Perhaps the biggest topic in health and wellness these days is sugar and how to cut back on consuming it. For ages, the average adult would add a spoonful of sugar here and there to food— it never seemed like a big deal. But over time, food manufacturers started adding sugar to just about everything in the grocery store, even foods that you don’t think of as sweet, like crackers and spaghetti sauce.
Today it’s clear that sugar is linked to various illnesses and conditions, and it is likely a major culprit connected to the rise in obesity and weight gain in this country. The information below will give some background on the sugar debate and suggest ways in which you can cut it out for good.
Does Sugar Make You Fat?
Obesity has been a hot topic in recent years, and with good reason. Roughly 38 percent of adults over the age of 19 in the U.S. are obese. What’s more staggering is that more than 70 percent of adults over the age of 19 are overweight or obese, suggesting that most people in this country have weight problems.
Just think about these statistics a bit: seven out of every 10 adults are overweight or obese. From a public health standpoint, effective weight loss programs are important, and it seems that sugar may play a role. Let’s take a look at how sugar is associated with weight gain.
Sugar’s Calorie Content
One of the first things with any body weight management program is to consider how much you eat and to cut out whatever is unnecessary. Sugar is a major culprit in weight gain since it contains calories, but not much else in the way of vitamins, minerals, or anything else that’s good for you. You can find a detailed description of the amount of calories in our calories in sugar guide, but overall, if you eat more than what you need, you will store the extra energy as fat. Some weight loss programs suggest that eating fat is the path to gaining fat, but in reality, it does not matter what nutrient you over consume; the more you eat, the more you gain.
Excess Sugar May Lead to Obesity
Considering the difference between how much sugar we should be eating and how much we’re actually eating, that excess sugar consumption might be one of the key factors in the rise in obesity levels in this country. If the recommended amount of sugar is at most 150 calories each day and the average adult is consuming more than double this value, perhaps the increase in overweight or obese adults is caused by this excess.
If a pound of fat equates to roughly 3,500 calories, and men consume 180 calories (at least) in excess and women consume 230 calories (at least) in excess, this could add up over the years. If you do the math on the extra amount men eat, 180 calories of sugar in excess from what is recommended each day, for a total of 365 days over an entire year, and this amounts to about 19 pounds of fat per year. Do the same math for women and this equates to 24 pounds of fat added each year. Doing the math, it seems clear how sugar can contribute to obesity across the nation.
Cutting Sugar to Lose Weight
One of the first rules in any weight loss program is to burn more calories than what you eat. This method suggests that for every 3,500 calorie deficit, you lose roughly one pound of fat. This is not an exact science, but it is a good way to estimate weight loss. In contrast, if you eat more than what your body needs, then you will gain weight. Figuring out the balance between the energy in and the energy out can be a challenge, but cutting sugar may be one of the best ways to reduce your excessive caloric intake.
If you use the figure of 82 grams of sugar consumed by the average adult each day, it should be no surprise that you could lose some serious weight from sugar alone. Consider this: if you eat a standard 2,000 calorie diet (men or women) each day and you immediately cut all sources of sugar from your usual food and drink, you would reduce your caloric load by 330 calories each day, assuming you eat the average of 82 grams of sugar each day. Reducing your caloric load by 330 calories in sugar each day would translate to about 34 pounds of fat loss each year, or close to three pounds per month.
If you are like many adults out there and you feel your diet is impeccable and that sugar is not an issue, consider this: one medium apple contains about 19 grams of sugar, a banana has 12 grams, one orange has 17 grams, and 1 cup of grapes has 15 grams. You can see that sugar is everywhere, even if you have a healthy diet. It is easy to hit the average 82 grams of sugar each day from fruits alone, but considering a plethora of other foods have sugar in them, it would be easy to consume this much without even touching a candy bar.
Cutting out Sugar Completely Can Be Challenging
One of the biggest issues in any weight loss plan is avoiding things that your brain wants. This is where many adults have issues when it comes to cutting sugar from the diet. The brain has a strong desire to obtain sugar as a way to boost dopamine (known as the happiness hormone), which can be a major sign of sugar addiction. Sugar also provides a quick burst of energy that also floods the brain with compounds that make you feel euphoric. This craving for euphoria is hard to defeat, and it is one of the biggest challenges people have when they’re trying to cut out sugar for good.
9 Effective Ways to Cut Sugar From Your Diet
Now that you have some information on how sugar impacts your weight management, some of the names that it goes by, and the difference between natural and added sugars, you will want to learn about some effective ways to cut sugar out for good. Consider the following tips to aid in your journey to successfully avoid sugar in your daily eating habits.
- Substitute sugary beverages for water.
It may taste boring when you first make this switch, but beverages are the primary source of added sugars in the adult diet. Consider drinking your coffee black without sweetener or sugars and avoid all forms of soda, including ones with artificial sweeteners.
- Be mindful of sugar substitutes.
Avoiding sugar is something that adults on diets aim to do, and many switch to artificial sweeteners as an alternative. While they may be calorie-free, artificial sweeteners and sugar substitutes can be up to 600 times sweeter than regular sugar, which means your brain thinks you are consuming enormous amounts of sugar at one time. This strategy often leads to you having intense sugar cravings throughout the day.
- Avoid fruit juices.
An orange has plenty of sugar, and a cup of orange juice has the juice of five oranges in there—so it has five times the amount of sugar. And that’s if you make the juice yourself. Orange juice found in cartons in the grocery store—even the ones that say they’re not from concentrate— are highly processed, and many brands have added sugar.
- Limit fruit.
If you are serious about cutting sugar from your diet, you should pay attention to how much sugar is in the fruit you’re eating. Fruit can be healthy for you, but you need to limit your intake to 2-3 pieces at most a day—and count that as part of your sugar consumption.
- Avoid jams, jellies, honey, or other preserves.
American breakfasts are often sweet, and jams, jellies, and other options are a source of sugar that you may not think about.
- Eat plain Greek yogurt.
You may be surprised that yogurt is a common source of added sugar—sometimes up to 30 or 40 grams in a serving! Choose plain Greek yogurt, which only has the natural sugars in dairy and no added sugars. Make sure to read the food label to double-check.
- Consider Sweet Defeat.
One amazing way to cut back on sugar and to fight some of the associated sugar cravings is to consider getting a little help. Sweet Defeat is a product that helps fight sugar cravings so that you can effectively eliminate it from your diet. It comes as a lozenge and it contains only five ingredients: gymnema, zinc, mint, sorbitol, and spirulina. The gymnema and zinc work together to temporarily block the sweet taste receptors in the mouth, so you can’t taste sweetness. The lozenge works in a few seconds, and it is clinically proven to stop cravings. Consider taking a look at Sweet Defeat if you are serious about quitting sugar.
- Get used to reading grocery labels.
Even if the ingredient list on your favourite food items doesn’t specifically list “sugar” as an ingredient, there’s still a chance that it could have a high sugar content under the veil of a different name. There are at least 60 other names for sugar out there, with the most common being high fructose corn syrup.
- Know the difference between natural and added sugar.
Not all sugar is created equal and it’s important to know the difference between natural vs added sugar. While it may be difficult to avoid all forms of natural sugar, avoiding added sugars that are refined or processed can be a realistic goal to strive for.
Helpful Weight Loss Tips
If you have ever been on a diet plan only to see it work briefly and then go south from there, then you should consider a lifestyle change to make your plan more effective. Consider the tips below as some of the most effective ways to boost your weight loss journey so that your previous frustrations turn into successes.
Adjust your exercise routine.
One way to boost your weight loss success is to adjust your exercise routine. Many adults hit the gym, perform endless amount of cardio exercise day after day, only to see minimal results. There are a couple of reasons for this. First, your cardio intensity may not be high enough. Consider high-intensity interval training (HIIT) for better results. Second, add a resistance training program—lifting weights, for example—which will help build muscle. Muscle burns more energy than fat, so this will help with weight loss. Changing your workouts to include high intensity interval training as well as resistance training is a great way to boost your metabolism and add lean muscle mass.
Avoid long periods of sitting.
One of the biggest issues with weight loss is that adults go all-out at the gym, only to lose all of the benefits directly afterwards. Studies have shown that sitting for long periods of time can lead to weight gain, suggesting that changing this habit may help with n your weight loss goals. Avoid sitting for longer than 30-60 minutes at a time throughout the day for best results. Taking standing breaks can help to circulate your blood, and it increases your heart rate and metabolism just enough to where your body is not in continuous fat storage mode.
Be mindful of alcohol.
Another factor that adults should watch when attempting to lose weight is alcohol consumption. Alcohol may have some health benefits, but consuming it often can lead to increased fat production as well as inflammation. Consider cutting alcohol from your diet any time you are looking to lose weight and only drink amounts that current health guidelines suggest you consume.
Make a Habit of Walking.
One effective way to control your body weight is to take a brisk walk after each meal. Research has shown that brisk walking after a meal for about 15-45 minutes can lead to an improvement in overall glycaemic control in older adults. An improvement in glycaemic control could cause better usage of insulin, which could lead to a reduction of fat in your body. Consider making a brisk walk a habit after each meal and you may see great benefits in both weight and in mood.
Sugar consumption is linked to a number of health concerns. Perhaps the most concerning one is obesity. Obesity is a highly prevalent issue in the U.S.: seven out of every 10 adults are overweight or obese. And sugar plays a major role in this statistic.
The average American consumes twice as much sugar as what’s recommended. That excess sugar adds up to about 330 calories each day, which means the average adult could be gaining close to 20 pounds a year simply from eating too much sugar. Sugar consumption is likely a major element contributing to obesity levels in this country.
Consider finding healthy ways to cut sugar from your life to help you lose weight. If you find that the easy tips listed above on how to cut back on sugar isn’t enough, and if you are finding it challenging to fight sugar cravings, then consider getting help from Sweet Defeat to boost your success.
SUGAR AND WEIGHT LOSS: HOW SUGAR AFFECTS YOUR WEIGHT LOSS GOALS
In 2015 9.4 % of the American population had diabetes, according to the American Diabetes Association. That is 30 million people with diabetes and the organisation also reported that 84.1 million Americans had prediabetes, meaning they have elevated blood glucose levels, but not high enough to be considered diabetic. 1.5 million Americans are diagnosed with type 2 diabetes every year and diabetes is the 7th leading cause of death in America. Type 2 diabetics make up the majority of people with diabetes. Furthermore, an estimated 415 million people worldwide had been diagnosed with diabetes.
The signs of having diabetes can be various and the consequences can plentiful. Diabetes is an illness that can be debilitating, lower your life quality, and even have fatal consequences as a result of the additional diseases and conditions you can develop if your diabetes is not managed properly – but did you know, that diabetes be managed through your diet?
You Are What You Eat
The food you consume and the fluids you ingest impact your body in numerous ways. Sugar of one kind or another are present in most foods, in varying amounts. This sugar, be it sucrose, fructose, or galactose, needs to be separated from the food in order to be broken down and used by the body. This happens with the help of insulin. In short, insulin is a pancreatic hormone that transports sugar from food into the body’s cells to be used for fuel when needed. The body’s resistance to insulin is measured by its ability to remove glucose (sugar) from the blood and thereby maintaining stable blood glucose levels.
Diabetes is a medical condition that occurs when your body is unable to produce enough insulin to regulate the blood glucose levels, or if your body cannot use its produced insulin efficiently enough. This causes the sugar to stay in the blood stream instead of entering the cells, thus resulting in high blood glucose levels.
There are three types of diabetes: Type 1, type 2, and gestational diabetes. Type 1 diabetes is a genetic, auto-immune disease where the body turns on itself, instructing the immune system to falsely deactivate the pancreas rendering it unable to produce insulin. This type of diabetes usually runs in the family and cannot be prevented or modified with diet or exercise, although a healthy diet is recommended to help prevent additional illnesses that often occur in the wake of diabetes. People with type 1 diabetes depend on daily insulin injections or an insulin pump to help their body turn glucose into energy.
Type 2 diabetes is usually caused by lifestyle choices and circumstances. While you are definitely at a greater risk of developing type 2 diabetes if there is a family history of diabetes, the risk greatly increases if you are overweight or obese, physically inactive, or aging. These risk factors mean that where there used to be a prevalence of older people getting type 2 diabetes due to aging, now there is a surge in diabetes in children and teenagers due to poor dietary choices and an inactive lifestyle.
Certain ethnic groups, such as Pacific Islanders, Indians, Native Americans, and Mexican Americans are also at a higher risk of developing type 2 diabetes.
Type 2 diabetes is a progressive illness and the treatment is dependent on the stage at which it is diagnosed. Symptoms include pronounced dizziness, an involuntary increase in weight, a constant feeling of hunger and thirst, frequent urination, headaches, and mood swings. While there is no cure for diabetes, preventative measures can be taken if you are diagnosed as prediabetic, and there are multiple steps you can take to manage it after being diagnosed with type 2 diabetes.
The last type of diabetes is gestational diabetes, which can occur during pregnancy. Pregnant women are especially vulnerable to the condition if they have a family history of diabetes, are overweight, if they are over the age of thirty, or if they have experienced gestational diabetes in previous pregnancies. The condition rarely requires insulin treatment and can usually be managed with diet. Most often gestational diabetes disappears again after birth.
While a healthy, active lifestyle is also important in order to live a healthy life with type 1 diabetes and gestational diabetes, this article will for all intents and purposes focus on type 2 diabetes. During the course of this article you will learn what diabetes is and how you can tweak your diet to help you manage it and increase your chances of avoiding diabetes complications such as glaucoma, cardiovascular disease, and strokes.
Nutrients for the Body
In order to understand diabetes, it is important to understand how different nutrients affect our bodies. All food consists of one or more macronutrients and a variety of micronutrients. Macronutrients are the major nutritional players such as carbohydrates, fatty acids, and protein, whereas micronutrients are vitamins and minerals.
The human body needs both macro- and micronutrients on a daily basis to thrive. The different nutrients serve different purposes within the body, but they each provide your body with the fuel it needs to perform optimally. Let’s break it down, starting with carbohydrates (the remaining nutrients will be covered later in the article), which is one of the key components in diabetes management. Understanding how carbohydrates is digested and absorbed and thereby affecting your body is paramount to understanding diabetes and learning how to manage it through your diet.
Carbohydrates are molecular structures comprised of carbon, hydrogen, and oxygen atoms. They serve many key functions in the human body including controlling blood glucose levels, aid in cell metabolism and regulate insulin metabolism, and they serve as a primary source of energy.
Carbs are found in such foods as fruit, vegetables, beans, legumes, bread, oats and pasta, and as mentioned they help regulate your blood glucose levels and the glycogen levels in the muscles and give you energy. This happens as you ingest carbs and the body starts breaking it down into glucose, which is then stored as glycogen in the liver and muscles where from it is released as energy when needed.
Carbs can be either simple or complex depending on how complex their molecular structure is:
A monosaccharide is the simplest form of carbs. This basic sugar structure forms the basis for more complex carbs and can by itself be found as glucose in molasses, fructose in various fruits, and galactose in yoghurt for instance. This is a fast, easily digested source of energy.
Comprised of glucose and fructose bound together a disaccharide is also a simple carb. Disaccharides are found in foods containing sucrose (white sugar) or lactose such as dairy products. Disaccharides are also easily digested and provides a quick burst of energy.
Generally speaking, mono- and disaccharides can be found in sweets, juices, honey, corn syrup.
Oligosaccharides and polysaccharides are more complex types of carbohydrates, consisting of three to ten strains of monosaccharides. They are found in fruits, grains and vegetables, and starchy foods. These complex carbs also contain fibre as opposed to the simple carbs. Fibre is a non-digestible complex carb essential in maintaining stable blood glucose levels and keeping your gut and colon healthy. They can be soluble or insoluble.
Carbohydrate Digestion and Absorption
The main function of a carbohydrate is to provide your body with energy. No matter what type of carbohydrate you ingest the digestive process begins in the mouth. Your saliva contains an enzyme known as salivary amylase, which begins breaking down the carbohydrates as you are chewing them up, mixing them with saliva. The food is then swallowed and transported to the stomach and on through to the small intestine known as the duodenum.
Once nestled in the duodenum, a substance called pancreatic amylase is released by the pancreas, hence the name. This pancreatic enzyme proceeds to break down polysaccharides into disaccharides, which is then broken down even further by enzymes produced by the duodenum itself. These enzymes, lactase, sucrase and maltase break down the disaccharides into monosaccharides readily absorbed by the body. The actual absorption happens in the duodenum and the energy is stored in the liver and muscle tissue.
At this point most of the carbohydrates from your meal has been broken down, absorbed by your body and stores accordingly. There are, however, some carbohydrates which cannot be broken down the duodenum and these are instead transported to the large intestine, the colon. Here the ones that can be broken down into smaller pieces are done so by the intestinal bacteria that flourishes in our colon. Some nutrients are, however, non-digestible and are therefore excreted through bowel movements. This is true for insoluble fibres, for instance, which serve the main purpose of keeping our bowels healthy by absorbing water to aid in a smooth digestion and regular bowel movements.
Blood Glucose, Glycogen, and Insulin
Having covered the various types of carbohydrates as well as fibre it is time to look at why exactly that is relevant when addressing the issue of type 2 diabetes.
Here is what we know so far: The body converts carbohydrates into glucose to be used for energy. The glucose levels in the blood are regulated by insulin, a hormone produced by the pancreas. Type 2 diabetes is a condition where the person has constantly high blood glucose levels because the pancreas is unable to produce sufficient amounts of insulin.
After you ingest a meal there will naturally be a spike in your blood glucose levels as insulin is released to direct the glucose into the liver and muscle cells for storage, thereby preventing your blood glucose levels from rising too much. When the glucose is stored in the liver and muscle cells it changes into a readily available form of energy called glycogen. Then, when needed, glycogen is converted back to glucose and released back into the bloodstream. Your blood glucose levels are called glycemia and when the body is unable to produce sufficient insulin to regulate it, you might get hyperglycaemia, meaning you have unusually high blood glucose levels.
So, what is the fuss, you may ask. Well, as explained, hyperglycaemia means that your blood glucose levels are too high. It is a condition that develops over a few days or a week, and it can have quite severe consequences if not treated.
Early symptoms are:
Headaches and dizziness
Blurred vision and fatigue
These are the early signs of hyperglycaemia and if treated appropriately it can be brought back under control. If you are diabetic, refer to your doctor’s instructions and how to administer your insulin. If you have not been diagnosed with diabetes, consult your doctor and inform him of your symptoms. If these early signs are not treated, hyperglycaemia will develop further and can cause the build-up of ketones in your blood and urine and can lead to ketoacidosis.
Later symptoms include:
Breath that smells fruity
Confusion and weakness
If hyperglycaemia goes untreated for long periods of time, such as if a person’s diabetic condition is not managed properly, it can have consequences such as cataract, blindness, bone and joint problems, and trouble healing wounds and sores. If you are experiencing any of these symptoms in a manner that concerns you, please see your general health provider and talk to them about your concerns. They will be able to do a blood test to determine if you have diabetes.
You can also experience hypoglycaemia, a condition where your blood glucose levels drop below average, causing dizziness, nausea, trembling, hunger, paleness, and sweating. If you measure your blood glucose levels and they are below 4mmol/L it is important to act on it. Hypoglycaemia can be caused by strenuous exercise, not eating enough carbohydrates in a meal, injecting too much insulin, or drinking a large amount of alcohol. If acted upon quickly, it can usually be remedied swiftly by ingesting a sugary snack, followed by a meal with slow acting carbohydrates once your blood glucose levels have stabilized.
The Glycaemic Index (GI)
As it has been established, different types of carbohydrates are digested by the body at different speeds. Fast-acting carbs such as sugary snacks and beverages, white bread and potatoes, raise your blood glucose levels at a high speed, while slow-acting carbs such as soy products, lentils, grains, porridge and fruit are digested slower and therefore helps keep your blood glucose levels stable. A scale has been established to help differentiate between foods that elevate your blood glucose levels and foods that help keep your levels stabile. This is called The Glycaemic Index (GI).
The GI is a sliding way of rating foods based on how they affect your blood glucose levels over a period of time; usually a period of two hours. The scale goes from 0-100 and food is measured against the reference foods glucose or white bread, which have a GI score of 100. The scale compares the different foods to the reference food, measuring it gram for gram. A food item with a GI score less than 55 is considered low GI. A medium GI score is between 55 and 70 and a high GI score is 70 and above, ranking the foods on this end of the spectre the as having the most impact on your blood glucose levels.
There are a number of factors that can affect a foods GI score. These include things such as texture, size, ripeness, fibre and fat content, and the way a food is processed or cooked. To make matters more complicated, most meals are usually made up of various foods with different GI scores, which means that they affect each other. Mixing different foods can actually mean that a food with a high GI score can end up with a low GI score when partnered with the right type of food.
Below is a short (and by no means complete) list of foods with low GI scores.
Foods with a low GI score:
Dairy products (reduced or low-fat products are recommended for people with diabetes)
Porridge and natural muesli.
Wholegrain bread and grains in general, such as barley and bulgur
Pasta and noodles
Legumes (beans, lentils, peas)
Vegetables and fruit
Managing Your Diabetes
So, let us get down to brass tacks: How do you successfully manage and live with a diabetes diagnosis?
When you have type 2 diabetes your pancreas is usually still working to some extent, as opposed to type 1 where the immune system has erroneously, but effectively, killed off most, if not all, of the insulin producing pancreatic cells. This means that type 2 diabetes is a progressive condition where the body will grow more and more insulin resistant and while you might be able to successfully manage it and function with a healthy diet and exercise, you may require insulin injections as the diabetes progresses and the body’s ability to regulate its insulin production fails additionally. Therefore, it is paramount that you adopt a somewhat healthy diet to help your body manage its blood glucose levels.
A Healthy Diet
A healthy dietary routine is recommended for everyone regardless of whether or not they have diabetes, but it is especially important for diabetics. Now, that does not mean that you can’t have your favourite treats once in a while, it just means that you have to put a bit more aware of what you eat.
The type of diet you choose will depend on your personal preferences and your lifestyle. In essence it is all about balance. A well-balanced diet is one consisting mainly of quality macro- and micronutrients from wholefoods such as wholegrain bread, vegetables, fruit, nuts, dairy, beans, legumes, meat and fish, but it also leaves a little room for the things you like to indulge in, such as chocolate for instance.
What is important is that you form realistic dietary habits that can be sustained long-term and incorporated into your daily routine. You should aim to eat three main meals and two snacks a day to keep your blood glucose levels stabile and you should hydrate with water frequently. We will have a look at a few ways to structure your meals throughout the day and a couple of dietary plans that are recommended for diabetics, but before diving into that, let’s have a look at the other macronutrients, as well as some of the important micronutrients.
Protein is an important macronutrient, playing a role in all cellular processes in the body. Proteins are made up of amino acids. There are 22 amino acids, which can be utilised by the human body. Of these 22 amino acids, the body can only synthesise 13, leaving the remaining 9. These 9 amino acids are known as essential amino acids and can only be found in food.
Proteins serve a lot of different functions in the body. Their main function is building, maintaining and restoring muscle tissue and cells. While protein can actually be found in most foods, quality sources are preferred. These include various beans, tofu, fish, lean meats, poultry, eggs and dairy products. The recommended daily intake is 0.8 grams per kilogram body weight. Protein is filling and helps keep you satiated longer.
Fatty acids are hydrocarbon chains with a tail of carboxylic acid groups. They are hydrophobic, which is why fat and water do not mix. Fatty acids serve several important functions in the human body, including providing vital fuel for the body’s cell and serving as a storage unit for energy within the adipose tissue.
There are different types of fats. Some are beneficial for the body and some are harmful. When you are diabetic, you have a higher risk of heart problems, which is typically associated with a high blood cholesterol count. Foods rich in saturated fats raise your blood cholesterol level, making you more vulnerable to heart problems. Instead, choosing healthy fats can actually help lower your risk of having a stroke.
Monounsaturated fats: A general rule of thumb is that unsaturated fats are good for your body, because they help lower your LDL cholesterol, which is the type of cholesterol that increases your risk of heart problems. Monounsaturated fats are liquid at room temperature but turn solid when put in the fridge for instance. Foods rich in monounsaturated fats include avocado, olive oil and olives, various nuts, safflower oil, and herring.
Polyunsaturated fats: Like monounsaturated fats, polyunsaturated fats are also good for your body and your heart. Try to make these types of fats the majority of fats in your diet. polyunsaturated fats are also heart healthy, helps lower your LDL cholesterol and provides the body with healthy and important vitamins and omega-6 and omega-3 fatty acids. Foods high in polyunsaturated fats include tofu, sunflower oil, walnuts, chia and flax seeds, and salmon.
Saturated fat and trans fatty acids: Try to keep these types of fat out of your diet as far as possible. The nature of their molecular structure means that they raise your blood cholesterol level, thereby increasing your risk of heart disease. Foods to avoid includes butter, high-fat dairy and meat products like bacon, hot dogs and sausages, highly processed foods such as chips and baked goods, lard, and palm oil. You may think that avoiding these items is easy, but look at the ingredients list next time you go shopping and you might be surprised to learn how prevalent these types of foods really are.
Let’s have a look at those small, but important micronutrients. Micronutrients are a blanket term for all the various vitamins and minerals that are present in food. If you eat a wholesome, healthy varied diet based on whole foods and plants, you will most likely get all your required micronutrients, with a couple of exceptions. If you want to be sure you are getting everything you need, a multi-vitamin is a good choice to supplement your diet. A multivitamin cover pretty much all your bases and tops of a well-rounded diet.
Vitamin D is a very important vitamin, especially if you live in a country where the sun does not shine a lot. Vitamin D is a fat-soluble vitamin, meaning it is stored in the body’s fatty tissue and you can build up a small reserve in the body. Your body synthesizes the vitamin in the liver and kidney from an inactive form of the vitamin that comes from sunlight and is found in various foods. Vitamin D is actually a hormone and it is essential for a healthy, thriving body as it controls the calcium levels in the body and is needed to absorb calcium from the food. It is vital for maintaining strong bones and muscles, and for an overall good health.
In the summertime you will probably get enough vitamin D if you spend time outside with any exposed skin. Remember, however, to be sun safe. Because vitamin D is stored in the body it can only be absorbed in small doses. Spending an extended time in the sun will therefore not increase the amount of vitamin D absorbed, but it will increase your risk of melanoma from exposure to harmful ultraviolet rays. In the winter it is recommended that you take a supplement. Foods high in vitamin D include fatty fish such as salmon, mackerel, and sardines and it can also be found in eggs, mushrooms, and caviar.
Calcium is important in maintaining healthy bones and is best absorbed when eating with a source of vitamin D. Try, as far as possible, to eat foods containing the two vitamins, together. Calcium is found in dairy products, almonds, tofu, oats, and green leafy vegetables.
Iron is another important micronutrient one and while actually being a mineral, and not a vitamin, iron is important because it is the main part of haemoglobin. Haemoglobin is the part of the red blood cells that obtains the oxygen in the lungs and transports it around the body, and a sufficient iron supply is important to ensure that this process happens correctly. If you are lacking in iron your body will lack enough healthy, red blood cells and they will have a hard time transporting the amount of oxygen required by the body to function properly. This will leave you fatigued and disoriented. Especially women are in danger of becoming iron deficient and it is recommended that they take a supplement.
Iron can be found in meat, spinach and other leafy, green vegetables, tofu, and fortified cereals. It is best absorbed when consumed with a source of vitamin C. If you are supplementing with iron tablets, try washing them down with a glass of water with lemon juice squeezed in.
Vitamin C is also known as ascorbic acid and like mentioned above, this vitamin helps the absorption of iron and strengthens the immune system. It is a water-soluble vitamin, meaning it is not stored in the body and needs to be replenished regularly. Vitamin C can be found in lemons and limes, kiwi fruits, berries, leafy green vegetables, tomatoes and potatoes.
B vitamins are a group of collection of micronutrients that all have important functions in the body. The group consists of eight different vitamins:
Thiamin (B1) helps convert glucose into energy and serves an important role in a functioning nervous system. Good sources of thiamin include sesame seeds, legumes, nuts, and yeast.
Riboflavin (B2) is vital for healthy skin and a strong vision. Sources include dairy products such as cottage cheese and yoghurt, egg white, lean meats, wholegrain bread and cereals.
Niacin (B3) assists in energy conversion and aids in maintaining healthy nervous and digestive systems. Niacin can be found where there is protein present. It is also found in nuts, mushrooms, and most type of meats.
Pantothenic acid (B5) also plays a part in energy conversion as well as being a crucial aid in producing red blood cells and steroid hormones. B5 is found in foods such as legumes, liver, kidney, eggs, and peanuts.
Pyridoxine B6 is an important vitamin because besides assisting in protein and carbohydrate metabolism, it also influences brain development, and the immune system. It is abundant in meat, fish and shellfish, nuts, and leafy vegetables.
Biotin (B7) is also used for energy metabolism, as well as fat and glycogen synthesis, and amino acid metabolism. It can be found in egg yolks, peanuts, liver, and chicken.
Folic acid (B9 or folate) is instrumental in foetal development (pregnant women should take a supplement or be highly aware of their folate intake through diet), cell growth, and the forming of red blood cells. Folic acid is the synthetic form available through supplements, while the organic form known as ‘folate’ can be found in legumes, seeds, leafy green vegetables, poultry, eggs, and cereals.
Cyanocobalamin (B12) is especially important and contributes to the forming of new red blood cells, maintaining myelin around cells, and energy conversion. If you are vegan, vegetarian or eat a plant-based diet, it is important that you take a daily B12 supplement as the vitamin is only found in animal products.
Most of these vitamins are water-soluble (with the exception of B12 and folic acid), so just like vitamin C they need to be replenished on a daily basis because they are only stored in the body for a short amount of time.
For many people a bit of alcohol is a way to unwind after a long day. They might enjoy a glass of wine while cooking dinner, a beer before bedtime, or a night out with their friends, but where does alcohol figure in the diet of someone living with diabetes? The answer is not a straight-forward as you may think. According to the American Diabetes Association people with diabetes can indeed enjoy a drink every now and then, but they should be aware of the risks. Here are a few guidelines to ensure that you can safely enjoy a drink or two:
The recommended alcohol intake is no more than one drink per day for women and two drinks per day for men.
Alcohol blocks the liver’s ability to turn glycogen into glucose to release into the bloodstream, making it hard for your body to try and self-regulate if your blood glucose levels get too low.
If you are taking any medications be sure to check with your doctor so you know how those medications interact with alcohol and with your diabetes.
Get a diabetes ID that lets people around you know that you have diabetes in case you become hypoglycaemic and need assistance.
Plan ahead. If you know you are going to be drinking later, have a meal consisting of slow-acting carbohydrates, lean protein, and healthy fats. Alcohol can lower your blood glucose levels and cause hypoglycaemia and the risk increases if you drink on an empty stomach.
If you are going to be drinking fun mixed drinks, aim for diet versions of the mixers as sugar-laden drinks will raise your blood glucose levels.
Don’t drink and drive.
Because alcohol consumption can cause hypoglycaemia up till 24 hours after drinking, you should always check your blood glucose levels before you drink, while you are drinking, before you go to bed, once or twice throughout the night, and frequently the following day. Generally, you should speak to your health care provider about how alcohol can affect you and what precautions you should take if you are insulin-dependent or take other medications.
It’s important to stay hydrated and while you should definitely indulge in water throughout the day, it can be a bit tricky to figure out what other beverages are okay to consume. In general, try to stay away from sugar-filled drinks such as regular sodas, energy drinks, juices, etc. They all contain copious amounts of sugary carbohydrates, which will raise your blood glucose levels. Instead, opt for unsweetened teas and coffee, low-fat milk, and water, or try a delicious matcha tea with abundant health benefits.
Water should be the main part of your daily fluid intake, but if you are getting a bit bored with plain old water, try putting lemon or lime in it, or maybe a few herb leaves such as mint.
Now, let’s have a look at how you can structure your meals to ensure stable blood glucose levels throughout the day, while keeping you full and nourished. When constructing your meal plan, try opting for the mono- and polyunsaturated fats that you can find in for instance fish, avocado, walnuts, chia and flax seeds, and avoid the saturated and trans fatty acids found in heavily processed products and deep-fried foods. Go for those slow-acting, low GI carbohydrates for blood glucose stability and choose good quality, lean meats, fish and shellfish. Drink water throughout the day to stay hydrated.
Eating Patterns and Meal Plans
Generally, you should try to aim for natural, whole foods, meaning foods that have not been altered from their natural state or processed in any way. Alternatively, go for the foods with the least amount of processing. Think vegetables, fruit, beans and legumes, and go for foods with a low GI score to avoid unstable blood glucose levels. Whole foods do not contain additives like sodium, fats or preservatives and they contain natural vitamins and minerals.
Choose lean meats such as fish or chicken filets instead of processed cold cuts, which can be full of preservatives, fats, sodium, and flavouring agents, and choose fresh fruits, berries and yoghurt and nuts for a breakfast smoothie instead of processed and sugar filled cereals.
Constructing a physical plan with your meals for the week is generally a good idea. Sit down, get out a pen and paper and write down what you (and your family) are going to eat the coming week. It helps make things manageable in a busy everyday life and ensures that you eat a varied diet. Here are nine simple guidelines to keep in mind when constructing a meal plan:
Know your GI scores. Look up the GI scores for some of the foods you eat on a regular basis and know where to look to find information on a new food when you need it. You will find the most comprehensive guide on the Glycaemic Index Foundation’s website. Here you can also find extensive information about managing diabetes as well as examples of various meal plans.
Make your foundation plant-based. Choosing to base your diet primarily on plants may not be such a bad idea when measured on a number of issues. Studies show that people who eat a plant-based diet have lower blood pressure and cholesterol levels; they have an easier time maintaining a steady weight (something that is also important for diabetics) and they are able to keep their blood glucose levels more stable than people who does not eat a plant-based diet.
Note that a plant-based diet does not necessarily exclude meats and dairy products, but should you choose to exclude meat and/or dairy products from your diet there will be tips and meal ideas further down.
Choose quality sources of protein. Supplement your plant-based diet with good protein sources from white meat and fish. White meat includes poultry and is generally more lean than dark meat, making it low-fat and low-calorie. Fish also comes with a myriad of health benefits, such as being rich in poly-unsaturated fatty acids and high in vitamin D. Aim at making fish a part of your meal plan at least 2-3 times a week.
Cut out the simple carbs as much as possible. As mentioned previously, fast, sugary carbohydrates will raise your blood glucose levels fast and leave them unstable. Try to avoid sugary and processed foods.
Eliminate saturated fats and trans-fats. It’s been established that diabetics have a greater risk of developing heart disease and suffering strokes. As saturated fats increase your blood cholesterol and trans-fat have been linked to heart disease and cancer, cut those out of your diet for a more heart healthy lifestyle. These fatty acids can be found in such foods as pastries and baked goods and fried foods of all kinds.
Eat breakfast. It is true what they say about breakfast being the most important meal of the day. What you choose to consume in the morning will be what will fuel you for the first part of the day and it is the meal that breaks the fast of the night. A healthy breakfast that starts the day out right with stable blood glucose levels contains healthy fats, protein and complex carbs. An example could be smashed avocado on wholegrain bread with a boiled egg on the side, hold the salt. Don’t forget to drink water first thing in the morning.
Fill up on beans. Whether you are trying to decrease your intake of meat or just want to switch up your diet a bit and try something new, beans contain lots of good protein and fibres, and they are tasty and filling. Kidney beans, chickpeas, butter beans, whatever your preference, cook them up and try them in a meatless tortilla or toss up a five-bean salad for lunch.
Go easy on the salt. Too much salt can cause hypertension, which is something you want to avoid when you have diabetes. Try other ways to season your food such as various herbs and spices.
Stay hydrated. Starting your day with a large glass of water is a great idea. It kickstarts your metabolism, which has been laying low while you were sleeping, and it gives you a fresh start to the day. It is important to keep hydrated by drinking water regularly throughout the day, so aim to drink eight to ten glasses of water daily. Try it with a few slices of lemon or lime for a fresh twist.
Sometimes it can be a bit hard to pinpoint exactly what constitutes a “healthy, varied diet good for diabetics”, but luckily the American Diabetes Association has a few recommendations for what to eat. Here are two examples of healthy diets recommended for people with diabetes.
The Mediterranean Diet
With its abundance of fruit and vegetables and its focus on mono- and polyunsaturated fatty acids from fish and olive oil, this way of eating has been hailed one the healthiest around and it is a great way to eat if you are diabetic. As the name suggests, this way of eating and viewing food stems from the countries in the Mediterranean and it is a diet that focuses on choosing whole foods over processed foods.
The diet is rich in vegetables, fruit, nuts and seeds, legumes, whole grains, and a wide variety of seafood, and olive oil as well as different variations of olives themselves are added to the meals in abundance.
Herbs and spices are generously sprinkled in the cooking and food is usually drizzled with healthy quantities of extra virgin olive oil and eaten with whole grain bread and a good quality feta. Meat, including both red meat and poultry, eggs, and dairy is used scarcely, and sugary drinks, refined oils, and processed foods rarely ever eaten.
The key to mastering this way of eating and turning it into a healthy, delicious way of managing your diabetes, is thinking in terms of whole, single ingredient foods. This is a recommended way of eating for diabetics because it is nutritious and healthy, it is high in mono- and polyunsaturated fats and low in sugar, sodium, and saturated and trans fats. Due to its abundance of healthy fats from olive oil, avocados, nuts and fish it is a heart healthy diet that lowers LDL cholesterol in the blood, thereby lowering the risk of heart problems and cardiovascular disease.
While this diet is healthy and great for people with diabetes there is, however, something you need to be mindful of. Adopting a Mediterranean way of eating comes with great health benefits, but it can also come with a high calorie count. Olives, olive oil, fatty fish, feta, and so on are all high-calorie foods, so be mindful of your intake to avoid gaining unwanted pounds.
A Healthy Diet for Diabetic Vegans or Vegetarians
Many Americans are going either vegetarian or vegan for a myriad of reasons, including making an effort to have a lower carbon footprint, taking a stand against conventional farming, or simply for health reasons. If you are living a plant-based lifestyle and foregoing the meat and maybe even dairy products as well, you may be wondering if that is a healthy lifestyle for someone with diabetes.
According to the American Diabetes Association a vegetarian or vegan diet is good choice for someone with diabetes as it is usually abundant in fruit and vegetables, and thereby full of vitamins and minerals. The base foods are usually rich in carbohydrates, but if you fill up on those slow-acting, low GI carbs, it can be a really nutritious and healthy way to eat. Choose beans, grains, legumes, tofu, and all the greens you can eat and enjoy a heart healthy, fibre-rich, inexpensive way of eating that will lower your cholesterol levels and keep your blood glucose levels steady.
The Diabetes Plate Method
Besides the two eating patterns suggested above, there are a whole range of other diets that might be suitable for diabetics. Whichever way you choose to fulfil your dietary needs, you can structure your meals after the Diabetes Plate Method for a quick, easy-to-remember way of eating healthy.
The idea is that you divide your plate in three: Half your plate is filled with non-starchy vegetables such as asparagus, green beans, cabbage, celery, cauliflower and mushroom. One quarter is filled with low GI grains and starchy foods, for instance bulgur, barley, brown rice or whole meal pasta. The last quarter is filled with lean protein, a food group that includes skinless chicken or turkey, various beans, fish and shellfish, tofu, nuts, and nut butters.
Meal Plan Examples
So, now that you have this vast knowledge of nutrition and how you can manage your blood glucose levels with the foods you choose, let’s put it into a meal plan. Below are two examples on what an average day might look like.
Mediterranean Style Meal Plan
Breakfast: Green smoothie breakfast bowl
Try a quick, easy-to-make, delicious smoothie bowl for a scrumptious morning tea to start your day off. Enjoy with a tall glass of water and maybe a cup of green tea.
Morning snack: One banana and a handful of almonds and walnuts will help tide you over until lunch.
Lunch: Grilled shrimp pitas
This is another quick treat that will satisfy your umami-craving palate and your hungry stomach by loading you up with delicious feta cheese, succulent grilled shrimps, and cooling gazpacho soup.
Afternoon snack: For most people the afternoon is where the cravings start to set in. Try to stay ahead of the curve by snacking on cucumber sticks, sliced carrots and celery sticks dipped in a yummy avocado-cucumber dip. Add a couple of garlic-chili soaked olives for a small dose of healthy fats.
Dinner: Greek salad pizza
Eating healthy does not have to be boring, and this delicious Greek style pizza is sure to satisfy your senses. Top with smoked salmon and serve with homemade tzatziki.
If you are craving something sweet at the end of the evening, try cutting up an apple and a couple of carrots and enjoying them with a bit of tzatziki or avocado-cucumber dip.
Vegetarian Style Meal Plan
Breakfast: Try a healthy smoothie with almond, blueberries and flax seeds for a nutritious, fulfilling breakfast treat packed with Omega-3 fatty acids and fibre.
Morning snack: A handful of mixed nuts, an apple, or a banana and maybe half an avocado with cottage cheese.
Lunch: This bibb and bean burrito bowl is a fun way to eat beans. Beans are full of protein and nutrients and they help manage your blood glucose levels.
Afternoon snack: Make your own delicious hummus and enjoy it with a selection of sliced vegetables.
Dinner: These yummy falafels will have your mouth watering while you’re cooking. Try them in a wrap with lettuce, tomatoes, avocado, purple onion, cucumber and salsa, or dip them in hummus.
HOW TO MANAGE YOUR TYPE 2 DIABETES WITH DIET – BY JEN MILLER
STAY IN CONTROL OF YOUR DIABETES
There are four things you need to do every day to lower high blood sugar:
- Eat healthy food
- Get regular exercise
- Take your diabetes medicine
- Test your blood sugar
If you have diabetes, you should try to keep your blood sugar level as close as possible to that of someone who doesn’t have diabetes. This may not be possible or right for everyone. Check with your doctor about what the right range of blood sugar is for you.
You will get plenty of help in learning how to do this from your health care team, which is made up of your doctor, nurses, and dietitian.
Bring a family member or friend with you when you see your doctor. Ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.
Eat Healthy Food
The foods on your diabetes eating plan are the same ones that are good for everyone. Try to stick to things that are low in fat, salt, and sugar and high in fibre, like beans, fruits, vegetables, and grains.
- Eating right will help you:
- Reach and stay at a weight that is good for you
- Keep your blood sugar in a good range
- Prevent heart and blood vessel disease
Ask your doctor for the name of a dietitian who can work with you on an eating plan for you and your family. Your dietitian can help you plan meals with foods that you and your family like and that are good for you.
If You Use Insulin
- Give yourself an insulin shot.
- Eat about the same amount of food each day at about the same time.
- Don’t skip meals, especially if you’ve already given yourself an insulin shot. Your blood sugar may go too low.
If You Don’t Use Insulin
- Follow your meal plan.
- Don’t skip meals, especially if you take diabetes pills. Your blood sugar may go too low.
- Skipping a meal can make you eat too much at the next meal. It may be better to eat several small meals each day instead of one or two big ones.
Get Regular Exercise
- Being active each day is good for everyone. Good ways to do it include:
- Playing sports
- Cleaning your house or working in your garden count, too.
- Getting active is especially good for people with diabetes because:
- It helps keep your weight down.
- Your insulin may lower your blood sugar more easily.
- It helps your heart and lungs work better.
Exercise gives you more energy.
Before you start, talk with your doctor. If you have high blood pressure or eye problems, some exercises, like weightlifting, may not be safe. Your doctor or nurse will help you find safe exercises.
Try to exercise at least three times a week for about 30 to 45 minutes each time. If you haven’t been active in a while, ease in. Start with 5 to 10 minutes, then work up from there.
If you haven’t eaten for more than an hour or if your blood sugar level is less than 100-120, have something like an apple or a glass of milk before you exercise.
When you’re being active, carry a snack with you in case your blood sugar drops. Make sure to carry an identification tag or card that says you have diabetes.
If You Use Insulin
- Exercise after eating, not before.
- Test your blood sugar before, during, and after. Don’t exercise when it’s higher than 240.
- Avoid exercise right before you sleep. It could cause low blood sugar during the night.
If You Don’t Use Insulin
- See your doctor before starting an exercise program.
- Test your blood sugar before and after exercising if you take diabetes pills. You want it no lower than 70 or no higher than 240.
Take Your Diabetes Medicine Every Day
Insulin and diabetes pills and shots are the kinds of medicines used to lower blood sugar. These can include:
Exenatide Extended Release (Bydureon)
If You Need Insulin
This is you if your body has stopped making insulin or if it doesn’t make enough. Everyone with insulin-dependent diabetes (or type 1 diabetes) needs insulin, and many people with type 2 diabetes also need it.
Insulin can’t be taken as a pill. You will have to give yourself shots every day. Some people give themselves one a day. Some people give themselves two or more a day. Never skip a shot, even if you are sick.
Insulin is injected with a needle. Your doctor will tell you what kind of insulin to use, how much, and when to give yourself a shot. Talk to your doctor before changing the type or amount of insulin you use or when you give your shots. Your doctor or the diabetes educator will show you how to draw up insulin in the needle. They’ll also show you the best places on your body to give yourself a shot. Ask someone to help you with your shots if your hands are shaky or you can’t see well.
Good places on your body for a shot are:
- The outside part of your upper arms
- Around your waist and hips
- The outside part of your upper legs
- Avoid areas with scars and stretch marks.
- Ask your doctor or nurse to check your skin where you give your shots.
At first, you may be a little afraid to give yourself a shot. But most people find that the shots hurt less than they expected. The needles are small and sharp and do not go deep into your skin. Always use your own needles, and never share them with anyone else.
Your doctor or diabetes educator will tell you how to throw away used needles safely.
Keep extra insulin in your refrigerator in case you break the bottle you’re using. Don’t keep insulin in the freezer or in hot places like your glove compartment. Also, keep it away from bright light. Too much heat, cold, or bright light can damage insulin.
If your body makes insulin but it doesn’t lower your blood sugar, you may have to take diabetes pills or some other injectable. These only work in people who have some insulin of their own. Some are taken once a day, and others are taken more often. Ask your doctor when you should take yours.
Diabetes medications are safe and easy to take. Be sure to tell your doctor if yours make you feel bad or if you have any other problems.
Remember, you’ll still have to follow an eating plan and exercise to help lower your blood sugar.
Sometimes, people who take diabetes pills may need insulin shots for a while. This may happen if you get very sick, need to go to a hospital, or become pregnant. You may also need them if the diabetes pills no longer lower your blood sugar.
You may be able to stop taking diabetes pills if you lose weight. Losing even a little bit can help lower your blood sugar.
If You Don’t Use Insulin or Take Diabetes Pills
Everyone with diabetes needs to follow their doctor’s advice about eating and getting enough exercise.
Test Your Blood Sugar Every Day
You need to know how well you are taking care of your diabetes. You need to know if you are lowering your blood sugar. The best way to find out is to test your blood. If it has too much or too little sugar in it, your doctor may need to change your eating, exercise, or medicine plan.
Some people test their blood once a day. Others do it three or four times a day. Your doctor may want you to test before eating, before bed, and sometimes in the middle of the night. Ask your doctor how often and when you should test your blood sugar.
How to Test Your Blood Sugar
You need a small needle called a lancet. You also need special blood testing strips that come in a bottle. Your doctor or diabetes educator will show you how to test your blood. Here are the basic steps to follow:
Depending on your monitoring device, prick your finger or another area of your body with the lancet to get a drop of blood.
Place the blood on the end of the strip.
Put the strip into the meter. The meter will display a number for your blood sugar, like 128.
Pricking your finger with a lancet may hurt a little. It’s like sticking your finger with a pin. Use the lancet only once, and be careful when you throw away used ones. Ask your doctor or nurse how to get rid of them safely.
You can buy lancets, strips, and meters at a drugstore. Ask your doctor or diabetes educator for advice on what kind to buy. Take your blood testing items with you when you see your doctor or nurse so that you can learn how to use them the right way.
Other Tests for Your Diabetes
Urine Tests: You may need to test your urine or blood for ketones when you are sick or if your blood sugar is over 240 before eating a meal. Your body makes ketones when there is not enough insulin in your blood. They can make you very sick.
You can buy strips for testing urine ketones at a drugstore. Also, some blood glucose meters can detect ketones with specialized strips. Your doctor or diabetes educator will show you how to use testing monitors correctly.
Call your doctor right away if you find ketones when you test. You may have something called ketoacidosis. If not treated, it can cause death.
Signs of ketoacidosis are:
- Fast breathing
- A sweet smell on the breath
NOTE: Ketoacidosis is more likely to happen in people with insulin-dependent diabetes.
The Haemoglobin A1c Test: This shows what your average blood sugar was for the past 3 months. It shows how much sugar is sticking to your red blood cells. The doctor does this test to see what level your blood sugar is most of the time.
To do the test, the doctor or nurse takes a sample of your blood. The blood is tested in a laboratory. The laboratory sends the results to your doctor.
See your doctor for a haemoglobin A1c test every 3 months.
Keep Daily Records
Write down the results of your blood tests every day in a record book or notebook. You may also want to include what you eat, how you feel, and how much you’ve exercised.
By keeping daily records of your blood and urine tests, you can tell how well you are taking care of your diabetes. Show your book to your doctor. She can use your records to see if you need to make changes in your insulin shots or diabetes pills or in your eating plan. Ask your doctor or nurse if you don’t know what your test results mean.
Things to write down every day in your notebook are:
- If you had very low blood sugar
- If you ate more or less food than you usually do
- If you felt sick or very tired
- What kind of exercise you did and for how long
TAKING CARE OF YOUR DIABETES EVERY DAY – STAY IN CONTROL OF YOUR DIABETES