Diabetes has been diagnosed in 23.7 million Americans, and 57 million more have been diagnosed with pre-diabetes. This disease costs our health care system more than $218 billion per year. New cases of diabetes are more prevalent in the age group 40 to 59 years — an increasing trend.
Diabetes is the seventh leading cause of death and the leading cause of blindness in adults ages 20 to 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. Overall, the risk for death among people with diabetes is about twice that of people without diabetes within similar age groups.
As primary eye care providers, we focus time and energy on how to treat the ocular complications associated with diabetes. However, we can do a lot within our scope of practice to prevent type 2 diabetes from ever developing. We need to concentrate on lifestyle modification, including proper dietary strategies and exercise concepts. Here are some tips on how to address some of these with your patients.
There are many concepts of the “proper” diet for any weight control issue, including diabetes prevention. Depending on the severity and length of time the condition has existed, varying amounts of proteins, fats, fiber and carbohydrates are recommended.
The American Diabetes Association recommends a diet consisting of:
• Total fat intake that equals 25% to 35% of total calories.
• Saturated fat intake less than 7% of total calories.
• A total cholesterol intake under 200 mg/d (low-density lipoprotein <100; high-density lipoprotein >40).
• Carbohydrate intake equal to about 50% to 60% of total calories.
• Fiber between 20 g/d to 30 g/d.
However, many health care practitioners find this a poor diet due to the high carbohydrate allowance, since carbohydrate processing is one of the main concerns for a patient with diabetes. Glucose is the body’s primary energy source, fueling the activities of nearly every cell in the body.
The availability and storage of blood glucose is tightly controlled by a process called glucose homeostasis, which involves the hormone insulin. Insulin is produced by the beta cells of the pancreas in response to changes in blood sugar and works to maintain blood glucose levels within an optimal range, or homeostasis. Overeating, physical inactivity and aging result in increased pro-inflammatory cytokine production 6. The over production of pro-inflammatory cytokines may represent a triggering factor in the origin of heart, blood sugar and other metabolic concerns. Thus, reducing carbohydrates reduces the strain on the pancreas to produce more insulin.
Next time, we’ll discuss some of the notable diets for patients who have diabetes.
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