate exercise your goal .............................................. 218

Is Golf a Sport? Choosing Your Activity .................................................... 218Walking 10K Steps a Day ............................................................................. 222Lifting Weights ............................................................................................. 224

Chapter 11: Medications: What You Should Know . . . . . . . . . . . . . . .231Taking Drugs by Mouth: Oral Agents ........................................................ 232

Sulfonylureas ...................................................................................... 232Metformin ........................................................................................... 234Alpha‐glucosidase inhibitors ............................................................ 237Thiazolidinediones (The glitazones) ............................................... 238Meglitinides ........................................................................................ 240DPP‐4 inhibitors ................................................................................. 241Bile acid sequestrants ....................................................................... 243Bromocriptine .................................................................................... 243SGLT2 inhibitors ................................................................................ 243Combining oral agents ...................................................................... 244New injectable drugs ......................................................................... 245

Taking Insulin ............................................................................................... 248Considering insulin options.............................................................. 249Shooting yourself ............................................................................... 251Conducting intensive insulin treatment.......................................... 253Adjusting insulin when you travel ................................................... 255Delivering insulin with a pen ............................................................ 256Delivering insulin with a jet‐injection device ................................. 257Delivering insulin with an external pump ....................................... 258Utilizing aids to insulin delivery ...................................................... 261

Using Other Medications ............................................................................ 262Avoiding Drug Interactions ........................................................................ 263Finding Assistance Obtaining Drugs ......................................................... 264

Chapter 12: Assembling Your Diabetes Team. . . . . . . . . . . . . . . . . . . .267Your Role as Author, Producer, Director, and Star ................................ 267The Primary Physician: Your Assistant Director .................................... 268The Diabetologist or Endocrinologist: Your Technical Consultant ...... 269The Eye Doctor: Your Lighting Designer .................................................. 270The Foot Doctor: Your Dance Instructor .................................................. 270The Dietitian: Your Food‐Services Provider ............................................. 271The Diabetes Educator: Your Researcher ................................................ 272The Pharmacist: Your Usher ...................................................................... 272The Mental‐Health Worker: Your Supporting Actor ............................... 273Your Family and Friends: Your Captivated and Caring Audience ......... 273The Internet: Your Potential Partner in Lifestyle Change ...................... 274

Sites for diet and weight loss ........................................................... 274Sites for exercise programs .............................................................. 275Finding reputable websites .............................................................. 275

xi Table of Contents

Part IV: Special Considerations for Living with Diabetes ........................................................... 277

Chapter 13: Managing Diabetes in Children . . . . . . . . . . . . . . . . . . . . .279Dealing with Diabetes in Your Baby or Preschooler ............................... 280

Nurturing a diabetic infant ............................................................... 280Taking care of a toddler with diabetes ........................................... 281Becoming an educated caregiver..................................................... 281

Helping Your Primary‐School Child with Diabetes ................................. 282Coping with type 1 diabetes ............................................................. 283Recognizing and treating type 2 diabetes ....................................... 285

Managing Your Adolescent’s Diabetes ..................................................... 287Handing Over the Reins to Your Young Adult Child

with Diabetes ............................................................................................ 288Preventing and Treating Obesity and Type 2 Diabetes

in Children ................................................................................................ 289Defi ning obesity in children.............................................................. 290Preventing obesity in children ......................................................... 291Dealing with type 2 diabetes ............................................................ 291

Taking Special Care of Sick Children ......................................................... 293Checking for Thyroid Disease in Type 1 Children ................................... 293Appreciating the Value of Team Care ....................................................... 294

Chapter 14: Diabetes and the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . .295Diagnosing Diabetes in the Elderly ........................................................... 295Evaluating Intellectual Functioning ........................................................... 296Considering Heart Disease ......................................................................... 297Preparing a Proper Diet .............................................................................. 297Avoiding Hypoglycemia .............................................................................. 298Using Medications ....................................................................................... 299Dealing with Eye Problems ......................................................................... 300Coping with Urinary and Sexual Problems ............................................... 301Monitoring Foot Problems ......................................................................... 301Considering Treatment Approaches ......................................................... 302Understanding the Medicare Law ............................................................. 303

Chapter 15: Dealing With Occupational and Insurance Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305

Traveling with Diabetes .............................................................................. 305Knowing Where You Can’t Work ............................................................... 307Becoming Familiar with Workplace Law .................................................. 309Navigating the Health‐Insurance System .................................................. 310

Employer insurance ........................................................................... 311Government insurance ...................................................................... 311Private insurance ............................................................................... 311No insurance....................................................................................... 313

xii Diabetes For Dummies

Changing or Losing a Job ............................................................................ 313Considering Long‐Term Care Insurance ................................................... 314Shopping for Life Insurance ....................................................................... 315

Chapter 16: Eyeing What’s New in Diabetes Care . . . . . . . . . . . . . . . .317Protecting Yourself from the Dangers of New Drugs .............................. 317Checking the Role of Intestinal Organisms in Type 2 Diabetes ............. 319Eating One Meal a Day to Control Diabetes ............................................. 319Losing Weight with Gastric Artery Embolization .................................... 320Blocking the Vagus Nerve for Weight Loss .............................................. 320Lowering Blood Glucose in Pregnancy ..................................................... 321Using an Endoscopic Duodenal‐Jejunal Bypass Liner

for Weight Loss ........................................................................................ 321Placing a Gastric Balloon ............................................................................ 322Understanding the Importance of the ACCORD Trial ............................. 323Taking Advantage of Metabolic Memory .................................................. 324

Chapter 17: Discovering What Doesn’t Work When You Treat Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .325

Developing a Critical Eye ............................................................................ 325Identifying Drugs and Supplements That Don’t Work ............................ 326

Chromium ........................................................................................... 328Aspirin ................................................................................................. 328Cinnamon ............................................................................................ 329Pancreas formula ............................................................................... 329Fat Burner ........................................................................................... 329Ki‐Sweet ............................................................................................... 329Gymnema sylvestre ........................................................................... 330

Avoiding Illegal Drugs ................................................................................. 330Knowing the Dangers of Some Legal Drugs for Other Purposes ........... 331

Antipsychotics ................................................................................... 331AIDS medications ............................................................................... 332

Recognizing Diets That Don’t Work .......................................................... 332

Part V: The Part of Tens ............................................ 335

Chapter 18: Ten Commandments for Excellent Diabetes Care . . . . .337Major Monitoring ......................................................................................... 337Devout Dieting ............................................................................................. 338Tenacious Testing ....................................................................................... 338Enthusiastic Exercising ............................................................................... 339Lifelong Learning ......................................................................................... 339Meticulous Medicating ................................................................................ 340Appropriate Attitude ................................................................................... 340Preventive Planning .................................................................................... 341Fastidious Foot Care ................................................................................... 341Essential Eye Care ....................................................................................... 342

xiii Table of Contents

Chapter 19: Ten Myths about Diabetes That You Can Forget . . . . . . .343Perfect Treatment Yields Perfect Glucoses ............................................. 343Type 2 Diabetes Occurs in All Overweight People and Not

in Normal Weight People ........................................................................ 344You Can’t Enjoy Your Food ........................................................................ 344You Can Tell the Level of Your Blood Glucose by How You Feel ......... 345People With Diabetes Get More Colds and Other Illnesses ................... 345If You Need Insulin, You’re Doomed ......................................................... 345People with Diabetes Shouldn’t Exercise ................................................. 346You Can’t Give Blood Because You Have Diabetes ................................. 347If You’re Sick and Can’t Eat, You Can Skip Your

Diabetes Medications .............................................................................. 347Diabetes Wrecks Your Sense of Humor .................................................... 348Soak Your Feet Daily if You Have Diabetes .............................................. 348

Chapter 20: Ten Ways to Get Others to Help You . . . . . . . . . . . . . . . . .349Explain Hypoglycemia ................................................................................. 349Follow the Standards of Care ..................................................................... 350Find an Exercise Partner ............................................................................. 350Use Your Foot Doctor ................................................................................. 351Enlist Help to Fight Food Temptation ....................................................... 351Expand Your Diabetes Knowledge ............................................................ 352Fit Your Favorite Foods into Your Diet with a Dietitian ......................... 353Seek Out Appropriate Specialists .............................................................. 353Discuss Your Meds with the Pharmacist .................................................. 354Share This Book with Everyone ................................................................. 354

Appendix: Mini‐Cookbook .......................................... 355Getting to Know the Contributing Restaurants and Chefs ..................... 355

Avra Estiatorio ................................................................................... 355Border Grill ......................................................................................... 356Greens ................................................................................................. 356Gerald Hirigoyen ................................................................................ 357Luna Blu .............................................................................................. 357Paulette Mitchell ................................................................................ 357

Cooking Some Healthful Recipes ............................................................... 358

Index ....................................................................... 391

Introduction

Y ou’re reading the 5th edition of Diabetes For Dummies, and you may be wondering why another edition is necessary. The previous edition (pub-

lished in 2012) had everything you needed to know to reverse the plague of diabetes, yet the problem seems to be increasing, not decreasing. Following are some of the possible explanations for this situation:

✓ Not enough people bought the last edition of the book.

✓ Even if they bought it, not enough people followed the recommendations in the book.

✓ Too many people aren’t even aware that this book exists.

✓ No book or books can stop an avalanche after the snow starts rolling downhill.

✓ Some new information, not available three years ago, may be able to make a major difference toward reversing diabetes, especially the information in Chapter  9 .

The real answer is actually all of the above (and probably more reasons).

The Centers for Disease Control and Prevention recently suggested that as many as one in three adults in the United States will have diabetes by the year 2050. The International Diabetes Federation reports that 387 million people had diabetes in 2014 and that 552 million will have the disease by 2030 — that’s one in every ten people on the earth. In a previous edition of this book, I set this figure at 366 million by 2030, so you can see that today’s predictions are even more dire than those of four years ago. This increase is because the population is aging, minority groups who have a higher risk for diabetes are increasing, and, fortunately, people with diabetes are living longer. However, these numbers are based on past trends. The prediction will not turn out to be true if people improve their lifestyle choices through the means discussed in this book.

Over the last decade, a large study was performed in Germany to see if life-style change could make a difference. Four major factors were evaluated in over 23,000 Germans. The factors were

✓ Never smoking

✓ Body‐mass index less than 30

2 Diabetes For Dummies

✓ Exercising for three and a half hours or more a week

✓ Following healthy dietary principles: high intake of fruits and vegetables, eating whole‐grain bread, and low meat consumption

The happy finding was that the more factors a person followed, the lower the risk of major chronic diseases, including heart disease, diabetes, and cancer. People who followed all four had a 78 percent lower risk of those diseases than people who had no healthy factor. People with three factors were a little less protected, with two a bit less and with one even less but still better than no factors at all.

About This Book So much has changed in the three years since the fourth edition of Diabetes For Dummies was written that a fifth edition was clearly necessary. I need to tell you about new medicines (see Chapter  11 ), new glucose meters (Chapter  7 ), and new ideas about diet and exercise and curing diabetes with surgery (Chapters 8 , 9 , and 10 ). I also need to share new information about diabetes in children (Chapter  13 ) and the occupational and insurance prob-lems of people with diabetes (Chapter  15 ). Just about every chapter has something new, especially (obviously) Chapter  16 , which deals specifically with what’s new in diabetes care.

A new edition also gives me the opportunity to thank the thousands of people who have thanked me for Diabetes For Dummies. You have given me a sense of enormous gratification for writing this book. You have shared your stories with me, permitting me to laugh and cry with you. One of the best is the fol-lowing from Andrea in Canada:

My 3‐year‐old daughter was recently diagnosed with diabetes type 1. It has been a rough time. To help us out, my brother and his wife bought us your book, Diabetes For Dummies. One day my daughter saw this bright yellow book and asked what I was reading. I told her Diabetes For Dummies. As soon as the words came out of my mouth, I regretted it. I didn’t want her to think that dummies got diabetes so I quickly added, “I am the dummy.” Without missing a beat, she then asked, “Am I the diabetes? ”

The story doesn’t just end there. The other day she was relaxing on the couch. She looked at me and said, “I don’t want to have diabetes anymore.” Feeling terrible, I responded, “I know sweetie; I don’t want you to have it anymore either.” I then explained that she would have diabetes for the rest

3 Introduction

of her life. With a very concerned look she then asked, “Will you be the dummy for the rest of your life? ”

As sad as it is, I guess you’re right, one must look for humor in every-

thing; otherwise we would have broken down by now.

You’re not required to read this book from cover to cover, although if you know nothing about diabetes, reading straight through may be a good approach. This book is designed to serve as a source for information about the problems that arise over the years. You can find the latest facts about diabetes and the best sources to discover any information that comes out after the publication of this edition.

Throughout this book I use some specific conventions to make the text clearer, to highlight information, and to make your read as effortless as pos-sible. These conventions are important to know, so I list them here:

✓ Sugar versus glucose: Diabetes, as you may know, is all about sugar. But sugars come in many types. So doctors avoid using the words sugar and glucose interchangeably. In this book (unless I slip up), I use the word glucose rather than sugar. (You may as well get used to it.)

✓ Emphasis on type 2 diabetes: There are a number of different types of diabetes (see my explanation in Chapter  3 ), and the most common are type 1 diabetes and type 2 diabetes. Because I recently published Type 1 Diabetes For Dummies (John Wiley & Sons, Inc.), most of what you read here is about type 2 diabetes.

✓ Abbreviations: To save time, I use the following abbreviations:

• T1DM: Type 1 diabetes mellitus (formal name of type 1 diabetes)

• T2DM: Type 2 diabetes mellitus (formal name of type 2 diabetes)

✓ Pharmaceutical drug names: When I mention a drug used in the treat-ment of diabetes, I give the generic name. I provide the trade name in parentheses if relevant.

Foolish Assumptions The book assumes that you know nothing about diabetes. So you won’t have to face a term that you’ve never heard of before and that is not explained. For those who already know a lot about diabetes, you can find more in‐depth explanations in this book as well. You can pick and choose how much you want to know about a subject, but the key points are clearly marked.

4 Diabetes For Dummies

Icons Used in This Book The icons alert you to information you must know, information you should know, and information you may find interesting but can live without.

When you see this icon, it means the information is essential and you should be aware of it.

This icon points out when you should see your doctor (for example, if your blood glucose level is too high or you need a particular test done).

This icon marks important information that can save you time and energy.

I use this icon whenever I tell a story about patients.

This icon gives you technical information or terminology that may be helpful, but not necessary, to your understanding of the topic.

This icon warns against potential problems (for example, if you don’t treat a complication of diabetes properly).

I use this icon to direct you to supplemental information online, including a glossary, at www.dummies.com/extras/diabetes .

Beyond This Book In addition to the content of this book, you can access some related material online. I have posted the Cheat Sheet at www.dummies.com/cheatsheet/diabetes . It contains important information that you may want to refer to on

5 Introduction

a regular basis. I also share some additional bits of information and pointers at www.dummies.com/extras/diabetes that can help you navigate this medical condition. You can find a glossary as well as a reference guide for additional help you can find online to deal with your diabetes.

Where to Go from Here Where you go from here depends on your needs. If you already have basic knowledge of diabetes and want to know more about complications, go to Chapter  3 . If you are a novice, start at Chapter  1 . If you want to know more about the medications you are taking, go to Chapter  11 . Each chapter title clearly tells you what you can find there, so check the table of contents to find what you need rapidly.

As you’ll find out, keeping a positive attitude and finding some humor in your diabetes can help you a great deal. At times you’ll feel like doing anything but laughing. But scientific studies are clear about the benefits of a positive atti-tude. In a very few words: He who laughs, lasts. Another point is that people learn more and retain more when humor is part of the process.

C heck out www.dummies.com/cheatsheet/diabetes for a handy Cheat Sheet chockfull of important information about diabetes that you can refer to on a regular basis.

Part I

Getting Started with Diabetes

In this part . . . ✓ Deal with the diagnosis of diabetes so you can take appropriate

action with your doctor to create a treatment and action plan.

✓ Obtain an in‐depth understanding of the definition of diabetes so you can determine the severity of your condition.

✓ Clarify the types of diabetes to form a foundation for your understanding of the various treatment options.

✓ Get to know your pancreas and all it does for you, allowing you to appreciate what it means when it isn’t working appropriately.

Dealing with Diabetes In This Chapter

▶ Discovering successful people with diabetes

▶ Coping with the initial diagnosis

▶ Upholding your quality of life

I f you have diabetes, in the course of a year you live with that diagnosis for about 8,760 hours. During that time, you spend perhaps one hour with

a physician. In Chapter  12 , I introduce you to many of the other people who may help you to manage your disease. Clearly, however, the ball is in your hands alone practically all the time. How you deal with your diabetes deter-mines whether you score or are shut out.

One of my patients told me about working at her first job out of college, where each employee birthday was celebrated with cake. She came to the first celebration and was urged to eat a slice. She refused and refused, until finally she had to say, “I can’t eat the cake because I am diabetic.” The woman urging her said, “Thank God. I thought you just had incredible will-power.” Twenty years later, my patient clearly remembers being told that having diabetes is better than having willpower. Another patient told me the following: “The hardest thing about having diabetes is having to deal with doctors who do not respect me.” Several times over the years, she had fol-lowed her doctor’s recommendations exactly, but her glucose control hadn’t been satisfactory. The doctor blamed her for this “failure.”

Unless you live alone on a desert island (in which case I’m impressed that you got your hands on this book), your diabetes doesn’t affect just you. How you deal with your diabetes affects your family, friends, and co‐workers. This chapter shows you how to cope with diabetes and how to understand its impact on your important relationships.

Chapter 1

10 Part I: Getting Started with Diabetes

Achieving Anything . . . Or Everything! Diabetes has become such a common disease in the United States that in any group of ten people, one will probably have it. Is it any wonder that success-ful people have diabetes in every walk of life? In this chapter, I tell you of the accomplishments of just a few of them. Just like them, I can promise you that if you follow the advice in this book, your diabetes will never prevent you from accomplishing your goals. In fact, your success in managing diabetes may lead to success in other areas of your life.

Keeping good company If you have diabetes, you’re not alone. Quite a few famous people live with diabetes every day, just like you. Here are just a few actors that you may recognize:

✓ Tom Hanks: This actor has played numerous roles since he was diag-nosed with type 2 diabetes in 2013, including Captain Phillips, Saving Mr. Banks, and others. Diabetes hasn’t slowed his career at all. In addi-tion to acting, he also produces, directs, and writes screenplays.

✓ Wendell Pierce: If you enjoyed The Wire on TV, you enjoyed watching this actor, who played Detective Bunk Moreland. He has been in more than 30 movies and has played many roles on TV including Treme . Pierce has tried to help others with his disease by starting a chain of groceries that sell quality food in low‐income areas.

✓ Sharon Stone: No one could say that this actress with type 1 diabetes has failed to obtain any roles or to play them with the greatest skill.

People with diabetes also successfully perform in every professional sport. Here are a few sports and the athletes who live with diabetes and still per-form at high levels: (To read about the role of sports and exercise in your life, see Chapter  10 .)

✓ Football: Kyle Love of the Carolina Panthers and Jake Byrne, who played with the San Diego Chargers, are football players who don’t let their diabetes slow them down. Love has type 2 diabetes, and Byrne has type 1 diabetes.

✓ Baseball: Sam Fuld plays baseball for the Oakland Athletics and Brandon Marrow plays baseball with the San Diego Padres.

✓ Basketball: Gary Forbes plays basketball for the Toronto Raptors and Adam Morrison recently retired from professional basketball after playing for the Los Angeles Lakers and the Charlotte Bobcats.

11 Chapter 1: Dealing with Diabetes

If you think that diabetes might prevent you from a career in the sciences, just consider these modern day researchers with diabetes performing at the highest level in every field:

✓ David Cummings, MD: A professor at the University of Washington, he is exploring the place of metabolic surgery in type 2 diabetes.

✓ Martin Gillis, DDS: He is clarifying the effect of diabetes on the oral cavity.

✓ Nicholas Mayall: He added to science’s knowledge of nebulae, superno-vae, spiral galaxies, and the age of the universe, and he’s in no way lim-ited by his diabetes. And neither should you be.

Realizing your potential The names in the preceding paragraphs are just a few examples of people with diabetes who have achieved greatness. Here is my point: Diabetes shouldn’t stop you from doing what you want to do with your life. If you follow the rules of good diabetic care, as I describe in Chapters 7 through 12 , you will actually be healthier than people without diabetes who smoke, overeat, and/or don’t exercise enough.

Reacting to Your Diagnosis Do you remember what you were doing when you found out that you had dia-betes? Unless you were too young to understand, the news was quite a shock. Suddenly you had a condition from which people can die. In fact, many of the feelings that you went through were exactly those of a person learning that he or she is dying. The following sections describe the normal stages of reacting to a diagnosis of a major medical condition such as diabetes.

Experiencing denial Your first response was probably to deny that you had diabetes, despite all of the evidence. Your denial mindset may have begun when your doctor tried to sugarcoat (forgive the pun) the news of your condition by telling you that you had just “a touch of diabetes,” (an impossibility equivalent to “a touch of pregnancy”). You probably looked for any evidence that the whole thing was a mistake. Perhaps you even neglected to take your medication, follow your diet, or perform the exercise that is so important to maintaining your body. But ultimately, you had to accept the diagnosis and begin to gather the infor-mation you needed to help yourself.

12 Part I: Getting Started with Diabetes

When you accepted the diabetes diagnosis, I hope you also shared the news with your family, friends, and people close to you. Having diabetes isn’t something to be ashamed of, and you shouldn’t hide it from anyone. You need the help of everyone in your community: your co‐workers who need to know not to tempt you with treats that you can’t eat, your friends who need to know how to give you glucagon (a treatment for low blood glucose) if you become unconscious from a severe insulin reaction (see Chapter  4 ), and your family who needs to know how to support and encourage you to keep going.

Your diabetes isn’t your fault — nor is it a form of leprosy or some other dis-ease that carries a social stigma. Diabetes also isn’t contagious; no one can catch it from you.

Feeling anger When you pass the stage of denying that you have diabetes, you may become angry that you’re saddled with this “terrible” diagnosis. But you’ll quickly find that diabetes isn’t so terrible and that you can do something to rid your-self of the disease. Anger only worsens your situation, and being angry about your diagnosis is detrimental in the following ways:

✓ If your anger becomes targeted at a person, he or she is hurt.

✓ You may feel guilty that your anger is harming you and those close to you.

✓ Anger can prevent you from successfully managing your diabetes.

As long as you’re angry, you are not in a problem‐solving mode. Diabetes requires your focus and attention. Use your energy positively to find cre-ative ways to manage your diabetes. (For help managing your diabetes, see Part III.)

Bargaining for more time and feeling depressed The stage of anger often transitions into a stage when you become increas-ingly aware of your mortality and bargain for more time. Even though you probably realize that you have plenty of life ahead of you, you may feel over-whelmed by the talk of complications, blood tests, and pills or insulin. When you realize that bargaining doesn’t work, you may even experience depres-sion, which makes good diabetic care all the more difficult.

Studies have shown that people with diabetes suffer from depression at a rate that is two to four times higher than the rate for the general population.

13 Chapter 1: Dealing with Diabetes

People with diabetes also experience anxiety at a rate three to five times higher than people without diabetes.

If you suffer from depression, you may feel that your diabetic situation cre-ates problems for you that justify being depressed. You may rationalize your depression in the following ways:

✓ You can’t make friends as easily because diabetes hinders you.

✓ You don’t have the freedom to choose your leisure activities.

✓ You’re too tired to overcome difficulties.

✓ You dread the future and possible diabetic complications.

✓ You don’t have the freedom to eat what you want.

✓ You’re constantly annoyed by all of the minor inconveniences of dealing with diabetes.

All of the preceding concerns are legitimate, but they also are all surmount-able. How do you handle your many concerns and fend off depression? Following are a few important methods:

✓ Try to achieve excellent blood glucose control (see Part III).

✓ Begin a regular exercise program (Chapter  10 ).

✓ Tell a friend or relative how you are feeling; get it off your chest (Chapter  20 ).

✓ Recognize that every abnormal blip in your blood glucose is not your fault (Chapter  7 ).

If you can’t overcome the depression brought on by your diabetic concerns, you may need to consider therapy or antidepressant drugs. But you probably won’t reach that point.

Moving on You may experience the various stages of reacting to your diabetes in a dif-ferent order than I describe in the previous sections. Some stages may be more prominent for you, and others may be hardly noticeable.

Don’t think that any anger, denial, and depression are wrong. These feelings are natural coping mechanisms that serve a psychological purpose for a brief time. Allow yourself to have these feelings — and then drop them. Move on and discover how to live normally with your diabetes.

14 Part I: Getting Started with Diabetes

These phases of coping may not occur in the order given, may not occur at all, and/or may last a long time. If one phase inhibits your ability to cope with your diabetes for more than a few months, you may need outside help.

Here are some key steps you can take to manage the emotional side of diabetes:

✓ Focus on your successes. Some things may go wrong as you find out how to manage diabetes, but most things will go right. As you concen-trate on your successes, you will realize that you can cope with diabetes and not let it overwhelm you.

✓ Involve the whole family in your diabetes. A diabetic lifestyle is a healthy lifestyle for everyone. For instance, the exercise you do is good for the whole family. By doing it together, you strengthen the family ties while everyone gets the health benefits. Also, should you need your family to help you, for instance, during a particularly severe case of low blood glucose, their early involvement in learning about diabetes will give them the peace of mind to know they are helping you, not hurting you. (See Chapter  20 for ways to enlist help from people around you.)

✓ Develop a positive attitude. A positive attitude gives you a can‐do mindset, whereas a negative attitude leads to low motivation preventing you from doing all that is necessary to manage your diabetes.

✓ Find a great team, pinpoint problems, and set goals. Determine the most difficult problems that you have with your diabetes and then con-sider how you can solve them by yourself or with a great team of sup-porting players like a primary care physician, a diabetes specialist, a diabetes educator, a dietitian, an eye doctor, a foot doctor, and so forth. Set realistic goals to get past your problems. (Chapter  12 tells you every-thing you need to know about getting help from the supporting players.)

✓ Don’t expect perfection. Although you may feel that you’re doing every-thing right, you may experience blood glucose levels that are too high or too low. This uncontrollable situation happens to every person with diabetes, and it’s one of the biggest frustrations of the disease. Don’t beat yourself up over something you can’t control. Keep doing the things I suggest in the treatment section, and you will be very gratified at the end.

Maintaining a High Quality of Life You may assume that a chronic disease like diabetes leads to a diminished quality of life, but you don’t have to settle for anything less than a full and fulfilling life.