Got Sugar?

Photo: Brian Bradley

This year, more than 190,000 people will die from diabetes and its related complications.

One out of three people have diabetes but do not know it. Diabetes is more common in Latinos, African Americans, Native Americans, Asian Americans and Pacific Islanders. Between 1980 and 1999, deaths from diabetes in the Hispanic population almost doubled.

A Chronic Condition

Like HIV, diabetes is a chronic disease with long-term treatments. Unlike HIV, however, diabetes cannot be transmitted from one person to another.

There are three types of diabetes: Type 1, Type 2 (the most common form) and gestational.

In Type 1 diabetes, the pancreas no longer makes insulin and insulin injections are necessary to live. In Type 2 diabetes, the insulin present in the blood is not properly being used by the cells of muscles, liver and fat or the pancreas does not make enough insulin to maintain normal glucose levels.

Gestational diabetes may occur during the later stages of pregnancy. It usually goes away after giving birth, though there is an increased risk of Type 2 diabetes later in life.

People living with HIV, taking anti-HIV medications and experiencing body shape changes and metabolic changes, are experiencing higher than normal blood sugar levels and insulin resistance. This can be determined by a two-hour glucose tolerance test. After fasting 12 hours, a person drinks a solution containing a known amount of glucose. A sample of blood is taken before the person drinks the glucose solution and then again every hour after the glucose is consumed, up to three hours.

Food and Insulin Link

After a meal, the body breaks down food into smaller components, and some of the food is turned into sugar called glucose.

Insulin is needed to remove sugar from the blood and put it into cells, where it is used to fuel the cells' activities, which support life. If glucose is not delivered to the cells, but instead stays in the blood, cells may die from starvation. Over time, this "high blood" sugar can damage blood vessels and nerves, which can lead to blindness, heart and kidney disease, nerve problems, infections and death of body tissue, leading to amputation.

What Can You Eat

When it comes to eating a healthy diet, it's not so much about the foods you can or cannot eat, but how much of those foods you can eat.

Foods containing carbohydrates, which include starches, fruits, dairy products and sugars, can raise blood glucose levels to unhealthy levels if eaten in too large of amounts at one time. Carbohydrates are converted to glucose in the body. Candy, sodas and sugar raise blood sugar, but eating too many tortillas, beans or rice can have the same effect. These foods, however, provide valuable vitamins, minerals, and energy for the body and need to be part of your everyday diet. Be careful not to overeat.

Portion Size

Eating foods in appropriate amounts and number of servings is key to controlling blood sugar with diabetes, insulin resistance or impaired glucose tolerance. Many people are surprised when they learn what an appropriate "portion" or "serving size" of a particular food is.

For some examples of foods from the different foods groups that have the greatest potential to raise blood sugar, see the box on this page. The number of servings from each group a day would depend on the total number of calories needed in a day, but generally, a total combination of three or four servings from the starch, fruit or dairy groups per meal would be a good start. Become familiar with portion sizes and compare them to the amounts you are eating.

For additional guidelines, see sample menus below.

Tips for Healthy Living

Risk factors for diabetes include inactivity, obesity, and family history. Prevention and successful management of diabetes starts with eating appropriate kinds and amounts of food, maintaining a healthy weight, losing weight if overweight, and regular exercise.

If you have pre-diabetes (see glossary), you can delay or avoid the onset of type 2 diabetes through lifestyle changes. Try walking 30 minutes a day, five days a week, and if you are overweight, decrease your weight by 5-10 percent through a controlled and appropriate weight loss plan.

If you have diabetes, checking blood glucose levels at home, staying within your target blood sugar goals, eating on a schedule and taking medication, if necessary, are also very important.

Symptoms

A person with diabetes may or may not have symptoms until more advanced disease. Symptoms can include:

• Frequent urination

• Excessive thirst

• Extreme hunger

• Unusual weight loss

• Increased fatigue

• Blurry vision

Complications of high blood sugar such as heart, nerve and kidney disease, stroke, blindness and impotence can be life-threatening. These complications can be avoided or greatly minimized by maintaining blood glucose levels as close to normal. Normal blood glucose levels are 70-110 mg/dl (milligrams of glucose per 100 milliliters of blood).

If you are overweight, inactive, have high triglyceride and low HDL levels, have given birth to a baby weighing more than 9 pounds or had gestational diabetes, are Latino, African American, Native American, Asian American, or Pacific Islander, have a family history of diabetes or symptoms of diabetes, call your doctor and schedule an appointment. Early detection and treatment for diabetes or high blood sugar is a must to prevent the onset or complications of diabetes.

Glossary

Blood sugar:

Fuel source for the body, also known as glucose. Normal values are 70-120 mg/dl.

Diabetes: Condition that occurs when there is (1) a fasting blood sugar level greater than or equal to 126 mg/dl on two separate occasions or (2) if diabetes symptoms exist and a blood sugar taken at any time is greater than or equal to 200, and a second test shows the same results.

Fasting blood sugar: Test taken when you have not eaten eight to 12 hours before the blood draw to measure sugar in the blood.

Glucose: Major fuel source of the body, also known as blood sugar.

Impaired glucose tolerance (IGT), Pre-diabetes, Impaired glucose tolerance (IGT) or Impaired fasting glucose (IFG): The term "pre-diabetes" is now the accepted term instead of IGT or IFG when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. This may mean blood sugar is greater than or equal to 110 mg/dl, but less than 126 mg/dl if done by a fasting plasma glucose test or greater than or equal to 140 and less than 200 mg/dl, after two hours in an oral glucose tolerance test.

Insulin: Hormone released into the blood by the pancreas. Insulin removes glucose and other nutrients from the blood and into cells where they are used or stored.

Insulin resistance: Term for when the normal amount of insulin is not enough to maintain normal blood glucose levels, causing the pancreas to release even more insulin.

Menus for a Healthy Diet

Janelle L'Heureux, M.S., R.D., is a nutritionist in AIDS Project Los Angeles' Treatment Education Program. She can be reached by calling (213) 201-1556 or by e-mail at janelleh@apla.org.