Once you’ve been diagnosed with diabetes, it is important to know what you can do to manage it and gain control!

The first thing to do is to work with your GP. If your GP has prescribed medication, or given you a referral to a specialist, it is important to follow your GP’s plan.

Aside from medication, there are other things you can do to help manage your diabetes. Lifestyle modification – including increasing your activity levels, and improving your diet – is effective in assisting in the management of type 2 diabetes.

Exercise improves glucose control in a number of ways. When you exercise, glucose is utilised as a source of energy. Glucose is stored in your blood, muscle and liver, so that after you exercise, the amount of glucose in your muscle and liver has been reduced. The next time you eat, glucose replenishes those diminished stores, rather than building up in your blood.

If you build some muscle through resistance exercises (also known as “weight training”), this provides even more storage sites for glucose, which also help to reduce the amount of glucose building up in your blood.

When you exercise, you also improve your insulin sensitivity – this means your cells respond better to insulin, so less of it is required to perform the same job. This also helps to improve your glucose control. On top of that though, it means your insulin levels tend to be lower – which is really important if you’re looking to lose weight, as high insulin levels signal your body to store fat from the food you eat, and prevent that fat being used as an energy source.

When it comes to diet, stick to a few simple rules to help keep you glucose levels in control:
-    Slow & steady carbs!
You’ve probably heard about low GI carbohydrates a lot! And it can be hard to know what to go for. Choose brown and grainy options over white options wherever possible! Except for rice – the best rices to go for are a couple of “white” options – doongara and basmati. These are even better than brown rice in terms of GI!
-    Go for green!
Fill up your plate with veggies at every meal – these provide lots of vitamins and minerals, but also tend to be low GI, helping to keep you feel satiated for longer. Plant sources of fats also tend to be mono and polyunsaturated (which are the good kind!) – things like avocado, nuts and seeds.
-    Keep it lean!
When it comes to animal sources of protein, trim all visible skin and fat prior to cooking, and keep portion sizes for meat to the size of the palm of your hand and fish up to the size of your whole hand.

For ideas about what sort of exercise you should get into, and meal and nutrition ideas, check out The Glucose Club’s articles page, or book into see one of our accredited exercise physiologists in our clinics, or through one of our programs.

Receiving a diagnosis of diabetes can be shocking, surprising, overwhelming, upsetting, frustrating or maybe all of the above! It can be a stressful time in a person’s life, and sometimes gives a person the feeling of helplessness.

While all of these reactions can be completely normal and are to be expected, it is important to know that you have the power to control your diabetes – your own decisions can play a big part in the management of your diabetes. It is important to have regular check-ups with your GP, and work with your GP in developing a management plan.

Your GP may recommend you see other specialists to assist in the management of your diabetes. These may include:
-    Endocrinologist
-    Accredited Exercise Physiologist
-    Dietitian
-    Diabetes nurse educator
-    Psychiatrist
-    Podiatrist
-    Optometrist


You may see none, one or all of these specialists at various stages! They will be able to provide you with specialist advice in their area of expertise. While your GP can be a great source of information, it is not possible for them to experts in all of these fields, so it can be a great opportunity for you to get expert information, which will help you manage your diabetes as effectively as possible!

Sunday 14th November 2010 was World Diabetes Day. The 3 key messages for this year are:

1. Know the diabetes risks and know the warning signs

2. Know how to respond to diabetes and who to turn to

3. Know how to manage diabetes and take control

So we've put together a little resource for each of these messages. Here's the first:

Know the diabetes risks and know the warning signs

These are the risk factors for type 2 diabetes:
•    Being overweight or obese
•    Being physically inactive
•    Poor diet
•    Increased age
•    Glucose intolerance (as diagnosed through a blood test)
•    Family history of diabetes
•    History of gestational diabetes
•    High blood pressure and high cholesterol
•    Ethnicity - higher rates of diabetes have been reported in Asians, Hispanics, Indigenous peoples (Australia, USA and Canada) and African Americans

Unfortunately, your age, family history and ethnicity are well and truly out of your control! But there is a lot you can do to help get a hold on your physical activity and diet, which can have a great impact on your weight, glucose tolerance, risk of gestational diabetes, and blood pressure and cholesterol.

Increasing your physical activity is such an important factor in improving your general health, as well as preventing and treating type 2 diabetes, and other chronic conditions. 3 things you want to try to include:
1.    Be more active each day! Reduce the amount of time spent sitting, and move around as much as possible. Walk as a means of transport wherever possible, and break up activities such as watching TV by doing 10 laps of your hallway in the ad break!
2.    Get huffy and puffy! Australian Physical Activity Guidelines recommend 30 minutes of moderate intensity physical activity on most if not all days! And if you can, also enjoy regular, vigorous activity for extra health and fitness benefits!
3.    Build some muscle! This can be anything from a simple home-based resistance exercise program, to a gym-based one. You don’t need to look like Arnold Schwarzenegger to get benefits, but increasing your muscle mass helps to provide more sites for glucose storage (important for diabetes prevention and management), raises your metabolic rate (even when you’re at rest, you’re burning more kilojoules!), helps keep you fit and strong, and is important for the prevention and management of other chronic conditions, particularly osteoporosis.

If you’re looking to improve your diet, don’t try to change everything all at once. Make small changes, one at a time. For example, start by ensuring you consume 2 serves of fruit and 5 serves of veggies each day. Replace beverages such as juice, cordial, soft drink and alcohol with water. These simple changes can make a big difference!

Diabetes doesn’t necessarily give you a lot of warning – it can creep up on many people! We’ve previously discussed the “diabetes surprise” – the shock many people experience when they receive their diagnosis. So it’s important to be on the lookout for the following warning signs  (though, be aware that these are sometimes mild, or completely absent in people with type 2 diabetes):
•    Frequent urination
•    Excessive thirst
•    Increased hunger
•    Weight loss
•    Tiredness
•    Lack of interest and concentration
•    Vomiting and stomach pain (often mistaken as the flu)
•    A tingling sensation or numbness in the hands or feet
•    Blurred vision
•    Frequent infections
•    Slow-healing wounds

The best thing you can do is to ensure you get regular blood tests through your GP, and if you notice any of the above warning signs, see your GP.

  http://www.worlddiabetesday.org/en/the-campaign/diabetes-education-and-prevention/diabetes-risk-factors
  http://www.worlddiabetesday.org/the-campaign/diabetes-education-and-prevention/diabetes-warning-signs

There have been two studies in recent times that are showing links to breast feeding and type 2 diabetes.  The first from ANU released in March 2010 found that mothers who breastfeed up to 3 months reduce their risk of developing type 2 diabetes to that of a woman who never had children. This study included accounting for woman's age, family history of type-2 diabetes, body mass index, smoking, and alcohol consumption. The second study, also by ANU showed that children who are breastfed for the first three months have a reduced risk of up to 50% in the development of type 2 diabetes.  This is fantastic news for mums who have been wondering if all the effort to establish and maintain breastfeeding has been worthwhile in the long run.  This is also great for those with a history of diabetes in the family, in trying to help prevent the development of type 2 diabetes.

While there are many benefits to breastfeeding both for mother and child, for some there are more cons than pros.  It’s worth remembering that there are many factors that influence a woman’s decision to breastfeed and when to wean.  Factors that may influence this decision include returning to work, finances, energy levels or personal health issues such as breast cancer, not to mention those babies needs that outstrip their mother’s milk production! These studies should not put undue stress on women who can’t breastfeed or have chosen to wean earlier than 3 or 6 months.  It should simply be one of the pros to help a woman continue if she is having trouble or be celebrated by those who enjoy breastfeeding.

Posted 1st July, 2010 in "Wellbeing" from Sydney Morning Herald

http://www.smh.com.au/lifestyle/wellbeing/big-food-and-you-rules-for-a-healthy-life-20100701-zp5p.html

Would you have thought a can of Coke and a "97% fat-free" yoghurt had the same amount of sugar in them? If you didn't, well that's OK - you're not alone. This article looks at how "healthy" diets and "healthy" foods can be doing us more harm than good!

"Michael Pollan is desperate to end our addiction to processed food. Jon Henley hears why

Michael Pollan, tall, fit, not quite skinny but very definitely lean, is holding a fruit yoghurt in one hand and a Coca-Cola in the other.

"So," he says, "which do you think, per 100 grams, contains more sugar?"

The Coke, I reply. Duh.

"Wrong," he says. "The yoghurt. And look, it's low-fat. Isn't that great? We're getting fat on low-fat food."

It's a nice illustration of Rule Nine in Pollan's magnificently sensible new book, Food Rules.

Along with such gems as "Don't eat anything your great-grandmother wouldn't recognise as food" and "Don't get your fuel from the same place your car does", Pollan recommends that you "Avoid food products with 'lite' or 'low-fat' or 'non-fat' in their names."

His reasoning: if you remove the fat from a foodstuff, it doesn't necessarily make it non-fattening.

Certainly not if the producer ratchets up the sugar content to compensate.

In fact, Pollan notes, since Americans began producing low-fat food products, they have been consuming up to 500 extra calories a day. Brilliant.

Pollan, an award-winning author, journalist and campaigner, is on a mission.

Food Rules is, in effect, a condensation of his previous work: much of the science behind these 64 deliberately catchy injunctions towards a healthier diet ("The whiter the bread, the sooner you're dead") has already been expertly dissected in his earlier books The Omnivore's Dilemma and the US bestseller In Defence of Food.

The rules spring from two facts.

The first is that people who eat what Pollan defines as a western diet ("lots of everything except vegetables, fruits and whole grains") tend to suffer from western ailments: obesity, type 2 diabetes, cardiovascular disease and cancer.

The second is that people who eat more traditional diets - including those of certain indigenous peoples - that, by the lights of western food science, might be considered way too high-fat, high-carb or high-protein, do not tend to suffer from these diseases.

In other words, people can thrive on a wide variety of foods and diets, with one major exception: the diet most of us in the west are now eating.

So why are we eating our way to death?

Because for big food manufacturers, the western diet is payday, every day.

"The more a food is processed, the more profitable it gets," says Pollan, who refers to these products as "edible food-like substances".

And that status quo is not challenged by modern food science, which is all about identifying the "good" and "bad" nutrients in processed foods and tinkering with them - by lowering the fat, for example, or fortifying the vitamins - rather than questioning the value of processed food products in the first place.

"We don't talk about food any more," says Pollan.

"We talk about nutrients, omega-3, antioxidants, saturated fats, polyphenols. And so we play into the hands of the food marketers."

This all has the crushing logic of truth.

But can we do anything about it?

Pollan has little faith that Big Food will change voluntarily: legislation will be needed, he fears, although he takes heart from the Obama administration's victory on healthcare reform in the US.

"Pretty soon," he explains, "the insurance industry is going to realise that we have to tackle obesity and type 2 diabetes.

"They might even come out in favour of taxes on soft drinks. And once we see one powerful industry pitted against another, then we might see progress."

The complication of food has been under way for a long time now.

After agriculture became more productive following the second world war, "corn and soy and wheat and rice got cheaper - and the only way to make money out of them was to process them.

"A sort of arms race started to make food more complicated: don't buy flour, buy cake-mix; don't buy cake-mix, buy cakes.

"Don't buy oats, buy Cheerios; not Cheerios, cereal bars."

Is that process reversible?

It may have to be, Pollan argues, as we start running out of fossil fuels.

Big Food as it exists today is, patently, not sustainable.

Pollan is sure we can produce enough real food, but fossil fuels will have to be replaced by manpower.

"Organic farms are wildly productive," he says, "but a lot more labour-intensive.

So convincing is Pollan's logic that you wonder where it all came from.

He started out, he says, as more of a naturalist than a foodie, but was gradually won over by the notion that "what happens on our plate represents our most powerful engagement with the natural world".

He no longer eats junk food (though his teenage son does).

He acknowledges, though, that many of the exchanges he has about this issue "are with skinny people".

An interest in good food is, still, something of a middle-class preoccupation.

"But abolition, women's suffrage, those movements began as elitist too," Pollan says. "I won't be discouraged."

The Guardian"

New Data Shows Kidney Disease Rising Due to Rampant Rates of Diabetes

AUSTIN, Texas--(BUSINESS WIRE)--New data confirms the rate of chronic kidney disease is inching upward, keeping pace with the rising rates of diabetes. In late September, the U.S. Renal Data System published its 2009 Annual Data report, which shows the incidence of chronic kidney disease in the U.S. Medicare population is now 9.8%, up from 8.7% reported in last year’s data analysis.

Diabetes, the leading cause of kidney disease, moved closer to affecting one in four Medicare beneficiaries nationally: the newest data shows 24.8% have this disease, up from the 23.6% reported a year earlier. The Texas Department of State Health Services estimates more than 1.8 million Texans have diabetes.¹

Dallas-based nephrologist Roberto Collazo-Maldonado, MD, is not surprised by the data.

“Because Texas has a big problem with diabetes,” Dr. Collazo says, “more people will get kidney disease. If we find it early, we can effectively treat kidney disease to prevent and avoid dialysis. That is, if we find it early.”

The American Diabetes Association recommends people with diabetes check their kidneys with an annual microalbumin test. However, fewer than 40% of Texas Medicare beneficiaries with diabetes received this screening in 2007, according to claims data from the Centers for Medicare & Medicaid Services².

“I regularly see patients who discover they have kidney disease when they come to the hospital for emergency treatment because their kidneys have failed,” Dr. Collazo continues. “This is too late. People with diabetes must check their kidney health every year.”

Why preventive testing is critical for people with diabetes

“It’s optimal to treat kidney disease before the damage is apparent to the patient,” says Dr. Collazo. “In the earliest stages, it’s unlikely the patient will experience obvious symptoms that would prompt a doctor’s visit.”

The urine microalbumin test looks for traces of albumin, a protein, in a patient’s urine. Damage impairs the kidneys’ ability to filter the blood for proteins, which then “spill” into a patient’s urine. This is an early marker of kidney disease.

“Getting a microalbumin test is very easy. It’s just a urine sample. No needles and no pain,” says Dr. Collazo. “If we find kidney disease at the early stages, we can treat it and most likely avoid dialysis. Not everyone with kidney damage progresses to kidney failure, but first you have to get tested regularly and then get timely treatment to prevent that outcome.”

People with diabetes and minorities at higher risk

Up to 40% of people with diabetes will experience kidney problems in their lifetime.³ Minorities with diabetes are also disproportionately affected: African-Americans are four times more likely than Caucasians to experience kidney failure, and Mexican-Americans with diabetes are twice as likely as non-Hispanic whites to have diabetes.^4,5

Accounting for 44% of new cases, diabetes is the leading cause of kidney disease, the U.S. Renal Data System reported in 2007. The second leading cause is high blood pressure.⁶ Other risk factors are age, obesity and a family history of kidney problems.

About TMF Health Quality Institute

TMF Health Quality Institute is an Austin, Texas-based nonprofit consulting company focused on promoting quality health and health care through contracts with federal, state and local governments, as well as private organizations. TMF partners with health care providers in a variety of settings to ensure that every person receives the appropriate care, every time. www.tmf.org

World Diabetes Day: Understanding Diabetes and Taking Control
Diabetes increases our risk of cancer and depression by 50 – 80%
We have all heard of diabetes and the obesity epidemic sweeping the world. We know that diabetes puts our health at greater risk, but the fall out of this epidemic is more far reaching than we ever thought possible. For many years we have known that diabetes is linked to obesity and heart disease and now ground breaking new research from Europe has turned the medical world on its head.  
At the 2009 European Association for the study of Diabetes Conference in Vienna, research1 was presented which showed that if you develop type 2 diabetes your risk of developing cancer is far greater.  In men, having diabetes increases your risk of getting the following cancers: 80% for pancreatic cancer; 30% for colorectal cancer; and 24% for bladder cancer. For women too, breast and endometrial cancer risk increases by 20 to 100% respectively, if you have diabetes.
In addition there is a new relationship between cancer and obesity, which is often seen with diabetes. Research has shown us that if you have a high BMI (over 35 or 40), men are 52% and women 62% more likely to die from cancer2
The devastation of diabetes does not stop there.
The relationship between diabetes and depression is often overlooked. People with diabetes have double the risk of developing depression compared to people without diabetes.3 Approximately 15% of people with diabetes will experience major depression, and 25–30% will have milder forms of depression.4 Unfortunately, depression often goes undiagnosed and untreated in people with diabetes, as there are often other medical issues that need addressing. This often leaves people to suffer depression without assistance or sometimes awareness of it.  

Even here in Australia we have determined that there is consistent evidence that depression is a risk factor for heart disease, stroke and diabetes mellitus.5 The relationship works in both directions, as older adults with depressive symptoms are at least twice more likely to develop diabetes than those without depressive symptoms.6

There is good news! Research has shown that simple lifestyle changes such as increased physical activity and diet change can dramatically reduce a person’s chance of developing diabetes, depression and cancer.   

Studies in both the US7 and Australia8 have highlighted the benefits of exercise in the treatment of depression. These studies showed that physical activity was up to two times as effective as anti-depressive medication in the treatment of depression. Similarly, studies have been completed on physical activity substantially reducing the risk of cancer9.

Diabetes, depression and cancer are three of the most devastating and life changing medical conditions we can ever experience. Knowing that they are linked places an even greater importance on leading a healthy lifestyle in order to prevent these diseases and any related complications.
Diabetes experts and authors of the book Sugar Daddy Dr Adam Fraser and Christine Armarego are working to raise awareness of the impact, complications and risks of diabetes for World Diabetes Day.
World Diabetes Day (WDD) is celebrated every year on November 14. The International Diabetes Federation (IDF) and its member associations lead the World Diabetes Day campaign. It engages millions of people worldwide in diabetes advocacy and awareness. Diabetes Education and Prevention is the World Diabetes Day theme for the period 2009-2013. The campaign slogan for 2009 is "Understand Diabetes and Take Control".  Type 2 diabetes can be prevented in the many cases by helping and encouraging those at risk to maintain a healthy weight and take regular exercise.

The Glucose Club
http://www.theglucoseclub.com.au
http://www.worlddiabetesday.org/
For more information or comments contact:
Aimée Cavanagh
E: aimee@dradamfraser.com
Ph: +61 2 9564 5763

1.    Jeffrey A Johnson, School of Public Health, University of Alberta, Edmonton Canada.
2.    Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ.  Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults.  N Engl J Med. 2003 Apr 24;348(17):1625-38.
3.    Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24:1069–78.
4.    Polonsky W. Diabetes burnout: what to do when you can’t take it anymore. Alexandria (Virginia, USA): American Diabetes Association, 1999.
5.    Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence.  Med J Aust. 2009 Apr 6;190(7 Suppl):S54-60.
6.    Atlantis E, Browning C, Sims J, Kendig H. Diabetes incidence associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA). Int J Geriatr Psychiatry. 2009 Oct 5. [Epub ahead of print]Click here to read Links
7.    Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, Waugh R, Napolitano MA, Forman LM, Appelbaum M, Doraiswamy PM, Krishnan KR. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. Effects of exercise training on older patients with major depression.Arch Intern Med. 1999 Oct 25;159(19):2349-56.
8.    Singh NA, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Fiatarone Singh MA. A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. J Gerontol A Biol Sci Med Sci. 2005 Jun;60(6):768-76.
9.    Emilie Friberg, Christos Mantzoros and Alicja Wolk Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden and 2Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

ATHENS, Nov. 10 (Xinhua) -- With dire estimates about the present and equally alarming predictions about the future, the Hellenic Diabetes Association unites its voice with other international organizations in the fight against the illness ahead of the World Diabetes Day which is celebrated on November 14.

    Almost one in ten Greeks suffers from type 2 diabetes today, after a 16 percent raise in the cases counted down between 2002-2006, according to a survey made by the Diabetes Department of the General Hospital of Nikaia in Piraeus and released by its director Alexis Sotiropoulos on Tuesday.

    "We must drastically change our diet and take up regular exercise to avoid the worse", he stressed at the press conference in Athens, warning that if citizens of the world will not change their life styles worldwide more than 380 million people will be diabetics by the end of the following decade.

    Hellenic Diabetes Association is taking part in the international awareness campaign which this year is titled "Understand Diabetes and Take Control".

Studies in the US are now looking at red grapes and pomegranate to see if it can assist in the fight against diabetes.  They are interested in a chemical compound called Resveratrol, which has shown promise in mice, in how it affects the brain.  Essentially they believe that mice given Resveratol can increase their lifespan.

They had some mice on a high fat diet and a usual group. After five weeks, 50% of the mice that were on high-fat diets showed that healthy insulin levels.  The research does hold promise, but the researchers warn there is a lot more to do before it’s near ready for humans.  They also state that using red wine as a substitute won’t work because it doesn’t contain enough Resveratrol in each serving (I hear the collective groan). The article will be published in the December edition of Endocrinology.  So as grapes are coming into season – enjoy the red ones!

Source: http://www.healthnews.com/medical-updates/red-grape-compound-showing-promise-against-diabetes-3792.html

With more than 70% of people over 15 years of age in Australia being sedentary or having low exercise levels according to the ABS National Health Survey for 2007-2008.  Being time poor is one of the most common reasons cited by people as to why they aren’t being active - they find it hard to fit in, they have kids, they run their own business, they have a stressful and demanding job.  However if you read Sunday Life magazine this weekend you will have seen the article on how busy people fit in exercise.  There’s a pilot and mother of four who’s also a dermatologist, Guy Grossi who you may have seen on Masterchef and an executive lawyer.  

What is common about them is that they all have challenges. They complete long days (up to 15-16 hours), have interrupted or poor sleep times, have high stress jobs and none of them were highly sporty as children or young adults. However they all discovered how valuable physical activity was to their health, to their well being, to their performance at work. There are many benefits in simply participating – you don’t have to be a “sporty type of person”.

In the article, they listed all the different ways they found to make exercise work for them and fit into their lifestyle.  They learnt about what makes them tick and use that as the driver.  Rex Wells (the pilot) tells himself that he only has to do 20 minutes but finds once he has started he is happy to go for longer – he just has to get there.  Josephine Yeatman (the dermatologist) sets goals for herself, attends courses and involves her family, she puts in her diary and ensures it is scheduled.  Guy Grossi talked about the time of day he exercises and he makes sure that on the weekends, which are his busiest days that he attends the gym.

What each of these high performers has done is worked out what drives them, how their mind works and stay within that. They have found what they can do to beat their Sugar Daddy and that is the key to their success.  There is no one program that will work for all of us all of the time.  But if you have control of your Sugar Daddy and know him or her well enough, you can manage all of the challenges life throws at you.