Minor Missteps Can Make Your Diabetes Worse

Despite what you may have heard, type 2 diabetes doesn't have to be a lifelong condition. It can be controlled and even reversed in the early stages or stopped from progressing in the later stages-with none of the dire consequences of out-of-control blood sugar.

The problem is, even people who are following all the doctor's orders may still be sabotaging their efforts with seemingly minor missteps that can have big consequences. Among the most common mistakes that harm people with diabetes are oversights in the way they eat and exercise. For example...

Skimping on protein. The majority of people with type 2 diabetes are overweight or obese. These individuals know that they need to lose weight but sometimes fail despite their best efforts.

Here's what often happens: We have had it drummed into our heads that the best way to lose weight is to go on a low-fat diet. However, these diets tend to be low in protein and you need more protein, not less, if you have type 2 diabetes and are cutting calories to lose weight.

What's so special about protein? You need protein to maintain muscle mass. The average adult starts losing lean muscle mass every year after about age 40. If you have diabetes, you'll probably lose more muscle mass than someone without it. And the loss will be even greater if your diabetes is not well controlled.

Muscle is important because it burns more calories than other tissues in your body. Also, people with a higher and more active muscle mass find it easier to maintain healthy blood glucose levels, since active muscle doesn't require insulin to clear high glucose from the blood.

My advice: Protein should provide 20% to 30% of total daily calories. If you're on an . 1,800-calorie diet (a reasonable amount for an average man who wants to lose weight), that's about 90 grams (g) to 135 g of protein a day. If you're on a 1,200- to 1,500-calorie diet (a sensible amount for an average woman who is dieting), that's about 60 g to 113 g of protein a day.

Examples: Good protein sources include fish, skinless poultry, nonfat or low-fat dairy, legumes and nuts and seeds. A three-ounce chicken breast has about 30 g of protein... a three-ounce piece of haddock, 17 g... one-half cup of low-fat cottage cheese, 14 g... and one quarter cup of whole almonds, 7 g of protein.

Note: If you have kidney problems, you may need to limit your protein intake. Check with your doctor.

Not doing resistance training. It's widely known that aerobic exercise is good for weight loss and blood sugar control. What usually gets short shrift is resistance training, such as lifting weights and using stretch bands.

When you build muscle, you use more glucose, which helps reduce glucose levels in the blood. If you take insulin for your diabetes (see below), toned muscles will also make your body more sensitive to it.

An added benefit: People who do resistance training can often reduce their doses of insulin or other medications within a few months.

My advice: Do a combination of resistance, aerobic and flexibility exercises. Start with 20 minutes total, four days a week-splitting the time equally among the three types of exercise. Try to work up to 60 minutes total, six days a week. An exercise physiologist or personal trainer certified in resistance training can help choose the best workout for you.

If you take Diabetes Meds...

Sometimes, diet and exercise aren't enough to tame out-of-control blood sugar. Traps to avoid...

Drug-induced weight gain. Ironically, the drugs that are used to treat diabetes also can cause weight gain as a side effect. If you start taking insulin, you can expect to gain about 10 pounds within six months-with oral drugs, such as glipizide (Glucotrol), you'll probably gain from four to seven pounds.

My advice: Ask your doctor if you can switch to one of the newer, "weight-friendly" medications.

Examples: A form of insulin called Levemir causes less weight gain than Lantus, Humulin Nor Novolin N. Newer oral drugs called DPP-4 inhibitors, such as Januvia, Onglyza and Nesina, don't have weight gain as a side effect.

Important: The newer drugs are more expensive and may not be covered by insurance. But if they don't cause you to gain weight, you might get by with a lower dose-and reduced cost.

Erratic testing. You should test your blood sugar levels at least four to six times a day, particularly when you're making lifestyle changes that could affect the frequency and doses of medication. Your doctor has probably advised you to test before and after exercise-and before meals.

My advice: Be sure to also test after meals. This will help determine the effects of different types and amounts of foods.