Janice Baker, a registered dietician, spoke about diabetes and nutrition at the February Woman of Wellness program at Fallbrook Library.
While she has worked at Pomerado Hospital for the last 12 years, she said that she has not been out of school for 35 years with all the continuing education classes she takes to keep up with the latest information.
She reviewed the basics of diabetes management, weight management and the associated health risks of having diabetes.
Baker explained that diabetes means that “blood sugar is at high levels and toxic to our organs, like an oil spill.” Food controls blood sugar so portion control plays a key part in managing the disease.
Being physically active is important but it is “all about the food,” Baker said. Changes in diet have to be individualized. There is no one right way to treat the disease.
She pointed out that the eyes, kidneys, and nervous system are all affected by high blood sugar which is the leading cause of heart disease. It also makes cholesterol more dangerous, is the leading cause of kidney disease and makes people prone to infections and dehydration.
According to Baker, normal blood sugar levels for a person with diabetes are 80 to 130 when fasting, less than 180 two hours after a meal. When diabetes is under control, a checkup every six months is good enough.
There is now an A1C blood test that measures blood sugar levels weighted over the last three months for a more accurate picture of the patient’s health.
Complications are starting at a lower blood sugar level and more people are being diagnosed. Part of the reason for that is the way people live, or work, now. Instead of manual typewriters, there are computers; instead of getting up to change the channel on a television, the watcher uses a remote control.
“Lifestyle realignment combined with large screen TVs, recliners, people driving everywhere and eating bigger meals” all lead to more people developing diabetes, Baker said.
“Movement is medicine,” Baker said, adding “chronic sitting is like smoking and recliners are like cigarettes.” When people sit a lot, the inactivity increases the risk of blood clots, deep vein thromboses and pulmonary embolisms, so “chronic sitting kills”.
She advised the attendees to break up sitting to no more than 30 minutes at a time. Getting up to move often is important, especially after age 40 as loss of muscle tissue happens with constant sitting. Physical activity not only regulates one’s appetite, it also improves one’s metabolism and mood. “Small little things, like a tire realignment, can make a difference,” Baker said.
The causes of diabetes also include genetic disposition. Ethnicity and family history play a part in the disease too.
Stress is also a factor. Psychological and emotional issues, including depression, can cause people to eat out of emotion, she said. The body releases hormones that raise blood sugar levels; hormones tell the liver to put out sugar in the blood.
“Stress management has great benefits; the impact of just having fun is just as important as medicine,” according to Baker.
Social isolation also has an impact on one’s health. When someone is sick, their blood sugar level goes crazy. In a hospital setting, blood sugar needs to be carefully monitored as any infection affects it, she advised. Therefore, the less time spent in a hospital is better, decreasing the chance of developing a secondary infection.
Dental care is critical as high blood sugar feeds bacteria, “like a HomeTown Buffet”, she said, which impairs immunity and affects recovery.
Besides regular visits to the dentist, it is important to get screening done for diabetes. Pre-diabetes is not benign, Baker added. It can cause vascular disease, high blood pressure and high cholesterol.
There are different kinds of diabetes, Baker said. It can be an autoimmune disease; people with type 1 diabetes are below the age of 30 and must have insulin.
Type 2 diabetes is a progressive disease. Half of the people diagnosed with it will eventually need insulin; by the time it is diagnosed, half of the cells in their pancreas no longer function. For some people, they need insulin at first, “to clean up the oil spill”, then can be taken off of it.
“Insulin is just another therapy,” Baker said, “not good or bad.” “There are 12 different classes of oral medication to treat diabetes. Insulin can be fitted to just what you need,” she added.
Gestational diabetes is more common in women who have a higher weight to start with, who are older, and who are certain ethnicities. Elevated blood sugars cause babies to be too large, develop lung/respiratory distress, and have a difficult delivery. These babies are also more likely to be obese and are 40 to 50 percent more likely to develop diabetes when they are older.
Prenatal health care makes a big difference, she said, as well as healthy eating, screening and breast feeding.
When someone asked what makes blood sugar go up overnight, Baker explained the “dawn phenomenon” as a nocturnal release of hormones that tells the liver to produce sugar. The blood sugar drops overnight, the liver overreacts and puts out more sugar causing a rebound effect.
It is important to know that when diabetes is combined with high blood pressure, they cause a double whammy effect on the cardiovascular system which increases one’s risk of developing dementia, Alzheimer’s or mini-strokes.
“It is not just what you eat, it’s how you eat,” Baker said; “eating in front of screens is like texting while driving, disconnects the brain from the GI tract.” Part of mindful eating is planning meals which is where consulting a registered dietician can help.
Taking diabetes and nutrition classes can also help people cope with the disease. Palomar Health offers free classes to everyone at both Palomar and Pomerado hospitals. For more information, visit www.palomarhealth.org/classes-and-events/classes-search.