Spirit of Women magazine is a national publication presented to women by hospitals and their physicians. The magazine provides up-to-date, evidence-based healthcare information and promotes our hospitals as leaders in women's health excellence.
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1 1 w w w. s p i r i t o f w o m e n . c o m FA L L 2 014 S P I R I T O F W O M E N SHUTTERSTOCK EMPOWERING EXERCISE Exerting greater control over type 1 or type 2 diabetes can begin with making some relatively simple changes in your life, such as moving more. A pair of tennis shoes can be a powerful weapon, because exercise helps the body process insulin and shed weight, both of which can ease the impact of the disease. Dr. Geoffrey Cooper, a family physician affiliated with Fremont Area Medical Center in Fremont, Neb., recommends that his diabetic patients walk 30 minutes five or six days a week at a moderate pace that increases their heart rate. "Walking is easy on the knees, and it doesn't require you to go to the gym," says Dr. Cooper. Mixing aerobic activity with strength training can also be effective, says Dr. Kimberly Rieniets, an endo- crinologist at North Colorado Medi- cal Center in Greeley, Colo. Aerobic exercise helps decrease excess blood sugar, while muscle mass develop- ment helps increase metabolism. WEIGHT-LOSS STRATEGIES If you're overweight, dropping some pounds can help you lower your risk of complications from diabetes. Aim to eliminate 10 percent of your body weight over six to 12 months, says Dr. Cooper, who recommends avoid- ing foods and drinks high in sugar, limiting desserts and cutting out foods such as bread or pasta that are high in complex carbohydrates. Dr. Rieniets suggests following the plate method: Fill half of a nine-inch plate with vegetables or vegetables and a little fruit, then fill one-fourth with lean protein and the final fourth with higher-fiber carbohydrates. As with any change in your diet, be sure to talk to your medical care provider or consult with a dietitian to make sure you're balancing your meals to produce insulin and use it better. Newer drugs include: • Exenatide (brand name Byetta), an injectable medication that helps with weight loss and blood sugar control • Sitagliptin (brand name Januvia), a pill that works only when you eat, eliminating the side effects of some medications that lower blood sugar indiscriminately and can make you shaky if you haven't eaten • Canagliflozin (brand name Invo- kana), which removes sugar from the body through urine, although the drug has side effects such as urinary infections due to the high sugar content in the urine Some people with diabetes still require insulin pumps, but these devices have come a long way. Today's pump is a small unit worn on the belt and includes a small cath- eter; it can be programmed to inject the correct amount of insulin that is needed by the patient. Gastric bypass surgery, once a treatment of last resort, is now on the front lines for obese type 2 diabetes patients who also suffer from other ail- ments, such as high blood pressure, says Dr. Hawkins. "It is drastic, but it can be life- saving," he says. • appropriately and to develop weight- loss goals that are sustainable. MEDICATION MANAGEMENT While some people with diabetes need only an improved diet and exercise to control the disease, many will still require medication. There are definitely more treatment options available for diabetes today than ever before, says Dr. Leslie Madrid, an endocrinologist affiliated with Community Medical Center, Toms River, N.J. Insulin remains the primary treat- ment for type 1 diabetes, in which the body fails to produce insulin. However, for type 2 diabetes, in which the body makes insulin but doesn't recognize it, several classes of medications that work in different ways can be effective. By combin- ing different medications, you may be able to take lower doses of each, reducing the potential for serious side effects. At least one or two new medications for diabetes are introduced each year, says Dr. Madrid, and the expanded choices help deliver better long-term disease management. "In the past, there were only a few oral medications available, and patients who were not helped by them had to go to insulin fairly quickly," says Dr. Madrid. "Today, even after failing a few oral medica- tions, there are more options avail- able, so not as many patients have to go on to insulin." The first line of defense, says Dr. Cooper, is generally metformin, which is sold under several brand names, including Glucophage. The drug, which has been on the market for several years, works to control blood sugar in type 2 diabetes. Gly- buride, whose brand names include DiaBeta, helps to lower blood sugar by stimulating the pancreas TYPE 1 DIABETES In this form of the disease the body produces no insulin, a hormone necessary for converting sugar, starches and other food into energy in the body. Formerly known as juvenile diabetes, it is usually diagnosed in children and young adults. TYPE 2 DIABETES The body produces insulin but doesn't use it prop- erly in type 2 diabetes, the most common form of the disease. Initially the pancreas makes extra insulin, but eventually it can't keep up and blood glucose exceeds normal levels. Source: American Diabetes Association Diabetes by the numbers