1. Type 2 Diabetes – An Overview
What is it?
Is it common?
What are the risk factors?
How does it start?
What is the best diet?
This show is an overview for type 2 diabetes. It will help the audience realize that it is a common disease.
This show emphasizes the importance of weight loss and a heart healthy diet to improve the quality of life and outcome for persons with type 2 diabetes or persons who are overweight and want to avoid type 2 diabetes. It promotes treating the disease and lowering the need for medications instead of just treating the symptoms (high blood sugar) of type 2 diabetes.
Another show in this package, Common Sense Guide to Eating with Type 2 Diabetes discusses food, meal planning, label reading, etc. in much greater depth.

2. What Is Type 2 Diabetes? High fasting blood sugar levels
Excessively high non-fasting BS levels
People with Type-2 diabetes usually have some degree of both:
resistance to the action of insulin
decrease in the capacity to produce insulin
Nonfasting blood sugar levels are often referred to as postprandial blood sugar levels.
Type-2 diabetes is diagnosed:
when fasting plasma glucose test is equal to or greater than 126 mg/dl on 2 occasions
or when a non-fasting blood sugar is 200 mg/dl or higher (this is usually reconfirmed by a fasting plasma glucose test)

3. True or False?
Diabetes has specific symptoms that are easy for most people to diagnose.
Answer: False
Most people are not aware that they have diabetes
Many people with Type-2 DM are not aware they have it even though it usually produces symptoms such as increased thirst and urination. However, because these symptoms come on so gradually, they are often missed or dismissed as being a normal part of the aging process. Type-2 DM is diagnosed when fasting blood sugar (FBS) is consistently >125 mg/dl or when a random nonFBS is>200 mg/dl and the patient has symptoms such as increased thirst and urination. A glycosylated hemoglobin (Hb A 1-c) is generally regarded as the best measure of average BS control over the last 2-4 months. In people with normal BS levels, it should be no more than 5-6%, in people with untreated or poorly treated DB, values are more than 7%, when above 10% the patient is considered in very poor control.

4. What Are the Symptoms?
Increased thirst
Increased urination
Blurred vision
Lack of energy
More frequent infections, especially gum disease and bladder infections
The symptoms of DM include increased thirst, increased urination, blurred vision, and lack of energy. The symptoms come on gradually and are often view as a normal part of the again process. Because of this, many people are unaware that they have diabetes.
Symptoms come on gradually and are often viewed as a normal part of the aging process

5. True or False?
Type 2 diabetes is the most common type of diabetes in the United States.
Answer: True Type 2 accounts for about 90% of the 21 million Americans with diabetes ?
Type-2 DM accounts for about 90% of the 16 million Americans with DM. By age 75, about 1 in 5 Americans have Type 2 diabetes. This type of diabetes is usually characterized by some degree of resistance to the BS lowering action of insulin (also known as insulin resistance).
Currently more than 21 million Americans have diabetes and about a third do not know they have the disease.

6. Diabetes Doubles
Look at how diabetes has increased in the US since CDC statistics for 2005 showed that diabetes now affects 7% of the population or about 21 million people.

7. Type 2 Diabetes
What is the annual cost of treatment for type 2 diabetes?
The cost of treating diabetes in the U.S. is over $100 billion annually. This includes actual cost of treatment plus dollars lost in productivity.
Over $100 billion dollars

8. What Are the Risk Factors?
Increasing age
Family history of type 2 diabetes
Prior history of gestational diabetes, impaired glucose tolerance, and/or insulin resistance
Being overweight or obese
Physical inactivity
Consumption of a high fat, high sugar, refined carbohydrate diet
Risk factors you can control
The risk of developing Type-2 DM increases with age primarily in areas where sedentary lifestyles and high fat, high sugar, refined carbohydrate diets prevail. It is well established that obesity increases the risk of developing diabetes. Genetic traits strongly influence the development of diabetes. In studies of identical twins, the concordance rate is nearly 100%. A prior history of gestational diabetes, IGT and/or IR will also increase the risk of developing Type-2 DM. Physical inactivity can lead to weight gain as can the consumption of a high fat, high sugar, refined carbohydrate diet, thus resulting in an increased risk of developing Type-2 DM.

9. The Progression of Type 2 Diabetes
1. Insulin resistance
Cancer, heart disease
2. Impaired glucose tolerance
3. Type 2 diabetes
Some people who have insulin resistance never develop impaired glucose tolerance; however they are at a high risk for cardiovascular disease because they usually have metabolic disturbances usually associated with insulin resistance. Some people who have insulin resistance or impaired glucose tolerance die before reaching type 2 diabetes; they are at an increased risk for cancer, cardiovascular disease or other causes.
Some people with insulin resistance continue to manufacture a high level of insulin that is necessary to keep their sugars from rising too high. This keeps them from developing impaired fasting glucose or type 2 diabetes. They might still have impaired glucose tolerance.
Impaired glucose tolerance can be present even when blood sugars are close to normal. IGT is a stage in the development towards type 2 diabetes. Your body is showing signs of the sugar being cleared more slowly. The rise of insulin does not shoot up after a meal so the sugar rises but then becomes cleared after some time – it is cleared before your blood sugar rises high enough for a diagnosis of diabetes. Most people are tested on fasting blood sugar levels instead of postprandial levels (after a meal). There are lots of people who have diabetes because doctors never think to check their HbA1c levels. If that level is 7% or higher it means the patient has type 2 diabetes. If it is 5-6% then it means that blood sugar is rising high after meals. If it is below 5% it means they don’t have IGT or Type 2 diabetes (unless they are on medication).
Some people who have insulin resistance or impaired glucose tolerance die of cardiovascular disease before reaching type 2 diabetes.

10. Insulin Resistance
Resistance to the blood sugar lowering action of insulin
Present for many years before fasting blood sugar levels rise above normal
Not everyone who has insulin resistance will develop diabetes but everyone with type 2 diabetes has insulin resistance
People with Type-2 DM usually have some degree of both resistance to the action of insulin and also some decrease in the capacity to produce insulin. This is known as insulin resistance (IR). When muscle, fat, and liver cells resist the action of insulin they are said to be IR. In some Type-2 DM patients, the IR is more severe while in others the capacity to produce insulin is severely depressed. As a result, the insulin levels in Type-2 DM patients may be higher than normal, close to normal, or below normal.

11. Insulin Resistance
A risk factor for the development of coronary artery disease and type 2 diabetes
Fasting insulin levels are often elevated
Insulin resistance is a risk factor for the development of coronary artery disease (CAD) and Type-2 DM. It has been estimated to occur in 20-30% of the US population. There are currently no routine laboratory procedures for establishing its presence. However, the ability of insulin to move out of the blood and into cells can be determined by using the euglycemic, hyperinsulinemic clamp technique (“glucose clamp”). This technique utilizes a constant rate of insulin being infused for a long enough time to attain steady-state metabolic conditions. IR can also be estimated using an intravenous glucose tolerance test, but this is less accurate than the “glucose clamp” technique. An intravenous glucose tolerance test is often abnormal when diabetes is present.
It is impractical to measure and screen people for IR. The tests mentioned here are usually reserved for laboratory/research use. Unfortunately there is no quick, accurate, inexpensive way to measure for IR before impaired glucose tolerance and type 2 diabetes develop.
Usually fasting insulin levels are elevated and often there are lipid abnormalities although these are not diagnostic of IR.
These are all suggestive of the presence of IR:
Family history of diabetes
Overweight
Inactive
Cardiovascular disease in family
High triglycerides and low HDL are often
High waist to hip ratio
Excessive energy intake, particularly when combined with lack of physical activity, leads to the development of IR in genetically predisposed individuals. It doesn't ‘t make them gain weight, it is the result of being overweight. This is contrary to several popular diet books that claim that IR leads to excessive weight gain. They have confused cause and effect. (Zone Diet and Sugar Busters)
Currently there is no cost effective, easy way to detect insulin resistance

12. Insulin Resistance Family history of diabetes Overweight
Lack of Physical Activity
Cardiovascular disease in family
High triglycerides and low HDL (good cholesterol)
High waist to hip ratio
Insulin levels increase with weight gain. IR can be present for many years before fasting blood sugar levels rise above normal. In some cases, fasting BS levels rise greatly, but still remain below the DM range.
These are all suggestive of the presence of insulin resistance

13. Heart Disease & Type 2 Diabetes
Even if fasting blood sugar is in normal range, risk of heart disease is elevated if insulin resistance syndrome is present
Insulin resistance and disturbances in lipid metabolism increase risk of heart disease. An estimated 20-30% of the U.S. population has what’s termed as the “deadly quartet,” “syndrome X,” “the metabolic syndrome,” and “the insulin resistance syndrome.” This syndrome is generally characterized by IR, hyperinsulinemia, dyslipidemia, central or visceral adiposity, and often hypertension or IFG, or Type-2 DM. Even if fasting blood sugar is in normal range, risk of heart disease is elevated if insulin resistance syndrome is present. Disturbances in lipid metabolism frequently lead to a more atherogenic blood lipid pattern, thus increasing risk of heart disease.

14. What Is the Best Way to Reduce Insulin Resistance
Exercise regularly
Lose excess body fat
Eat a high-fiber, whole food diet that is low in fat, sugar and refined carbohydrates
These are the best strategies to reduce insulin resistance.

15. Impaired Glucose Tolerance
A pre-diabetic state
A large percentage will progress to type 2 diabetes with time
Occurs in about 20 million Americans
Impaired glucose tolerance (IGT) occurs in about 20 million Americans. It is considered as pre-diabetic state. A large percentage will progress to Type-2 DM with time. IGT is characterized by insulin resistance.

16. Impaired Glucose Tolerance
Often present when fasting blood sugar is between mg/dl
Usually not associated with any symptoms
Usually associated with an increased waist to hip ratio
Often associated with a family history of type 2 diabetes
IGT is often present when fasting blood sugar is between mg/dl. Because IGT is not usually associated with any symptoms, most people who have this condition are not aware of it. IFG is associated with an increased risk of CVD and is often a prelude to the development of Type-2 DM.

17. Impaired Glucose Tolerance
Associated with an increased risk of cardiovascular disease
Increased blood clots
Insulin resistance is present
Impaired glucose tolerance is associated with an increased risk of cardiovascular disease and is often a prelude to the development of Type-2 diabetes. Insulin resistance is present. Dyslipidemia is frequently present.
Dyslipidemia is frequently present
Low HDL
High triglycerides
Small dense LDL particles

18. What Is the Best Way to Reduce or Reverse Impaired Glucose Tolerance?
Exercise regularly
Lose excess body fat
Eat a high-fiber, whole food diet that is low in fat, sugar and refined carbohydrates
The best way to reduce or reverse impaired glucose tolerance is to follow these strategies. Note how they are the same as the ones given for insulin resistance.

19. Complications of Diabetes
Damage to small blood vessels and peripheral nerves
Risk of dying of a heart attack is 2-3 times greater
Number one cause of kidney failure in US
Elevated blood sugar levels causes damage to small blood vessels.
About half of patients with diabetes develop nerve damage and or damage to the retina
Those with poorer blood sugar control are more likely to see these microvascular complications develop.
Patients with diabetes should have their eyes checked every year. They should also learn to check their own feet for lesions or sores and keep their practitioner informed if they see anything abnormal.
The risk of dying of a heart attack is about 3-5 times greater in people with diabetes. Cardiovascular disease accounts for about 2/3 of all death in patient with Type-2 diabetes. People with Type-2 diabetes at least 2-3 times more likely to diet from heart disease for any given serum cholesterol level.
Nerve damage
Damage to retina
Number one cause of amputations in US

20. Most Important Strategies for Type 2 Diabetes
Focus on calories so you lose weight
Eat a heart-healthy diet
Keep your blood pressure under control
Exercise regularly:
Aids weight loss without hunger
Reduces insulin resistance
Lowers blood sugar levels
Improves blood lipids
Reduces blood pressure
Reduces risk of heart attack & stroke
Exercising every day is important because the beneficial effects of exercise wear off after about a day. You can see that exercise provides 6 important benefits in controlling type 2 diabetes.
If you have been sedentary for a while, see a physician before embarking on any strenuous exercise program.

21. What Is the Optimal Diet for Type 2 Diabetes?
5 or more servings of whole grains
Examples of whole grains are whole wheat pasta, brown rice, barley, oats or oatmeal, whole grain cereals, etc. Look on the package to see if it says 100% whole grain. Also read the ingredient list to make sure a product contains whole grains such as whole wheat instead of white flour.

22. What Is the Optimal Diet for Type 2 Diabetes?
5 or more servings of vegetables
It is important to consume enough vegetables if you are trying to lose weight. They contain fiber and are low in calorie density so they fill you up with fewer calories than foods that are high in refined carbohydrates, such as cookies, muffins and bagels.

23. What Is the Optimal Diet for Type 2 Diabetes?
3-5 servings of fresh or whole fruit
It is important to eat fresh or whole fruit instead of fruit juice or dried fruit because the former is more satiating.

24. What Is the Optimal Diet for Type 2 Diabetes?
2-3 servings of nonfat dairy products
It is important to eat nonfat dairy products because regular, whole fat versions are high in saturated fat which causes LDL to rise.

25. What Is the Optimal Diet for Type 2 Diabetes?
1-2 servings of heart-healthy, protein-rich food such as beans, fish, nuts, tofu, lean poultry, etc.
These are more heart healthy than fatty versions of meat. Fish is a good choice, especially cold water fatty fish, because it contains omega 3 fatty acids. Beans and tofu can actually help lower cholesterol.

26. What Is the Optimal Diet for Type 2 Diabetes?
Choose whole, carbohydrate-rich foods that are satiating and low in calorie density
A potato is lower in calorie density than potato chips. Baked potatoes are high on the satiety index – higher than croissants or Danish. The key to weight loss is to fill up on whole foods that are not high in calories. Most people eat until they feel full and if they eat plenty of whole grains, fruits, vegetables and beans/legumes with little added fat or sugar then will consume fewer calories and not feel hungry. More is mentioned on this topic in the Weight Loss Show of the Diet and Type 2 Diabetes Kit.

27. What Is the Optimal Diet for Type 2 Diabetes?
Limit foods that are high in refined carbohydrates
Foods that are made with white flour and white sugar are high in refined carbohydrates. Some examples include candy, cake, brownies, cookies, white bread, white pasta, bagels, baked goods, etc. Also foods like white rice, instant white rice and instant mashed potatoes are more refined and they produce a higher spike in blood sugar. These foods are also much higher in calorie density than their whole counterparts.

28. What Is the Optimal Diet for Type 2 Diabetes?
Eat a low salt diet, especially if blood pressure is high
Eating a low salt diet will help keep your blood pressure from going too high. Look at the label – this food contains 100 calories and 100 mg of sodium – it is ideal to find foods that keep the sodium the same or lower as the number of calories.

29. Important Dietary Strategies for Type 2 Diabetes
Choose whole, carbohydrate-rich foods that are satiating and high in fiber
Limit refined carbohydrate foods such as cookies, cake, baked goods with white flour, etc.
Limit foods that are high in saturated fat and hydrogenated fat
Eat a low salt diet, especially if blood pressure is high
A potato is lower in calorie density than potato chips, French fries or instant mashed potatoes. Baked potatoes are high on the satiety index meaning they make you feel relatively full for the amount of calories they contain as compared to other foods like a croissant. The key to weight loss is to fill up on whole foods that are not high in calories. Most people eat until they feel full and if they eat plenty of whole grains, fruits, vegetables and beans/legumes with little added fat or sugar then will consume fewer calories and not feel hungry. More is mentioned on this topic in the Weight Loss Show of the Diet and Type 2 Diabetes Kit.

30. “Make no little plans; they have no magic to stir men's blood
“Make no little plans; they have no magic to stir men's blood... Make big plans, aim high in hope and work.”
-- Daniel H. Burnham
Take each day one day at a time. Set small obtainable goals for yourself and stick to them. Pretty soon you will have made major changes in your lifestyle that will take you on a road to better health.