In medium bowl, stir together the nectarines, bell pepper, onion, jalapeno, lime juice, orange juice, sugar if you like, ginger, allspice, and salt. Refrigerate until serving time.

PER SERVING.

19 calories, 0 g protein, 5 g carbohydrate, 0 g fat, 0 mg cholesterol, 49 mg sodium, 1 g fiber; plus 23 mg vitamin C (38% DV)

CHAPTER 9.

TYPE 2 DIABETES.

I'm not going to try to sugar-coat it-diabetes is a silent killer. Of all the disorders I treat, diabetes is among the sneakiest and nastiest.

Sneaky...because unless you know you're at risk and are checking for signs, symptoms might not appear until your body is damaged in some way. Nearly one-third of people who have diabetes don't know it. If you suspect there's a problem but wait until you feel sick to get help, you may be well on your to developing complications.

Nasty...because if it goes untreated, one or several serious complications can kill you, although the process might take years. Diabetes can lead to a heart attack or stroke, continuous pain from degenerated nerves, foot or leg amputations from gangrene, kidney failure, or blindness from retinopathy.

It's not a pretty picture, but the condition is serious, and one that deserves your serious attention if you've been diagnosed, know or even suspect you're at risk!

On a positive note, if you work with your doctor to closely monitor and control your blood sugar and commit to eating right and exercising regularly, there's great reason to believe you'll live a long, healthy life. New medications, clever blood testing devices, and breakthrough information about diabetes processes, foods, and supplements mean that near-perfect glucose control is within everyone's reach.

WHAT IS DIABETES?.

Your body's primary source of energy is glucose, a simple sugar created when carbohydrates are broken down during digestion. If everything is working properly, glucose enters the blood stream...which triggers the pancreas to release insulin...which allows glucose to leave the blood and enter every cell in your body. That's how cells get their nourishment. This energy transfer at the cellular level fuels all the your bodily functions from thinking to digestion to all the fantastic physical feats the human body is capable of. Think of glucose as the electricity in a house-you have one main line which branches off into each room and branches again to supply power to the outlets within them. Skimp on the glucose, and your power goes out.

If you have diabetes, there is a problem with the way your body produces or uses insulin. If glucose can't move into the cells, it stays in the blood stream leading to the high blood sugar levels characteristic of the disease.

There are three main types of diabetes. With type 1 diabetes type 1 diabetes, the insulin-producing cells of the pancreas are destroyed, so there is no insulin available to let glucose enter body cells. It is as if a circuit breaker tripped, and the power is simply cut off. No insulin means no energy getting to the cells. Type 1 diabetes is an autoimmune disorder for which there is no known prevention. It requires treatment with insulin and carefully planned meals.

With type 2 diabetes type 2 diabetes, there are two potential insulin problems. Either 1) the pancreas can't make enough insulin; or 2) the cells have become resistant to the insulin your body produces. Either or both these conditions may be present. Going back to the electricity a.n.a.logy, insulin resistance is like having a dimmer switch on your body's power supply stuck on "low"-some energy gets through to the cells, but much of the glucose is blocked from entering cells and stays in the blood stream. Treatment options vary from person to person, depending on the severity of the condition. Some people with type 2 diabetes can manage their disease with dietary changes alone. Others require medications or insulin replacement.

There is also a third type of diabetes called gestational diabetes gestational diabetes, which affects about 4 percent of pregnant women. Although this type of diabetes usually disappears after the baby is born, research suggests that women who develop gestational diabetes have an increased risk of developing type 2 diabetes later in life.

The information in the rest of this chapter pertains only to type 2 diabetes. People with type 1 or gestational diabetes should consult a private nutritionist or trained diabetes educator for one-on-one dietary counseling.

WHAT AFFECTS TYPE 2 DIABETES?.

Type 2 diabetes was once called adult-onset diabetes adult-onset diabetes, but now we know that even young children can develop this disease. The number one risk factor-by far-is being overweight. Genetics, age, and lack of exercise also contribute to your personal risk, but body weight is the biggest contributor. The American Diabetes a.s.sociation recommends that anyone who is overweight should talk with his or her physician to see if testing is appropriate. If your doctor believes you're at significant risk, she'll order blood tests to rule out a thyroid disorder, and to determine if you have diabetes or prediabetes. There are two tests used to check for diabetes: A Fasting Plasma Glucose test (FPG) measures blood glucose after an overnight fast. It is quick, convenient, and inexpensive. Normal fasting blood sugar is below 100 mg/dL. If your blood glucose is 126 mg/dL or higher, the test will be repeated. Two readings of 126 mg/dL or higher means a diagnosis of diabetes. If your blood glucose is 100 to 125 mg/dL, your diagnosis is prediabetes. (Prediabetes used to be called impaired glucose tolerance impaired glucose tolerance or or impaired fasting glucose impaired fasting glucose.) An Oral Glucose Tolerance Test (OGTT) measures blood glucose after an overnight fast, and again 2 hours after you drink a high-glucose liquid. This test is more sensitive than FPG, but it is inconvenient because of the 2-hour wait between blood draws. Normal 2-hour blood glucose is below 140 mg/dL. If your 2-hour blood glucose is 200 mg/dL or higher, the test will be repeated. Two readings of 200 mg/dL or higher means a diagnosis of diabetes. If your 2-hour blood glucose is 140 to 199 mg/dL, your diagnosis is prediabetes.

WHAT ARE THE DANGERS OF PREDIABETES?.

It's probably obvious, but the greatest danger of prediabetes is that it can lead to diabetes. In fact, research shows that most people with prediabetes will develop diabetes within 10 years unless they lose weight (at least 5 percent of body weight), become more active, and make changes to their eating habits (like embracing the eating plan I'll tell you about later in this chapter).

Prediabetes is also one of the hallmarks of another disorder called the metabolic syndrome the metabolic syndrome. The metabolic syndrome describes a cl.u.s.ter of risk factors that, when taken together, create a toxic environment in your blood vessels. Doctors diagnose metabolic syndrome in patients who have at least three of the following conditions: high blood pressure (130/85 mmHg or higher), high triglycerides (150 mg/dL or higher), low HDL cholesterol (below 50 mg/dL for women, below 40 mg/dL for men), large waist circ.u.mference (greater than 35 for women, greater than 40 for men), or fasting blood sugar higher than 110 mg/dL. The combination of any three is dangerous, even if the numbers are only slightly out of the normal range. People with the metabolic syndrome have an increased risk of heart attack and stroke. If you have been diagnosed with metabolic syndrome but have a normal fasting glucose level (below 100 mg/dL), follow the 4-step plan outlined in my cardiovascular disease chapter. If you have been diagnosed with metabolic syndrome and your fasting glucose level is elevated (higher than 110 mg/dL), follow the 4-step program outlined at the end of this chapter. You should also read the cardiovascular disease chapter to learn about the most beneficial foods to eat (and not!) in order to bring down all other elevated numbers, such as blood pressure, LDL cholesterol, and triglycerides.

FAQSIs it safe for people with diabetes to drink coffee?

Coffee has a bad reputation, a largely undeserved one, especially when it comes to its effect on diabetes. Many studies have linked moderate coffee drinking with a lower risk of developing type 2 diabetes. A Swedish study found that people with diabetes and low glucose tolerance who regularly drank coffee had less glucose resistance and better beta cell function. Caffeinated or decaffeinated, instant or filtered coffee, all can lower diabetes risk. But of all the varieties, decaffeinated coffee seems to have the greatest effect. The Iowa Women's Health Study, which followed nearly 29,000 women for about 10 years, found that drinking decaffeinated coffee reduced the risk of developing diabetes by 33 percent, while coffee with caffeine reduced the risk by only about 21 percent. Because some other studies have shown that caffeine reduces insulin sensitivity, decaf is definitely the way to go.

The good news is that prediabetes doesn't necessarily progress to diabetes. The Diabetes Prevention Program, which studied more than 3,000 people with prediabetes, showed that partic.i.p.ants who changed their diets, lost weight, and started exercising reduced their risk of developing diabetes by an astounding 58 percent. That's slashing your risk of diabetes by more than half, without drugs! Treatment with the medication metformin reduced the risk of diabetes by 31 percent-still significant, but less than the combined effect of diet and exercise. Every step you take-and I mean that both literally and figuratively-can help prevent or delay the onset of disease. Every year you don't have to deal with the complications of diabetes is a blessing for your future health.

One of my clients is counting on those blessings. Dina, 49, went to her doctor for a routine checkup and blood work before her second marriage, and discovered that she had the metabolic syndrome. Her fasting blood sugar was 125-just shy of full-fledged diabetes. In addition, she had triglycerides of about 200, high blood pressure, and total cholesterol of 340-her "bad" LDL cholesterol was over 200! (Although LDL cholesterol is not a diagnostic marker for metabolic syndrome, optimal levels are less than 100.). At 5?5? and 163 pounds, Dina was also overweight and carried a significant amount of fat around her middle. She also had a family history heart disease-her brother had died of a heart attack in his late 30s. Until her test results came back, Dina had eaten whatever she wanted and didn't give a darn about exercise. Her doctor set her straight: "Those days are over. You're getting married and have a whole new adventure ahead of you. You have a lot to live for." He wrote her a prescription for a cholesterol-lowering medication and sent her to me.

After just two months following every point of my 4-Step Program for Diabetes, Dina lost 16 pounds and trimmed 4 off her waist. Her fasting blood sugar was down to 105-still too high, but a significant improvement. Her blood pressure was now in the normal range and her blood lipids were lower, too, thanks to medication and nutrition changes. Her triglycerides had fallen to 130 (now considered normal), and her total cholesterol had fallen to about 210 (the bad LDL cholesterol dropped below 130!). She drew her motivation from both fear and hope-fear of meeting the same early death as her brother, and hope for years of love and happiness she dreamed of sharing with her new husband. Hope, for many of us, blooms as we see the powerful effects making just a few changes can have on our overall health.

WHAT ARE THE DANGERS.

OF TYPE 2 DIABETES?.

If you have diabetes, it is important to understand that it's a chronic condition. You can control the disease, but it will never go away. The best you can hope is that your disease will go into a form of remission-contained, but subject to return. You'll need to monitor your blood sugars daily, and your doctor will want to periodically check your progress, too. One of the most powerful medical tools is a blood test for glycosylated hemoglobin, more commonly called HbA1C HbA1C or simply or simply A1C A1C. This test doesn't require fasting, and it estimates how well you've been controlling blood glucose over the past two to three months. So A1C captures more than your blood glucose level at the moment your doctor draws blood for the test-it is a measure of whether you're controlling your diabetes...or if your diabetes is controlling you.

High A1C levels mean a high risk of complications from diabetes. To put it bluntly, uncontrolled blood sugar is a poison. Because all cells need and use glucose, many different body systems are affected. The most common problems faced by people with diabetes are: CARDIOVASCULAR PROBLEMS.

Although a little extra blood sugar doesn't sound dangerous, it is toxic to your blood vessels. High levels of glucose form free radicals, unstable molecules that damage cellular membranes, including the delicate cell membranes of your blood vessels. Over the long-term, the damage may trigger the immune system to address the damage. Unfortunately the inflammatory chemicals sent to the site of the damage further a.s.sault the blood vessels. The process can lead to serious cardiovascular problems...which in turn may cause a heart attack or stroke. (For more information about the cardiovascular system, see Chapter 7.) EYE DISEASES.

Diabetes increases your risk of cataracts, which cloud the lens, and glaucoma, which can lead to blindness from damage to the optic nerve. In addition, uncontrolled blood glucose damages the delicate blood vessels in the retina, leading to a condition called diabetic retinopathy diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness in America, but that doesn't mean it's in your future. Studies show that people can prevent retinopathy by keeping their blood sugar levels as close to normal as possible. Once retinopathy develops, careful blood sugar control can keep the disease from progressing.

NEUROPATHY.

Uncontrolled diabetes exposes your nerves to something like a sugar bath, which leads to degeneration of nerve axons-the bodies of the nerve cells. In addition, the protective coating around the nerves-the myelin-may be stripped, slowing the speed at which nerves can transmit sensory messages. If the blood vessels that feed the nerves are damaged by diabetes, then those nerves can die.

Early nerve damage may not cause any discomfort. Mild symptoms can include tingling or numbness, particularly in the feet. Over time, neuropathy progresses and may cause pain or large areas of numbness. Scientists estimate that about 26 percent of people with type 2 diabetes have painful neuropathy. If nerves die, muscles of the feet or hands can whither. As the nerve damage becomes more extensive, it can cause impotence, dizziness, gastrointestinal problems, and general weakness.

Because the feet are usually affected first, good foot care is critically important. You may overlook a blister, sore, or cut if that part of your foot is numb. If your foot becomes infected, it could eventually spread internally to the bone. In some cases, an infection can become so severe that it becomes necessary to amputate the limb.

The longer you have uncontrolled diabetes, the greater your risk of neuropathy, and the greater the potential damage. But, as with eye diseases and other complications, studies have shown that neuropathy can be delayed and yes, even prevented if you control blood glucose level strictly.

HOW FOOD AFFECTS DIABETES.

Let's talk about food on a grand scale for a minute. Regardless of whether you have prediabetes or diabetes, the best thing you can do for your health is to lose weight. I know, I know...that's what your doctor said, right? But did she tell you that you don't have to slim down to swimsuit shape to reap the benefits? Research has shown that losing even small amounts of weight-as little as 10 pounds over two years-can reduce the risk of developing diabetes by up to 30 percent. That's a small amount of weight to lose for such a large return on the quality of your life! And if you add more lifestyle changes, you'll reduce your risk even more. Among people with diabetes, weight loss improves insulin sensitivity and glycemic control, reduces triglycerides and LDL cholesterol, and lowers blood pressure. That is to say, losing a few pounds may very well save your life. (For more information on the basics of losing weight, see Weight Loss on Chapter 3.) But healthy eating for diabetes prevention or control is about more than weight loss....

HIGH-QUALITY CARBOHYDRATES.

VERSUS LOW-QUALITY CARBOHYDRATES.

During digestion, carbohydrates break down to create glucose, which enters the blood stream, triggering a rise in insulin, which is necessary for the glucose to enter cells. In people with diabetes, this system is defective, so glucose stays in the blood. This is what you are checking when you test your blood sugar level.

You have no doubt heard about the concept of the glycemic index glycemic index (GI). GI is a measure of how fast and how high a particular food will raise blood sugar. Foods with a high GI raise blood sugar faster and higher than foods with a low GI. It's a controversial topic in nutrition because when it comes right down to it, GI values simply aren't very user-friendly. One type of food can have many different GI values depending on ripeness (of a fruit or vegetable), method of preparation, and other factors. For example, a ripe banana has a higher GI than a green banana, and a baked potato has a different GI than a boiled potato. If you eat a high-GI food with a protein (and/or a food containing fat), the GI value goes down because protein and fat slow down the absorption of carbohydrate. Beyond that, a tomato grown in a North Carolina farm may have a different GI than a tomato grown in a Pennsylvania greenhouse. The myriad factors that influence GI values boggle the mind! There's an easier way to achieve low-glycemic eating without feeling like every meal is an exercise in advanced mathematics. (GI). GI is a measure of how fast and how high a particular food will raise blood sugar. Foods with a high GI raise blood sugar faster and higher than foods with a low GI. It's a controversial topic in nutrition because when it comes right down to it, GI values simply aren't very user-friendly. One type of food can have many different GI values depending on ripeness (of a fruit or vegetable), method of preparation, and other factors. For example, a ripe banana has a higher GI than a green banana, and a baked potato has a different GI than a boiled potato. If you eat a high-GI food with a protein (and/or a food containing fat), the GI value goes down because protein and fat slow down the absorption of carbohydrate. Beyond that, a tomato grown in a North Carolina farm may have a different GI than a tomato grown in a Pennsylvania greenhouse. The myriad factors that influence GI values boggle the mind! There's an easier way to achieve low-glycemic eating without feeling like every meal is an exercise in advanced mathematics.

If you're looking for foods that raise blood sugar levels slowly and gently like rolling waves, choose high-quality carbohydrates (see list below) instead of low-quality carbs, and whenever possible, couple these carbs with protein and/or healthy fat. For example, eat brown rice and vegetables (high-quality carbs) together with grilled chicken or pork tenderloin (lean protein). High-quality carbs are full of vitamins, minerals, and fiber. They are found primarily in plant foods, including whole grain products, brown and wild rice, oats, vegetables, fruits and legumes. In addition, some of these high-quality carbs also contain soluble fiber, a component of plant cell walls. Soluble fiber slows the absorption of glucose from food in the stomach, which also helps keep blood sugar under control. Studies have shown that eating a diet rich in whole grains and high-fiber foods may reduce the risk of diabetes by between 35 and 42 percent.

BEST FOODS FOR HIGH-QUALITY CARBS: Vegetables, fruits (fresh, frozen; unsweetened), beans, peas, lentils, brown rice, wild rice, barley, oatmeal, whole grain cereals, whole grain breads, whole grain crackers, quinoa, amaranth, wheat berries, millet Vegetables, fruits (fresh, frozen; unsweetened), beans, peas, lentils, brown rice, wild rice, barley, oatmeal, whole grain cereals, whole grain breads, whole grain crackers, quinoa, amaranth, wheat berries, millet BEST FOODS FOR SOLUBLE FIBER: Psyllium seeds (ground), oat bran, rice bran, oatmeal, barley, lentils, Brussels sprouts, peas, beans (kidney, lima, black, navy, pinto), apples, blackberries, pears, oranges, grapefruit, cantaloupe, strawberries, bananas, peaches, broccoli, carrots, cauliflower, cabbage, spinach, sweet potatoes, yams, white potatoes, tomatoes, avocado, raspberries, corn, almonds, flaxseed (ground), sunflower seeds Psyllium seeds (ground), oat bran, rice bran, oatmeal, barley, lentils, Brussels sprouts, peas, beans (kidney, lima, black, navy, pinto), apples, blackberries, pears, oranges, grapefruit, cantaloupe, strawberries, bananas, peaches, broccoli, carrots, cauliflower, cabbage, spinach, sweet potatoes, yams, white potatoes, tomatoes, avocado, raspberries, corn, almonds, flaxseed (ground), sunflower seeds Low-quality carbs, on the other hand, have much less nutritional value. They are made primarily of sugar, including sugar itself, candy, soft drinks, syrup, honey, jam and jelly, cakes, and most other foods we typically think of as sweets or desserts. Refined starches-the "white" carbs, such as white rice and white bread-are also low-quality carbohydrates because they act very much like sugars once you begin to digest them. You should also avoid drinking fruit juice-all fruit juice, even 100% pure fruit, fruit juice. Although these beverages certainly provide better nutrition than soft drinks, they're concentrated in fruit sugar and raise blood sugars quickly. The same thing goes for dried fruit. Like fruit juice, dried fruit provides ample nutrition and fiber, but when the water content is removed from fresh fruit, the dried, dehydrated version becomes super concentrated in sugar and can cause a sharp rise in blood sugar. Clearly not worth the spike! Root vegetables-such as potatoes, carrots, beets, and turnips-have a higher glycemic index than other, non-root veggies, such as broccoli, peppers, and mushrooms. However, you can enjoy moderate amounts of root vegetables if you eat them with lean protein at meals (instead of eating them alone). For example, a balanced dinner might include grilled chicken, broccoli, and a small baked white or sweet potato topped with fat-free sour cream; lunch might include turkey breast in a whole wheat pita pocket with 1 cup crunchy baby carrots.

Your goal, then, is to choose high-quality carbohydrates whenever possible, and to limit or avoid most low-quality carbs.

MODERATE TOTAL CARBOHYDRATES, COUPLED WITH PROTEIN.

If you stick with high-quality carbs, can you eat as much as you want? Unfortunately, NO. To best control your blood sugars, you have to moderate moderate ALL carbs-even if they're the best of the best carbohydrates. Your total carb intake should be limited to about 40 percent of your daily food intake. That's why on my meal plan you'll notice things like "half a baked white or sweet potato" or "reduced-calorie, whole wheat bread." I've picked the best of the best carbs, but still had to limit the total amount. ALL carbs-even if they're the best of the best carbohydrates. Your total carb intake should be limited to about 40 percent of your daily food intake. That's why on my meal plan you'll notice things like "half a baked white or sweet potato" or "reduced-calorie, whole wheat bread." I've picked the best of the best carbs, but still had to limit the total amount.

To further slow or prevent a blood sugar rise, remember that, in general, carbs should be eaten together with high-quality protein. Some foods-such as lentils, beans, yogurts, milk, split peas, and soybeans-naturally contain both high-quality carbohydrate and lean protein. My food plan incorporates everything-moderate amounts of high-quality carbohydrate, coupled throughout the day with protein. If you like to have the plan laid out for you in detail, it's all there; if you like to add your own flair to meals, use it as a reference guide.

CARB COUNTING AND THE EXCHANGE SYSTEMPeople with diabetes are sometimes told they need to count carbs or follow a food exchange system to standardize their diets.Counting carbs is particularly important for people who take insulin because their dosage is dependent on the amount of carbohydrate they need to offset. They determine the number of carbs they will eat in a particular meal, calculate the amount of insulin they will need to clear those carbs from their blood, then give themselves an injection (or program the amount into their insulin pump). Every "portion" of food in a carb-counting list is equal to 15 grams of carbohydrate-including grains, fruits, dairy products, and starchy vegetables. All you need to know is that every 15 grams of carbohydrate counts as 1 carb choice. For example, one medium apple = 15 grams of carbs = 1 portion. Some doctors and diabetes educators instruct their patients either to count total carb grams, or count the number of carb portions. If you are a carb counter, I have provided total carbohydrate grams after each of the meals and snacks in the 4-Step Program.The Food Exchange System organizes food according to their nutritional content: Starch, Fruit, Vegetable, Fat-Free/Reduced-Fat Milk (including milk and yogurt), Very Lean Meat, Lean Meat, Medium-Fat Meat, High-Fat Meat, and Fat. If your doctor has instructed you to follow the exchange system, then follow those recommendations. I have included exchange information alongside carb grams after each of the meals in my 4-Step Program.

BEST FOODS FOR HIGH-QUALITY PROTEIN: Turkey breast, chicken breast, seafood and fish, veal, pork tenderloin, lean ham, lean beef, egg whites, yogurt (fat-free, low-fat), milk Turkey breast, chicken breast, seafood and fish, veal, pork tenderloin, lean ham, lean beef, egg whites, yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, cheese (fat-free, reduced-fat), beans (lima, black, navy, white, pinto, garbanzo), lentils, split peas, tofu, tempeh, soybeans, nuts (soy nuts, peanuts, almonds), peanut b.u.t.ter (fat-free, 1% reduced-fat), enriched/fortified soy milk, cheese (fat-free, reduced-fat), beans (lima, black, navy, white, pinto, garbanzo), lentils, split peas, tofu, tempeh, soybeans, nuts (soy nuts, peanuts, almonds), peanut b.u.t.ter HEALTHY FATS VERSUS SATURATED AND TRANS FATS.

All fats are not created equal-some can decrease your risk of diabetes and complications, while others are downright dangerous. Let's talk about the bad fats first.

Avoid Saturated Fats. Saturated fats are found in animal-based foods, including meats, b.u.t.ter, whole-milk dairy products (including regular yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, including palm oil. Some studies have shown that eating a diet with lots of saturated fats can lead to insulin resistance, and may increase the risk of diabetes by up to 20 percent. In addition, many studies confirm that saturated fats increase the risk of heart disease. Because people with diabetes already have an increased risk of heart disease, eating these unhealthy fats will push your risk even higher. By making a few simple changes, you can dramatically reduce the amount of saturated fats in your diet: Saturated fats are found in animal-based foods, including meats, b.u.t.ter, whole-milk dairy products (including regular yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, including palm oil. Some studies have shown that eating a diet with lots of saturated fats can lead to insulin resistance, and may increase the risk of diabetes by up to 20 percent. In addition, many studies confirm that saturated fats increase the risk of heart disease. Because people with diabetes already have an increased risk of heart disease, eating these unhealthy fats will push your risk even higher. By making a few simple changes, you can dramatically reduce the amount of saturated fats in your diet: - Avoid: b.u.t.ter, cream cheese, lard, sour cream, doughnuts, cake, cookies, chocolate bars, chocolate chips, ice cream, fried foods, pizza, cream- or cheese-based salad dressing, cheese sauce, cream sauce, animal shortening, high-fat meats (including hamburgers, bologna, pepperoni, sausage, bacon, salami, pastrami, spareribs, and hot dogs), high-fat cuts of beef and pork, whole-milk dairy products. If a food label lists palm oil, and the saturated fat content is more than 2 grams per serving, put the package back on the shelf.

- Choose: lean meat only (including skinless chicken and turkey, lean beef, lean pork), fish, reduced-fat or fat-free dairy products.

- Always remove skin from poultry.

- Prepare foods by baking, roasting, broiling, boiling, poaching, steaming, grilling, or stir-frying. No deep-fat frying.

Avoid Trans Fats. Trans fats are worse than saturated fats for diabetes and its complications. Trans fats were developed in a laboratory to improve the shelf life of processed foods, and to turn oils solid. Most stick margarines contain trans fats, and trans fats are found in many packaged baked goods, crackers, potato chips, snack foods, fried foods, and fast food that use or create Trans fats are worse than saturated fats for diabetes and its complications. Trans fats were developed in a laboratory to improve the shelf life of processed foods, and to turn oils solid. Most stick margarines contain trans fats, and trans fats are found in many packaged baked goods, crackers, potato chips, snack foods, fried foods, and fast food that use or create hydrogenated oils hydrogenated oils. (Good news for consumers-all food labels must now list the amount of trans fats, right after the amount of saturated fats.) By subst.i.tuting vegetable oil for trans fats, you may be able to reduce your risk of diabetes by about 40 percent, and you can reduce your risk of heart disease by 53 percent. Whether you already have diabetes or are working to prevent it, there is no amount of trans fats you can safely incorporate into your diet, so try to keep them as far from your plate as possible.

Choose Omega-3 and Monounsaturated Fatty Acids. Polyunsaturated fatty acids (PUFAs) come in two varieties-omega-3 fatty acids and omega-6 fatty acids. Scientists believe that PUFAs have many beneficial effects, including improving insulin sensitivity by changing the composition of cell membranes and aiding in glucose metabolism. When it comes to food, omega-3 fats are the PUFAs you want to pay close attention to. Polyunsaturated fatty acids (PUFAs) come in two varieties-omega-3 fatty acids and omega-6 fatty acids. Scientists believe that PUFAs have many beneficial effects, including improving insulin sensitivity by changing the composition of cell membranes and aiding in glucose metabolism. When it comes to food, omega-3 fats are the PUFAs you want to pay close attention to.

Studies have shown that omega-3s from fish oil may delay the development of glucose intolerance, but the effects are unclear when it comes people who already have diabetes. The studies are all over the place-some show worsening of glycemic control with increased intake of fish oil, others show improved insulin sensitivity, and yet others no benefit or harm at all. Because there is no clear consensus, if you have diabetes, I would not recommend taking fish oil supplements (unless instructed by your endocrinologist). However, food sources of omega-3s are a safe bet, especially if they replace other, more harmful fats in your diet. Omega-3s from food will definitely help reduce your risk of heart disease, so I highly recommended them for all my clients with diabetes.

BEST FOODS FOR OMEGA-3 FATTY ACIDS: Wild salmon, herring, mackerel (not king), sardines (fresh, canned), anchovies, rainbow trout, Pacific oysters, omega-3fortified eggs, flaxseed (ground and oil), walnuts, b.u.t.ternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans Wild salmon, herring, mackerel (not king), sardines (fresh, canned), anchovies, rainbow trout, Pacific oysters, omega-3fortified eggs, flaxseed (ground and oil), walnuts, b.u.t.ternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans Monounsaturated fats, found in olive oil and some nuts, are generally considered among the healthiest of fats. Research into the effects of olive oil on diabetes has been limited, but one Danish study found that people who ate a diet high in monounsaturated fats and low in low-quality carbohydrates had lower fasting blood glucose, lower average glucose levels, and lower peak blood glucose responses. Consider using olive and canola oil for cooking, adding a thin slice of avocado on your next sandwich, tossing olives into your salad, and snacking on an ounce of healthy nuts instead of sweets.

BEST FOODS FOR MONOUNSATURATED FATS: Olive oil, canola oil, avocado, macadamia nuts, hazelnuts, pecans, almonds, peanuts, cashews, Brazil nuts, pistachio nuts, pine nuts, peanut b.u.t.ter, olives Olive oil, canola oil, avocado, macadamia nuts, hazelnuts, pecans, almonds, peanuts, cashews, Brazil nuts, pistachio nuts, pine nuts, peanut b.u.t.ter, olives OTHER VITAMINS AND MINERALS.

Calcium and Vitamin D. According to the Nurses' Health Study, which followed more than 83,000 women for 20 years, both calcium and vitamin D may help prevent type 2 diabetes. Women who got at least 800 IU of total vitamin D daily from food and/or supplements had a 23 percent lower risk of developing diabetes compared with those who consumed less than 200 IU daily. According to the Nurses' Health Study, which followed more than 83,000 women for 20 years, both calcium and vitamin D may help prevent type 2 diabetes. Women who got at least 800 IU of total vitamin D daily from food and/or supplements had a 23 percent lower risk of developing diabetes compared with those who consumed less than 200 IU daily.

Women who got at least 1,200 milligrams total calcium daily from food and/or supplements had a 21 percent lower risk of developing diabetes compared with those who consumed less than 600 milligrams per day. Combining vitamin D and calcium was even better-women who got at least 800 IU vitamin D and and 1,200 milligrams calcium reduced their risk of diabetes by 33 percent. Strive to add more vitamin D-rich foods to your diet. It can be difficult to get all the vitamin D you need from foods, so consider taking a supplement. (See Supplements section, Chapter 9, for more information.) 1,200 milligrams calcium reduced their risk of diabetes by 33 percent. Strive to add more vitamin D-rich foods to your diet. It can be difficult to get all the vitamin D you need from foods, so consider taking a supplement. (See Supplements section, Chapter 9, for more information.)

FAQSI've heard that vinegar can help lower blood glucose levels. Is it true?

There is some research evidence that taking vinegar before meals may reduce the rise in blood glucose and insulin that can occur after eating. A Swedish study published in 2005 found that vinegar dampened the body's metabolic responses after a meal. In addition, the researchers discovered that vinegar helped people feel full and satisfied longer, even two hours after eating. If you want to try vinegar, I recommend talking with your doctor first-if it really does work, you may need to change your treatment plan (and medications). In the research studies scientists gave partic.i.p.ants a "c.o.c.ktail" of 4 teaspoons vinegar mixed with 3 tablespoons water before each meal.

Scientists are unclear about exactly what these nutrients do to reduce diabetes risk. It could be that vitamin D regulates the insulin-producing cells of the pancreas, and calcium may improve insulin sensitivity. Of course, the synergy between the two makes sense-the body can't absorb or use calcium without vitamin D. Improvements in insulin sensitivity are important for everyone with diabetes, but calcium also seems to help control blood pressure, which contributes to heart disease. So whether you have prediabetes or diabetes, calcium and vitamin D are wise food choices.

I recommend that women aim to eat at least three servings of calcium-rich foods daily, and to consider taking a calcium supplement if they can't reliably fit calcium into their meals. (See the Supplements section, Chapter 9, for more information.) Men should eat no more than two or three servings of calcium-rich foods daily, and should never take a calcium supplement without approval from their doctors-some early research suggests that high calcium diets may increase the risk of prostate cancer.

BEST FOODS FOR CALCIUM: Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, cheese (fat-free, reduced-fat), tofu with calcium, sardines (with bones), wild salmon (with bones), soybeans, calcium-fortified whole grain waffles, bok choy, kale, white beans, broccoli, almonds Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, cheese (fat-free, reduced-fat), tofu with calcium, sardines (with bones), wild salmon (with bones), soybeans, calcium-fortified whole grain waffles, bok choy, kale, white beans, broccoli, almonds BEST FOODS FOR VITAMIN D: Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin D-fortified margarine (soft tub, trans fat-free), fortified whole grain cereals Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin D-fortified margarine (soft tub, trans fat-free), fortified whole grain cereals Magnesium. Scientists believe that magnesium works hand-in-hand with enzymes involved in carbohydrate metabolism. In laboratory animals, abnormally low blood levels of magnesium led to insulin resistance. Other research confirms the benefit of magnesium for people-the combined results from two large studies-the Health Professionals' Follow-up Study, which followed more than 42,000 men for 12 years, and the Nurses' Health Study. Compared with people who consumed very low amounts of magnesium (less than about 250 milligrams daily), high daily magnesium reduced the risk of developing diabetes by about 33 percent. The amounts that defined Scientists believe that magnesium works hand-in-hand with enzymes involved in carbohydrate metabolism. In laboratory animals, abnormally low blood levels of magnesium led to insulin resistance. Other research confirms the benefit of magnesium for people-the combined results from two large studies-the Health Professionals' Follow-up Study, which followed more than 42,000 men for 12 years, and the Nurses' Health Study. Compared with people who consumed very low amounts of magnesium (less than about 250 milligrams daily), high daily magnesium reduced the risk of developing diabetes by about 33 percent. The amounts that defined high high were 377 milligrams daily for women, and 458 milligrams daily for men-both close to the RDA recommended amount of 400 milligrams per day. Strive to add more magnesium-rich foods to your diet. Because most people don't get enough magnesium from food alone, consider taking a supplement, as well. (See the Supplements section, Chapter 9, for more information.) were 377 milligrams daily for women, and 458 milligrams daily for men-both close to the RDA recommended amount of 400 milligrams per day. Strive to add more magnesium-rich foods to your diet. Because most people don't get enough magnesium from food alone, consider taking a supplement, as well. (See the Supplements section, Chapter 9, for more information.) BEST FOODS FOR MAGNESIUM: Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut b.u.t.ter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut b.u.t.ter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed BONUS POINTS.

- Get your team together. Diabetes is a life-long, whole-body problem. Although your primary care physician may have been the one to order blood glucose testing, you need a team of professionals to guide you through all the medical details. Ideally your team will include your primary care physician, an endocrinologist (a hormone specialist) who understands the intricacies of insulin, a registered diet.i.tian to help you fine-tune your eating plan, an ophthalmologist (an eye specialist) who can look for diabetes-related signs of damage to the retina, a podiatrist (a foot health specialist) who can help prevent complications from diabetes-related nerve damage and skin sores, and a dentist to keep periodontal disease and other infections under control. Because people with diabetes have a high risk of heart disease, your primary care physician will also be your guide to preventing and/or managing high blood pressure and/or high cholesterol (or your primary care physician may refer you to a cardiologist). Diabetes is a life-long, whole-body problem. Although your primary care physician may have been the one to order blood glucose testing, you need a team of professionals to guide you through all the medical details. Ideally your team will include your primary care physician, an endocrinologist (a hormone specialist) who understands the intricacies of insulin, a registered diet.i.tian to help you fine-tune your eating plan, an ophthalmologist (an eye specialist) who can look for diabetes-related signs of damage to the retina, a podiatrist (a foot health specialist) who can help prevent complications from diabetes-related nerve damage and skin sores, and a dentist to keep periodontal disease and other infections under control. Because people with diabetes have a high risk of heart disease, your primary care physician will also be your guide to preventing and/or managing high blood pressure and/or high cholesterol (or your primary care physician may refer you to a cardiologist).

- Monitor your blood glucose levels every day. Some people fight against checking their blood sugar levels, but daily monitoring really is the only way to know if they are under control. Foods, activity level, medications, illness, and even stress can affect blood glucose. Unless you check, you won't know whether your levels are holding steady or spiraling out of control. Your doctor will tell you how often you need to check. Some people only need to check once a day, others may need to check four or five times per day. In addition, you should ask-in advance-what to do if your blood glucose readings are abnormal. Some people fight against checking their blood sugar levels, but daily monitoring really is the only way to know if they are under control. Foods, activity level, medications, illness, and even stress can affect blood glucose. Unless you check, you won't know whether your levels are holding steady or spiraling out of control. Your doctor will tell you how often you need to check. Some people only need to check once a day, others may need to check four or five times per day. In addition, you should ask-in advance-what to do if your blood glucose readings are abnormal.

- If you have diabetes medication, take it as directed. People who have head-splitting migraines remember to take their medications because pain is a terrific motivator. People who take medication for severe acne have no trouble remembering to take it, because they know if they miss a few doses, the consequences will be written all over their faces. But diabetes symptoms are silent, and thinking they won't pay the price for missed meds means far too many people "forget" or to decide against taking prescribed medications, despite the grave risks of heart disease, nerve damage, and other complications. Don't be one of them. Take medications or insulin as directed by your physician. If you have uncomfortable side effects or questions about your medication or treatment plan, talk with your doctor. People who have head-splitting migraines remember to take their medications because pain is a terrific motivator. People who take medication for severe acne have no trouble remembering to take it, because they know if they miss a few doses, the consequences will be written all over their faces. But diabetes symptoms are silent, and thinking they won't pay the price for missed meds means far too many people "forget" or to decide against taking prescribed medications, despite the grave risks of heart disease, nerve damage, and other complications. Don't be one of them. Take medications or insulin as directed by your physician. If you have uncomfortable side effects or questions about your medication or treatment plan, talk with your doctor.

- Exercise. Next to weight control and medical treatment, exercise is the most important thing you can do to take control over diabetes. Exercise decreases body fat and promotes weight loss. But even if you don't lose weight as a result, exercise will improve blood sugar control and your body's response to insulin, and can even reduce triglycerides. So activity helps diabetes control directly, and also helps prevent heart disease. Next to weight control and medical treatment, exercise is the most important thing you can do to take control over diabetes. Exercise decreases body fat and promotes weight loss. But even if you don't lose weight as a result, exercise will improve blood sugar control and your body's response to insulin, and can even reduce triglycerides. So activity helps diabetes control directly, and also helps prevent heart disease.

It is never too late to start a healthful program of exercise. There are virtually no risks, other than a few sore muscles at the beginning. Studies have reported significant improvements in blood sugar control after just eight weeks. A review of research discovered that all levels of activity were beneficial, from moderate-intensity walking to high-intensity resistance training with weights. The important thing is the activity, not how much weight you lose. Aim for at least 150 minutes of moderate-intensity exercise per week (that's just two and a half hours total for the week). For most people, that means planning to be active for 30 minutes, five days per week. Feel free to add-on-you might try low-intensity activities, such as tai chi, stretching, or yoga. For fighting the complications of diabetes, any kind of activity beats sitting on the couch. The key is to find something you enjoy doing-walking, swimming, cycling, dancing-and get moving.

- Keep a food record. As you get control over your weight and blood sugar, it can be helpful to keep a log that includes some specific information about your eating habits. Every time you eat, jot down 1) where you are; 2) what time it is; 3) how hungry you are before beginning to eat; 4) how hungry you are when you stop eating; 5) the foods and amounts eaten; and 6) your thoughts or feelings at the time. Over time, you'll start to see patterns that can help you learn to eat only when you are physically hungry, and not just as a way to relieve anxiety or stress. It can also help you to stay focused on new food habits. Some clients enjoy the process. They find that they feel empowered by it, and keep food records for months. Others just do it for a few weeks, stopping once they understand their personal eating patterns. I strongly recommend keeping the record for at least a week-you may be surprised at what you learn. As you get control over your weight and blood sugar, it can be helpful to keep a log that includes some specific information about your eating habits. Every time you eat, jot down 1) where you are; 2) what time it is; 3) how hungry you are before beginning to eat; 4) how hungry you are when you stop eating; 5) the foods and amounts eaten; and 6) your thoughts or feelings at the time. Over time, you'll start to see patterns that can help you learn to eat only when you are physically hungry, and not just as a way to relieve anxiety or stress. It can also help you to stay focused on new food habits. Some clients enjoy the process. They find that they feel empowered by it, and keep food records for months. Others just do it for a few weeks, stopping once they understand their personal eating patterns. I strongly recommend keeping the record for at least a week-you may be surprised at what you learn.

- Learn the value of distraction. Your food record will help you identify the times of day and situations in which you're mostly likely to make poor food choices and that's an important first step. Once you know the weak spots, you can plan new activities to take the place of unhealthy habits. One trick that many of my clients use is a combination of delay and distraction. If you get the urge to eat (you're not physically hungry and it isn't a mealtime), set a timer and wait 20 minutes. In that time, do something else to keep your mind off food-clean out a closet (or purse!), organize your email files, put on a fresh coat of nail polish, call a friend, schedule your outstanding appointments, pick up that knitting you've been meaning to finish...anything that keeps your hands busy and off food. If you still want to eat when the timer goes off, have a healthy snack. Most people discover, however, that their craving disappears. Your food record will help you identify the times of day and situations in which you're mostly likely to make poor food choices and that's an important first step. Once you know the weak spots, you can plan new activities to take the place of unhealthy habits. One trick that many of my clients use is a combination of delay and distraction. If you get the urge to eat (you're not physically hungry and it isn't a mealtime), set a timer and wait 20 minutes. In that time, do something else to keep your mind off food-clean out a closet (or purse!), organize your email files, put on a fresh coat of nail polish, call a friend, schedule your outstanding appointments, pick up that knitting you've been meaning to finish...anything that keeps your hands busy and off food. If you still want to eat when the timer goes off, have a healthy snack. Most people discover, however, that their craving disappears.

- If you smoke, quit. Smoking increases the risk of developing diabetes. Once you have diabetes, smoking makes every problem and complication worse. Smoking raises blood glucose levels, constricts blood vessels, and causes inflammation. As a result, people who smoke have an increased risk of kidney disease, nerve damage, blood vessel damage, and foot and leg infections. One extra piece of advice: Many people gain weight after quitting smoking because they try to satisfy their nicotine cravings by eating more. NOT a good strategy for anyone, but it is particularly dangerous for people with diabetes. Talk with your doctor about the best ways to quit smoking without overeating. Smoking increases the risk of developing diabetes. Once you have diabetes, smoking makes every problem and complication worse. Smoking raises blood glucose levels, constricts blood vessels, and causes inflammation. As a result, people who smoke have an increased risk of kidney disease, nerve damage, blood vessel damage, and foot and leg infections. One extra piece of advice: Many people gain weight after quitting smoking because they try to satisfy their nicotine cravings by eating more. NOT a good strategy for anyone, but it is particularly dangerous for people with diabetes. Talk with your doctor about the best ways to quit smoking without overeating.

- Drink alcohol only in moderation...if at all. Drinking between one-half and two alcoholic drinks per day has been shown to reduce the risk of developing type 2 diabetes by an average of 40 percent compared to nondrinkers or heavy drinkers. However, among people who already have diabetes, there is some question about the benefits of alcohol. A review of medical literature published in 2004 concluded that there doesn't seem to be any significant risk of moderate alcohol consumption for people with diabetes. Drinking between one-half and two alcoholic drinks per day has been shown to reduce the risk of developing type 2 diabetes by an average of 40 percent compared to nondrinkers or heavy drinkers. However, among people who already have diabetes, there is some question about the benefits of alcohol. A review of medical literature published in 2004 concluded that there doesn't seem to be any significant risk of moderate alcohol consumption for people with diabetes. Moderate Moderate typically means drinking no more than one serving of alcohol per day if you're a woman, and no more than two servings if you are a man. (A serving is 12 ounces of beer, 5 ounces of wine, or 1 ounces of liquor.) If you have diabetes, I also recommend checking with your doctor to make sure that alcohol is safe for you, and that you understand how it might affect your blood glucose levels. If you don't already drink alcohol, don't start. typically means drinking no more than one serving of alcohol per day if you're a woman, and no more than two servings if you are a man. (A serving is 12 ounces of beer, 5 ounces of wine, or 1 ounces of liquor.) If you have diabetes, I also recommend checking with your doctor to make sure that alcohol is safe for you, and that you understand how it might affect your blood glucose levels. If you don't already drink alcohol, don't start.

- Brush and floss regularly. Just as unregulated diabetes leads to high levels of glucose in your blood, it also leads to higher-than-usual levels of glucose in your saliva. This high-glucose environment in your mouth allows bacteria to multiply and live quite happily, raising the risk for dental decay. Plus, diabetes makes fighting infection harder, so that if gum disease develops, you'll have a more difficult time getting rid of it than someone without diabetes. Studies have born this out-among people with periodontal disease, those who also have diabetes have more severe gum disease than those without diabetes, with deeper gum "pockets" and a greater loss of attachment that could eventually mean tooth loss. On the flip side, getting treatment for gum disease may help with diabetes management. Research suggests that people with diabetes who gain control over their periodontal problems have Just as unregulated diabetes leads to high levels of glucose in your blood, it also leads to higher-than-usual levels of glucose in your saliva. This high-glucose environment in your mouth allows bacteria to multiply and live quite happily, raising the risk for dental decay. Plus, diabetes makes fighting infection harder, so that if gum disease develops, you'll have a more difficult time getting rid of it than someone without diabetes. Studies have born this out-among people with periodontal disease, those who also have diabetes have more severe gum disease than those without diabetes, with deeper gum "pockets" and a greater loss of attachment that could eventually mean tooth loss. On the flip side, getting treatment for gum disease may help with diabetes management. Research suggests that people with diabetes who gain control over their periodontal problems have better better glycemic control after gum treatment than before. For healthy teeth and gums, dentists and nutritionists alike recommend that you see your dentist regularly, brush with a fluoride toothpaste at least twice a day, and remember to floss. glycemic control after gum treatment than before. For healthy teeth and gums, dentists and nutritionists alike recommend that you see your dentist regularly, brush with a fluoride toothpaste at least twice a day, and remember to floss.

- If you have sleep apnea or daytime sleepiness, seek treatment. Excessive daytime sleepiness is often a sign of sleep apnea, a disorder that causes interruptions in breathing during sleep. Breathing stops for 10 seconds or more because of faulty signals from the brain, or because the soft tissue at the back the throat relaxes and blocks the airway (called Excessive daytime sleepiness is often a sign of sleep apnea, a disorder that causes interruptions in breathing during sleep. Breathing stops for 10 seconds or more because of faulty signals from the brain, or because the soft tissue at the back the throat relaxes and blocks the airway (called obstructive sleep apnea obstructive sleep apnea, or OSA). This can happen several times per night. Each time, the sleeper will partially awaken, begin to breathe again, and then fall back asleep. Most people with sleep apnea don't know what is happening, or why they feel so tired after what seemed like a full night's rest. People with diabetes are more likely to have sleep apnea than people without diabetes. Even more intriguing is the possibility that sleep apnea may contribute to diabetes. OSA itself increases the risk of insulin resistance, and may be a roadblock to controlling your diabetes. If you have sleep apnea, or if you experience unusual sleepiness during the daytime, talk with your doctor. A full night's sleep is not just a luxury, it's a health necessity.

- Be meticulous with your foot care. The key words are The key words are clean clean and and dry dry. Wash your feet daily in warm water, and dry with a clean soft towel. Do not soak your feet, or use hot water. Inspect your feet every day for sores, blisters, calluses, swelling, bruising, or breaks in the skin-talk with your doctor about how to treat them. Don't walk barefoot-always wear shoes or slippers, and wear clean, soft socks with your shoes. Talk with your podiatrist about other ways to keep your feet safe.

FAQSI used to read a lot about chromium picolinate supplements. Are they valuable for people with diabetes?

Back in the 1990s, chromium picolinate was popular as a simple treatment that scientists thought might help improve glycemic control and insulin sensitivity. Most of the studies that supported that claim had been done on laboratory animals, which is never the same as investigating the effects of a treatment on people. More recently, the picture for chromium picolinate has turned much less optimistic. In 2006, scientists reported that they were unable to find any benefit of chromium picolinate supplements in people with type 2 diabetes, even when relatively high dosages were tested. A major review of all high-quality studies found that the data were ultimately inconclusive-no one can say with any degree of certainty whether chromium is helpful or not. More research will need to be done, but as of right now, I can't recommend chromium supplements for diabetes control.

SUPPLEMENTS.

For years, scientists have been hunting for a "magic bullet" to treat diabetes-one or more nutrients that could be taken in supplement form to improve glycemic control. As of now, the search is still on. Researchers have tested all logical possibilities, including antioxidants, vitamin E, and fish oil. Results are confusing and inconsistent, sometimes showing a benefit, and sometimes showing that taking a particular supplement actually makes blood sugar control worse.

The follow supplements are generally considered safe, and have quite a bit of supporting research. But diabetes management and blood glucose control can be tricky and tenuous. Before taking any any supplement, talk with your endocrinologist, especially if you are already taking a hypoglycemic or insulin-sensitizing medication. supplement, talk with your endocrinologist, especially if you are already taking a hypoglycemic or insulin-sensitizing medication.

1. Multivitamin. If you want to a.s.sure that you get your daily supply of all vitamins and minerals, consider taking a multivitamin. Look for a brand that contains 100% DV of most nutrients. If you are a man, or a women who is no longer menstruating, choose a "senior" formula, which doesn't contain iron. I cannot recommend taking high doses of any individual vitamins at this time. If you want to a.s.sure that you get your daily supply of all vitamins and minerals, consider taking a multivitamin. Look for a brand that contains 100% DV of most nutrients. If you are a man, or a women who is no longer menstruating, choose a "senior" formula, which doesn't contain iron. I cannot recommend taking high doses of any individual vitamins at this time.

2. Calcium, with vitamin D3 and magnesium. and magnesium. In addition to taking a multivitamin, women may want to consider taking supplements of calcium with vitamin D In addition to taking a multivitamin, women may want to consider taking supplements of calcium with vitamin D3 (cholecalciferol, the most potent form) and magnesium. Vitamin D (cholecalciferol, the most potent form) and magnesium. Vitamin D3 is important because it allows the body to absorb and use calcium. Magnesium is important because people seldom get enough of this important mineral through food or a multivitamin pill. is important because it allows the body to absorb and use calcium. Magnesium is important because people seldom get enough of this important mineral through food or a multivitamin pill.