An Important Note, Part 2

Diabetes is a serious, life-threatening disease that’s reached epidemic proportions and the chances are everyone either has it or knows someone who does. Given its prevalence everyone should have a basic knowledge of it.

The Diabetes Book offers this. The information presented is accurate, but please understand it’s a general overview and shouldn’t be used for medical advice. It simply aims to convey how the two major types of diabetes work, drive home the importance of the patient’s active participation in his/her own care and offer some practical advice for living with it. Readers must remember that diabetes affects individuals differently and professionals are needed to develop personal treatment strategies. If the book raises questions – and I hope it does – you should see your medical professional for answers. Believe me, it’s a complicated disease and you won’t figure it out on your own.

This book isn’t comprehensive and I readily acknowledge that many things have been simplified or omitted. For example, the chapter on “Incorrect Common “Knowledge” note that diabetics don’t need special foods aside from the normal, healthy diets that a good for everyone. That’s true for the vast majority of us but there are exceptions. If you have diabetic kidney disease, you’ll need a low-protein diet. Or you may have a gluten intolerance possibly caused by the autoimmune system in Type 1s.

My purpose is to help people easily learn about diabetes. If I tried to explain all the “ifs,” “ands,” “whys” and “buts” it would have become too long, boring and time consuming for most people to read. That would have defeated its purpose, which is to inform as many people as possible.

If you’re diabetic you’ll need to refine, modify and add to this information as you learn what works in your individual case. If you’re not, you’ll better understand how it works and have a real idea of what your diabetic friends and relatives are dealing with. I sincerely hope The Diabetes Book makes everyone more knowledgeable, curious and committed to good health.

An Important Note, Part 1

The Diabetes Book is for everyone – diabetic or not – who wants a basic understanding of diabetes and some insights into the day to day issues involved in it. People with diabetes and those close to them will probably learn some new things. I know I did in doing the research.

Everyone else can benefit too. The book is written like its directed toward diabetics but it can help others by throwing light on a threat that’s often feared as a dark, mysterious monster lurking around the corner. Once non-diabetics learn of the strides made in treatment and understand diabetes can be treated, they’ll discover that the horror shows they imagine do not need to happen. And once they know the symptoms they may more readily seek treatment for themselves or suggest it for others. If people with symptoms get medical help sooner rather than later they’ll take a huge step toward staying healthy.

I was in Chicago the week Ron Santo was inducted into the Baseball Hall of Fame. Previously unknown to me, Santo had Type 1 diabetes in the 1960s and kept it to himself for fear of losing is job. The Chicago Tribune ran stories about his battle that I, as a person with diabetes, could relate to. But I realized most people couldn’t understand them because they don’t know enough about diabetes to appreciate Santo’s position. That’s where the idea for this book came from.

Over the next few months I spoke to people about Santo’s story and found there’s a much greater lack of knowledge about diabetes than I ever dreamed. And it’s almost as prevalent among diabetics as it is in the general public. To make matters worse, misinformation, old wives’ tales and often-repeated falsehoods cause confusion for people who accept them at face value. Good, caring people often “know” things that simply aren’t true and harbor misconceptions that can be counterproductive.

Excerpted from The Diabetes Book: What Everyone Should Know

What Does a Diabetic Look Like?

Photo by Pixabay on

I didn’t tell people about my diabetes for 30 years to avoid negative perceptions of who I am and what I can do. During that time I co-founded a company that melted stainless steel and poured it to make castings for corrosive applications. I was as likely to find myself on one end of a ladle holding 3,000 pounds of 3,000 degree metal as to be sitting across from a banker negotiating a loan. The last thing I needed was anyone questioning my abilities.

When I opened up about the disease most people reacted with surprise. A business associate I had known for 20 years said “So you’ve got diabetes. You don’t look like a diabetic.” I wondered what he thought a diabetic should look like.

But you know what? Depending on his personal experiences my friend may not have been off base. Here are some quotes taken from Dr. Bernstein’s Diabetes Solution:

“I met a wealthy car dealer at the golf club, with his legs cut off as high as legs go, who explained he hadn’t paid much attention to his diabetes at the time and his doctor couldn’t help him.”

“I developed severe retinopathy, glaucoma, high blood pressure, neuropathy that required me to wear a leg brace. Both of my kidneys ceased functioning … and I was placed on kidney dialysis for many months until I received a kidney transplant.”

“Years of widely fluctuating blood sugars affected my mental and physical ability, with great injury to my family life. The resultant disability also forced me to give up my surgical practice and suffer an almost total loss of income.”

“During a subway ride which generally took about 25 minutes, the train was delayed for close to 2 hours and – to my utter dismay – I had forgotten my bag of goodies. As I felt myself “going bananas” (from low blood glucose), sweating and perhaps acting a little strange, a man sitting across from me screamed “She has diabetes!” Food, juice, candy bars and fruit came from all directions. I was so grateful and embarrassed that I stopped riding the subway.

Perhaps my friend witnessed things like this. If he did, it’s understandable that they would have a jaded view of diabetics in general. After all, for every negative episode the public sees there are probably 20 diabetics like me who outwardly live normal lives. We commonly don’t tip our hands to avoid being lumped in with the bad stereotypes.

Unfortunately, our silence helps perpetuate a stigma that diabetics are less able or reliable than those who don’t have the disease.

What is a "CWD?"

You’ve probably heard the term “PWD” which is short for “person with diabetes.” But “CWD?” It stands for “character with diabetes.” Characters who have a variety of diseases and conditions appear in movies, television shows and books all the time. But diabetes is rarely mentioned even though it’s so widespread and serious.

Why is this? Maybe it’s because writers are afraid of alienating diabetics by presenting them unfavorably. After all, people commonly believe a stigma that blames us for getting the disease in the first place and then not dealing with it like uninformed people think we should. Or maybe it’s just too complicated to explain quickly enough to give viewers/readers the knowledge needed to understand the CWD’s situation and how the disease affects it.

Sometimes I’ve wished people could appreciate the decisions and actions diabetics think about and take every day. A little education could erase the stigma and generate the respect responsible diabetics deserve. But CWDs are rare critters that, if anything, are likely to be depicted in times of diabetes-related trouble.

There are some exceptions. A Cure: A Novel About Diabetes by Dr. H. Peter Chase has characters who struggle with the disease and work on a cure. Author K.J. Howe wrote Skyjack, a thriller that features a diabetic hostage negotiator.

PWDs do extraordinary things with a degree of difficulty that’s lost on non-diabetics. It would be wonderful if more CWDs painlessly informed them.

What's with the Keto Diet? Part 2

Watching carbohydrates is key to managing the blood glucose level (BGL). It’s critical because 1 gram of carbs digests into 1 gram of sugar so the impact on the BGL is the same. Keto diets rigidly restrict carbs and this helps keep the BGL low.

Like most things, it’s more complicated than it looks at first. Here are some things to consider:

  • Typical healthy diets recommend that about half of total calories be from carbs. The keto diet is not regarded as highly nutritious and dieters are encouraged to use vitamin/mineral supplements .
  • The diet’s very high fat content may sound like a chance to indulge without guilt but the kinds of fats consumed make a difference. Avocados, nuts and unprocessed foods can actually help prevent disease but pigging out on less healthy choices like processed sausage, cold cuts or meat balls is problematic.
  • When the body adjusts to using ketones it often goes through temporary symptoms that can include vomiting, fatigue, dizziness and others. It’s called “keto flu.”
  • Diabetics who use insulin or other BGL lowering medications are susceptible to very low blood sugars. Medications must be adjusted to account for this and professional medical advice is essential.
  • Ketogenic diets are not permanent lifestyle changes and generally last between 2 weeks and 12 months. Transitioning back to a normal diet should be gradual and monitored.

The diet is not off-limits for diabetics and it can certainly help with weight loss. But it does add a layer of complexity to managing a disease that’s already complicated.

What's with the Keto Diet? Part 1

Real quick, this is how the keto diet works.

Keto is short for ketogenic, which means that your body produces ketones. Ketones are released when fat cells are broken down to provide energy. The fat loss results in lower weight.

The body usually gets its energy by digesting carbohydrates into glucose (sugar). In most people the presence of glucose in the blood triggers the release of insulin, which enables the cells to use it. As long as there’s insulin present your body doesn’t need the ketones.

Ketosis (the creation of ketones) begins when there’s a lack of insulin. The diet restricts carbohydrates, which cuts down the glucose which means the insulin isn’t released. Instead of glucose, the body relies on protein and fat. Because protein and fat will not raise the blood glucose level, eating them rather than carbs can help manage diabetes.

Some diabetics, like Lele Jaro have had good results from the diet and she recounts the changes in lifestyle she made. She also emphasizes that diabetics should get advice from their health care professional before starting.

The keto diet can be problematic for type 1 diabetics and type 2s who use insulin because it’s possible for extremely low insulin levels to cause ketoacidosis (ketosis simply means the presence of ketones and is not harmful; ketoacidosis is a potentially fatal condition).

More on the keto diet next week.

Does Fear Help?

I won’t bore you with the details of diabetic complications.  Here’s the question:  Does having fear of them incessantly pounded into you really help? Most of us know what they are.  We get it.

But it doesn’t change how difficult and  unpredictable the disease is.  Or how frustrating it is to try to manage the beast while full well knowing the possible consequences of failing to do it well enough.

Fear can be counterproductive, as Renza Scibilia discovered.  She tells her story at

Help for the Holidays

Holiday meals are like an Olympic boxing match: Each has three rounds.

Round 1 Try not to start the big meal with an outsized appetite. You can start with a breakfast that’s heavy in protein – like eggs and meats. This will digest slowly and leave you with less hunger than carbs will. Staying hydrated also helps because thirst sometimes seems like hunger and the fluids will also help you feel fuller.

Round 2 Dinner is usually loaded with food choices and they’re not all equal. Lots of them have low or moderate amounts of carbohydrate. Carbohydrates have the same impact on blood glucose levels as sugar (1 gram of carbohydrate = 1 gram of sugar). You can eat whatever you want, including tasty high carb foods, but you should limit those and fill up on lower carb choices. Here’s a comparison of typical holiday foods with their carb content per 1/2 cup:

  • Cheddar cheese 0
  • Turkey, ham, beef, fish 0
  • Garden salad (no dressing) 0
  • Dressings (from oil & vinegar to 1000 Island 0
  • Asparagus 3
  • Broccoli 3
  • Green beans 3
  • Squash 3
  • Spinach 4
  • Zucchini 4
  • Cauliflower “mashed potato” 4
  • Carrots 6
  • Broccoli casserole (no bread/cracker topping ) 10
  • Stuffing 11
  • Creamed onions 15
  • Egg nog 17
  • White or sweet potato 20
  • Yams 20
  • White pasta 20
  • Peas 21
  • Brown rice 22
  • Dinner roll 22
  • Macaroni & cheese 23
  • Gravy (from thin to thick) 24-36
  • Croissant 26
  • White rice 30
  • Cranberry sauce 53 Butter, margarine and olive oil have no carbs. Spices are zero to low carbohydrate.
  • Fruit pie (1/8 of 9″ pie) 44
  • Ice cream (1/2 cup) 17

If you fill up on foods you like on the upper part of the list and enjoy those on the lower section moderately you’ll be in a much better position than if you loaded up on the high carb dishes.

Round 3 OK, maybe you overindulged anyway and lost the second round on points. You still haven’t lost the match because it’s decided by average blood glucose levels, not temporary spikes.

You can still win by knocking it down and it’s not all that hard to do. Moderate exercise drops the blood glucose level naturally without requiring medication. Going for a brisk walk will work. You know you’re doing it effectively if you can talk but not sing, so going with others can be fun. If this isn’t feasible, any type of exercise – anything that makes your skeleton move – will help.

You can enjoy a great meal and come out a winner! I plan to.

The Toolbox

Three tools help manage diabetes: diet, exercise and medication.  Some people can do it with just diet and exercise, but most diabetics eventually need medication in addition.

In a nutshell, here’s what the tools do:

    The food you eat determines how much glucose your body must deal with.    

    Physical activity is the magic bullet because It naturally and quickly removes glucose from the blood. ​

    Medication helps the body function closer to normal, but it can’t control blood glucose levels on its own.

The tools work together and a change in one means a change in another. We’re all different and we need to figure out what works for us. It’s a big reason diabetes is so challenging.

What about Food?

Foods aren’t equal.  High carbohydrate foods like table sugar raise the blood glucose level a lot. Meats, fish, eggs and many vegetables raise it minimally, if at all. Eating intelligently is critical to managing diabetes.

You’re more likely to succeed if you eat foods you enjoy.  Nothing is forbidden, but diabetics need to recognize the carb content of what they eat.  Once you know this, there are lots of ways to manage food:

    Eat less of the high carb and more of the low carb.

    Bake with less sugar (you won’t miss it).

    Use sugar substitutes.

    Cook with spices, which generally have no carbohydrate.

Our tastes are different. The challenge is to create a personal strategy with foods that are nourishing, taste good and don’t drive blood glucose levels through the roof.

The Magic Bullet

Exercise recommendations can be daunting.  A typical program recommends 30-60 minutes of exercise per day, a combination of aerobic and resistance training 3-4 days a week, exercising all major muscle groups, exercising at least every other day while working up to five days a week, walking 10,000 steps a day…and more.

Runners and gym rats may not have a problem with this, but others are intimidated and troubled to think they’re doomed if they don’t comply.

If a person with diabetes follows the guidelines, their blood glucose management will improve – no question about it.  But what about those who can’t?

“Exercise” doesn’t necessarily mean sweating, sore muscles and exhaustion.   It can. but it’s helpful to think of it as “anything that makes your skeleton move.”  This includes vacuuming, walking to the store and doing anything that isn’t sedentary.

The more active you are, the more muscle you’ll build. Muscle is a powerful tool for diabetics.  It naturally pulls glucose from the bloodstream without medication and either burns it or stores it for future use.  The blood glucose level (BGL) will drop immediately and it will be easier to manage for about two days, even if you’re relatively inactive.

“More is better.”  The more muscle you have and the more you move the better your BGL will be.  It’s the magic bullet for diabetics.

If you keep it up, you’ll get stronger and become even more active.  The payoff is that your blood sugars will be easier to manage.

Physical activity is free and effective.  It’s a magic bullet for diabetics.


Type 1 diabetics no longer produce insulin, so insulin is the necessary med.  Digestion destroys it, so insulin is delivered by injection or a port inserted under the skin.

Type 2 cripples the ability to produce insulin so the pancreas can’t control blood glucose levels on its own. Some diabetics manage with only diet and exercise, but the condition is progressive most eventually need meds.

Over 50 medications do various things. They promote insulin production, reduce insulin resistance, induce muscle to absorb glucose and others.  A health care professional is needed to find the best option.

Medication’s effectiveness depends on food intake and physical activity.  Even with medications If you eat lots of carbs and veg out, you’ll have a higher BGL than if you ate smarter and went for a walk.  It’s easy to blame doctors for not prescribing the right medication, but an erratic lifestyle gives them a moving target they can’t hit.

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We have a problem.

Millions of diabetics don’t treat their disease well, if at all. It’s the reason they, their families and everyone who counts on them suffers from the avoidable complications of a manageable disease.

Why is this?

Widespread misperceptions are a big reason. They come from a confused jungle of information that includes old wives’ tales, hucksters who promote “cure” and “reversal” programs, zillions of diet suggestions, inaccurate advice from misunderstood health care providers and others.

They all contribute to an unjustified stigma that criticizes diabetics and blames them for getting the disease.

Bad information leads people to think the disease isn’t all that serious, it’s a killer you can’t beat and everything in between. Clueless diabetics can experience apathy, denial, depression, frustration, fear and shame. All of them hinder good treatment and all are reinforced by a public that is woefully ignorant about diabetes.

This is serious. It’s time to stop the nonsense, fix the problem and cut down on the amputations, blindness, kidney disease and other complications that destroy lives.

Be yourself; Everyone else is already taken.

— Oscar Wilde.

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