How Type 2 Diabetes Can Change Over Time

• By Madeline R Vann, MPH
• Reviewed by Farrokh Sohrabi, MD

Even when you work hard to control type 2 diabetes, the progression of the condition will likely require adjusting medications and lifestyle over time. Here’s what you may expect

You probably already know that type 2 diabetes can cause long-term damage if you don’t control it, but it’s also important to understand that even well-controlled diabetes progresses over time — meaning you may have to adjust your treatment plan more than once.
The key to learning about the progression of diabetes is to understand the role of your pancreas, which produces insulin. For people with type 1 diabetes, the pancreas does not make any insulin, so they must take it through injections. With type 2, the pancreas doesn’t make enough insulin or the cells don’t respond to it adequately, according to the American Academy of Family Physicians. This means that the body has trouble moving sugar from the blood into cells to be used for energy. Diet, exercise, and medication, if prescribed, can all help those with type 2 diabetes lower their blood sugar levels and help their bodies use insulin made by the pancreas, according to the American Diabetes Association (ADA).
If blood sugar levels remain high, the ADA says, you may be at risk for such diabetes complications as vision loss, heart disease, nerve damage, foot or leg amputation, and kidney disease. However, proper diabetes management can help prevent or delay the onset of these complications.
How Your Diabetes Treatment Plan Might Change
Over time, your medications, diet, and exercise goals may need to be adjusted. “Initially the pancreas produces extra insulin to make up for insulin resistance, but in most people, the pancreas eventually is unable to make the extra insulin to keep blood sugar levels normal,” says Marc Jaffe, MD, a San Francisco endocrinologist in practice with Kaiser Permanente in Northern California.
After a type 2 diabetes diagnosis, your doctor will set blood sugar goals for you, recommend lifestyle changes, and perhaps prescribe oral medications such as metformin to help manage blood sugar levels, Dr. Jaffe says. “Because type 2 diabetes usually progresses over time, even people who don’t need medications at first are likely to need medications eventually,” he notes.
The next step in diabetes management, if these strategies aren’t working, is to change or add medication or add insulin, according to the 2014 Standards of Medical Care in Diabetes, published in the January 2014 issue of Diabetes Care. Your blood sugar goals might also be adjusted, based on your overall health and history with diabetes control, according to the guidelines. For some people who are obese, bariatric surgery might also be an option.
The guidelines also note that because many people with type 2 diabetes will eventually need insulin, insulin therapy should not be feared or viewed as meaning that you’ve failed at managing your diabetes.
“This is a progression of the disease and not to be thought of as something that you caused,” says Erin Palinski-Wade, RD, a certified diabetes educator in Franklin, New Jersey, and author of Belly Fat Diet for Dummies.
Tailoring Your Diabetes Treatment as You Age
Not only does diabetes itself progress, Palinski-Wade points out, but your body also changes over time. For example, you may experience complications from diabetes, like nerve pain, or develop osteoarthritis, which could make exercise more challenging, she notes. Those kinds of changes in your body would lead to adjustments in your diabetes management plan.
Because of the way diabetes progresses as people age, the ADA, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics came together in June 2015 to publish a joint statement recommending that doctors give people with diabetes a referral to see a registered dietitian or certified diabetes educator at least once a year to fine-tune their management plans, including diet and exercise. It’s also a good idea to see a diabetes educator any time you’re facing a new challenge that’s getting in the way of your self-management, such as when you’re diagnosed with another health condition or have physical limitations. Research published in 2014 in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy also emphasizes that a personalized approach to diabetes nutrition with realistic goals that meet the individual’s lifestyle is an important part of diabetes treatment.
Coping With Type 2 Diabetes Progression
Even though type 2 diabetes is progressive and you will likely need to make adjustments to your management and treatment plans, you can take steps to cope with the changes:

• Eat healthfully. Your diet should be individualized, but people with diabetes can also benefit from Palinski-Wade’s advice to “focus on filling your plate halfway with plant-based foods such as vegetables at all meals.” She also urges people to learn to read labels and understand portion sizes — skills that will serve you well throughout your life.
• Aim for a healthy weight. Losing weight can improve your diabetes control; the ADA's 2014 guidelines for self-management suggest that many people with diabetes can benefit from losing at least a small amount of weight. Check with your doctor for a specific recommendation for you.
• Check your blood sugar. “As diabetes progresses, people may need to start checking or increase the frequency of checking their blood sugar levels, especially when blood sugar levels are high or low, hard to control, or in people who take insulin,” says Jaffe. Talk with a certified diabetes educator about the testing strategies that would work best for you.
• Be active. A mix of aerobic activity and resistance training helps to improve insulin sensitivity, which means your body uses insulin more efficiently, according to the ADA guidelines.

It can be challenging to live with a chronic condition, but taking care of yourself each day and checking in with your doctor and diabetes educator regularly can help you stay on top of your diabetes management.

The Emotional Effects of Diabetes

• By Dr. Sanjay Gupta

For people with type 2 diabetes, managing their emotional health can be as important as keeping their blood sugar under control. The condition requires constant attention, and that can trigger feelings of stress and anxiety. Studies have shown that diabetics are much more likely to have an anxiety disorder or depression. They may neglect their diet, stop monitoring glucose levels, or revert to unhealthy habits.
Steve Sternlof, PhD, a psychologist with the Harold Hamm Diabetes Center at the University of Oklahoma, talks about the psychological impact type 2 diabetes can have and ways to help patients cope.
How do you know if a diabetes patient is suffering from stress or anxiety?
There are different situations. It might be someone who is not compliant with their self-care and isn’t checking their blood sugar regularly or taking their medications as prescribed. Their doctor notices this and sees their A1C [hemoglobin test] levels are up and there are problems. In that case we might get communication from their physician, and we’ll help them work through their issues and come up with a game plan.
It might be a patient who is severely depressed and openly talking about their level of sadness and that they’ve given up hope. Their diabetes is affecting them socially and putting a strain on their relationships or marriage.
Sometimes patients are good at hiding these feelings. It’s important that doctors ask questions and probe beyond how their medical care is going. A lot of patients are reluctant to talk about their feelings unless asked. When a doctor is willing to ask questions above and beyond whether or not they’re checking their blood sugar, the patient is more willing to talk.
What are some of the major mental health issues that affect diabetics?
There’s a high correlation between diabetes and depression. It can come in different forms and different levels of severity. Some people just get down a few days out of the week or month, others have chronic depression. It can be difficult for them just to get out of bed and function in their daily lives.
It can also create anxiety in that people worry about how they’re going to talk about their disease to other people, and whether or not they’ll understand what they have to go through.
They also worry about how diabetes will affect how long they live, they worry about complications, whether or not they’ll go blind, if they’ll need a limb amputated. It creates a lot of stress and worry. Even if their diabetes is under control, it’s that “what if” factor.
Diabetes also has a big effect on interpersonal relationships. People who have these depression or anxiety problems and have a chronic illness tend to withdraw from others and isolate themselves. The problem is a lot of depressed patients put loved ones off. I tell family members to not give up—the patient may not respond after the first or fifth time, but maybe after the twentieth time. They at least have to leave the door open.
How do you help someone diagnosed with diabetes cope with the pressures of constant self-care?
It’s a big struggle. People live their lives and have a certain way of living it and have certain habits and routines. Those things are very hard to break. When you get diagnosed with diabetes, you don’t have to totally break them. But now you have to fit in something else throughout the day every day for the rest of your life. This involves checking your blood sugar, taking your medication, watching what you eat, doing some kind of physical activity, following up with your doctor.
Some people decide their diabetes care either doesn’t fit into their routine or it falls short on their priority list. Most people will list their job and their family and other things way above diabetes care on their priority list.
I usually have new patients reflect on why diabetes care is such a low priority when it involves taking care of their health and quality of life and how long they’ll live well with the disease. It’s helpful when they can make that connection on their own that if they don’t take care of themselves and don’t manage the disease properly, then they’re not going to be around to have a job or spend time with their family.
Does there need to be more of a focus on mental health in caring for people with diabetes?
When the emphasis is just on the physical – that my body isn’t performing the way that it should – that’s difficult for some people. It’s helping to change their thinking and have them realize that while they may not have control over the way their body uses insulin, they can at least control how they feel about it. Everyday life, even without diabetes, is tough enough. When you add diabetes that requires so much of someone every single day, it creates an extra burden of stress. Sometimes people don’t feel like they have an avenue of escape. It’s important they have something they can find joy or comfort in.

The BrainFood Cookbook by Angela Taylor

Foreword written by Dr. Natasha Campbell-McBride Gluten Free - Lactose Free - Soy Free - Sugar Free Autism / ADHD Recovery using the SCD / GAPS / Paleo diet The BrainFood Cookbook contains 12 chapters of recipes used by author Angela Taylor to successfully recover her child from Autism. The recipes are gluten-free, and based upon the Specific Carbohydrate Diet (SCD) / Gut and Psychology Syndrome Diet (GAPS) / Paleo diet which has been embraced in the Autism community. The BrainFood Cookbook explains the SCD/GAPS/Paleo diet in an easy and delicious way to inspire busy parents who are desperate to heal their children, but may be daunted by learning a whole new way of cooking. The cookbook will appeal to inexperienced cooks, and to those who enjoy gourmet flavors. This book aims to demonstrate the power of food in changing lives like none other before it. There is hope. You can start this today. You can recover your child!   At the 2010 Defeat Autism Now conference, the SCD / GAPS diet was listed as the #1 most effective non-drug intervention for autistic children. The BrainFood Cookbook contains: • A brief but inspiring testimonial of how Taylor recovered her son from Autism using the GAPS diet • An outline of the basic principles (and the science behind) the GAPS diet • Real-life tips for making it work • 12 chapters of recipes, with a color photo of each recipe I and many others believe that ADD —> ADHD —> Asperger's Syndrome —> Autism are disorders which share a common etiology; therefore GAPS diet interventions may work to recover children diagnosed with these related disorders as well. As the Greek physician Hippocrates said more than 2000 years ago: "Let food be thy medicine and let medicine be thy food." It is beyond doubt that food plays a very decisive role in preservation of human health, but also in the development of diseases. Nutrition scientists are discussing vehemently which diet is the right one. In my studies at the BioIndividual Nutrition Institute, I have learned about genetic and biochemical differences between individuals which result in the fact that one person tolerates well a particular foodstuff, whereas it causes problems for someone else. I encourage you to muscle test every food your family consumes to determine what is good for you. These resources can be helpful: Sample of a Muscle Testing Foods Chart Read my script for the muscle testing video I will be shooting soon. Contains complete "how-to" instructions. Hi Angela, I'm a desperate mom reaching out to you. I have a wonderful little 4 year old boy with Autism. We do a lot of therapy and interventions (ABA, OT, NeuroFit, music therapy, equestrian therapy, GFCFSF diet and bio-med). Something is still missing. He is so close to recovery we feel, but constipation still is a major issue/trauma. He also has central auditory processing difficulties, scripts TV shows, concepts are hard, and no conversational speech. The last 3 days we have been prisoners in our home trying to get him to have a bowl movement. Poor guy. I am at the end of my rope and my heart is broken for him. I watched your videos and saw so much of my son in yours. I have contemplated GAPS for about 5 months, but a few things hold me back: 1. I work full time and have two children with special needs. How will I ever find the time to make all the broth and food from scratch? It seems really impossible. Am I building it up in my head too much? Is it doable for someone like me who doesn't go to bed until 11 or midnight as it is with all that needs tending to? 2. Will my son eat? He eats a very healthy GFCFSF (Gluten-free, Casein-free, Soy-free) diet, but it's a struggle to get him to eat things like meat. He likes chicken, but all other meats he refuses. He also won't touch soup. Out of all the research and blogs I've read, no one really seems to address in detail what the actual eating process was like for their young, picky toddler. Can you share thoughts? He has Mitochondrial dysfunction and I really am fearful of weight loss, etc. Thanks so much for your time. I am sure you are very busy. Just needing that last little nudge from someone who can calm my fears.... Best, K (name withheld upon request) Hi K, I won't lie to you, GAPS takes more time than GFCFSF because you can't buy as much prepackaged stuff. However, rather than take the approach "If I can't do GAPS perfectly, I won't do it at all", I urge you to do "Good enough GAPS". As your child simply can't heal if they are continuing to eat foods they are allergic to. (Please re-read the first pages of my book which explain all this) In terms of getting yourself motivated, I am quite familiar with "overwhelm". I resolved to cut back my life to the essentials for the time being until my son was healed, and it paid off. So, no fancy vacations or new cars to pay for, and no volunteering / no hobbies to take up my precious time. If my parents/friends wanted to see us, great, they can come to me. Still, we as parents can have other stuff blocking us from achieving our goals. To help you, I'd suggest: Neuro Emotional Technique (NET) www.netmindbody.com/for-patients/find-a-practitioner-near-you Homeopathy (any trained homeopath would be helpful, but maybe you'd like to find one who also knows CEASE for your kid) www.cease-therapy.com/make-appointment Constipation - well the first thing is to get him to poop, today! (That's great you're tuned in enough to know it's been three days.) Increase your child's fluids and probiotics. Go to the drugstore and buy some glycerin suppositories. Bribe your kid with a treat so he'll let you stick in the suppository, then wait for the fireworks. And if you are giving calcium supplements, stop them immediately - they seem to always cause constipation and a host of other problems. I have found that raw milk kefir which we make into smoothies (see pg 119) EVERY DAY without fail, is the key to my entire family's bowel health and also not getting colds. When we skip a day we get constipated, and/or "catch a cold". If you are afraid of raw milk, don't be, we've been drinking it for over 7 years without a single problem. Yes it's hard to find, but it's imperative, so please - try harder! www.realmilk.com (I'd suggest visiting the farm to assure yourself of the cleanliness of the cow's pasture and milking facility.) Now, regarding my "disregard" for CF (casein-free diet) I have found our 2 actual problems with dairy are: lactose - every kind of lactose - so either raw or pasteurized are both problems milk solids - only pasteurized (or cooked) is the problem So, the only types of dairy I permit are: Ghee (it's cooked, but it's free of lactose and milk solids) Raw milk kefir and raw milk yogurt (since it's cultured, it's free of lactose. And since it's raw, the milk solids are still "OK") Note: there are a few children who are so dairy-intolerant, they can't even have raw milk kefir. Please muscle test to be sure. Grass-Fed Butter Oil (along with probiotic capsules) may be a good constipation solution for these kids. If your son is picky: Clip him into his highchair/booster seat. (See, How Do I Get My Kid to Eat This Stuff pg 20) So maybe you cook (GAPS-legal) chicken nuggets every night for a week. (pg 68) So be it. But do please use "Soy-free" chicken that has eaten a soy-free diet. I buy my chicken directly from a farmer - it's easier for me to know the chicken's diet that way. Tell him "First peas, then chicken" - you control the plate, and you alternate his bites, for the entire meal. (To make him eat all his peas.) Put lots of ghee and salt on those peas to make them tasty. It is imperative that you train him to eat lots of fruits and vegetables, as he needs to get his carbs to avoid weight loss. And, if you allow him to eat too much protein (vs. not enough produce) it's hard on his kidneys. BTW - my child still refuses to eat soup. Won't touch it. He healed anyway, just by avoiding allergens and increasing the probiotics in his diet with the kefir smoothies. (Since he won't drink broth I put powdered gelatin into his smoothies.) Time savers - see pg 22 of my book "Saving Time and Saving Money" and pg 21 "Menu Planning". (It's no surprise that your family is going to be hungry 3 times a day. Plan ahead! Even if you're planning chicken nuggets 7 nights in a row!) IMHO - All the good money (and time) you are investing in all these other therapies is "wasted" until you change your child's diet to GAPS. It really is that crucial. If I was short on time and money, and I had to choose between doing GAPS, or dropping everything else, I would honestly choose GAPS. But of course, doing GAPS + everything else is the best choice if you can swing it. (Homeopathy, especially!) Best, Angela	eBook Regular Price $18.99 Fall 2015 Sale Price $12.99 Print Book Regular Price $39.99 Fall 2015 Sale Price $34.99 (plus S+H) Email:

This protein may explain why Ebola is so deadly

Washington University in St. Louis rightOriginal Study

Posted by Michael Purdy-WUSTL on August 14, 2014

Researchers have developed a detailed map of how the protein, VP24, binds to a host protein that takes signaling molecules in and out of the cell nucleus. The map reveals that the viral protein takes away the host protein’s ability to carry an important immune signal into the nucleus.
This signal helps activate the immune system’s antiviral defenses, and blocking it is believed to contribute significantly to the virus’s deadliness.
“We’ve known for a long time that infection with Ebola obstructs an important arm in our immune system that is activated by molecules called interferons,” says senior author Gaya Amarasinghe, assistant professor of pathology and immunology at University of Washington in St. Louis.
“Now that our map of the combined structure of these two proteins has revealed one critical way Ebola does this, the information it provides will guide the development of new treatments.”

Protein blocker

Coauthor Christopher Basler, professor of microbiology at Mount Sinai Hospital was the first to show that VP24 and VP35 were important to the virus’s ability to keep the immune system at bay.
In an earlier paper, Amarasinghe, Basler, and others revealed that VP35 blocks production of interferon, one of the main regulators of the innate immune system. This branch of the immune system specializes in fighting viruses.
“Interferon is critical to our ability to defend ourselves against viruses,” Basler says. “It makes a variety of responses to viral infection possible, including the self-destruction of infected cells and the blockage of supplies necessary for viral reproduction.”
In the new study, published in Cell Host & Microbe, Amarasinghe and Daisy Leung, assistant professor of pathology and immunology, show that VP24 tightly binds to a nuclear transporter, a protein that takes molecules into and out of the cell nucleus. Among the molecules these transporters take into the nucleus is STAT1, an important component of the interferon signaling pathway.
“Normally STAT1 is transported into the nucleus and activates the genes for hundreds of proteins involved in antiviral responses,” Leung says. “But when VP24 is attached to some of these transporters, STAT1 can’t get into the nucleus.”
The study shows that VP24’s action specifically prevents STAT1 transport. Other proteins that travel in and out of the cell nucleus and are important to viral replication likely are unaffected. The scientists already have initiated efforts to look for small molecules that block VP35 and now are applying those same approaches to VP24.
A National Institutes of Health grant is helping Amarasinghe and other researchers look for drugs to block VP24 and another Ebola protein, VP35. The group includes researchers at the Icahn School of Medicine at Mount Sinai, Washington University, the University of Texas Southwestern Medical Center, Howard University, and Microbiotix Inc., a Massachussetts biopharmaceutical company.
Source: Washington University in St. Louis

The Anti-Inflammatory Diet: Putting Out the Fire In Your Diet

By Shilpi Agarwal, MD

Published Jul 9, 2013

If you’re feeling more achy, tired, or sluggish than usual, inflammation may be lighting your body up both inside and out. Recent research suggests that persistent inflammation is at the source of many diseases such as arthritis, heart disease, cancer, diabetes, and even Alzheimer’s disease. Generally, inflammation is a defense mechanism in the body that helps stop growth of abnormal cells, promotes healing of injured tissues, and signals cells to fight off viral and bacterial infections. But when inflammation persists, it requires the body to recruit different mediators to protect the cells. And when these mediators are present for prolonged periods of time they can destroy healthy tissue and trigger disease.

Adding anti-inflammatory foods to your diet can promote healing and reduce health hazards in the body. We all know that completely changing your diet overnight is challenging, but adding a few foods that cut down inflammation can go a long way.

The cornerstone of reducing inflammation through diet includes eliminating foods with preservatives and additives and consuming more whole foods, fruits and vegetables. Additionally, spices like turmeric, ginger, and cayenne pepper all have anti-inflammatory properties. Pepper contains capsaicin, a compound that reduces substance P, a pro-inflammatory protein that can be found at the site of swollen tissues, and abnormal cells. Reducing substance P can decrease pain, swelling, and even joint and tissue damage.

Consider adding the following foods into your diet to stomp out inflammation:

White and Green Tea: These teas are full of polyphenols, which are chemicals found in foods and spices that fight off inflammation and reduce oxidative stress.  Try adding two cups to your daily routine.

Olive Oil: Using this type of oil in your cooking adds omega-3 fatty acids, which are known to be inflammation busters. Olive oil also contains oleocanthal which is a natural, and powerful anti-oxidant that works similar to medications like ibuprofen.

Red Wine: Enjoying red wine can improve heart health and diabetes because it contains resveratrol another natural anti-inflammatory. Remember to enjoy in small quantities!

Walnuts: Walnuts are a great source of omega-3 fatty acids, and have been shown to reduce inflammation in the body. These nutritious nuts also contain high levels of protein, magnesium and fiber.

Cocoa: Enjoying cocoa (in moderation!) can increase flavonols in the body. Flavonols help eliminate toxins and are known to reduce the production and effect of pro-inflammatory substances. Dark-chocolate is a great source.

What are your favorite ways to add anti-inflammatory foods to your diet? Let us know in the comments!

Uncovering Hidden Sources of Carbohydrates

• By Diana Rodriguez
• Reviewed by Pat F. Bass, III, MD, MPH

Counting carbs can be essential to your type 2 diabetes management game plan, but you could be missing hidden grams in your favorite foods and beverages.

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Managing your intake of carbohydrates plays an important role in controlling blood sugar when you have type 2 diabetes. Carbohydrates are an essential part of your diet, but you need to choose wisely and be aware of hidden carb sources, says Angela Ginn-Meadow, RD, LDN, CDE, a spokeswoman for the Academy of Nutrition and Dietetics.
Some foods — such as white rice, white pasta, mashed potatoes, and pastries — are obvious high-carb, low-nutrition sources that you most likely already know to limit in your diet because they can spike your blood sugar. However, there are many less obvious sources of carbohydrates, such as jarred spaghetti sauce, which can contain as many as 24 grams of carbohydrates per cup. That’s about half of the 45 to 60 grams of carbohydrates per meal suggested by the American Diabetes Association.
“Make pasta sauces at home and use a sugar substitute for sweetness,” Ginn-Meadow says. Start with a can of crushed tomatoes, add some spices along with the sugar substitute, and heat. This way, you cut back on the carbs without missing the flavor of jarred sauce.
Uncovering the Carbs
Here are six other hidden sources of carbohydrates and their lower-carb substitutions:

• Condiments. “Barbecue sauce, cheese sauce, cocktail sauce, and mole sauce range from 10 to 15 grams of carbs per serving,” Ginn-Meadow says. “The key is to keep the portion size small.” Use a pastry brush to spread on the condiment rather than pouring it straight from the bottle. You’ll still get plenty of flavor but with fewer carbs. Ginn-Meadow recommends tartar sauce instead of cocktail sauce for fish, but says to stick to a 2-tablespoon serving to avoid too many calories. And for fewer calories and carbs, top pasta with freshly shredded cheese instead of making a creamy cheese sauce.

• Smoothies. “Beverages always seem to surprise everyone,” Ginn-Meadow says, noting that a 12-ounce smoothie can pack 60 grams or more of carbs. Control your carbs by making your own using a cup of unsweetened almond milk, a cup of frozen strawberries, and about 3.5 ounces of plain Greek yogurt. You’ll have a filling, healthy breakfast for less than 20 grams of carbs.

• Flavored coffees. If a café mocha is your sweet treat, you’re packing in a lot of carbs for just a few sips. A typical 16-ounce mocha contains more than 40 grams of carbohydrates. A cappuccino, which has just 12 grams of carbs, is a better choice. Sprinkle on cinnamon for a flavor boost. And keep in mind that plain black coffee has no carbs.

• Yogurt. While yogurt is packed with protein and calcium, watch out for carbs, especially in flavored yogurts and varieties with lots of add-ins. A typical 6-ounce serving of a low-fat, fruit-flavored yogurt contains more than 20 grams of carbohydrate so it's important to read and compare nutrition labels. “Yogurt is a natural source of carbohydrate, which comes from milk,” Ginn-Meadows says. To cut carbs, choose Greek yogurt or select light flavored yogurt, she says. One container (170 grams) of plain, nonfat Greek yogurt has just over 6 grams of carbohydrates.

• Oatmeal. Oatmeal, which is a whole grain, makes a healthy breakfast when you make it fresh. But one of those convenient packets of instant flavored oatmeal can pack about 33 grams of carbohydrates, while one-third cup of uncooked old-fashioned oats has about 18 grams of carbs. Top with some fresh fruit for natural sweetness.

• Fat-free and sugar-free foods. “Fat-free products are often high in carbohydrates due to the removal of the fat and adding flavor with sugar,” Ginn-Meadow says. One-half cup of fat-free vanilla ice cream has nearly 21 grams of carbs, while the full-fat version has less than 16 grams. Fat-free sour cream has nearly 36 grams of carbs per cup; full-fat sour cream has less than 7 grams. Many sugar-free varieties of foods contain sugar alcohols, according to the Joslin Diabetes Center, which are heavy on carbs. Opt for a full-fat product and limit your portion size, Ginn-Meadow recommends. Compare the carbohydrates from the fat-free to sugar-free and original varieties and choose the one-serving product that will satisfy you, she adds.

Is Your Type 2 Diabetes Care Up to Date?

By Athena Philis-Tsimikas, M.D.

Published Apr 3, 2015

By Athena Philis-Tsimikas, MD, Special to Everyday Health
This year, the American Diabetes Association (ADA) announced updated standards of medical care for people with diabetes. These are the guidelines and parameters medical professionals and diabetes care providers use to determine the most appropriate treatment plans for their patients — and they can help you better manage your diabetes as well.
Here’s a look at what’s new for 2015:

Blood-Sugar Targets

Previously, the ADA had established an average pre-meal blood sugar target range — the ideal value for your blood glucose level before eating — between 70 milligrams/deciliter to 130 mg/dL. The new values have increased this range to 80 mg/dL to 130 mg/dL. According to the ADA, this better reflects new data that compared actual average glucose levels with A1c mean values, which measure average blood glucose control over a period of two to three months. Setting the targets higher also could help prevent unwanted hypoglycemia, or low blood sugar.
Post-meal blood sugar targets remain the same, at less than 180 mg/dL.
In addition, the new standards recommend more individualized A1c targets:

• The A1c goal for non-pregnant adults ranges from less than 7.0 percent or less than 6.5 percent, depending on the individual.
• Tighter targets (6.0 to 6.5 percent) may be recommended for younger, healthier patients.
• Looser targets (7.5  to over 8.0 percent) may be appropriate for older patients and those who have more health problems or are more likely to develop hypoglycemia.
• A target of 7.5 percent is recommended for children and adolescents.
• A target of less than 6 percent (without significant hypoglycemia) is recommended for pregnant women.

Pneumonia Vaccines

A new guideline for 2015 recommends the pneumonia vaccine for people with diabetes. Everyone over age 2 should get a Pneumovax vaccination. If you are 65 or older and have had Pneumovax, the ADA recommends a Prevnar vaccine 12 months after your Pneumovax vaccination. Adults 65 years and older who have not had either vaccine should have Prevnar first, followed by Pneumovax 12 months later. Talk to your doctor about your vaccination schedule.

Heart-Disease Risk Management

For 2015, the updated standards of care now recommend a blood pressure goal of less than 140/90. For younger patients, less than 130/90 may be appropriate. Talk to your doctor about your individual blood pressure goal and whether you should take a daily aspirin to help prevent heart attack or stroke — aspirin therapy is not appropriate for everyone.
What about statins? The new guidelines for statin treatment, which is used to help lower cholesterol levels, depend on your age and risk of cardiovascular disease (CVD). These risk factors include high LDL cholesterol, high blood pressure, smoking and being overweight. If you’ve had a heart attack or have acute coronary syndromes, you are considered to have “overt CVD” and should be on a high statin dose. Your physician can determine whether you need a moderate or high dose — or none at all.

E-Cigarettes

Smoking is a health hazard for everyone, and the new standards of care explicitly state that electronic cigarettes (e-cigs) should not be considered any less harmful than conventional cigarettes. If you need help quitting, call 1-800-NO-BUTTS for free assistance.

Foot Screenings

Finally, if you have diabetes you should have a comprehensive foot exam every year to identify high-risk foot conditions. If you have neuropathy, your physician should examine your feet at every health care visit.  The 2015 updates also advise having a foot exam at every visit if you have foot deformities, a history of foot ulcers, or limited sensation in your feet.
It’s important to keep in mind that these guidelines are just that — guidelines. Every individual is unique, and you and your diabetes care team should decide what is right for you.
Athena Philis-Tsimikas, MD, is an endocrinologist and the corporate vice president for the Scripps Whittier Diabetes Institute at Scripps Health in San Diego.