This disappeared from the original site, but @Alan S has managed to track it down. Rather than risk losing that link I'm posting the text here. I've had to split it over a few posts, as there is a size limit for each post and it wouldn't all fit in one! An open letter to the newly-diagnosed type 2 diabetic Copyright © 2004 RJM Davey Permission granted to reproduce freely for personal and educational use only. Commercial copying, hiring, lending is prohibited. In all cases this copyright notice must remain intact. Hi, You've had the bad news: you've got diabetes. Now, here's the good news: you've got diabetes. Of all the chronic conditions there are, diabetes can be controlled very effectively, and you can live a pretty normal life with it. But, you have to work at it, there's a lot you need to learn, and you've got to make the decision to take charge and do what's necessary to control it. Once you have brought your diabetes under control, you'll find that there are definite bonuses that go with it: you'll probably be more fit than you've ever been in your life, you'll have energy that you maybe thought had gone forever, and you're likely to be in better mental shape as well. None of what I'm about to tell you is original with me. I got this information from reading books, surfing the internet, and talking to other diabetics in my support group, and it has taken me a long time to locate the information and resources I needed, and that you need now. This letter is an attempt to boil that information down to the minimum amount you need to give you a better start at controlling your diabetes than I had. This is not meant to be a criticism of my GP. We too often forget that a GP is just that: a General Practitioner. While many practices have a GP who has had additional training in dealing with diabetes, he or she is not a specialist. Given that, in most surgeries, the GP can only give you 7, or 10, or 12 minutes for an average appointment, there are going to be limits on how much information you can get about your condition. That's the point of this letter: to give you some of the information you need now. I'm going to describe how I came to control my diabetes, by changing my diet and lifestyle, and then I'm going to suggest what I think would have been a better way, if I had known then what I know now. This applies to the type 2 diabetic [may use, but is not dependent on, insulin injections], which is what I am, but it could be adapted for the type 1 diabetic [must have insulin injections]. If you need to inject insulin, you would have to talk to your doctor to decide how to proceed. What follows is what worked for me. Whether it will work for you or not will depend on lots of things: whether you have other medical conditions that need to be taken into account, whether you're employed full- or part-time, whether you have a family to consider, how comfortable you are in the kitchen [and whether or not you have kitchen facilities available to you], probably lots of other things that I haven't thought of. If you can't do things the way I've done them, for whatever reasons, the information and basic principles outlined here should enable you to make some changes to your diet and lifestyle to help bring your diabetes under control. I'll also give you a short list of resources to find out more about your condition. Some of these are books, some are internet websites. All are resources I have used myself and found helpful. Be warned: some of these resources will frighten you half-way out of your wits – mainly because the complications that can accompany diabetes are terrible and frightening things. That said, I cannot emphasise strongly enough that knowledge is the best tool you can have to control your diabetes and minimise your risk of suffering those complications. Oh, and there's a brief glossary, so you can look up the terms you don't know. What happens when you eat? This is the Janet-and-John version: Through digestion, your food is broken down to glucose [and other stuff, which we'll ignore for now]. Glucose is the fuel your cells need to provide the energy for you to catch the bus, breathe, fly a kite, walk the dog, get the shopping in, think, go to school/work, and all the other things you do. Insulin is a hormone that most of your cells need to use the glucose. You get glucose from carbohydrates [sugary and starchy foods] and proteins [meat, poultry, fish, some plant foods]. There are very complicated mechanisms for controlling the amounts of glucose and insulin that are floating around in your bloodstream, available for the cells to use. When you have diabetes, these control mechanisms have gone wrong, and you end up with too much or too little glucose. Too much and too little are both Bad Things. If you aren't diabetic, your blood glucose level will be between 4 and 7 mmol/L [the scale used to measure blood glucose levels: don't worry about what that means right now, you just need to remember the numbers]. When you have diabetes, your blood glucose level can fall below 4 and go well over 7. Go too far below 4, your body doesn't have enough energy to keep working, you can slip into a coma, and, if this state of affairs continues too long, you can die. Go too far above 7, and you're likely to get one or more of the complications of diabetes, and you can end up a blind amputee on dialysis before you die. [I told you they were terrible and frightening.] THIS DOES NOT HAVE TO HAPPEN! That's so important that I'm going to repeat it: This does not have to happen. When you can't rely on your body to keep your blood glucose level in that 4–7 range, you can control it in other ways. It might mean taking medication – injecting insulin, or taking tablets of some kind – or it might be through the diet-and-exercise route, which is how I control my blood glucose levels. With or without medication, you need to understand how the food you eat affects your blood glucose [BG] levels. You probably know that your body needs a certain amount of carbohydrates, proteins, and fats, as well as vitamins and trace minerals, to work well. The carbohydrates and proteins are the things we'll concentrate on, since these are the things that most affect the glucose in your bloodstream. Sugars are the simplest forms of carbohydrate, and are the easiest for the body to break down. They send your BG levels soaring quickly, which is why you've [probably] been advised to avoid them. Starchy foods – potatoes, rice, pasta, sweet corn, breads, crisps, and such-like – are sugar molecules joined together to make more complicated chains of molecules [think of joining lego blocks together to make a one-room house – sugars – then adding more lego blocks to turn it into a 16-room castle – starches]. These take longer for your body to break down than sugars, so it takes longer for your BG levels to peak, the levels are not likely to get quite as high as with sugars, and the levels take longer to come down. Protein digestion is even more complicated: your body breaks down the proteins and then uses the products to make glucose in the liver. This process can take anywhere from several hours to a couple of days, and produces very little rise in BG levels. Current scientific thinking is that frequent and sustained high BG levels cause the damage that leads to complications, and that keeping BG levels as near to the normal range as possible can prevent complications from happening, or prevent complications you might already have from getting worse. How high is too high? There's a lot of debate about that. From my reading, I've come to think that up to 8 is acceptable, up to 9 is not good, and 10 or over is seriously bad. Other folks think anything over 8 is too high. I don't have the expertise to say anything definite about this, so I'm not going to try. I just aim at keeping my BG levels as close to the 4–7 range as possible, accept it if it goes up to 8, and take action if it goes higher than that. And it has worked: over the last week, my highest reading was 6.7, my lowest was 4.3, and the average was 5.5. "So how do you go about getting BG levels in the 4–7 range and keeping them there?" you ask. Well, when I first got my BG test meter [more about meters – and strips – later] in January 2004, I tested first thing in the morning, before and after meals, and at bedtime, sometimes 10 or 12 times a day. I didn't really know what I was doing, so a lot of those tests were a waste of time and test strips. However, I wrote down everything I ate and at what time, and what the test results were and at what time, and I started finding out how my body was reacting to the foods I was eating. I kept up my reading, and I found the wonderful folks at ASDUK, a support group on Usenet. [There's more information about them under Resources.] Between the various things I was reading and advice from the ASDUK crowd, I decided to test as follows: on getting up; just before each meal; 1 hour after the start of the meal; 2 hours after the start of the meal. I carried on recording all this information, then looking at my results and working out which foods made my BG levels shoot up, and which ones made them rise just a bit. As I cut out the foods that caused spikes in my BG levels, and increased the ones that didn't, my BG levels came down steadily and stayed there more of the time. I still get the occasional spike, but, for the most part, I don't go much over 8 these days. And, since I now know what I can eat without raising my BG levels too much, I don't have to test nearly so often: first thing in the morning every other day as routine; on some days when I don't do an FBG, I'll do an odd reading one or two hours after a meal; a full day's profile about once a fortnight; or when I'm adding a new food item to my diet: just before, and one and two hours after eating the new food. The results: I feel physically much better; I have bags more energy; I no longer have wild mood swings [although my husband might argue with that!]; I've lost a lot of weight; and I am much less likely to become a blind amputee on dialysis before I die. I've also reduced my risk of heart attack a lot. Next question: Is there a better way to get your BG levels under control? I think a more structured testing regime, right from the start, would have made it a lot easier to get where I am now, a lot sooner, and with less wastage. So, if I were starting today to bring my blood sugars under control, here's how I would go about it. First off, I would get a blood glucose test meter [a machine that measures the glucose in a tiny drop of your blood – there's a website listed under Resources which discusses different types of meters]. After all, you can't begin to change your diet to adjust your BG levels until you know what those levels are right now. Meters are available in any chemist's shop, and your GP or diabetes clinic nurse can show you how to use it. [Pay particular attention to the use of the finger-sticker – the manual that came with my meter didn't explain that nearly well enough. Or read Alan's instructions, which appear later.] I would also decide how I was going to keep track of all this information - it's far too much, especially in the beginning, to remember it all. A notebook of some sort would do. If you have a computer, you can download the Health Diabetes software [see Resources], which makes it easier to keep track of it all and produces graphs of everything and is free. If you're a computer nerd, you could use a spreadsheet programme, and if you're seriously geeky, you could build your own programme. You need to decide whether you'll go high- or low-tech, whatever you feel most comfortable with. [If there's a computer in the household, but the only people who can use it are your teenagers, get them to download the Health software and show you how to use it – it will get them involved in your care, and they'll maybe gain some understanding of what you're trying to do.] A note about testing: Wash your hands with warm water before testing, not only from the cleanliness angle, but because you're more likely to get a good-sized drop of blood for the test. Blood flows better when it's warm. You'll also avoid the risk of contaminating the sample drop with anything that might affect the test result. I once took a load of bottles and jars for recycling. One of the jars had contained mango chutney. I didn't wash my hands before my next test, and was shocked to get a reading of 13.7! So I washed my hands thoroughly, tested again a few minutes later, and it came up 7.6. It only took a tiny bit of chutney from the jar, so small I wasn't aware of it, to give a false reading.