Diet and Exercise for People with Type 2 Diabetes by Catherine Tuck, MD - Naomi Berrie Diabetes Centre, Columbia University

Introduction DIET and exercise are a common prescription for a healthy life. For people with Type 2 diabetes, it is especially important to follow a healthy diet and get lots of exercise. Often this is enough to get blood sugar levels under good control, especially early in the illness. For a person with Type 2 diabetes, a healthy diet has to include three elements. These are foods: Low in saturated fat, balanced or low in carbohydrates, low in calories, if you are overweight.

The following is a description of each of these essential elements in detail along with some tips on how to exercise and lose weight. Eating foods that are low in saturated fat Saturated fats are animal fats. They are found in meats, in dairy products like milk, cheese and ice cream, and in some kinds of cooking oils, such as lard. We have known for a long time that when you eat a lot of saturated fats your cholesterol and triglycerides tend to go up.

When your cholesterol is high, you are at a higher risk of developing hardening of the arteries and getting heart attacks and strokes. When you have diabetes, you are especially prone to developing heart attacks and strokes, so you should do everything you can do to lower your risk of heart disease, and following a low saturated fat diet is very important.

Also, if you tend to have high triglycerides (fats in the blood), then following a low-fat diet will help bring your triglycerides back down. Not all fats are the same, though. Saturated fats are bad for you, but monounsaturated fats, in moderation, seem to be good for you. Monounsaturated fats include olive oil, canola oil, and nut oils.

If you cut out the saturated fats in your diet and replace them with monounsaturated fats, you can avoid filling up on carbohydrates. As you will learn below, carbohydrates are hard on your blood-sugar levels. Talk to your doctor or your nutritionist about how to integrate foods with monounsaturated fats into your diet. Eating foods that are balanced or low in carbohydrates Carbohydrates are sugars and starches. Examples of carbohydrates are: pasta, bread, rice, potatoes, yellow vegetables, sugars, fruit, fruit juice, baked goods, and regular sodas. You can tell how much carbohydrate is in a food by reading the label. When you eat any kind of carbohydrate, your stomach and intestine turn them into simple sugars. In other words, all carbohydrates are eventually turned into sugar. When you eat a meal, that meal includes three things: fat, protein and carbohydrates. It turns out that the only part that makes your blood sugar go up is the carbohydrate part.

In other words, if you ate an entire meal that had only fat and protein in it, your blood sugar would not go up. That doesn't mean that the fat and protein don't have calories — in fact, the fat has more calories by weight than the carbohydrate does. But it is only the carbohydrates that get turned into the glucose that goes into your bloodstream.

So if you want to predict how a meal will affect your blood sugar then all you need to account for is the amount of carbohydrate in the meal. If you want to get really good at assessing your meals, you can buy books or take lessons in "carbohydrate counting".

When you have diabetes, you need to try to balance how much carbohydrate you have at each meal. For example, if you had a breakfast that included a big glass of orange juice, sugared cereal with strawberries on top and a piece of toast, most likely your blood sugar after that meal would be way too high.

That meal contains mostly carbohydrates — except for the little bit of fat and protein in the milk in your cereal. Instead, in order to better control your blood sugar, you should cut out some of the carbohydrates and substitute a little fat and protein. Eating foods that are low in calories if you are overweight The majority of people with Type 2 diabetes are overweight. If you are overweight and you really want to control your blood sugar without medicines, the only way you are going to be able to do that is by losing weight.

For reasons that are not currently understood, being overweight makes it hard for your body's insulin to work. It causes what we call insulin resistance. That's the bad news. The good news is that if you lose some weight — often only about ten pounds, even if you are more than 50 pounds overweight — you can usually get your blood sugars back down to normal. Move around Those with the best weight loss results are those who follow a low-fat diet and exercise, at the same time. Our weight is controlled by a pretty simple equation: Energy In (what you eat) = Energy Out (what you burn by exercising).

If you eat too much or exercise too little you will gain weight. Anything — anything — that you do during the day to move around is good! You should spend at least 30 minutes every day exercising. For some, this could be briskly walking to work. For those who are able to do more strenuous exercise, it could be jogging, aerobic classes, or a sport.

There is something about moving around that helps your insulin work better. It is literally the best thing you can do for yourself. You have to make it a priority in your life. Understand that your diet and exercise regimen has to become a permanent part of your life.

Unfortunately, you are not going to be able to go on a diet for a few months, lose weight, and then go back to your old eating habits and stop exercising. That never, ever works.Putting it all together A healthy diet and exercise are important for everyone, but for people with Type 2 diabetes, they are also the first-line treatment. To review, steps to both a smarter diet and a regular exercise regimen include: Cut out saturated fats (animal fats). Include some monounsaturated fats (olive oil, canola oil, nuts and nut oils). Cut down on and balance your carbohydrates (sugars and starches).

Lose weight if you are overweight. Exercise: Talk to your doctor if you have never exercised before and want to start an exercise programme — if you are at risk for heart problems you should have a stress test before you start.

Plan to follow this programme for the rest of your life and find ways to make it something you can live with.

Get your friends and family involved so that you don't have to do this alone. With these steps, you are on your way to a healthier life and better control of your Type 2 diabetes.