Answers from the Experts: Diabetes Management

Updated:Mar 3,2016

You've asked and we've answered your questions about managing diabetes in the following categories:

Diet and nutrition


Lori Wolf, R.D./L.D., patient education advisor for the American Heart Association in Dallas, Texas, explains:

Diabetes increases the risk for cardiovascular disease (CVD), and dietary intervention has been proven to help lower that risk. Following recommendations from the American Heart Association is heart healthy. Since diabetes is a major risk factor for CVD, you should protect your heart with diet and physical activity (as your healthcare provider allows).

To manage your diabetes, it's important to monitor calories, fat and carbohydrates. On a diabetic meal plan, your caloric intake should remain about the same from day to day. That's because the meal plan is designed around a total caloric level. Your healthcare provider set your level to support optimal blood sugar control and to allow gradual weight loss or weight maintenance, depending on your need. That's why it's imperative that you comply with the recommended calorie levels.

Fat is an important nutrient in the diet, so don't exclude it. To manage your diabetes to protect your heart, it helps to know about saturated, unsaturated and trans fats.

- Saturated fats are usually solid at room temperature and come from animal products such as meats, cheese, eggs, milk products and butter. They are also found in tropical oils such as coconut and palm oils. Saturated fats increase CVD risk by increasing the bad cholesterol (LDL) . To protect against CVD, you should limit these fats to less than 5-6 percent of calories in your diet.

- Unsaturated fats are liquid at room temperature and come from vegetable sources such as canola oil and olive oil. They also can be found in soft tub or liquid margarine. These fats protect your heart's health by lowering the bad cholesterol, so most of your daily fat should come from unsaturated fats. And you should use these oils to substitute for saturated fat choices, not in addition to them.

- Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. Another name for trans fats is "partially hydrogenated oils." Look for them on the ingredient list on food packages. Trans fats raise your bad (LDL) cholesterol levels and lower your good (HDL) cholesterol levels. You should limit your diet to less than 1 percent of your total daily calories. To manage diabetes and decrease CVD risk, it's best to increase unsaturated fats and decrease saturated fat and trans fat.

Carbohydrates should be the main focus of your daily efforts to control your blood sugar and thus your diabetes. Carbohydrates are completely digested and put into your bloodstream in the form of sugar within two hours of eating them. (This is one of the reasons it's important to test your blood sugar two hours after a meal to monitor how your body handled the amount of carbohydrates you just ate and to design the perfect plan for your body.) To successfully manage diabetes, consistency is the key with carbohydrates. Typically, eating the same amount of carbohydrates at each meal at the same time every day is a great formula for stabilizing blood sugar levels according to the caloric level of your meal plan. Some people are more sensitive because of medications and/or activity levels. They will need more specific monitoring of their meals and carbohydrate intake with a dietitian's help.

Weight management and physical activity

First, congratulations on your weight loss! Losing even 10 pounds will improve your blood sugar readings and HbA1c. It also will help lower your blood pressure and LDL ("bad") cholesterol and raise your HDL ("good") cholesterol.

It's hard for most people to get enough physical activity to substantially reduce their weight. Regular physical activity must be combined with sensible eating — and, most importantly, portion control.

Even when physical activity and reducing calories are used together, people often reach a plateau. The number of calories that your body needs depends on your body weight. The heavier you are, the more calories you can eat to maintain your body weight. As you lose weight, though, you may need to adjust your calorie intake downward to keep losing weight.

Sometimes if people have been severely restricting their calorie intake, they may lower their metabolic rate. Then they may need to add 100 to 200 calories per day of healthy foods to rev up their metabolism.

When people have been working at weight loss for a long time and feel that they've hit a plateau, it's often a good idea to take a break from actively trying to lose more and spend some time maintaining this new weight. Also, varying the type of physical activity can be helpful. By doing this you will not only use different muscle groups, but you will be less likely to become bored. In addition, you may want to assess how much and what types of food you are eating. It is easy to believe you are eating less when in fact you are taking in more calories than is necessary. Remember to drink enough water, too — it helps your metabolism and cellular function.

Losing weight is hard work. The people who are most successful in the long-term are those who have lost weight slowly and steadily and who have learned to incorporate sound eating habits and moderate levels of physical activity into their everyday life.

Cardiovascular disease risk

Dr. Lori Mosca, an American Heart Association volunteer and director of preventive cardiology at New York-Presbyterian Hospital explains:

Type 2 diabetes is the type that often develops in adulthood, though more and more children and adolescents are also developing it. It's often associated with being overweight and leading a not-so-healthy lifestyle.

We've learned in our research that people with diabetes have almost the same risk of having a future heart attack as people who already have heart disease or other vascular disease. So diabetes is really one of the strongest risk factors we have.

Some of us feel so strongly about diabetes that we call it a risk equivalent, which means it's equivalent to having heart disease already. We are extremely aggressive with this risk factor, because we know that if you have diabetes, you are at substantially higher risk for future heart disease.

We also know that diabetes is associated with unhealthy levels of different types of blood cholesterol. So, people with diabetes tend to have an increased level of the bad cholesterol (LDL) and of triglycerides, and they tend to have reduced levels of the good cholesterol (HDL). This may be one of the explanations for why people with diabetes are at such high risk for heart attacks.


Many parents who are diabetic worry about their child’s risk for diabetes. It is true that having a family member with diabetes measurably increases the risk that a child may develop diabetes. Fortunately, with some knowledge and with help from your health care providers, there are things you can do to keep your children healthy.

Type 2 Diabetes Mellitus

Having a parent with type 2 diabetes increases a child’s risk for developing diabetes. This is related in part to genetics and in part to learned habits around exercise and eating. One way of thinking about it is that genes lay the groundwork, and the lifestyle allows for or protects against a diabetic predisposition. So, having a healthy lifestyle is extremely important.

The risk that your child will develop type 2 diabetes depends on the parent’s gender and how old they were when they were diagnosed; children of mothers diagnosed before the age of 50 years have significant risk, 1 in 7.

No medication has yet been shown to slow the progression to type 2 diabetes in children, although some medications may be useful in adults, and research is ongoing. Fortunately, lifestyle change can prevent diabetes in adults, and this is likely to be true in children as well.

Weight loss, regular moderate-intensity, aerobic physical exercise such as 30 minutes of brisk walking 5 times per week and healthy eating habits, decrease the risk of diabetes in adults. Research in children shows that having a healthy lifestyle can improve factors associated with diabetes, including weight, cholesterol and blood pressure. Some specific things you can do to improve your child’s health are:

  • Limit screen time: Keeping screen time to 2 hours or less per day may reduce rates of obesity, an important risk factor for diabetes type 2
  • Encourage a healthy diet: Serve lots of fruits and vegetables, unsalted nuts, low-fat (1%) or fat free dairy, fiber-rich, whole grain foods, fish twice per week, and limit intake of saturated fat, trans fat, and cholesterol. Choose healthy, monounsaturated and polyunsaturated fats and avoid highly processed foods that can be high in sodium. Limit added sugars in beverages and foods such as sodas, fruit drinks, sucrose, fructose, maltose, honey, high-fructose corn syrup, concentrated fruit juice, corn syrup, cane juice, sweets (examples: candy, cookies, cake, etc.).
  • Aim for a healthy weight: helping your child work towards a healthy weight is an important way to reduce your child’s risk of diabetes. Children and adolescents should do 60 minutes or more of physical activity per day.
  • Model good habits: Positive role modeling is important. Show your children that physical activity is important and can be fun by spending time playing actively. Keep in mind that if you don’t take care of yourself, it will be hard for your children to follow a healthy lifestyle.

Type 1 Diabetes Mellitus

For parents with the more rare type of diabetes mellitus, Type 1, the risk that your child will develop the disease depends in part on your gender and also the age you were diagnosed. Children of male type 1 diabetics have a 1 in 17 risk of contracting diabetes, while children of very early onset diabetics, those with two affected parents, and with multiple endocrine problems are at much greater risk (1 in 2-10). Breastfeeding may offer some protection from Type 1 diabetes. Some research has evaluated blood tests that may be available for siblings of children with type 1 diabetes; speak to your child’s doctor about this. So far, no medication has been shown to prevent type 1 diabetes in children, although research studies are ongoing.

Testing for Diabetes

You and your doctor can better understand your child’s individual risk for diabetes using blood testing. A fasting glucose test should be done in overweight children with 2 of the following risk factors: family history of Type 2 diabetes including gestational diabetes in the child’s mother, at risk racial/ethnic background, high risk medical conditions such as insulin resistance, PCOS or metabolic syndrome. Screening should be done at least every 3 years using either a fasting glucose or a glycosylated hemoglobin (hemoglobin A1C). A more specialized test (oral glucose tolerance test) can tell how the body responds to glucose and can help your provider evaluate your child more closely. Talk to your child’s doctor about these tests.



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