Q: I KNOW THAT MANY PEOPLE WITH DIABETES DEVELOP KIDNEY DISEASE. HOW CAN I PREVENT IT?
A: You are correct. Diabetes is the single leading cause of kidney disease and, as a result, kidney dialysis and kidney transplants. Clearly you want to do all you can to prevent it. Here are the steps to take:
1) Keep your blood glucose in control as much as possible. Good control has been shown to delay the start of kidney disease, as well as slow its progression.
2) Keep your blood pressure in control as much as possible. Because you have diabetes, your blood pressure goal is less than 130/80. High blood pressure can make kidney disease worse. If you have high blood pressure, make sure you take your blood pressure medication. If you are not on medication, ask your health care provider if you should be.
3) Get your kidneys checked each year for diabetes-related damage. This is important for everyone with diabetes, even if you just found out you have it. The easiest way to test for diabetes-related kidney damage is to do a urine microalbumin test. This test measures the amount of protein present in a urine sample. Leaking of small amounts of protein into your urine is the earliest sign of kidney disease. Check with your health care provider to make sure you have had this test done within the last year. If not, have it done now.
4) If you have early kidney damage or are at risk for kidney disease, your health care provider may prescribe one of two types of medications—an ACE inhibitor or an ARB. Both of these types of medicines help slow down diabetes-damage; they also may help decrease heart problems. Talk to your health care provider to see if you should be taking one of these medicines.
Don’t delay taking steps to protect your kidneys. It is important to take action as soon as you learn you have diabetes, since most people with type 2 diabetes actually have had high blood glucose levels for a number of years before they were diagnosed.
Q: CAN YOU CLARIFY WHAT MY BLOOD GLUCOSE LEVELS SHOULD BE BEFORE MEALS AND AFTER I EAT?
A: For general purposes, it is best to use the American Diabetes Association goals for blood glucose control. The ADA suggests that your blood glucose level should be between 90 and 130 mg/dL (plasma reading) when you wake up and before each meal.
Blood glucose levels increase when you eat and are highest about two hours after the start of meals. The ADA recommends that your blood glucose level be at or under 180 mg/dL (plasma reading) two hours after the start of a meal. Ideally, your blood glucose level will be back to the before-meal goal of 90 mg/dL to 130 mg/dL four hours after your previous meal.
Note: These goals are provided as plasma values. Most of the newer blood glucose monitors report your results as plasma values. If you have an older monitor, it may report results as whole blood values. Ask your diabetes educator or Walgreens pharmacist to help you determine how your meter reports your blood glucose values. Meet with your health care provider to discuss what your personal blood glucose goals should be. It might be that the ADA’s goals are not right for you. They may be too ambitious because you have just begun to get your blood glucose levels under control, or they may be too high for you because you are pregnant and need to have even lower goals for the health of your baby. Eventually, these could be your targets, but it is important to remember that everyone is different.
Q: CAN I EAT CHINESE FOOD OR OTHER ASIAN CUISINES IF I HAVE DIABETES?
A: Absolutely! Asian cuisines, from Chinese to Japanese and Thai, are great-tasting and can be healthy. People usually think of Asian cuisine as very healthy, and it can be if you order wisely and practice portion control. But it also can be a nutritional disaster if you start with fried appetizers and move on to dishes with deep-fried meats and sweet sauces.
Here are a few tips to help you eat Asian cuisines healthfully:
- Start with a clear soup, such as a bowl of egg-drop or hot-and-sour soup. In Japanese restaurants, a healthy soup is Miso, and in Thai restaurants, tom yum koong, which is a clear broth-based soup. Avoid the fried appetizers.
- Eat family style. That means splitting and sharing. And order fewer dishes than the number of people at the table. This helps you eat smaller portions. If there’s too much food at the table, you may be more likely to overeat.
- Order dishes with plenty of vegetables, such as sizzling sliced chicken with vegetables or shrimp and broccoli. Look at the vegetarian offerings; try mixed vegetables with tofu (ask that the tofu not be fried).
- Avoid items that are deep-fried, such as those that are battered, served golden or crispy. In Thai restaurants, try an appetizer meat or vegetable roll that is not fried.
- Order steamed brown rice. If not available, choose steamed white rice in place of fried rice and keep your portion to less than one cup.
- When eating Chinese, enjoy the fruit and fortune cookies. In Japanese and Thai restaurants, dessert receives little attention.
WHAT TO WATCH OUT FOR:
Be aware that there are usually some carbohydrates hidden in the sauces and thickeners. These can raise blood glucose higher than you might expect. Try to use limited amounts of the sauces. Learn more about how Asian-style meals impact your blood glucose by checking your blood glucose level when you start to eat, as well as two hours and four hours later. This can help you learn whether you should eat less or adjust your diabetes medications, if you can, when you eat out. Also note that Asian cuisines can be quite high in sodium, due to the soy sauce and other high-sodium sauces. If you must keep you sodium intake below 2000 mg per day, then you should eat Asian cuisine rarely. You can reduce the amount of sodium you eat by avoiding soup, using a minimal amount of the sauces and ordering brown or white rice instead of fried rice.
