October 22, 2012
By Amelia María de la Luz Montes
Diabetes is different from other diseases. Once you have it, you have it for life. There is no remission. Your pancreas will remain either completely non-working (type 1) or forever debilitated (type II). With diabetes, if you want to live a long life with a balanced glucose level, it is primarily up to you to completely change your eating and exercise habits (even with medication). Unlike cancer which most often concerns medical doctors locating and excising a tumor, followed by chemotherapy and/or other medications, the burden of controlling blood sugars rests upon the individual, not in excising the pancreas or getting a new one. An individual with diabetes could be taking medication like metformin, a well-known drug that has been on the market a long time and has had a good record in assisting the body to control sugar or glucose levels, but that is not enough. Notice that I wrote “assisting” because, again, the burden falls upon the individual. You can take all the drugs you want, but without a diet you create yourself that fits your chemical makeup, and without a good exercise regimen—complications from diabetes will appear (retinopathy, nephropathy, neuropathy).
And that is why doctors become so very frustrated with patients. “I tell them until I’m blue in the face,” a doctor once told me. “I tell them that it’s up to them. They have to control their glucose levels. A pill is not the answer. Most people are not willing to make any changes until it’s too late—until they can’t walk, they go blind, they go on dialysis.”
I’ve thought about what this doctor and others have similarly said. And in reading so much about this disease, I’ve also understood another aspect to the patient’s inabilities to change.
First: It’s very hard to come home after a diagnosis and be told to completely change your diet. To what? How does one know? Insurance companies often will not include “Diabetes Education” for patients until they are actually diagnosed with the disease. For those who are diagnosed as “Pre-Diabetic” (meaning that there is evidence of high glucose levels but not quite high enough for the diabetes diagnosis), there is no education. This should be the exact time when much of the education should take place. Or, if it is apparent that the disease is a genetic factor in an individual’s family history, that individual should have the opportunity to enroll in diabetes education even if she/he may never manifest the disease—at least they are more equipped to understand themselves and help other family members or friends who have it.
Second: Michael Montoya’s book, Making the Mexican Diabetic (2011) is a must-read for all of us because he points out how Chicano and Chicana/Latina and Latino communities can so easily become areas with high rates of diabetes. For familias with a tight income, it’s hard to think about buying expensive organic food and taking the time to cook it when McDonalds offers a sausage burrito for $1.00 and when you are tired from working two jobs—who wants to cook? And if you’re tired from work, the last thing you want to think about is exercise. Or if the doctor tells you to at least walk your neighborhood for a half hour every day, you may live in a neighborhood where that would not be a safe thing to do. I agree with Dr. Montoya that as long as we have the fast food companies setting up shop everywhere, as long as towns and cities do not offer safe public areas (parks!) with activities to join (swimming, running clubs, yoga, kick ball, sports for youngsters and adults), it’s going to be very difficult to lower the rate of diabetes in our population.
Third: A key component to understanding your body is to test your blood and if you are on a very tight budget, this can be difficult. The glucose test monitor is often available for “free” (once you’re diagnosed). But the problem here concerns the test strips, which are expensive. Just yesterday, I bought (with my prescription) my supply of test strips. There are 100 in two vials. With insurance: $62. Without insurance: $124.
If you do not have diabetes (but you know it runs in your family and you’d like to start monitoring your blood so you will prevent the disease) or if you have been told you have “Pre-Diabetes”—you will have to shell out the $124. Something needs to happen so that the cost of test strips can be more affordable making it possible for people to purchase. I’m not sure what the answer is yet regarding the cost of test strips.
Why testing is so important: Without testing, you have no idea what your body is doing. You could feel just fine and your body may be riding on high levels of glucose and the longer you have such high levels running throughout your bloodstream, the quicker you will damage various organs in the body. It will only take a few months before the damage manifests itself in a variety of ways (neuropathy, retinopathy, nephropathy).
Fourth: Trying meditation or learning strategies to cope in stressful situations is also key but difficult. Studies show that testing one’s blood regularly and keeping it balanced plus learning coping strategies is important in lowering glucose levels. Why? Keeping a normal blood pressure level prevents inflammation and inflammation will then also cause high glucose levels in your body which then also damages organs. And that is another aspect to this disease: it’s not only about the food you eat, it’s also about how much stress there is in your life. Something as small as a simple cold cause glucose levels to rise. Illness, trauma, stress, major disappointments in life: all cause glucose levels to rise.
The U.S. can boast about all of us being hard-working people who produce more in a year than neighboring countries around the world. And we do. However, a study showed that even though we produce more, we also make more mistakes (because we are overworked) and therefore spend millions having to correct those mistakes. We also spend millions on emergency hospital visits and doctor’s visits. The first year of my diagnosis, I ended up in the emergency room three times and even with insurance, my out-of-pocket expenditure to medical issues were quite high.
What to do? Some tips:
1. There are foods that do not have such a high residual pesticide load and are very affordable (non-organic). These are:
f. brussel sprouts
2. A QUICK RECIPE: I have found “mashed cauliflower” a most delicious substitute for mashed potatoes. Potatoes are not good for all individuals with diabetes. The high starch content will affect most people (and that includes rice as well—brown or white). Directions:
a. cut up the cauliflower
c. mash it up (either in a food processor or with a potato masher)
d. add spices if you wish
Mashed cauliflower is easily frozen so you can make a lot of it, freeze it, and then you don’t have to keep taking the time to cook it each time you want some.
3. During that first year of diagnosis, what really helped me was figuring out how many carbohydrates are in foods. There is a little book which I call the “carb helper.” It’s title is: The Calorie King: Calorie, Fat, and Carbohydrate Counter 2012. It is revised every year or so and it’s vital for those of us with diabetes. You’ll be surprised what foods are high in carbohydrates (glucose) and what foods are not. Those who are unfamiliar with diabetes may think that it’s just about staying away from desserts or sugary drinks. Onion and carrots have a lot of sugar, but I did not know this until I began studying carbohydrate counts. One carrot is like a spoonful of sugar. Who knew? And onions: why do onions carmelize? Because they have a high glucose level. Since finding this out, I now cook with shallots instead of onions and it’s just as delicious.
4. For exercise: If you cannot afford a gym or cannot exercise outside, walk around your house (inside) for twenty minutes to a half hour, or climb stairs (if stairs are at your work, take time to walk up and down during half your lunch hour) if there are stairs at or near home or at work. Purchase a new/used bike if you can afford it.
The most important aspect I have discovered in researching this disease is understanding how each individual (chemically) is so vastly different. Two people with diabetes may react very differently when they eat, say, a banana. I know someone with Type II Diabetes who enjoys eating a banana every day and their glucose levels do not spike. I cannot eat a banana—not even a bite because then my glucose levels spike. The one thing to understand about diabetes is that the journey to balance glucose levels demands a journey into keenly understanding your body. Our bodies are like fingerprints. Our chemical and genetic makeup is so fascinatingly individual. And it takes commitment to want to do this. But it can be done!
Amelia María de la Luz Montes, Ph.D. is an Associate Professor of English and Ethnic Studies at the University of Nebraska, where she also serves as Chair of the Institute for Ethnic Studies. She frequently blogs about diabetes and health issues.
- Dawn Valadez October 22, 2012 at 2:36 PM
Thanks so much for posting this! Latinas, especially Mexican American women, have such high rates of diabetes – it is like an epidemic in our community. However, with your guidelines all is not lost. I disagree that it is with you forever though – with a healthy diet and lots of exercise people are able to get off of medicine and live a healthy diabetes-free life. You still have to be vigilant, but shouldn’t we all be anyways? I get concerned when I hear it’s “with you forever” because for some of us with food issues that feels like “why bother” when in fact we can do a lot to stop it in it’s tracks! and even if we need meds we can live healthy lives. My mom has had diabetes for 30 years, she’s in her 80’s and is still walking y qué fregosa! She lives with me and we work together to have a healthy diet and walk daily.
I agree about the financial and convenience issues but some ways we can help each other is to grow our own food and share it! Or go to the farmer’s market together and buy in bulk, most farmer’s markets take food stamps now which is very helpful for people receiving those benefits. Starting a walking group helps too.
Anyways, thanks for the post and here’s some more helpful info:
- Amelia ML Montes October 24, 2012 at 8:43 AM
Thank you so much for your “reply.” I am so happy to read that your mom is in her 80s and has been self-managing the disease with a healthy diet and walking. This is key to keeping one’s glucose numbers low so that complications do not occur.And thanks for addressing the topic about “reversing Diabetes.” It’s important to discuss this further. When one is diagnosed with Diabetes (Type II), it means that one’s pancreas is debilitated. It is not able to emit enough cells that can collect glucose from the bloodstream. Some of the cells are malformed. With Type I– the pancreas is not working at all and the individual must be on daily insulin. But with Type I, diet and exercise is still key. With Type II– I think the miscommunication here is about being able to self-manage instead of a life of pills and insulin and becoming progressively worse.So I want to be clear here: what I mean by having if “forever” is that those with Diabetes Type II will always have a debilitated pancreas– always. It’s about what you do with your debilitated pancreas that is the key. If you do nothing, you will obviously get progressively worse. Pills and insulin help but again– with only pills and insulin, you will also get progressively worse.Self-managing your pancreas with diet and exercise (as David Spero points out) can have such great effects that a person may not need insulin, meformin, and other Diabetes medication.I am like Bob and Terri who are on very low carbohydrate diets and exercise daily. They were quoted in the article as feeling healthier than they’ve ever felt before and that their A1C levels are below normal which is GREAT because that will definitely prevent complications.But what will always “forever” be the issue is the pancreas not being able to do the work necessary without the individual helping the pancreas with diet and exercise.
Here’s why diet and exercise is so key:
First: a low carbohydrate diet keeps the amount of glucose in the blood stream minimal so that the pancreas’ low production of cells will not be overtaxed.
Second: Exercise is so important because exercise “stimulates” the pancreas to emit more cells than a normal person would need. And since a debilitated pancreas is creating some normal cells and some misshapen cells, having more cells than one needs will definitely take the glucose out of the bloodstream.
So– low carb diet (making sure you aren’t filling up your bloodstream with glucose) and exercise (stimulating the pancreas to make more cells to take out the glucose) will certainly lower glucose levels and prevent complications.
One does not die of Diabetes. You die from complications of the disease. And when they say “disease”–they’re talking about the debilitated pancreas.
So this is why I say “forever”–I’m talking about the pancreas. And this is why I do not agree with anyone who thinks that they can reverse a debilitated pancreas.
What they CAN PREVENT is getting progressively worse and having complications. So I think it is a matter of semantics. But I worry that people think they can suddenly be Diabetes free. I think the better term is that they are “successfully self-managing the disease” and that is certainly what your mom is doing!
Hope my further explanation helps.
And yes–so important to help each other, go to farmer’s markets, have a walking group. I lead a Diabetes Support Book Group at an Independent Bookstore in town and this has been very helpful. I love the idea of a walking group too!
Sending you and your mom my best wishes, Dawn!
- Anonymous October 22, 2012 at 4:04 PM
I am a Registered Dietitan in Tx. I have seen many patients w/ DM & understand your experience. It is a great article. My one disagreement is w/ Promoting organic foods to be healthy. Yes, they are a “better” choice if possible, but for so many it’s just not an option. Just adds stress to an already stressful situation.
Recommend Fresh or Frozen, as avail.
Thank you for sharing your experience.
- Amelia ML Montes October 24, 2012 at 8:08 AM
Thanks so much for your response to my blog. It is indeed an epidemic in our community and I am hoping with more education, we can help each other. I agree with you that with a healthy diet and daily (and I mean daily!) exercise, people can self-manage the disease. And this is what I mean by having diabetes for the rest of your life: the pancreas will never be a normal pancreas if you have this disease. Being off medication only means that you are self-managing the pancreas/the disease. And this is where it can get dangerous if people think that once they are off insulin or medicine, that they no longer have diabetes. The pancreas has not changed. It is still debilitated. I think the better term is that the individual is able to “self-manage” the disease with diet and exercise.As for reversing Diabetes: Once the pancreas is debilitated, it cannot be “reversed.” I think the word choice is the problem here and in Spero’s article he explains it better. He is talking about doctors who tell patients that they will only get progressively worse. And, like Spero, I disagree with that kind of doom and gloom projection. You will only get progressively worse if you do not do anything about it– but it’s up to you. And that is the key to self-managing: it’s all up to you.
Like Bob (who was quoted in the article), I am on a very low-carb diet and do daily exercise (as my endocrinologist advised) and my A1C level is now lower than what is considered normal. And like Terri (who was also quoted in the article) I also am “far healthier” and feel it is easy now to maintain my glucose numbers. But in the beginning, I knew, when I was diagnosed, that this was going to be a life-long process. It’s important to face the truth. Now I no longer am afraid about this truth. After you get used to self-managing via diet and exercise, it does get easier– but in the beginning it demands a lot of changes in your life.I am so very glad that your mom is doing well and in her 80s. Bravo on the walking– that is key!And yes– growing our own food, farmer’s markets, helping each other– so very important!I’m so glad you wrote in!
Thank you Dawn. Mil gracias!
Sending you and your mom healthy energias!