Start Good Habits Early

Starting off with the right approach is really important for two reasons: First, it’s usually easier to get your diabetes under good control in the early stages of the disease, and secondly, clinical studies show that achieving good control early provides benefits to your body that can last for decades.

Also, the diabetes habits you develop now will stick with you in the long-run. Really, we all know how hard it is to change behavior once we’re set in our ways!

So for example, you might want to take some time to look at the user’s manual that came with your glucose meter in order to learn how to set the alarms that will remind you to test at different times of day: before meals, about two hours after, and at wake time and bed time. You want those test times to become habit!

You’ll also want to set up some kind of reminders to get your essential medical tests done regularly:

the A1c blood test - every three months
blood pressure - every six months at least (take advantage of every doctor’s appointment to have this checked, especially if it’s been elevated or you’ve had concerns)microalbumin, lipids, and eye exam—all annually (unless concerns call for more frequent checks)

Another “habit” that you’ll want to nurture early on is keeping an upbeat attitude. The voice in your own head is very, very important: you’ll want it to act as a “cheerleader,” rather than a negative force always telling you that you’ve failed.

There’s no question that it’s hard to stay upbeat when you’ve been diagnosed with a chronic illness.

You might be thinking: How do I stay positive when I feel like I’m being punished? Or when I feel so overwhelmed by having a disease that requires so much attention?

Taking care of yourself with diabetes is indeed a “mental game,” requiring you to learn to function comfortably on a number of levels:

Personal (Emotional)—fighting off negative thoughts
Social—interacting with others in social situations without stress
Behavioral—preventing yourself from doing things you wish you wouldn’t, sometimes even self-destructive things

If you do find that you’re experiencing a mental struggle with your diabetes, connecting with other people walking in your shoes is often very comforting – and helpful.

Connecting with other PWDs (people with diabetes) regularly, either online or offline, is a habit worth forming!

Should I Pick Up the Pace?

Q: My doctor told me that I need to get more aerobic exercise, but I hate going to the gym! I do like to walk, but how fast and how long should I go to improve my cardiovascular health?

A:
I understand exactly what you mean about going to the gym; I'm not a big fan of it either. Personally, I prefer to exercise outdoors or at home. And like you, I really enjoy walking.

Recently, I've begun recommending what's known as interval walking to many of my patients. With interval walking, you alternate between short bursts of intensive effort and easier recovery periods, as opposed to walking at a steady, continuous, and potentially monotonous pace. In fact, studies show that you can get better results in 20 minutes of interval exercise than you would in an hour of steady-state exercise. And you can apply the principles of interval walking to a treadmill or elliptical trainer, to biking or swimming, or even to doing jumping jacks in your living room.

So how do you do interval walking? Instead of walking at a constant pace for your entire workout, as you've probably been doing, you should mix it up. That is, after a three-minute warm-up where you walk at an easy or moderate pace, you should alternate short bursts of very fast walking (15 to 60 seconds, depending on your conditioning) with recovery periods of slower walking after each fast burst. You can repeat each interval six to 12 times, or more depending on your fitness level. Aim for walking a total of 20 minutes to start. In general, the more intense the workout (in other words, the faster you go), the shorter the duration of that interval and the longer the recovery period. Conversely, when you're not working as hard, your work period will be longer and your recovery period will be shorter. For example, if you like taking an hour-long walk on weekends, you can certainly do intervals, but don't try to spend the entire hour working at high intensity. And always end with a two-minute cooldown at an easy pace.

I recommend that you do interval walking every other day, alternating it with some core-strengthening exercises. Not only will this type of walking improve your cardiovascular health, it will boost your metabolism so you burn more calories and fat, and that translates into faster weight loss.

Interval training is not only for the very fit. It works just as well for people who are less fit, and is even being used to help cardiac patients and people with lung disease get back in shape. That said, I do recommend that you talk with your doctor before embarking on this or any other exercise program.

Meal Schedule for Type 2 Diabetes

Q: What’s the best meal schedule for a diabetic? When should snacks be included?

A: I recommend eating a meal or snack every four to five hours. This allows enough time for your blood sugar to come back down to a healthy baseline after eating, but it’s frequent enough to help you manage your appetite and keep hunger pangs at bay, which is especially important if you’re trimming calories to lose a few pounds. In general, you can meet this guideline by eating breakfast, lunch, a mid-afternoon snack, and dinner, evenly spaced throughout your day. At all meals and snacks, combine a small to moderate amount of high-quality carbohydrates (vegetables, fruit, whole grains, beans/lentils) with a good dose of lean protein from foods like skinless turkey or chicken, egg whites, seafood, low-fat dairy, or beans/lentils (beans and lentils count as both a carb and a protein). The protein helps slow your body’s absorption of carbs and prevent spikes in your blood sugar. Here’s an example of an A+ day of eating designed for optimal blood-sugar control.

Breakfast:
Egg-white omelet with vegetables (spinach, mushrooms, peppers and/or onions)
One orange
Coffee with skim milk

Lunch:
2 cups hearty, low-sodium soup (lentil, black bean or minestrone) topped with ¼ cup shredded
reduced-fat cheese
Crunchy red-pepper sticks
Water

Snack:
Nonfat yogurt
1 apple

Dinner:
Homemade shrimp-and-broccoli stir-fry
¾ cup cooked brown rice
Zero-calorie seltzer

After Dinner:
Handful of almonds or pistachio nuts
Cup of decaf or herbal tea

Stop the Progress of Prediabetes

You can prevent this precursor to type 2 diabetes from developing into full-blown disease.

Nearly 24 million American adults are living with diabetes, according to figures released last month by the International Diabetes Federation. But what may be even more alarming is that there are also about 79 million Americans with a condition known as prediabetes — and many aren't aware of it.

Prediabetes means that while your blood sugar levels are higher than normal, that level isn’t high enough to warrant a diabetes diagnosis. However, a prediabetes diagnosis means it is time for action to prevent diabetes.

"In simple terms, there is a gap between what we call diabetes, which is a fasting blood sugar of 126 and above, and normal, which is less than 100 fasting," explains Vivian Fonseca, MD, a professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans. "In between, you have impaired fasting glucose. If you do a glucose tolerance test, and you are in the gap, you have prediabetes. You are at risk for getting diabetes in the future and you are also at risk for heart disease."

Research has also found that prediabetes may be more common in men than in women.

Type 2 Diabetes: Prevention

If you are told your blood sugar is abnormally high, you’ve just had a red flag waved in front of you. You’re being warned that unless you make some changes in your life today, your future will probably include a diabetes diagnosis.

"Walking 30 minutes a day and reducing weight by 5 percent can decrease the risk [of getting type 2 diabetes] by 60 percent over three years," says Dr. Fonseca. While there are medications that have the same effect, lifestyle change is less expensive and has fewer side effects, Fonseca says.

Cutting your weight is crucial. "One of the links with obesity is that fat induces a mild low-grade inflammation throughout the body that contributes to heart disease and diabetes," Fonseca explains. Without making any changes, you could develop type 2 diabetes within 10 years of first developing prediabetes.

Type 2 Diabetes: Who Should be Tested?

Prediabetes is a "silent" condition, says Fonseca. While some people may experience symptoms of diabetes such as fatigue or increased urination, most people’s blood sugar rises without any outward signs at all. This means you might not know you need to be tested for prediabetes — and even if you are screened, your doctor might not give you all the information you need to prevent it.

For these reasons, diabetes experts developed criteria for those who should be tested. The American Diabetic Association recommends that any adult age 45 or older should be tested for diabetes and prediabetes.

The ADA also recommends that any adult under age 45 who is overweight and has at least one of the following risk factors should be tested:

Family history (especially parent or sibling with diabetes) Physically inactive lifestyle Native American, African-American, or Hispanic heritage Prior gestational diabetes diagnosis Birth of a baby over nine pounds in weight High blood pressure or treatment for high blood pressure Polycystic ovarian syndrome (PCOS) diagnosis Dark, velvety rash around the armpits or neck History of heart disease If your test reveals that you have prediabetes, you should be tested again in one to two years, depending on your doctor’s recommendations.

Type 2 Diabetes: Types of Tests

There are two tests used to screen for diabetes and prediabetes:

Fasting plasma glucose: a test of your blood after you haven’t eaten for eight hours (usually overnight) Oral glucose tolerance test: a comparison of your blood taken first after eight hours without food (fasting) and then two hours later after you have consumed a sugary drink given to you by the lab technician. If you fit the screening criteria listed above, make an appointment to get tested as soon as possible. It could be the first step toward preventing the development of type 2 diabetes.

Why Are My Feet Hurting When I Walk?

Q: My feet have started to hurt a lot — so much that when I wake up in the morning I cannot walk barefoot for at least the first 20 minutes. I can't be on my feet too much anymore without pain. What might be causing this, and what can I do to get some relief?

A: What you are describing sounds like a painful condition known as plantar fasciitis. This is a situation where there is inflammation of the soft tissue along the sole of your foot, all the way from your heel to your toes. It may be caused by high-impact exercise, structural problems such as being flat-footed, arthritis, or ill-fitting shoes. It is also more common in people with diabetes. The most characteristic symptom of plantar fasciitis is severe shooting or burning pain in the feet in the morning. The pain typically improves after some movement, only to recur after periods of prolonged rest or intense activity.

Preventive measures include always wearing shoes that fit well, stretching in the morning, afternoon and evening and before any exercise, limiting high-impact exercises, and maintaining ideal body weight, as obesity does predispose to plantar fasciitis. The key is to exercise carefully rather than eliminating exercise altogether. Treatment includes surgical and nonsurgical approaches, though surgery is a last resort and is rarely necessary. Night plints, orthotics, and physical therapy may hasten your recovery, but if the condition is left untreated, it will not resolve itself. In severe cases, injections with steroids or treatment with ultrasound may be warranted.

Foot Anatomy: Your Amazing Feet

Despite delicate foot anatomy, your feet are able to take a pounding every day. Help them go the distance by identifying and correcting common foot problems, from corns and calluses to Athlete's foot and hammertoes.

The human foot has 42 muscles, 26 bones, 33 joints, and at least 50 ligaments and tendons made of strong fibrous tissues to keep all the moving parts together … plus 250,000 sweat glands. The foot is an evolutionary marvel, capable of handling hundreds of tons of force — your weight in motion — every day. The foot’s myriad parts, including the toes, heel, and ball, work in harmony to get you from one place to another. But the stress of carrying you around puts your feet at high risk of injury, more so than other parts of your body.

Many foot problems, including hammertoes, blisters, bunions, corns and calluses, heel spurs, claw and mallet toes, ingrown toenails, toenail fungus, and athlete’s foot, can develop due to neglect, ill-fitting shoes, and simple wear and tear. Your feet also can indicate if your body is under threat from a serious disease. Gout, for instance, will attack the foot joints first.

Foot Problems: Athlete's Foot
Caused by a fungus that likes warm, dark, and moist environments like the areas between the toes or on the bottoms of the feet, athlete’s foot can inflame the skin and cause a white, scaly rash with a red base. The athlete’s foot fungus also causes itching, burning, peeling, and sometimes a slight odor; the infection can also migrate to other body parts. You can avoid athlete’s foot (also called tinea pedis) by keeping your feet and toes clean and dry and by changing your shoes and socks regularly. Over-the-counter antifungal creams or sprays can be used to treat athlete’s foot. If these remedies do not work, however, you may need to see a podiatrist and ask about prescription-strength medication.

Foot Problems: Hammertoes
If your second, third, or fourth toe is crossed, bent in the middle of the toe joint, or just pointing at an odd angle, you may have what’s called a hammertoe. Hammertoes are often caused by ill-fitting shoes. Early on, wearing inserts or foot pads can help reposition your toe, but later it becomes fixed in the bent position. Pain then sets in and you may need surgery. Because hammertoes are bent, corns and calluses often form on them.

Foot Problems: Blisters
It’s this simple: If your shoes fit well, you won't have blisters. Soft pockets of raised skin filled with clear fluid, blisters are often painful and can make walking difficult. It’s important not to pick at them. Clean the area thoroughly, then sterilize a sewing needle and use it to open the part of the blister located nearest to the foot’s underside. Drain the blister, slather with antibiotic ointment, and cover with a bandage. Follow these same care steps if a blister breaks on its own.

Foot Problems: Bunions
A bunion is a crooked big-toe joint that sticks out at the base of the toe, forcing the big toe to turn in. Bunions have various causes, including congenital deformities, arthritis, trauma, and heredity. A bunion can be painful when confined in a shoe, and for many people, shoes that are too narrow in the toe may be to blame for the formation of bunions. Surgery is often recommended to treat bunions, after conservative treatment methods like over-the-counter pain relievers and footwear changes fail.

Foot Problems: Corns and Calluses
Corns and calluses form after repeated rubbing against a bony area of the foot or against a shoe. Corns appear on the tops and sides of your toes as well as between your toes. Calluses form on the bottom of the foot, especially under the heels or balls, and on the sides of toes. These compressed patches of dead skin cells can be hard and painful. To relieve the pain, you may want to try placing moleskin or padding around corns and calluses. Don’t try to cut or remove corns and calluses yourself — see a podiatrist for care.

Foot Problems: Plantar Fasciitis and Heel Spurs
It’s common for doctors to confuse heel spurs and plantar fasciitis when a patient comes to them with heel pain. Heel spurs are found in 70 percent of patients with plantar fasciitis, but these are two different conditions. Plantar fasciitis is a painful disorder in which the tissue that connects the ball of the foot to the heel – the fascia – becomes inflamed. Heel spurs are pieces of bone that grow at the heel bone base and often develop after you’ve had plantar fasciitis. The heel spurs themselves are not painful; it’s the inflammation and irritation caused by plantar fasciitis that can hurt. Heel spurs are often seen on X-rays of patients who do not have heel pain or plantar fasciitis.

Foot Problems: Claw Toes and Mallet Toes
Claw toe causes all toes except the big toe to curl downward at the middle of the joints and curl up at the joints where the toes and the foot meet. Calluses and corns may often form when someone has claw toes. While tight shoes can be blamed for claw toes, so can nerve damage to the feet (from diabetes or other conditions), which weakens foot muscles.

With mallet toes, the last joint of the toe bulges, and a painful corn will grow near the toenail. Generally the second toe is affected because it’s the longest. Injuries and arthritis are among the causes of mallet toe.

Foot Problems: Gout
Gout is a type of arthritis caused by a build-up of uric acid in joint tissues and joint fluid, which happens when the body is unable to keep uric acid levels in check. One of the first places for this build-up to occur is in the big toe joint — temperature-wise, the toes are the body’s coolest parts, and uric acid crystallizes with temperature changes. You’ll know a gout attack when it happens: The toe will get warm, red, and swollen and will be painful to even the slightest touch. The best way to prevent a gout attack is to learn to identify triggers, including high-purine foods, red meat, seafood, and alcohol. Applying ice, keeping hydrated, and staying bed may help, too.

Foot Problems: Ingrown Toenails
The right way to clip toenails — straight across — is key to foot health. If you don’t cut them properly, the corners or sides of the nail can dig into skin and become ingrown. Other causes of ingrown toenails include shoe pressure, a fungus infection, and even poor foot structure. When you cut your toenails, use larger toenail clippers and avoid cutting nails to short, as this can also cause ingrown toenails or infection.

Foot Problems: Toenail Fungus
Toenail fungus can give nails an unattractive, deformed appearance. It can alter the nail’s color and spread to other nails, even fingernails. Avoiding toenail fungus is difficult, especially if you walk through wet areas where people tend to go barefoot, such as locker rooms and swimming pools. People with chronic conditions, such as diabetes or immune deficiency diseases like HIV, are especially vulnerable and may want to keep their shoes on.

Shin Pain While Walking

Q: I love walking, but when I walk at a fast pace my shins really start to hurt. What can I do to stop the pain?

A: First, make sure your walking shoes have good arch support, since shin splints often happen because of a fallen arch or flat feet. Also, try to avoid walking hills until you've walked on a flat surface for at least five minutes. This will warm up your shins so they don't become overstressed.

If you want to strengthen your shins, here's an easy towel exercise you can do! Sit in a chair, your feet bare, and place a rolled-up towel just in front of your toes. Grab the towel between your toes and your forefeet and unroll it, flexing the arches of your feet at the same time. Try to do this for 15 to 30 seconds every other day. It will help you keep up the good work and stay fit.