Common Complications of Diabetes

Many people become aware that they have diabetes when related illnesses or complications develop. Diabetes is the leading cause of new cases of blindness in people ages 20 to 74. These complications account for 40% of the new cases of end-stage kidney disease requiring dialysis. Lower leg nerve damage, infection and amputation also affect up to 70% of people with diabetes. Heart disease and stroke risk are two to four times higher in the diabetic.

Drug Therapies and a Cure for Diabetes

Currently, the ADA is acquiring signatures on a petition in support of a cure for diabetes. When one million signatures are obtained the ADA plans to present the petition to lawmakers. The petition cites government spending of $40 billion a year to treat people with diabetes. At the 59th Annual ADA Meeting many presenters gave impassioned pleas for more funding of pharmaceutical research and development in search of a cure for diabetes. The hope of all seems to be for the "magic bullet" (a miracle drug) that will end the reign of terror of diabetes once and for all.

Each year, new medications are being added to the drug arsenal in an attempt to better manage diabetes and its complications. Insulin has been used as a therapy for diabetes since the 1930's. Early diabetes drugs worked by stimulating the pancreas to produce and release more insulin in an effort to help lower the blood sugar. Of the newer generation of antidiabetic medications, some work to decrease insulin resistance, while others delay or block the absorption of some of the glucose during the digestive process. An important part of diabetic management has been the ADA dietary guidelines; 60% carbohydrate, 20-30% fat and the remaining 10-20% protein.

Clinical Trials with the Zone Diet

In 1997 and 1998, Type 2 diabetics were enrolled in a clinical trial in San Antonio, Texas which used the Zone Diet as the nutritional foundation for each study participant. Each person in the study had previously undergone intensive individual nutrition counselling according to the above ADA guidelines. Participants attended four one-hour weekly group sessions to learn the Zone Science and lifestyle management principles. The program was offered in addition to each participant's regular medical visits. Zone Perfect food bars and omega-3 fish oil supplements were provided for the duration of the study. For the duration of the study, specific food (Zone Favourable), food bar and fish oil supplementation guidelines were followed. A summary of the results included significant improvements in blood sugar control, cholesterol panels (total cholesterol, HDL and triglyceride levels), and fasting insulin levels. In one group where 34 participants were using insulin at the start of the study, only one individual still required insulin at the conclusion of the 12-week study period.

Applying the Zone Nutrition Program

Implementing the Zone Diet often results in reduced insulin resistance, a reduced need for injected insulin for those who take insulin, and improved eicosanoid balance to prevent many of the long-term complications of diabetes. Zone Certified Instructors often provide introductory lectures and training on the Zone Diet and in-depth classes about the Zone Science and its application. Others learn how to eat in the Zone by reading Enter the Zone or Mastering the Zone by Dr. Barry Sears. As a Zone Certified Instructor, I teach detailed classes on how to master the Zone. The real value of the Zone Nutrition program is apparent with each diabetic who reduces or discontinues diabetes medication and other medical conditions improve in the process. Implementing the Zone Diet with an insulin dependent diabetic can best be illustrated by looking at a case history of this diabetic client.

Case History

50 year-old male with diagnoses of insulin dependent diabetes, obesity, and borderline dyslipidemia (abnormal triglycerides and/or cholesterol). 12-year history of diabetes mellitus with a 4-year history of insulin use. Daily insulin dosages: 30u NPH and 10u Regular twice a day. Other medical conditions: obesity x 4 years. Client received education in the Zone Nutrition Program 6 weeks prior to the May 1999 lab work. Beginning weight 255 lb.; after 12-weeks client's weight was 225 lb. Waist measurement decreased from 42" to 38". Total body weight reduction as of August 1999 was 11% of body mass. Total weight loss over 16 weeks was 30 pounds. August 1999 insulin usage was variable depending on activity level, 5-20u NPH twice a day was used with rare use of any "sliding scale" coverage of regular insulin. Client reports high energy level, less numbness or tingling in hands or feet (peripheral neuropathy) symptoms and improved vision. The actual lab values and various statistics on this client are listed below.

Lab Values November 1998 / May 1999 - % change after 6 months

• Cholesterol 214 / 170 - 21% decrease
• Triglyceride 119 / 91 - 24% decrease
• LDL cholesterol 150 / 117 - 22% decrease
• Cholesterol/HDL ratio 5.35 / 5.0 - 7% reduction
• Triglyceride/HDL ratio 2.97 / 2.68 - 10% reduction
• HA1C 9.1 / 7.4 - 18% reduction
• Weight 255 / 225 - 11% reduction
• Insulin Use:

  * Rare use of regular insulin, no insulin usage on days with increased physical activity.

  Date	AM	PM
  11/1998	10u R + 30u NPH	10u R + 30u NPH
  05/1999 *	5u R + 20u NPH	5u R + 20u NPH

Blood Sugar Levels More Controlled on the Zone Diet

When a meal with either many or large amounts of less favourable carbohydrates is eaten the blood sugar rises quickly and peaks at a high level, often between 300 and 500. The pancreas then releases large amounts of insulin to lower the blood sugar. If the diabetic takes insulin, a higher dose is necessary to restore the blood sugar to a normal range. Soon after the Zone Diet is started dramatic changes in the blood sugar are apparent. Following a hormonally balanced Zone Perfect meal with mostly favourable carbohydrates, the blood sugar level typically rises to only 50% of the previous level. Less insulin is needed to restore the blood sugar to the normal range. When working with diabetic clients, I have found that it is not uncommon for a diabetic on insulin to need only HALF the insulin dose after a Zone favourable meal. Logically, when the blood sugar rises only half as high, only half the amount of insulin is needed for blood sugar maintenance. In my practice, this has been one of the most exciting benefits of the Zone for my clients-insulin dosages are greatly decreased. Several clients have also been taken off insulin after their physician has evaluated their blood sugar trends over time and noted their improvement in overall health.

You, Your Physician and the Zone

Diabetics will need to work closely with a physician for periodic physical exams and evaluations for possible medication adjustments. Often, the physician will want to do baseline lab tests, such as a fasting blood sugar, HA1C level, and cholesterol panel. Your physician will then be able to monitor your diabetes as well as other medical conditions more effectively. Provide your physician with some information on the Zone Nutrition program. Diabetics who take insulin will get a "sliding scale" (adjustments in insulin dosing depending on the blood sugar test) from the physician and will closely monitor blood sugar levels throughout the day. Increased physical activity decreases insulin resistance and many diabetics are able to take lower doses of insulin by increasing their daily activity level. This is why regular exercise is invaluable to blood sugar control-even for those who do not have diabetes. Diabetics who take diuretics ("water pills") need to be followed closely by their physician so that dosage adjustments or discontinuance can be done as indicated by their medical condition.

Zone Benefits and Better Eicosanoid Balance

As you balance the hormonal response with each meal, you experience the many benefits of the Zone. You will think better as blood sugar levels are stabilized, not too high or too low. Your physical performance and energy level will improve as oxygen supply and transfer to the body cells is improved. You will have a better level of satisfaction after meals and between meals and be free from hunger and food cravings. You will also experience permanent body fat loss at a safe steady rate and look better. Better eicosanoid production and balance will result in many additional health benefits. You will have more energy, enhanced mental performance, lower blood pressure and cholesterol, a stronger immune system, and you will slow the natural aging process.

Based on the ADA statistics and the predictions of Dr. Sears, I feel that there will soon be only three types of people: those who have diabetes, those who are going to get diabetes, and those who are in the Zone! If you are in the first two categories, I encourage you to do your homework and learn about the Zone Nutrition Program. Next, contact your physician and share the information about the Zone. Stay focused on your goal as you continue to learn the principles of the Zone Diet. Use this website to help you keep motivated. Soon you will be enjoying the many benefits of the Zone as you move toward better health.

All the best in your Zone Perfect approach to diabetes management,

Jeanne Rhynsburger, RN

View the Sample Zone Gourmet Menu.