Small lifestyle changes that are doable and sustainable are the key to managing diabetes and avoiding complications.

Many people with diabetes believe the condition is serious only if they start feeling sick or the doctor puts them on insulin or diabetes medications. But there’s a much more accurate way to gauge your risk: how well-controlled your disease is.

When you aren’t taking steps to manage your diabetes, you’re placing yourself at risk for all the devastating complications of the disease: vision loss, nerve damage, foot amputations, and kidney disease.

“It’s true the complications can be quite serious. But what’s often overlooked is that they’re a result of poorly controlled diabetes—they’re not necessarily from the diabetes itself,” notes Linda M. Delahanty, M.S., R.D., chief dietitian and director of nutrition and behavioral research at the Massachusetts General Hospital Diabetes Center in Boston. “You know you’re managing diabetes well if you have your ABCs in line,” Delahanty explains.

A stands for A1C levels—a measure of your average blood sugar levels over the past three months.

B stands for Blood pressure levels.

C stands for Cholesterol levels.

The bottom line: You need to closely monitor your blood sugar, blood pressure, and cholesterol levels and always aim to keep them within a healthy range, according to your doctor’s advice.

Best Moves
To keep these three important measures at healthy levels:

• Stay physically active. Especially in the case of type 2 diabetes, exercising for 30 minutes five or six times a week can lower blood sugar by as much as 50 points in most people, with the beneficial effects lasting a good 24 hours, Delahanty notes. Exercise also can help keep blood pressure under control, and can raise the body’s levels of HDL “good” cholesterol.
• Eat a low-fat diet. Limiting the fat—particularly saturated fat—in your diet can help you manage your LDL “bad” cholesterol.
• Lose weight. Shedding a few pounds is a powerful way to control all three ABCs.

  “Especially with type 2 diabetes, losing 5 to 10 percent of your body weight can bring these levels down significantly over time,” says Delahanty.

  Limiting your calorie intake also can bring immediate benefits by reducing the workload on the pancreas.

  “The day you reduce your calorie intake is the day your blood sugars typically improve, even before the first pound is lost,” she adds.

• Monitor your blood sugars. “It’s very important to keep up with both the A1C testing and daily monitoring,” Delahanty stresses. “If your blood sugars are on target, you’ll feel good that you’ve done just what you should to keep yourself healthy and avoid complications.”

  The A1C test tells your average blood sugar level over the previous three months, while daily blood sugar monitoring shows the immediate highs or lows of your blood sugar that may result from your eating and exercise routines.

• Get regular medical care. Having the checkups your doctor recommends is essential to ensure you’re keeping any complications in check.

  “Probably most important is talking with your health care provider about the challenges and barriers to your self-management, so you can get up-to-date advice tailored to your specific situation,” says Delahanty. “If you feel alone with your diabetes, ask about support groups available to you.”

Small Steps
Clearly, if you’ve been diagnosed with diabetes, you don’t want to bury your head in the sand. But neither do you have to immediately lose a lot of weight, exercise vigorously, or give up your favorite foods, Delahanty stresses.

Small steps can go a long way, particularly the steps your health care provider recommends.

For example, Delahanty recalls one of her patients, a gentleman on insulin therapy. By losing just 10 percent of his weight and engaging in a regular walking program, he was able to come off insulin totally. “He hasn’t been on insulin for seven years,” she says. “He knows he just has to keep that 10 percent of his weight off.”

People often feel that if they can’t do everything perfectly, then they won’t do anything at all, Delahanty adds. But all that’s needed is to set small, achievable goals.

“This is a lifelong condition,” she explains. “You don’t have to get there overnight, you just need to pace yourself and do it one step at a time.”

Polly Turner spoke with Linda M. Delahanty, M.S., R.D., chief dietitian and director of nutrition and behavioral research at the Massachusetts General Hospital Diabetes Center in Boston. Delahanty is coauthor of Beating Diabetes: The First Complete Program Clinically Proven to Dramatically Improve Your Glucose Tolerance, McGraw-Hill, 2005, $15.95.

How Diabetes Does Its Damage
Simply put, when diabetes isn’t managed well, there isn’t enough of the hormone insulin in your bloodstream to move blood sugar, fats, and proteins into your body’s cells. So the sugar, fats, and proteins build up in the bloodstream, instead.

• As blood sugar (glucose) builds up to toxic levels in the bloodstream, it silently causes damage to the thin membranes in the eye, the kidney’s filtering system, and the body’s nerves.
• As high levels of fats flow through the bloodstream, plaque silently builds up in the arteries, leading to sluggish circulation and an increased risk for the artery blockages that bring on a heart attack or stroke.
• As proteins accumulate in the bloodstream, the kidneys get overworked trying to process them; this can silently lead to kidney disease.

“If you have your ABCs under control, your body won’t build up those toxic levels of glucose, fats, and proteins and you won’t experience all the related complications,” explains Linda M. Delahanty, M.S., R.D., of the Massachusetts General Hospital Diabetes Center in Boston.

This means, hopefully, that:

• You won’t have increased risk for vision loss due to diabetic retinopathy.
• Your nerves will remain undamaged, so you won’t lose sensation in your feet, develop untreatable skin ulcers, and end up having to have a foot amputated.
• You won’t have that extra risk for heart attack or stroke.
• You won’t require kidney dialysis.

And maybe, just maybe, you won’t need to be on insulin or take diabetes medications—all because you’ve kept those ABCs under careful control.

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