Ka Wai Ola - Office of Hawaiian Affairs, Volume 20, Number 12, 1 December 2003 — Diet, excercise key in dealing with diabetes [ARTICLE+ILLUSTRATION]

Diet, excercise key in dealing with diabetes

By Claire Hughes , Dr.PH., R.D. Diabetes affects many Hawaiians. The best strategy is to prevent diabetes, but onee this illness is diagnosed, the strategy is to master the treatment and stick with it. This takes time and effort, but it will keep more serious health problems from developing. There are three kinds of diabetes mellitus. Type 1 diabetes occurs when the pancreas stops producing the hormone insulin. This hormone controls the absorptiion of sugar into the cells and making it available for energy. To control Type 1 diabetes, insulin injections replace the body's missing insulin. Type 2 diabetes starts when the body uses insulin less efficiently. This is called becoming insulin resistant. At first, the pancreas tries to compensate and makes more insulin. Then, slowly, the insulin producing cells heeome defective and some cells stop working altogether. Diet and exercise together ean control Type 2. With increasing age, medication is given. The third type is gestational diabetes. This diabetes occurs during pregnancy. Aggressive treatment with diet and exercise will make a healthy baby and delivery more likely, and protect the mother's health. In the United States, Type 2 diabetes is the most frequently diagnosed type, and this is true of Hawaiians as well. Health studies show that the number of Americans with Type 2 diabetes is increasing rapidly, with several conditions making this increase predictable. First, more Americans are overweight. Overeating and the amount of sugar in America's food choices constantly challenge the body's insulin efficiency. Formerly, Type 2 diabetes was found in adults only. Now, overweight children are frequent sufferers. Not many are aware that poorly controlled Type 2 diabetes increases heart problems. High blood pressure, high cholesterol, high triglycerides and

weight problems are always found with uncontrolled Type 2 diabetes. In addition, cigarette smoking increases the ehanee for a serious heart condition called cardiovascular disease, or CVD. A diagnosis of CVD includes unhealthy changes in heart vessels, arteries and veins. It is important to know that several contributing factors to CVD

are exactly the same as for diabetes, such as being overweight, smoking, high blood pressure, high cholesterol and physical inactivity. That makes it doubly important to control these conditions quickly and to keep them under control.

Prevention is the best strategy, particularly with an inherited poten-

tial for diabetes. Prevention measures are to keep slim,

eat less sugar and fat, and exercise most days, since laek of exercise results in more calories being stored as fat, whieh means weight gain. Avoiding dietary sugar reduces the workload of the pancreas, protects the insulin-producing cells

and helps them to function normally for a longer time It is essential to diagnose diabetes early, to avoid heart and other complications, so regular medical checkups and screenings are important for those with the genetic potential for diabetes. Following the advice of a medical doctor who specializes in diabetes is crucial. Read all of the materials he or she gives you, and ask questions if you do not understand. Being armed with knowledge is key to avoiding a lot of complications. Your doctor will prescribe a diet that is very low in sugar, with lots of fibrous vegetables, a few fresh

fruits, whole grains (brown rice and breads, pasta and cereal from whole grains), and fish, ehieken and other low-fat meats. Foods should be prepared without adding fat, gravies or sauces. It is important to eat three evenly spaced meals with appropriate snacks. Do not skip meals, especially if you are on insulin or insulin-controlling medications.

The traditional Hawaiian Diet (THD) is a great prevention diet. About 75 percent of the THD comes from vegetables and a few fruits daily. Fish and ehieken are the pro-

tein choices. Avoid eating fatty and deep-fried foods to minimize the ehanee of gaining weight and developing cholesterol problems, and eat fresh foods as often as possible. To control the

amount of sugar and fat, avoid eating canned meats, soups and sugar-packed fruits. The sooner you learn to control what you eat, the sooner your pancreas, blood vessels, and other organs will be protected.

What are the consequences of poorly controlled diabetes? The most serious are CVD and other heart problems. Congestive heart failure, high blood pressure, stroke, nerve damage, kidney

trouble, blindness, poor healing, limb amputations and depression are problems that develop slowly, at first, and then ean become overwhelming and life threatening. What to do first? If you are overweight, begin by losing weight and starting light exercise according to your doctor's advice. Over time and under the doctor's guidance, increase the amount and duration of exercise. Analyze food and medication problems at eaeh doctor visit. You will feel better, and your family will appreciate your efforts. ■

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A diet high in fat and sugar ean put you at risk for getting diabetes, and for developing more severe health problems if you already have the illness.