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- Herausgeber: Ryland Peters & Small
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2017
Understand the causes and effects of diabetes so you can live a full, active and long life. Plus, discover 70 nutritious and tasty recipes that will help control your diabetes and aid weight loss – one of the key remedies for reversing Type 2 diabetes. If you're suffering from diabetes, you already know that simple tasks such as deciding where to dine out can be a challenge. Dr Karin M Hehenberger, a renowned diabetes expert, helps you navigate key challenges associated with living with diabetes. As someone who has suffered from Type 1 diabetes herself since the age of sixteen, she explores key issues, including understanding your diagnosis, eating in and eating out, travelling safely, living on your own, coping with the emotional toll of the disease and more. Dr Hehenberger tackles each issue and offers the best strategies for navigating the situation at hand, weaving in lessons from her personal experience along the way. She also offers advice on the benefits of healthy eating and weight loss in managing your diabetes, and how these can even contribute to the reversal of an early diagnosis of Type 2 diabetes. There are then 70 delicious recipes that are tailored towards those affected by diabetes, including a special three-course menu by a celebrated New York chef. Whether you are suffering from diabetes or support someone who is, this guidebook will help inspire you to continue chasing your dreams and give you the tools you need to realize them.
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the everything you need to know
about diabetes cookbook
the everything you need to know
about diabetes cookbook
expert advice, plus 70 recipes complete with nutritional breakdowns
Dr Karin M Hehenberger, MD, PhD
This book is dedicated to my parents who gave me life, and who continually and heroically fight with and for me to keep it.
Published in 2017 by CICO Books
An imprint of Ryland Peters & Small Ltd
20–21 Jockey’s Fields 341 E 116th St
London WC1R 4BW New York, NY 10029
www.rylandpeters.com
10 9 8 7 6 5 4 3 2 1
Text © Dr Karin M Hehenberger 2017
Design and original photography
© CICO Books 2017
For additional photography credits, see page 159.
The author’s moral rights have been asserted. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without the prior permission of the publisher.
A CIP catalog record for this book is available from the Library of Congress and the British Library.
eISBN: 978-1-78249-519-2
ISBN: 978-1-78249-435-5
Part 1 and the Conclusion were previously published through Lulu.com as Ten Things You Need to Know About Living with Diabetes by Dr Karin M Hehenberger.
Editor: Clare Churly
Photographer: Ria Osborne
Home economist: Sue Henderson
Food stylist: Luis Peral
Commissioning editor: Kristine Pidkameny
Senior editor: Carmel Edmonds
Art director: Sally Powell
Production controller: David Hearn
Publishing manager: Penny Craig
Publisher: Cindy Richards
Notes to read before you start cooking
● Both American (US cups/imperial) and British (metric) measurements and ingredients are included in these recipes for your convenience. However, it is important to work with one set of measurements and not alternate between the two within a recipe.
● Eggs are US large and UK medium unless stated otherwise.
Important note
The views expressed in this book are those of the author and readers are urged to consult a relevant and qualified medical practitioner from their diabetes care team for individual advice before beginning any dietary regime. While every attempt has been made to ensure the medical information in this book is correct and up to date at the time of publication, the Publishers accept no responsibility for consequences of inappropriate use of any dietary regime.
Contents
Introduction
Part 1: Living Well With Diabetes
1 Being Diagnosed with Diabetes
2 Your Diabetes Team
3 Going Low
4 How to Eat
5 Exercise and Diabetes
6 Traveling and Vacations
7 Your Relationships
8 Living on Your Own
9 Looking Good
Part 2: The Recipes
Nutrition and Weight Loss
Breakfast Recipes
Light Meals and Salads
Main Meals
Sides and Dips
Desserts and Treats
A Three-course Meal
Conclusion: Fears and Hopes
Useful Resources
Glossary
Index
Photography credits
Acknowledgments
Introduction
As both a medical doctor and a person with diabetes, I know how difficult it is to accept your diagnosis and to adjust your lifestyle to deal with a chronic condition, such as diabetes. In this book you will find the top things I think you ought to know as a person with diabetes or as a person who loves and cares about someone with diabetes.
I received a diagnosis of type 1 diabetes as a teenager living in Sweden, and it affected my career choices and my life in a dramatic way. I decided early on to learn as much as possible about my disease and figure out a way to beat it, but I never accepted the disease as a part of me. My journey with diabetes taught me to face adversity with good humor and to never, ever give up. However, it also affected my confidence, love for life, and belief in my future. For a long period of time, I lived in the moment and did not expect to be around for many years. I have studied diabetes from more angles than most, first submerging myself into medical science as a scientist and clinician, and later as an analyst of companies and developer of drugs and devices. I have learned that sharing our stories, struggles, and victories may be the best way to overcome issues related to the disease and to live a life beyond survival mode.
In the first part of this book, I describe issues, situations, and problems that are part and parcel of daily life with diabetes, and are sometimes things you would have never considered prior to being diagnosed. For each one, I give you advice and tips on how to deal with them, and share my personal experience of them. In Part 2, I explain the benefits of a healthy, nutritionally balanced diet (which is good for everyone, not just those with diabetes), and how to approach adjusting your diet accordingly. There is also a collection of recipes for breakfast, light meals and salads, main meals, sides and dips, and desserts and treats. All have been designed to work with a diabetic diet and are recipes I would personally eat and enjoy.
My journey has now reached a stage where I am more comfortable with my condition. It has taken twenty-five years of living with type 1 diabetes, going through brutal complications, fighting fear and pain, and ending up with one of my father’s kidneys and the pancreas of a young deceased donor. My father’s sacrifice and the generosity of the family who donated their daughter’s organs saved my life and made it worth living. I will be forever grateful, and I want to spend the rest of my life doing good for others while still doing well for my family and myself.
I hope that by reading this book you will learn some new facts, but that you will also better understand how to address your condition and discover fresh ways of living practically.
Above all, stay positive, be active, remain open to new ideas, and never hesitate to reach out to others for help and advice!
PART 1: Living Well with Diabetes
1 Being Diagnosed with Diabetes
2 Your Diabetes Team
3 Going Low
4 How to Eat
5 Exercise and Diabetes
6 Traveling and Vacations
7 Your Relationships
8 Living on Your Own
9 Looking Good
1
Being Diagnosed with Diabetes
To receive a diagnosis that you have a chronic disease is a daunting experience, since the very word “chronic” implies that it will never go away. In contrast to the flu, a urinary infection, or even certain kinds of cancer, type 1 diabetes (T1D) does not have a cure yet, although billions of dollars have been invested in the research and development of new technologies and therapeutic drugs intended to treat the disease.
T1D and T2D
There are two major types of diabetes: type 1 (T1D) and type 2 (T2D). Both diseases require diet and behavior modification as part of their treatment and may lead to serious complications, such as heart, eye, nerve, and kidney disease in the long term and loss of consciousness in the short term.
T1D is an autoimmune disease that requires lifelong treatment with insulin for survival. Autoimmune means that the body’s own immune system targets the healthy cells in the body instead of fighting outside threats, such as bacteria or a virus. Examples of other autoimmune diseases are multiple sclerosis and celiac disease. T1D is generally diagnosed in children, adolescents, and young adults. About 200,000 Americans under the age of twenty are estimated to have diabetes (Centers for Disease Control and Prevention—CDC) and in 2008 and 2009, almost 20,000 young people were diagnosed with T1D and 5,000 were diagnosed with T2D each year. In the UK, there are about 31,500 children and young people under the age of nineteen with diabetes, and the vast majority of them have T1D (Diabetes Facts and Stats: 2015).
Scientists still don’t know exactly what causes diabetes. There is clearly a genetic component since people with T1D have a higher risk of having children with the disease. But interestingly, only 10 percent of people with T1D have a relative with diabetes. In my case, I was the first one in my family who developed this disease.
There is also an environmental component to T1D, and since the highest incidence in the world is in Scandinavia, where I am from, a great deal of research has been conducted into the food, environment, and even the greatly increased exposure of young children to vaccines and antibiotics in that area of the world. The “hygiene hypothesis”—that children are being exposed to fewer infections, in part because of clean water supplies, uncontaminated food and milk, improved sanitation, and higher standards of cleanliness—may be related to all autoimmune diseases. In countries where hygiene is poor, there appears to be a low incidence of all autoimmune diseases, including T1D.
Some speculate that T1D is triggered by infection, which somehow overstresses the pancreas. As a result, the immune system mistakenly targets the pancreas, instead of the bacteria or virus causing the infection. I, for example, had three serious bouts of tonsillitis, all requiring treatment with antibiotics, in the spring before I got a diagnosis of diabetes. Were those infections related to my condition? Not enough is known yet to say for sure. Fortunately, much is known about how to deal with the disease once it is diagnosed.
DIABETES FACTS AND FIGURES
• According to the Centers for Disease Control and Prevention (CDC), 29.1 million Americans had diabetes in 2012 (National Diabetes Statistical Report, 2014)—this means that almost 10 percent of all Americans have some form of the disease—and the number of new cases of diabetes per year is increasing faster than the population grows
• From 2001 to 2009 in America, T1D among youth increased 23 percent and T2D among youth increased 21 percent (Mayer-Davis et al., 2012; Dabelera, D. et al., 2012)
• According to Diabetes UK, it is estimated that 3.5 million people have been diagnosed with diabetes in the UK (Diabetes Facts and Stats: 2015) and it is predicted 549,000 have diabetes that is yet to be diagnosed: this means that over 4 million people are estimated to be living with diabetes in the UK at present, which represents 6 percent of the UK population or 1 in every 16 people having diabetes (diagnosed and undiagnosed)
• Epidemiologists estimate that by 2030, 550 million people will have diabetes worldwide (International Diabetes Federation)—of these, 183 million will be unaware of their condition
• In the US only, one in three people may have diabetes by 2050 (CDC)
• Diabetes requires much medical care, so the financial burden on society due to diabetes is great, with total costs approaching $250 billion in 2012 (CDC)
• Diabetes was the underlying cause of death of almost 70,000 Americans in 2012 and a contributor to more than an additional 230,000 deaths, making it the seventh most deadly disease (CDC)
• People with diabetes are two to four times more likely than other people to die of heart disease, and diabetes is also the leading cause of kidney failure, accounting for 44 percent of all new cases, as well as the leading cause of new cases of blindness in adults (CDC, 2012)
Karin’s story: ACCEPTING MY DIAGNOSIS
On July 5, 1989, two days before my seventeenth birthday, I received a diagnosis of T1D. It was the worst day of my life up to that point, and to this day, it still is. I felt as if I had become an entirely different person, one with a chronic disease who had lost in life. I had been a member of the Swedish National Junior Tennis Team. I ran and I skied. I was competitive about everything, even crossing the street; I wanted to get to the other side first. I never questioned my ability to win or my ability to control my body.
I was not only an athlete. My parents placed a high priority on academic achievement. My father is a quantum chemist, and my mother a highly educated stay-at-home mom. I worked hard and did well in school. In particular I excelled at the sciences and had already developed what would become a lifelong fascination with medicine.
That summer, I played in a major tennis tournament in southern Sweden. I was playing hard every day and had reached the finals, but I was also experiencing the first symptoms of diabetes. No one in my family had ever received a diagnosis of diabetes, and my parents and I did not recognize any of the signs.
I was drinking enormous amounts of fluids, which ran right through me so that I was constantly peeing. I was losing weight daily, which didn’t bother me since I thought it made me look better (I was a typical teenage girl). But I was getting weaker, too, and developing cramps in my lower legs. My vision became blurry; I was always a little nauseated and lost all interest in food. After the tournament, I went to my grandparents’ country home in northern Sweden to rest. It was they who finally recognized that what I was experiencing were symptoms of diabetes and took me to the hospital. There, blood tests revealed that my blood sugar level was sky high; I had T1D.
“Seventy years ago, you would have been dead,” the nurse told me.
Her comment was the first of many that made me feel different and vulnerable. I was no longer a strong young woman, but someone who would die if she didn’t have access to insulin injections. Indeed, fear crept into my everyday life, and many nights I had a nightmare about not being allowed onto Noah’s Ark. Like most teenagers, I struggled with fitting in with my peers, and getting a diagnosis of a life-threatening and debilitating disease made doing so much more difficult.
No one in my family had ever received a diagnosis of diabetes, and my parents and I did not recognize the signs
T2D is all too common in the Western world, accounting for 90 to 95 percent of the total 29.1 million cases, with T1D being responsible for the remaining 5 to 10 percent. Another 86 million have prediabetes—blood glucose levels higher than normal, but not yet in the diabetic range. Thirty percent of people with prediabetes develop full-blown T2D. T2D is also believed to have a genetic component; people who are genetically predisposed to obesity are more likely to develop the disease. For example, when one identical twin develops T2D, the chances of the other twin developing it are 80 percent, whereas in T1D, the risk is less than 50 percent.
The reason T2D is often considered a “disease of the Western world” is because it mainly affects those who are overweight, eat poorly, are not sufficiently active, and make other lifestyle choices that are detrimental to their health. In the United States it has reached almost epidemic proportions. It tends to affect people later in life, at middle age or older. Unfortunately, that is changing because obesity is increasing, largely as a result of our unhealthy Western lifestyle. Now even children are developing T2D, which means that millions of young adults are facing (and will face) the late-stage complications of the disease.
Both T1D and T2D are chronic diseases and are diagnosed based on blood glucose levels as indicated by the following criteria:
● a blood glucose level of 126 milligrams per deciliter (mg/dL) or higher after an eight-hour fast as measured by the fasting glucose test;
● a blood glucose level of 200 mg/dL or higher two hours after drinking a beverage containing 75 grams of glucose dissolved in water as measured by the oral glucose tolerance test;
● a random blood glucose level of 200 mg/dL or higher, along with the presence of diabetes symptoms;
● an HbA1c level of 6.5 percent or higher—the long-term measurement for glucose that measures the percentage of red blood cells that are glycosylated (red blood cells in which the hemoglobin is bound to glucose).
People with T1D or T2D are unable to control glucose levels in their blood due to an inability to manufacture a sufficient amount of insulin. That means, if unregulated, the dangerously elevated amount of sugar in their bloodstream adversely affects organs, vessels, and tissues. If people with diabetes do not take proper care of themselves, the long-term complications are the same for both types of diabetes: eye, kidney, and nerve disease, as well as cardiovascular complications.
Ketoacidosis and hyperglycemia
Based on how the disease is diagnosed, its causes, and, importantly, my own reaction and experiences, I want to help families and individuals with the disease deal with the situation.
Because the incidence of diabetes is growing to almost epidemic proportions, it is important that people—particularly the family and friends of people with diabetes—be educated about the symptoms of ketoacidosis and hyperglycemic coma in the case of T1D, and the warning signs before diagnosis in the case of T2D. Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies formed by the breakdown of fatty acids and the deamination of amino acids—i.e. what happens when the body breaks down fat for energy. The two common ketones produced in humans are acetoacetic acid and beta-hydroxybutyrate.
Ketoacidosis is a dangerous, pathological metabolic state marked by extreme and uncontrolled ketosis (when you have hyperglycemia—high blood sugars—and your body uses ketones instead of glucose as energy, which is extremely dangerous). In ketoacidosis, the body fails to adequately regulate ketone production, causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased (acidosis). In extreme cases ketoacidosis can be fatal.
Ketoacidosis is common in untreated T1D and is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. The lack of insulin in the bloodstream prevents glucose absorption and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine. Dehydration results from the osmotic movement of water into urine, exacerbating the acidosis. Ketoacidosis can be smelled on a person’s breath, due to acetone (a type of ketone body), often described as smelling like fruit.
Recognizing symptoms
A child who experiences increased fatigue, frequent urination, excessive thirst, and weight loss should be seen by a doctor immediately. Intervention at this point could prevent hospitalization upon diagnosis and might avert some of the damage that occurs before diagnosis and before the child’s blood sugar indicates that he or she has full-blown diabetes. Beta cells in the pancreas secrete insulin, and during the critical stage prior to clinical diagnosis there may be ways in the future to protect those cells from damage and thus allow for delayed diagnosis or a milder disease.
A child who experiences increased fatigue, frequent urination, excessive thirst, and weight loss should be seen by a doctor immediately—early intervention can prevent hospitalization
In adults, the symptoms of T2D are much more subtle and can go unnoticed for years. There is no reason for people not to have annual physical exams and blood work done, including glucose tests. If you are overweight—even slightly—you should have blood work and blood pressure tests performed more frequently. Today, pharmacies and mini-clinics are excellent options for this kind of testing, simplifying the process for everyone and reducing the cost and time required.
Once you have received your diagnosis, doctors, nurses, and other health care professionals will explain how the condition should be managed and how it will affect your life. This information can be difficult to take in. When you first get your diagnosis, I recommend having a family member or friend accompany you when the doctors explain the new life you are required to lead. They can listen, maybe ask some questions, and take notes, but perhaps most importantly, they can be there for you and hold your hand, both literally and figuratively. This will not be the only conversation you have with your doctor and other medical professionals about the topic, so try to take in what you can but do not worry if you need to go over the information more than once.
The practical aspects of dosing insulin, counting carbohydrates, and pricking your fingers for blood glucose values multiple times a day can be overwhelming. I found, however, that the serious health consequences of not perfectly managing the disease scared me much more, and I really did not want to hear about them. You can’t ignore the fact that your life has changed. Adjusting to being dependent on a drug such as insulin and realizing you have to modify your lifestyle can be difficult. Indeed, some people will be in denial about the seriousness of their condition. It is important to understand that only you can manage your disease, and that by doing so with medicines, diet, and exercise, you can have a long, healthy, and enjoyable life.
2
Your Diabetes Team
After you have received your diagnosis, you, along with your doctor and other health care professionals, will need to create the best possible treatment program for you—and not just from a medical perspective. The reality is that people with diabetes require many touchpoints within the health care system.
Primary care
If you have T1D, your basic medical care, which includes monitoring and managing your blood sugar levels, will be handled by an endocrinologist or a doctor who specializes in treating diabetes. (Unfortunately, there are not enough of these doctors in the United States to handle the more than 100 million people at risk or with a diagnosis.) If you have T2D, you may be treated by a primary care doctor, who may or may not be knowledgeable about treating and managing diabetes. It is important to interview your doctor and not settle on one until you find someone who has sufficient experience with and knowledge of all the intricacies of your condition.
Managing diabetes is not just about controlling your blood sugar levels; your primary care doctor must function as a coordinator for your entire health care team. This team should include a nurse who can help manage your blood sugar levels, respond to daily requests, and talk to you about technical problems with devices or drugs. The nurse often has more practical skills than the doctor; for example, if you have a blood glucose meter, the nurse can help you download glucose values from the meter through a cable or even wirelessly to the nurse’s or doctor’s computer to help manage dosing, carbohydrate loads, exercise, etc.
Diet and fitness
Another important member of the team is the dietician. Your blood sugar levels are affected by the food you eat in a major way; knowing what foods can help you manage the disease and which ones to avoid will be essential. You will also need a fitness professional or coach to help you design a good exercise program. Your primary care doctor may have a recommendation, or you may be able to get help from a local gym, YMCA, or community center. The way you exercise when injecting insulin is different from when you don’t, and it is very beneficial to understand what each situation requires.
Additional specialists
Unfortunately, diabetes involves the risk of damage to the small (micro) and large (macro) blood vessels (vasculature). This is very common in people with T2D who may have had the disease for years before getting a diagnosis and often have some complications already. For this reason, it is critical to be seen by a retinal specialist. This doctor examines you to determine whether you have diabetic retinopathy, a condition affecting the blood vessels in the back of the eye that may lead to blindness if untreated. In fact, the CDC notes that diabetes is the leading cause of blindness in people younger than sixty-five in the Western world. The other key player on your team is the nephrologist, or kidney doctor. Similar to the eyes, the kidneys have many small blood vessels that may be damaged by longstanding diabetes. In fact, a person who has had diabetes for more than ten years likely has some signs of kidney disease; however, in most cases it will not progress if blood pressure and blood sugar levels are closely managed.
A cardiologist should be part of the team as well, particularly if you have received a diagnosis of T2D and are older than fifty. Annual exams are crucial. The World Heart Federation says diabetes increases the risk of heart disease by two to four times, and in women that number may be even higher.
A foot doctor or podiatrist is another component of the diabetes team. The extremities, especially your feet, are vulnerable to blood sugar fluctuations, as well as poor circulation and nerve damage. The latter can cause loss of sensitivity, and all three can lead to poorly healing wounds, followed by amputations in the worst cases. Your dental health may also be affected by diabetes, so identifying a good dentist, and possibly an orthodontist, is very important too. Last, your team must include psychological and social support. It isn’t easy to live with a chronic disease. You have to manage multiple doctors’ visits, as well as deal with devices and drugs on a daily basis. Everyone needs someone to talk to, and having an impartial ear can alleviate the feeling of being dependent on or a burden to your family and loved ones. A social worker or health advocate can help with insurance issues and provide information about benefits. It is very costly to have diabetes, and there are many resources available of which you may not be aware.
It is important that people with diabetes get access to proper care in order to prevent the serious complications associated with the disease. The consequences of poor management are grave, both medically and economically, and the entire health care system should be very active in prevention. This can happen through a greater effort to educate people with diabetes about their condition, providing less expensive alternatives to junk food, and emphasizing exercise and healthful living in young people through school programs.
3
Going Low
For people living with diabetes, sugar is not only something we consider when we eat, but something we measure in our blood several times a day. Blood glucose levels determine our mood and energy in the short term, and if our blood glucose is unstable, it can lead to serious long-term consequences for our health.
In diabetes terms, “going low” or, in more technical terms, being hypoglycemic, is a very specific concept, defined by a blood sugar level that is less than 70 mg/dL. However, it is important to realize that different people have different tolerances for low blood sugar levels, and some people, especially those with longstanding diabetes, may suffer from hypo-unawareness. In other words, despite having dangerously low blood sugar, they do not exhibit the normal symptoms of low blood sugar, so it is much harder for those around them to intervene.
Going low is a scary event for someone with diabetes. We all know that when we skip a meal or exercise too hard without having consumed enough calories to support the expenditure of energy, we may feel shaky, develop a headache, and/or become irritable. For someone with diabetes, these feelings are even more intense. Eventually, the person will lose consciousness, and without intervention, he or she could die. Every year, one out of every twenty people with T1D dies from hypoglycemia; this occurs more commonly in people under forty. “Dead in bed” is the term used when a person develops serious hypoglycemia while asleep and just never wakes up. You can imagine the fear that family and friends feel when their loved ones with diabetes go to sleep.
