Diet - Without a proper diet (and appropriate numbers of calories), the likelihood of successfully managing your diabetes is, ahem, slim.  That is not to say that there can be no deviation from a "proper" diet.  Quite the contrary.  Indeed; I encourage all my patients to occasionally indulge themselves and eat those things they generally don't, but would like to.  Cake is not a four letter word!  Well, I guess it is, but you know what I mean.  The key word is "occasionally."  And while we're at it let's get rid of the word "cheating" when we're talking about diet therapy.  I hate the patronizing connotation.  Having a piece of cake is not cheating.  There is no such thing as cheating!  Occasional indulgence; yes.  Cheating; no.  (Incidentally, alcohol isn't a four letter word either; though smoking is!).

A "diabetic diet" does not have to be a highly restrictive, unpleasant, boring set of meals.  In fact, many of my patients are pleasantly surprised with the variety of foods they can eat which they had thought (prior to meeting with a nutritionist) were "forbidden."  The American Diabetes Association guidelines, though written for a professional audience, are actually presented in a very readable way and you may find it well worth your while to have a look at them.  I discuss the potential role of vitamin and mineral supplements here.  Now, if we're going to talk about dietary therapy (by the way, the new, official, fancy title for dietary treatment is "Medical Nutrition Therapy;" abbreviated as 'MNT.'  Do you think there will come a day when we can make names simpler, not more complex?  Please, please, let it be soon), I have to mention the Glycemic Index.  The premise  behind the Glycemic Index is that certain foods are more likely than others to make your blood sugar go up after you eat them.  And so, of course, one would think it is best to avoid (or at least restrict) such things.  Indeed, medical organizations in a number of countries in the world have found sufficient merit to this that they advocate following a diet based on Glycemic Index principles.  There are, however, some buts; for instance, a low Glycemic Index diet:

My opinion?  Simply this; a diet based on Glycemic Index may turn out to be the best diet in the world to treat diabetes, but for now we do not have proof of this.  Once again, only time (in the company of more research and, in particular, clinical trials) will tell.

Another issue about dietary therapy is whether it is a good idea to follow a low carbohydrate/high protein diet.  My concern about this type of diet is that the benefits seemingly achieved with such diets are either short-lived (weight loss is almost always temporary) or, in some cases, offset by disadvantages (constipation, fatigue, dizziness, possible worsening of cholesterol levels as well as a theoretically increased risk of osteoporosis and kidney stones).

To find out the scoop on proper nutrition have a look at the Healthy Eating page which has been ever-so-kindly written by the wonderful dietitian and diabetes educator, Claire Lightfoot, RD, MEd, CDE.

Exercise - When it comes to physical activity, many people shudder at the prospect of being asked to "start exercising."  This is often because people have an expectation that what is necessary is beyond their reach (so to speak).  Not so!  Taking up an exercise "program" does not mean preparing for the Boston Marathon (though you are welcome to if you are so inclined).  Simply going out for a reasonably brisk twenty to thirty minute walk several times per week has a significant impact on health.  More activity than that I consider a bonus.  If you are accustomed to doing virtually no exercise at all then set your sights even lower; start by doing even by five to ten minutes of exercise a couple of times per week.  If need be, start by just doing some stretching and work your way up from there.  Any exercise is better than no exercise!  (But, please note that if you are not accustomed to exercising you should consult your physician first to make sure your heart is up to the challenge).  Type 2 diabetes is a condition of "insulin resistance;" and exercise-any exercise-helps to lessen insulin resistance (and thus helps to achieve better blood glucose control.  And as additional benefits, often helps blood pressure, the heart, cholesterol levels and hey, usually makes one feel generally better).  A letter in The Lancet from January 4, 2003 had an interesting observation about the Amish community in the United States and how, despite having similar rates of obesity as most of the U.S., the Amish still had much lower rates of diabetes; perhaps due to their being more physically active.

Weight Loss - If you are overweight (and the great majority of people with Type 2 diabetes are) and your doctor asks you to "lose weight" then your reaction, if you are like most people in this circumstance, is probably to think "but I've tried and tried and tried."  And that makes most people feel frustrated.  What most people with diabetes don't recognize is that improved blood sugar control is often seen after only a few pounds are shed.  You do not have to reach your ideal (or even close to ideal) weight in order to have lower glucose levels (and better health).  Sure, try to get down to a "perfect weight," but don't feel that the goal is so far out of reach or so unrealistic that it is not worth even trying.  Any weight loss is beneficial! 

We generally determine if someone is overweight (and to what degree) by determining an individual's body mass index (BMI).  For most people, if your BMI is above 25 then you are considered overweight.  Note that this does NOT apply to pregnant or breastfeeding woman nor does it apply to infants, children or adolescents (nor to particularly muscular individuals).  If you have Acrobat Reader installed, click here to see a Health Canada chart that will allow you to calculate your BMI. 

Another way to establish if you are overweight is by measuring your waist circumference.  Your health risk goes up if your waist circumference exceeds 32 inches for women; 37 inches for men.  Your risk is considered "high" if your waist circumference exceeds 35 inches for women; 40 inches for men.  I would add that other numbers are used in some studies, but the key point is, simply enough, if you are overweight, it ain't good for your health in general and is particularly bad for your health if you have diabetes.  'Nuff said.

Well, okay, one more point.  You can also assess your health risk by calculating what is called the "waist-hip ratio."  The waist-hip ratio (WHR) is obtained by measuring the circumferences of the waist at its narrowest point and the hips at their widest (around the buttocks) and simply dividing the values: waist/hips. Men with a WHR of 0.95 or more and women with a WHR of 0.85 or more are considered to be at increased cardiovascular risk.