Can continuous glucose monitoring help with type 2 diabetes?

Reuters Health – People taking insulin for type 2 diabetes may manage symptoms better with a device that constantly checks their blood sugar, a small study suggests.

Researchers focused on 158 adults with type 2 diabetes, which is tied to aging and obesity and happens when the body can’t properly use insulin to convert blood sugar into energy. All of the patients had poorly controlled blood sugar even though they were injecting insulin several times a day.

For the experiment, all of the patients continued using insulin and testing their blood sugar on their own. Researchers randomly assigned half of the participants to also use a continuous glucose monitoring device made by DexCom Inc., which paid for the study and has financial ties to several of its authors.

After 24 weeks, patients on continuous glucose monitoring did a little better, on average, at managing their blood sugar than the people only using self-testing. But people in both groups typically still had poorly controlled blood sugar at the end of the study.

“The value of continuous glucose monitoring is in the ability to see glucose readings continuously – every five minutes – plus having alarms that indicate that the blood sugar is going up or down,” said lead study author Dr. Roy Beck, executive director of the Jaeb Center for Health Research in Tampa, Florida.

“The blood sugar if it gets too low can lead to seizure or loss of consciousness, so having the ability to know ahead of time that the glucose levels are trending in that direction is extremely valuable so that the patient can eat or drink carbohydrates to raise the blood sugar,” Beck said by email.

Over time, seeing what types of food raise blood sugar and which exercises can help lower sugar are other advantages of the continuous glucose monitors, Beck said.

“For instance, it is common that a carbohydrate-heavy breakfast will raise the blood sugar considerably, but many patients with type 2 diabetes don’t realize this,” Beck added.

To see how well self-testing stacked up against continuous monitoring, Beck and colleagues used what’s known as a hemoglobin A1c test, which measures the percentage of hemoglobin (a molecule on red blood cells) that is coated with sugar. That provides a picture of average blood sugar levels over about three months. Normal A1C is below 6 percent, and readings of 6.5 percent or above signal diabetes.

At the start of the study, participants were typically testing their glucose about three times a day and they had average A1c readings of 8.5 percent, indicating poorly controlled blood sugar with an increased risk of serious complications.

After 24 weeks, people had average A1c readings of 7.7 with continuous glucose monitoring and 8.0 without the device, researchers report in the Annals of Internal Medicine.

There wasn’t a statistically meaningful difference in how many patients in each group achieved A1c levels below 7.5 percent or below 7.0 percent by the end of 24 weeks, however.

Patients with type 2 diabetes typically don’t use continuous glucose monitors because the devices can be expensive, may not be covered by their insurance plan and might not be recommended by their doctors. DexCom’s continuous glucose monitoring systems can cost more than $1,000.

Currently, the devices are more typically used for patients with type 1 diabetes, which happens when the body doesn’t make insulin and is usually diagnosed in childhood or young adulthood.

The study results suggest that continuous glucose monitoring might make sense for certain patients with type 2 diabetes, said Dr. Vanessa Arguello, an endocrinologist at the David Geffen School of Medicine at University of California, Los Angeles, who coauthored an accompanying editorial.

“Continuous glucose monitoring may be unnecessary if people with type 2 diabetes have impeccable glucose control and no (low blood sugar) risk,” Arguello said by email.

But this option might make a big difference for people at high risk of low blood sugar and for patients who really struggle to manage their blood sugars and have dangerously high A1c levels above 9 percent, Arguello added.

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Diabetes? Managing Depression Can Improve Blood Sugar

Diabetes and depression have long been linked. About 12% of those with diabetes have major depression, and about 10 to 20% have minor depression.

What experts have long debated, however, is whether reducing the depression can also help control diabetes.

Now, in a new analysis, German researchers have found that reducing depressive symptoms does indeed translate to better blood glucose control, even increasing the chances of getting to the goal of a hemoglobin A1C under 7.5.1

Explaining the Link

There could be many explanations for why reducing depression helps blood sugar,  says study investigator Andreas Schmitt, PhD, a postdoctoral researcher at the Research Institute of the Diabetes Academy Mergentheim in Germany. It could be that the less depressed people are, the better care they take of themselves. And the more depressed, the worse care.  “Evidence suggests a behavioral relationship between depression and glycemic control, mediated by impaired diabetes self-management,” he tells EndocrineWeb.

“Depression is associated with reduced motivation, reduced activity, suboptimal lifestyle factors such as an unhealthy diet and smoking,” he says. “Adherence to diabetes treatment regimen may be reduced.”

The link could go the other way, too, he says, with poor diabetes control perhaps triggering depression or worsening it.

Depression is often stressful, of course. Dr. Schmitt says that “under chronic stress conditions, blood glucose levels may vary more strongly and poorer glycemic control can result.” Chronic, low-grade inflammation is linked with both stress and depression, and that could explain the poorer control. “There is evidence supporting that inflammation can lead to hyperglycemia and anti-inflammatory medication might improve glycemic control,” he adds.

Study Details

The researchers followed 181 men and women, on average age 45, with type 1 and type 2 diabetes. They were on a variety of diabetes medicines, but most were on insulin therapies, as type 1 affected 63% of the people in the study.

At the start, the majority, 76%, had A1Cs of 7.5 or higher.

They each took a standard depression test, called the CES-D, with questions such as whether they are bothered by everyday events, if their appetite lagged, if they had trouble concentrating or sleeping, and their mood.2

The possible scores range from zero to 60, and these men and women averaged a score of 23 at the start. “Depression levels included both major depression as well as elevated depressive symptoms,” the latter is known as subclinical depression, Dr. Schmitt says.

At the end of the study, the average decline in the depression scores was 5 points, down to 18. And nearly half showed scores of 15 or lower, suggesting a recovery.

The A1C dropped from an average of 8.8 at the study start to 8.1 after a year. And 35% of the people got to the target of under 7.5.

Next, the researchers looked to see if the lower depression scores predicted lower A1C, and found they did. Each one-point reduction in depression score raised the odds of reaching the A1C target by 4%. Those whose score dropped enough to be termed recovered were twice as likely to reach that A1C goal.1

More about the New Analysis

The new analysis was a secondary evaluation of the researchers’ previous study, called DIAMOS (Diabetes-Specific Cognitive Behavior Treatment Program). In this original study, the same researchers compared cognitive behavioral therapy, commonly called talk therapy, with simply getting care for diabetes. The researchers looked to see how much the depressive symptoms declined and also if the A1C declined.

After 12 months, those getting talk therapy showed reductions in depression, but so did the comparison group. Initially, the results seemed to speak out against the benefit of treating the depression, so the researchers decided to look at the results in a different way, conducting the secondary analysis. They looked at whether the reduction in depression could predict improved blood sugar control, regardless of whether the people got conventional depression treatment or not. And that’s when they found that it did. When the depression went down, so did the blood glucose.

The study is published in the Journal of Diabetes and Its Complications.1

Perspectives

“This study is consistent with our expectations,” says Elena Christofides, MD, FACE, CEO of Endocrine Associates in Columbus, Ohio, and a member of the EndocrineWeb editorial board.

In the original study, she notes, both the group getting ”talk therapy” and the group getting regular diabetes care had their depression lessen, and she speculates as to why that was so. “It’s the interaction,” she says.

Both groups had interaction and care from health care providers, she says, and ”a simple human connection is enough to make people feel better. When you feel better, you take better care of yourself.”

Whichever the intervention—standard care or talk therapy—those who responded to the intervention in a positive way reduced their depression, Dr. Christofides says.

How To Lessen Depression

If interactions with health providers aren’t enough to improve depression, what to do? That decision must be individualized, as Dr. Schmitt says.

“Not all patients respond to antidepressant medication,” he says. He adds that ”cognitive behavioral therapies addressing both depressive cognition and behavior change regarding diabetes” are most likely to help the diabetes control.

Does Having Sugary Food Cause Diabetes?

Diabetes Mellitus, often referred to as diabetes, is a life-long condition in which a person suffers from high blood glucose levels either because the body does not produce adequate insulin or because the body’s cells are not able to respond properly to insulin or in some cases even both. Insulin is released by the pancreas and plays a major role in helping your body store and utilize the sugar and fat from the food you eat. But do you think eating too much sugar.

The American Diabetes Association regards this as a myth but the answer is not so simple. According to their experts, Type 1 Diabetes is caused by genetics and unknown factors that trigger the onset of the disease. This is the types of diabetes that often begins in childhood and therefore, is also known as juvenile-onset diabetes. It is an autoimmune condition which means that in this case the antibodies in our body start attacking the pancreas and so, it is not able to produce insulin.

Further, type 2 diabetes is caused by genetics and lifestyle factors. This is the most common type of diabetes. In this case, the pancreas does produce some amount of insulin but either it is not enough or the body’s cells are resistant to it.  However, the American Diabetes Association does recommend that people should avoid the intake of sugar-sweetened beverages to help prevent diabetes such as soda, energy drinks, fruit drinks and sports drinks.

We asked Dr. Sujeet Jha, Director – Endocrinology, Diabetes & Obesity at Max Healthcare to clear our doubts. He tells us, “Consumption of sugar directly may not cause diabetes but it may lead to other problems that may trigger diabetes. For instance, obesity or being overweight, which are the biggest causes of diabetes. Since diabetes is linked to the management of sugar in body, it does not mean that having sugar can cause diabetes. But you must know that excess of refined sugar or added sugar is anyways harmful as it contains no nutrition and only adds to your calories. I would suggest that you to stick the WHO guidelines that recommends limiting the intake of added sugar to 25 grams or 6 teaspoons.”

It is now understood that sugar alone is not the factor that can cause diabetes.  Noida-based Nutritionist and Physician from Kailash Hospital, Dr. Parveen Verma agrees and shares, “Diabetes is not necessarily caused by just eating sugary food items. It can result from diverse factors such as obesity, stress, polyphobia or polyuria. The possible connection between refined sugar and diabetes is the fact that foods containing carbohydrates depress blood glucose levels the most such as sugar. It is suggested that foods containing only carbohydrates have a more severe impact on the bloody glucose level in comparison with foods containing fats and protein along with carbohydrates.

Therefore, diabetes is not necessarily the result of eating more sugar. More often than not, it can also be caused by both genetic and environmental factors. As scientific studies suggest and to reiterate, diabetes is usually due to the pancreas not producing enough insulin or the cells not responding to the insulin produced in the body. As a result of this, your body may not be able to manage the blood sugar levels.

Due to lack of the right knowledge, the procedure for managing diabetes often gets cluttered. We consume sugar on a daily basis found naturally in the fruits and vegetables we eat. In fact, according to Macrobiotic Health Practitioner Shilpa Arora,some fruits such as pomegranates, grapes, apples, papaya and guavas can be good for diabetics.

The debate about sugar affecting our health is mainly fixated on the ‘added sugar’ such as caster sugar used for baking, table sugar added to our drinks and the concealed sugars in ready-made meals, drinks and various other packaged eatables which is definitely harmful for our health when consumed excessively. However, the causes of diabetes vary considerably depending upon an individual’s genetic make-up, ethnicity, family history and environmental factors.

Cinnamon: Pantry staple, medical powerhouse?

Use as a medicinal agent has scientists buzzing

(CNN) – Cinnamon is one of the world’s most popular spices, sprinkled on lattes, boiled with ciders and enjoyed in numerous dishes. Without it, Thanksgiving and Christmas meals might well become tasteless and definitely less fragrant.

Harvested from the inner bark of a tropical evergreen plant, cinnamon has been used in Ayurvedic medicine to treat respiratory and digestive problems for centuries. Ancient Egyptians used cinnamon as a perfume during the embalming process, while Romans used it in funeral pyres to mask the stench of burning flesh.

The Bible mentions cinnamon several times, most commonly as a way to perfume bedding, clothes and anointing oil. The essential oil form is made from the bark, leaves or twigs of the plant.

But it’s cinnamon’s use as a medicinal agent that has scientists buzzing, trying to determine just how well its antioxidant capabilities might work to better our health.

“Medicine started as herbs and plants,” said Lauri Wright, a spokeswoman for the Academy of Nutrition and Dietetics. “So it almost comes full circle, as we’re now going back and proving what some of these plant substances may do for health.”

Not all cinnamon is created equal

There are two basic types of cinnamon. Ceylon, or Cinnamomum verum, is grown in Sri Lanka. C. cassia, C. loureiroi and C. burmannii, communally known as cassia, are widely produced in China and Indonesia. Cassia has the stronger flavor and odor of the two and, due to its much lower cost, is what we buy in the store to sprinkle on our food.

But it’s the more expensive Ceylon version, with a milder, sweeter flavor, that might be the best for your health.

Cassia can contain relatively high concentrations of coumarin, a plant compound that can damage the liver. A study of 91 cinnamon samples from various stores in Germany found 63 times more coumarin in cassia cinnamon powder than Ceylon powder. Cassia sticks, which look like a thick layer of rolled bark, also contained 18 times more coumarin than Ceylon sticks, which have thin layers.

“A challenge with some of these herbal solutions, because they are not a regulated drug, is that you don’t know exactly what you are getting,” said registered dietitian Melinda Maryniuk, who serves on the professional practice committee for the American Diabetes Association. “A lot of things affect the makeup of the product: where it’s grown, the soil, growing conditions, even how the spice was stored and dried.”

That problem also plagues research on cinnamon. Scientists have used different doses, species and compounds of the spice for their research.

“The doses have varied greatly among the studies, from less than 1 gram to levels that would be toxic in humans,” Wright said. “The duration of taking the capsules has also varied greatly. That’s the problem with translation of all of this work. Even when we find positive results, how do we come up with the correct compounding and dosage for maximum safety?”

Keep that in mind as you read on about where science stands on cinnamon.

Diabetes and cholesterol

“I think the strongest evidence lies so far with diabetes and the promise of cinnamon and blood sugar control,” Wright said, pointing to studies in test tubes and mice and even small studies in people showing that cinnamon helps with insulin sensitivity and glucose transport while decreasing inflammation.

“A lot of the studies have been in postmenopausal women and men of that age,” said biochemist Amy Stockert, who studies cinnamon at Raabe College of Pharmacy at Ohio Northern University. “Some have found positive effects; other studies have not.”

Stockert co-authored a small study of 18 people with type 2 diabetes that showed the cassia species of cinnamon was more effective than diet alone in lowering blood glucose levels. In fact, her study found that it was comparable to oral diabetes medications.

Another study of 60 people with type 2 diabetes found that small doses of cinnamon reduced blood sugar levels and improved LDL, or “bad” cholesterol, triglycerides and total cholesterol.

“I like the fact that the amount that showed benefits for blood sugar and cholesterol in that study was 1 to 6 grams, which is the range of half-teaspoon to three teaspoons, or one tablespoon, so it’s easy to sprinkle on cereal or in yogurt or use in recipes,” said registered dietitian Lisa Drayer, who writes about nutrition for CNN. The Food and Drug Administration’s recommended limit is 6 grams a day.

But while the future looks promising, the American Diabetes Association urges caution.

“The ADA believes there’s not enough evidence,” Maryniuk said. “A 2013 meta-analysis, which is one of the most rigorous of reviews, found that cinnamon had no impact on hemoglobin A1c levels, which is what we look at to measure how well blood sugar is being controlled over time. If that had gone down, I’d be more impressed.”

Still, if you want to see whether cinnamon works for you, Maryniuk suggests that people with type 2 diabetes do a self-test.

“Do some paired blood glucose testing,” she said. “Use a half a teaspoon in the morning, on fruit or oatmeal or in coffee, and see what happens to your blood sugar levels before and after you eat. Check again two to three hours later and see if there’s a difference.

“But keep taking your medicine,” she warned. “You don’t want to try something to the exclusion of the medicine you’re taking.”

“We still need a bit more work before we roll this out,” Wright agreed. “And you must be careful to work with your doctor when using cinnamon with diabetes medications, as it might drop your blood sugars too low.”

Dementia, HIV, cancer and more

The antioxidant properties of cinnamon are also being studied for their impact on the formation of the plaques and tangles of Alzheimer’s disease and other dementias. Cinnamaldehyde, a compound responsible for the spice’s sweet smell, and epicatechin, a powerful antioxidant that’s also in blueberries, red wine and chocolate, seem to offer some protection against the oxidative stress that damages tau, a key player in the development of dementia.

Another study found a component of Ceylon cinnamon to have the same effect. However, research has occurred only in mice, rats and laboratory Petri dishes.

“It appears to work as an anti-inflammatory or antioxidant, protecting the body on a cellular level from bad things that happen,” Wright said, “by getting rid of waste products and keeping the cells healthy.”

Cinnamon and other traditional Indian medicinal plants are also being tested in the fight against HIV. One study found that green tea, elderberry and some extracts of cinnamon rich in flavonoids blocked the virus from entering and infecting certain cells.

“That’s how AZT works, which is one of the early HIV drugs,” said Wright, who specializes in nutrition for infectious disease at the University of South Florida. “And while that’s interesting, what I would hate is that patients will use cinnamon and other supplements instead of their HIV medications.

“Having worked with many HIV clients over the years, I know there’s definitely a big interest in supplements,” she said. “But I would always caution them to always use the meds that we know work, that have been tested and dosed, and then look carefully to make sure there are no conflicts with any additional supplements.”

The research on cinnamon doesn’t stop there. Ceylon cinnamon has also been associated with cancer-fighting properties in rodents, anti-parasitic effects, improved diabetic neuropathy, lower blood pressure and wound healing, including liver damage. Studies have shown that solutions of cinnamon oil can kill a number of common bacteria, such as streptococcus and E. coli. The National Center for Complementary and Integrative Health is investigating cinnamon’s impact on multiple sclerosis.

Using a computer model, biochemist Stockert found that cinnamon was as effective as resveratrol, an antioxidant in red wine known for anti-aging and disease-fighting properties, in activating SIRT-1 — also known as the longevity gene because of its role in repairing DNA.

“In some cases, it did better than resveratrol,” Stockert said. “We’re talking anti-cancer, anti-aging, a very, very big deal if that is what is going on.”

Cinnamon as health aid

Based on all this preliminary research, the potential of cinnamon seems enormous. But experts caution that it’s still too early in the scientific process to suggest cinnamon as a daily supplement.

“I don’t recommend capsules. There’s not enough science to tell us to take capsules,” Wright said.

“You are affecting your body’s signaling,” Stockert said, “and that’s significant. We’re at an early stage in research where we don’t know how cinnamon will affect most people. Is it healthy to cook with spices and use them liberally? I’m sure that’s fine. But I would be cautious about taking any supplements on their own.”

“I think the bottom line is that cinnamon is a perfect pantry staple, a pleasant spice that can add flavor to foods for minimal calories, with antioxidant properties that may give an edge to those looking to better control their blood sugar,” Drayer agreed. “But we need to see more research before we can make any solid health claims linking cinnamon to reduce risk of disease or improved health.”

Check your blood sugar with your smartphone’s camera

Around 29 million people with diabetes have to poke their fingers for a blood sample daily. That’s painful!

What if you could check your glucose levels without drawing blood? There’s a groundbreaking piece of technology that’s going to do just that.

How to check glucose levels without drawing blood

This is really exciting news, and not just for diabetic patients. Everyone needs to take care of their health and monitoring glucose levels is essential.

What we’re talking about is a free health app that lets you check glucose levels without drawing blood. The app is called Epic Health and will be released sometime before the end of the year for both Android and iOS gadgets. It’s currently going through clinical trials.

The app not only gives the user the ability to accurately measure blood glucose levels, but it also measures Insulin Resistance levels. This is key in determining if you are pre-diabetic. Watch the following video for a brief demonstration.

The app works by placing one fingertip over your smartphone’s camera lens. A series of close-up images are taken that show data on the user’s blood flow. These images are then sent to the cloud for analysis and can provide feedback on vitals including heart rate, temperature, blood pressure to respiration rate and blood oxygen saturation.

Users will also find out how different foods affect their body. This will be a big help in setting up the perfect diet for you.

Diabetes has become an epidemic in America. According to the American Diabetes Association, over 30 million people in the U.S. had diabetes in 2015. That’s nearly 10 percent of the population.

Advances in technology, like the Epic Health app, might be able to help get this epidemic under control. We can sure hope anyway.

Click here if you would like to sign up for early access. You will be put on a list to be one of the first to get the app.

Here’s Exactly What I Ate To Cure My Type 2 Diabetes & High Cholesterol

Mary Jenkins is 51 and lives in Kanab, Utah. Last December, before starting her new diet, she weighed 225 pounds. She has since lost 50 pounds—and the weight is still coming off. This is her story.

I was born in Charlotte, North Carolina, so I lived off a Southern-fried diet for most of my life. As a result, I had extremely high blood pressure for over 30 years. I tried every eating plan out there to get it under control: low-carb diets, high-protein diets—all that stuff. None of it worked for me. I was still obese, and my cholesterol levels didn’t improve.

 

Then two years ago, my doctor ordered an A1C test. He had a hunch I may have type 2 diabetes as a result of my weight. My score was a seven, which meant his suspicions were correct. (A normal A1C level is below 5.7. ) It got worse: Because I’ve had high blood pressure for so long, he said I could have long-term organ damage now that I also had diabetes. You’d think at that point, he would have sat me down and talked to me about how I could improve my diet, but he didn’t. He just said something like, “Watch your carbs and exercise.” That was it. So I basically kept living as I had before.

 

My motivation
Then my doctor moved away, and I found another doctor in a larger town nearby. My new physician told me that I needed to go on metformin (the generic name for a drug used to treat high blood sugar levels) immediately. He also told me that I should ramp up my exercise routine. So last year, I started hiking and rock climbing with my neighbor, who happens to be a yoga instructor. I’m just a regular gal who sits at a desk all day, so this was not serious rock climbing or anything. But still, with the help of my new workout buddy, I lost 10 pounds. It felt great to be making progress, and my neighbor even started calling me “the amazing disappearing woman.” I have to admit it was a big ego boost.

I thought my doctor would praise my progress, too, but at my next appointment, which was this past December, he told me that my blood pressure was still too high. He said, “If you don’t make drastic diet changes, I’m going to send you to a nephrologist because your kidney function is very poor.”

That terrified me. I lost my pastor to kidney disease, and I knew it was a terrible affliction. So I Googled ‘What do you eat to improve kidney function?’. I found information on the DASH (Dietary Approaches to Stop Hypertension) diet, which is the diet recommended by the National Heart, Lung, and Blood Institute for lowering blood pressure. In 30 years, no one had talked to me about a dietary approach to lowering my blood pressure. I started reading about it, and I thought, if it didn’t work, no harm no foul. I decided to start my new diet on January first, because everyone else starts their goals then, right?

My diet & exercise routine
The DASH diet is all about portion control and eating less fat, sugar, and salt. I bought smaller plates, spoons, and cups to make sticking to the plan easier. I also got smaller storage containers marked with various serving sizes so I could eat out of them and keep my portions in check. (Buy something similar on Amazon.com for $10.) I also posted to Facebook to let my friends know what I was doing and started keeping a food diary. These things helped keep me accountable—and continue to do so to this day.

On the DASH website, I also found and printed out this shopping list that provides a list of foods that fit into the diet. I took it with me to the grocery store and stocked up on everything I needed—which took me three long hours. (Thinking back on that now, it’s actually a bit humorous. Shopping is far easier for me now that I’ve been eating this way for nearly a year.) I bought lots of healthy grains, fruits and vegetables, and low-fat yogurt. I cut out cow’s milk and started using almond milk instead. I switched from processed peanut butter to natural almond butter.

I also started preparing most of my food myself, which is something I hadn’t done before. I’d always eaten out or bought ready-to-eat stuff. I found new things that I liked, and many were things I’d never eaten before. For example, I’d never had steel-cut oatmeal. As a Southern gal, I’d only had grits. I started eating strawberries and raspberries. I had never had asparagus or Brussels sprouts, but I started adding them to my shopping cart. I also began buying fresh meat and making grilled chicken or pork with cauliflower rice. (Which, by the way, is so good!)

I also started walking. Every two hours, I would walk for 10 or 20 minutes or even an hour. It didn’t really matter how long, it was just to get up out of my chair and move. I’d already proven I could hike and do more challenging forms of exercise, so walking seemed like a smaller task that would help me get healthier.

The reward
Come March 1st I had my next doctor’s appointment, and I was excited to see the changes. I don’t have a scale at home; I refuse to buy one. So it had been three months since I’d seen the doctor, and two months since I’d started the diet, and he said I’d lost 33 pounds. He was in shock. And not only that, he told me that if I stuck with it, I could reverse my diabetes. I was determined to make it happen.

Two months later I had another appointment. I found out that I had lost an additional 20 pounds. He also shared the most amazing news with me: I didn’t have diabetes anymore! My A1C was 5.3, down from 7. My blood pressure was also down to 115 over 30—healthy numbers I haven’t seen since I was 21 years old. I felt ecstatic, but also relieved.

Even though my health has improved, I haven’t stopped my medications; that’s not what my journey is about. With my long-term blood pressure issues, there’s no way to tell what harm’s already been done, so I need to continue taking them.

My doctor is shocked I’ve maintained my good health and weight loss for so long. He told me he doesn’t care if lose another pound; he just doesn’t want me to put weight back on. “You have made too much progress to go back,” he said. And I agree. I want to do everything I can to maintain my newfound health for the rest of my life.

How you can improve your diet, too
People will say, “I don’t have money to start one of these diets.” But don’t let that excuse hold you back. I shop for food at Walmart, and I promise that you don’t have to spend a lot on groceries. Just follow a healthy shopping list and find ways to keep your portions reasonable. One way I do this is by asking the butcher to cut things into really small portions. This way I don’t have to spend time measuring as many things at home, and I can cook only what I should be eating in one sitting. You just have to figure out what strategies work for you, and not let anything stand in your way.

Avoid diabetes with these healthy eating tips

What you put on your plate can make a huge impact on your ability to prevent Type 2 diabetes. This serious disease affects 9 percent of all Americans and 25 percent of those over age 65. Type 2 diabetes can lead to high blood pressure, high cholesterol, heart attacks, and stroke. Keeping your blood sugar low and eating a healthy diet are critical to avoiding this disease. Here are a few simple tips to help you do just that: 

Read labels. Because sugar adds flavor and is an effective preservative, it’s hidden in all types of foods, from spaghetti sauce to cold cereals. I recommend checking nutritional labels before using prepared items in your cooking.

Forego processed and fast foods. They’re not just high in fat, but high in added sugars too. Cheeseburgers, tacos, French fries, burritos and frozen foods are usually best avoided. Crackers, chips, white bread, white rice, instant cereals and pasta contain lots of sugar and few nutrients.

Save sweets for special occasions. Cakes, cookies, ice cream, pop and candy should be eaten in moderation. This is true of juice as well. All-natural fruit juice is still just sugar. If you’re craving something sweet, choose whole fruit. The fiber slows down and even reduces how much sugar your body absorbs.

Beware of so-called health foods. Milk has protein, but no fiber, and many yogurts have a lot of added sugar. Both can cause a rapid increase in blood sugar. Honey is another food that, while natural, isn’t healthy for people watching their sugar intake.

Half of creating a diabetes-resistant approach to eating is learning what foods to avoid. The other half is discovering what foods to include — and how to stick with it.

Choose fresh foods and whole grains. Fresh fruits and vegetables are high in vitamins and low in sugar. Consuming a variety of colors helps ensure you’re maximizing flavor and getting all the nutrients you need. Whole-wheat bread and pasta, oatmeal, barley, brown rice and buckwheat and rye flour are all complex carbohydrates that will give you the energy you need without the sugar boost. Nuts, beans, lean meats and fish are also part of a healthy diet.

Set yourself up for success. Limiting the sugary foods you have available in your home can be a good way to avoid eating things that aren’t healthy. When you go to the grocery store, focus on shopping the perimeter and avoid buying things you’ll struggle to avoid later.

Eat at home. Making food at home and eating it with family or friends allows you to control sugar, salt and fat quantities, as well as portion sizes. It also minimizes the number of times you eat out each month, lowering calorie and sugar consumption.

Changing your diet requires patience, persistence, and support. If you want to learn more about what you can do to eat healthier and lower your risk of diabetes, talk to your doctor.