Why Skipping Meals Is Harmful to Diabetes


Eating at regular intervals can help keep blood sugar in check. In fact, skipping meals can have harmful effects for people with type 2 diabetes.

Skipping meals isn't the best diet plan for anyone, but for people with diabetes, skipping a meal can lead to immediately dangerous blood sugar swings, as well as potential complications down the road.

An eating approach that involves consuming a consistent amount of carbohydrates which break down into glucose or blood sugar at regular intervals throughout the day can help prevent blood glucose spikes and improve the effectiveness of prescribed medication in people with diabetes, says Andrea Goergen, RD, a health coach at Cultivate Healthy, a nutrition consultancy practice in Washington, DC.

To better manage your blood sugar and help avoid complications, be sure to eat regularly. If you don't, one of the following six issues may arise.

You're More Likely to Binge on Junk Food



At some time or another, we've all been too busy, too stressed, or too tired, and ended up skipping a meal. But skipping meals may increase your chances of binging on food that aren't good for diabetes. If you skip meals, you'll be hungrier and more vulnerable to eating foods that are particularly calorie-dense, and you'll be in a hurry to get food, so anything that requires cooking or extra effort won't be very appealing, says Adina Pearson, RD, who specializes in diabetes at Walla Walla Clinic in Washington state.

Resist skipping meals even if you have to eat something small, like a non-meal meal pieced together when time is tight. My go-to choice for keeping blood sugar down is a Greek, whole-milk, plain yogurt in the large container, says Julie Stefanski, RDN, CDE, at Leg Up Farm, a nonprofit therapy center in Mount Wolf, Pennsylvania. Scoop a cup of yogurt on top of fruit, such as berries, and give it a squirt of vanilla-flavored liquid Stevia. Pair with another protein, such as a hard-boiled egg, lean turkey stick, or 20 almonds. To keep cravings down later, skip any yogurt mix-ins, especially if they contain candy pieces.

Fatigue Will Set In



We all know the feeling of being angry due to hunger sometimes called hangry that can lead us to feel irritated, make impulsive food choices, and even isolate ourselves from our loved ones. But being hungry can also make us feel tired, Goergen says.

When we don't nourish our bodies appropriately, our cells don't get the energy they need to function, thereby zapping our energy stores, she explains. Although anybody can experience a feeling of crashing after skipping meals, people with diabetes especially those on insulin or blood sugar lowering medication — can suffer dangerous dips in blood sugar during these crashes, Pearson says. Managing blood sugar is key for avoiding diabetes-related complications down the road.

To fight off fatigue, don't skip meals, and fuel up with a healthy snack when needed. Having a meal based on lean protein, such as grilled skinless chicken breast, salmon, or a lean cut of steak, paired with two different kinds of nonstarchy vegetables, like asparagus and zucchini, or sauted broccoli and cauliflower, is a good way to feel full without indulging in too many carbohydrates, says Stefanski. Carbohydrate-heavy foods with refined grains and sugars raise blood sugar quicker and higher than protein or oils, she says.

Your Mind May Get Foggy



Regardless of whether you have diabetes, the brain uses glucose as fuel, so skipping meals means depriving the organ of the food it needs to concentrate and perform mental tasks, explains Goergen. In a study published in January 2017 in the journal BMC Public Health, researchers found that white-collar workers without diabetes who ate a quality breakfast significantly improved their short-term cognitive functioning compared with those who didn't eat breakfast or ate a poor-quality one. Nobody wants to feel foggy, but people with diabetes also need a clear head to best manage their disease effectively.

Breakfast is especially important because at this time of the day the body is breaking the fast from the night before, so eating not only fuels thinking and mental acuity in the morning, but also helps with blood sugar management. Stefanski recommends an omelet with spinach, salsa, or peppers as a diabetes-friendly breakfast. A few small nitrate-free turkey sausages with a half-cup of whole fruit works well, too. But skip the juices, recommends Dr. Youdim, explaining that fruit juice is packed with sugar but devoid of the fiber that can help regulate blood sugar.

You Could Gain Weight



An animal study published in July 2015 in the Journal of Nutritional Biochemistry found the practice of skipping meals to save calories sets the body up for fluctuations in insulin and glucose that ultimately puts weight on rather than takes it off. Maintaining a healthy weight is essential for managing diabetes, says Adrienne Youdim, MD, associate clinical professor of medicine at the David Geffen School of Medicine at UCLA in Los Angeles.

The National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) similarly warns that being overweight or obese has significant detrimental effects on managing blood sugar levels, and may lead to complications, like high blood pressure, heart disease, and stroke. If you skip meals often enough, your body may become less adept at regulating your feelings of hunger and fullness, Pearson warns.

Also, just because you don't feel hungry doesn't mean your body doesn't need food at regular intervals. The appetite that is on pause often comes back with a vengeance later in the day, leading to overeating and subsequent high blood sugar.

Pearson explains that it's not enough to practice portion control after skipping a meal, as your body literally fights for what it has missed. In fact, a study published in October 2009 in the European Journal of Neuroscience showed that your brain is primed to seek out high-calorie foods when it's been starved.

You May Bonk Midway Through Your Workout



Bonking, or experiencing reduced energy due to low blood sugar, is another potential effect of skipping meals that can be particularly dangerous for people with diabetes. Signs of bonking include dizziness, nausea, and shakiness, says Goergen.

Glucose feeds your cells while you're exercising, but without fuel from food, the body begins burning fats to create glucose, causing acids called ketones to accumulate in the body. Your muscles may experience fatigue during physical activity simply because your body has run out of energy from its usual energy source, says Goergen, explaining that this process is called ketosis.

More important, if you take diabetes medication that is meant to help lower your blood glucose levels, but you don't fuel your body with carbohydrates to provide that glucose, you may become hypoglycemic. Hypoglycemia, or low blood sugar, can lead to dizziness, shaking, blurred vision, headache, confusion, and nausea during your workout. If left untreated, hypoglycemia can be life-threatening, Goergen says.

Prevent low blood sugar by eating a little something before your workout, such as a small banana or pressed fruit bar, recommends Stefanski. Sometimes planning a workout about 60 minutes after a meal can be a good way to keep blood sugar stable, have good energy, and not have to add extra food into the day just for the workout, she says.

It May Cause a Medication Imbalance



When it comes to skipping meals, people with diabetes face many of the same challenges as everyone else, except when it comes to medication, says Pearson. A skipped meal alters the balance between food intake and insulin production, and can cause your blood sugar levels to eventually drop. For diabetic people dependent on insulin or blood sugar lowering medication, skipping meals can be more dangerous because it can lead to low blood sugar, says Pearson .

What's more, an article published in July 2013 in The Pharmaceutical Journal found that people may be at risk of hypoglycemia when they take certain diabetes medications without food. The paper notes there's also a risk of gastrointestinal side effects, like nausea and diarrhea, when medication isn't taken with meals.

Diabetes dosing is typically twice a day, and not eating a meal when taking medication can cause an imbalance of its effects. To ensure your medication works as intended, follow the directions on the label closely, and do not neglect to accompany it with food when instructed. Keeping snacks in the car, at your desk, and in your purse is also important in case you find yourself away from food when it's time to take your medication.

Picking the right foods to eat when you have diabetes can help lower your blood sugar or keep it stable. Find out what to put on the menu when planning your diabetes diet. While nothing is off-limits in a diabetes diet, some food choices are better than others if you're trying to lower your blood sugar.

Following a type 2 diabetes diet doesn't mean you have to give up all the things you love you can still enjoy a wide range of foods and, in some cases, even help reverse type 2 diabetes. Indeed, creating a diet for type 2 diabetes is a balancing act: It includes a variety of healthy carbohydrates, fats, and proteins. The trick is ultimately choosing the right combination of foods that will help keep your blood sugar level in your target range and avoid big swings that can cause type 2 diabetes symptoms from the frequent urination and thirst of high blood sugar to the fatigue, dizziness, headaches, and mood changes of low blood sugar (hypoglycemia).

The Basics of the Type 2 Diabetes Diet: What Should You Eat?

To follow a healthy diet for diabetes, you must first understand how different foods affect your blood sugar. Carbohydrates, which are found to the largest degree in grains, bread, pasta, milk, sweets, fruit, and starchy vegetables, are broken down into glucose in the blood faster than other types of food, which raises blood sugar, potentially leading to hyperglycemia. Protein and fats do not directly impact blood sugar, but both should be consumed in moderation to keep calories down and weight in a healthy range.

To hit your blood sugar level target, eat a variety of foods but monitor portions for foods with a high carbohydrate content, says Alison Massey, RD, CDE, the director of diabetes education at Mercy Medical Center in Baltimore. [Foods high in carbohydrates] have the most impact on blood sugar level. This is why some people with diabetes count their carbohydrates at meals and snacks, she says.

How Many Carbs Can You Eat If You Have Diabetes?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), you can calculate the amount of carbs you need by first figuring out what percentage of your diet should be made up of carbohydrates. (The NIDDK notes that experts generally recommend this number be somewhere between 45 and 65 percent of your total calories, but people with diabetes are almost always recommended to stay lower than this range.) Multiply that percentage by your calorie target. For example, if you're aiming to get 50 percent of your calories from carbs and you eat 2,000 calories a day, you're aiming for about 1,000 calories of carbs. Because the NIDDK says 1 gram (g) of carbohydrates provides 4 calories, you can divide the calories of carbs number by 4 to get your daily target for grams of carbs, which comes out to 250 g in this example. For a more personalized daily carbohydrate goal, it's best to work with a certified diabetes educator or a registered dietitian to determine a goal that is best for you.

The Best and Worst Type 2 Diabetes Choices by Food Group As you pick the best foods for type 2 diabetes, here's a helpful guideline to keep in mind: Fill half your plate with nonstarchy vegetables. Round out the meal with other healthy choices — whole grains, nuts and seeds, lean protein, fat-free or low-fat dairy, and small portions of fresh fruits and healthy fats.

Sugar and processed carbohydrates should be limited, says Massey. That includes soda, candy, and other packaged or processed snacks, such as corn chips, potato chips, and the like. And while artificial sweeteners like those found in diet sodas won't necessarily spike your blood sugar in the same way as sugar, they could still have an effect on your blood sugar and even alter your body's insulin response, though more research is needed to confirm this.

For now, here's what you need to know about choosing the most diabetes-friendly foods from each food group.

What Foods High in Protein Are Good for Type 2 Diabetes?

The American Diabetes Association (ADA) recommends lean proteins low in saturated fat for people with diabetes. If you're following a vegan or vegetarian diet, getting enough and the right balance of protein may be more challenging, but you can rely on foods like beans, nuts, and tofu to get your fix. Just be sure to keep portion size in mind when snacking on nuts, as they are also high in fat and calories.

Meanwhile, processed or packaged foods should be avoided or limited in your diabetes diet because, in addition to added sugars and processed carbohydrates, these foods are often high in sodium and therefore may increase your blood pressure and, in turn, the risk of heart disease or stroke two common complications of diabetes. It's important to keep your blood pressure in check when managing diabetes.

In addition to getting enough fiber, incorporating protein-rich foods in your diet can help keep you satiated and promote weight loss, thereby reducing insulin resistance, the hallmark of diabetes.

Best options:

• Fatty fish, like sockeye salmon
• Canned tuna in water
• Skinless turkey
• Skinless chicken
• Beans and legumes
• Plain, nonfat Greek yogurt
• Raw, unsalted nuts, like almonds and walnuts (in moderation)
• Eggs
• Tofu

Worst options:

• Deli meats, like bologna, salami, ham, roast beef, and turkey
• Hot dogs
• Sausages and pepperoni
• Beef jerky
• Bacon
• Sweetened or flavored nuts, like honey-roasted or spicy
• Sweetened protein shakes or smoothies

What Are the Best Grains for Type 2 Diabetes?

Contrary to popular belief, not all carbs are off-limits if you're managing diabetes. In fact, the ADA recommends vitamin-rich whole grains in a healthy diabetes diet. These foods contain fiber, which is beneficial for digestive health. Fiber can also promote feelings of fullness, preventing you from reaching for unhealthy snacks, and it can help slow the rise of blood sugar. Plus, whole grains contain healthy vitamins, minerals, and phytochemicals that are healthy for anyone, regardless of whether they have diabetes or not.

On the other hand, grains in the form of popular foods such as white bread, as well as sugary, processed, or packaged grains, should be avoided or limited to avoid unwanted blood sugar spikes. Also, refined white flour doesn't contain the same vitamins, minerals, fiber, and health benefits as whole grains.

Just keep in mind that any type of grain contains carbs, so counting carbs and practicing portion control are keys to keep your blood sugar level steady.

Best options (in moderation):

Wild or brown rice
Quinoa
Whole-grain breads, such as 100 percent whole-wheat bread
Whole-grain cereal, such as steel-cut oats
Whole-wheat pasta
Worst options:

White bread
Pastries
Sugary breakfast cereals
White rice
White pasta

Which Types of Dairy Can People With Diabetes Eat?

When picked well and eaten in moderation, dairy can be a great choice for people with diabetes. Just keep fat content in mind, as being overweight or obese can reduce insulin sensitivity, causing prediabetes to progress to full-blown diabetes or increasing the risk of complications if you have type 2 diabetes. Whenever possible, opt for fat-free dairy options to keep calories down and unhealthy saturated fats at bay.

Best options:

Skim milk
Nonfat plain Greek yogurt
Nonfat, low-sodium cottage cheese
Reduced-fat cheese (in moderation)
Nonfat, unsweetened kefir

Worst options:

Full-fat or reduced-fat (2 percent) milk, especially chocolate or other flavored milks
Full-fat or reduced-fat cottage cheese
Full-fat yogurt
Full-fat cheese
Full-fat, sweetened kefir

What Vegetables Are Good for People With Diabetes and Which Aren't? Vegetables are an important food group to include in any healthy diet, and a diabetes diet is no exception. Veggies are full of fiber and nutrients, and nonstarchy varieties are low in carbohydrates — a win for people with diabetes who want to gain control over their blood sugar level, Massey says.

As for packaging, frozen veggies without sauce are just as nutritious as fresh, and even low-sodium canned veggies can be a good choice if you're in a pinch. Just be sure to watch your sodium intake to avoid high blood pressure, and consider draining and rinsing salted canned veggies before eating, per the ADA. If possible, opt for low-sodium or sodium-free canned veggies if going that route.

Follow this general rule: Aim to fill half your plate with nonstarchy veggies. And if you’re craving mashed white potatoes, try mashed cauliflower, Massey suggests. You could also opt for sweet potatoes, which people with diabetes may enjoy safely in moderation.

Best nonstarchy veggie options:

Greens, like spinach, kale, and Swiss chard
Cruciferous veggies, like broccoli and cauliflower
Cucumbers
Asparagus
Jicama
Brussels sprouts
Onions
Artichoke hearts
Peppers

Veggies to enjoy in moderation (starchy veggies to count toward your carb total):

Corn
White potatoes
Sweet potatoes
Yams
Peas
Beets

What Fruits Are Good for Diabetes and Which Should You Avoid?

Fruit often gets a bad rap due to its carb content, but this food group can actually be great in a diabetes diet when chosen wisely and eaten in moderation. In particular, fruit can be a great replacement for unhealthy processed sweets, such as pastries, cakes, and cookies, while providing disease-fighting antioxidants, vitamins, minerals, and satiating fiber to boot.

But just as with grains, it's important to roll out your carb-counting skills when noshing on nature's candy. The ADA notes that a small piece of whole fruit or ½ cup of canned fruit in natural juices or frozen fruit typically contains 15 g of carbs, while fruit juice a less ideal source of fruit for diabetes can have that much in 1/3 to ½ cup.

Also, dried fruit isn't the best way to get your fix. Because so much water is removed, a serving of this variety is much smaller and usually less filling than whole fruit — the ADA warns that just 2 tablespoons of raisins contains the same 15 g that a whole apple contains!

Same goes for canned fruit: This variety often contains sugary syrup at a high concentration, which should be avoided at all costs. Trendy juices are similarly less than ideal, as they're stripped of the beneficial fiber that you'd find in whole fruit with the skin on.

But some pleasant news: When consumed in moderation and made with whole ingredients and without added sugar, fruit smoothies can be a good food for diabetes. Consider stocking your fridge with unsweetened frozen fruit so you can whip up one in a hurry for breakfast. Adding ingredients with protein, such as yogurt or a small amount of nut butter, will also help your body break down the carbohydrates more slowly, leading to less of a spike in blood sugar.

When in doubt, consult the glycemic load (a scale that can help you measure how much a serving of a certain food is likely to spike your blood sugar) to pick a diabetes-friendly fruit. Your healthcare team can also help you safely incorporate fruit in your diabetes diet.

Best options:

Berries, like blueberries, strawberries, and raspberries
Apples with the skin on
Peaches with the skin on
Cherries
Apricots with the skin on
Pears with the skin on
Oranges
Kiwi
Bananas
Grapes
Melon

Worst options:

Dried fruit
Packaged juices
Fresh juices that are part of fad cleanses
Canned fruit in syrup

What Sources of Fat Are Good and Bad for Diabetes?

Fat is not the enemy! In truth, getting enough of the right kind of fat can help you curb unhealthy cravings, lose weight, and ultimately attain better control over your blood sugar. The key is knowing how to tell good fat from bad fat.

The monounsaturated fats found in avocados, almonds, and pecans or the polyunsaturated fats found in walnuts and sunflower oil, which can help lower LDL ("bad") cholesterol, are great picks when eating for type 2 diabetes.

Meanwhile, saturated fats and trans fats can harm your heart and overall health, according to the American Heart Association. To spot trans fats, look for the term hydrogenated on labels of processed foods, such as packaged snacks, baked goods, and crackers. I always tell my clients to double-check the ingredient list to make sure they don't see any partially hydrogenated oil in their food products, Massey says.

Best options:

Avocados
Nuts, like almonds, pecans, walnuts, and pistachios
Nut butters
Olives
Edamame
Plant-based oils, like soybean oil, corn oil, olive oil, and sunflower oil
Seeds, like flaxseed and chia seed
Fish, like salmon and tuna
Tofu

Worst options:

Fast food
Beef, veal, lamb, and pork
Full-fat dairy products
Coconut and palm oil
Packaged snacks, like crackers, corn chips, and potato chips
Processed sweets, like doughnuts, cakes, cookies, and muffins

Frequent urination, fatigue, and blurry vision are just some of the symptoms of uncontrolled type 2 diabetes.

Blood sugar (glucose) control is crucial when you're living with type 2 diabetes. Dips and spikes can not only make you feel cranky and sluggish, but they can also wreak havoc on your personal health. (No wonder your primary care doctor was on you about your last A1C checkup.)

The most serious effects of blood sugar swings are a higher risk for diabetes-related health complications such as stroke, heart disease, and nerve damage (neuropathy).

For the record, the American Diabetes Association (ADA) notes that you have diabetes if one of the following applies to you:

• Your blood glucose after fasting (and before a meal) is 126 milligrams per deciliter (mg/dl) or higher.
• Your blood glucose two hours after eating a meal is 200 mg/dl or higher.
• Your hemoglobin A1C (a two- to three-month average measure of how much glucose attaches to the hemoglobin in your red blood cells) is 6.5 or higher.

The tricky part is that with type 2 diabetes you may not feel it when blood sugar levels are too high, according to the ADA. It feels different for everyone. Not everyone will have the same symptoms, and some individuals will have no symptoms at all, says Lori Zanini, RD, CDE, a Los Angeles based former spokesperson for the Academy of Nutrition and Dietetics.

Because blood sugar management is so important to your overall health with type 2 diabetes, you need to take action if you think your levels may be out of control, even if you're feeling totally fine.



Symptoms of uncontrolled diabetes may not appear until prolonged hyperglycemia (high blood sugar) has been present, says Mary Ann Emanuele, MD, an endocrinologist, professor, and medical director of inpatient diabetes at Loyola University Medical Center in Maywood, Illinois. She adds that if your healthcare team determines your glucose isn't well controlled, adjusting your medication with their help can make a difference.

Controlled Means Different Things to Different People

There's no one-size-fits-all recommendation for blood sugar control.

The ADA says that a reasonable goal for many nonpregnant adults is to aim for an A1C level of less than 7. Yet some patients may be given a more stringent goal by their healthcare providers, such as 6.5, if that's reachable without harmful side effects, including hypoglycemia.

On the other hand, if you are elderly, managing other health complications, or reliant on insulin, you may be given less stringent goals. It really becomes more important to just keep [levels] in the same place, says Rahil Bandukwala, DO, an endocrinologist at MemorialCare Saddleback Medical Center in Laguna Hills, California. Keeping A1C between 7.5 and 8.5 may be very reasonable for such a patient, Dr. Bandukwala adds, echoing the ADA's recommendations.

Because elderly people are more likely to have blood sugar that swings too far downward, with fewer warning signs, managing their glucose too tightly can put them at greater risk for hypoglycemia, says Bandukwala. When you have low blood sugar, you're at a higher risk for becoming dizzy and falling or passing out, notes the ADA.

First, Know That Being Asymptomatic Doesn't Mean Diabetes Is Controlled



How (and When) to Check Your Blood Sugar Levels

As Dr. Emanuele says, glucose monitoring can be an important tool to help you get your blood sugar under control. Typically, you would do it yourself using a glucose meter or glucometer, which analyzes a drop of blood that you draw by sticking your finger with a lancet and placing the blood on a disposable test strip that you insert into the meter. Your blood sugar goals are set by you and your doctor, but blood glucose for an adult without diabetes is below 100 mg/dl before meals and at fasting; and less than 140 mg/dl two hours after a meal, notes the ADA.

Some people will check their blood sugar daily or multiple times a day, sometimes using a continuous monitor that is worn on the body particularly those who have type 1 diabetes or who have type 2 but take insulin. Yet how frequently a person should monitor their blood sugar is based on a number of factors, including but not limited to whether they're on insulin, whether they're taking oral medication, and how well their blood sugar is controlled and how old they are.

It's an individual discussion with each patient, but in general I tell my patients with type 2 diabetes whose blood sugar is controlled that they don't need to check it every day, says Bandukwala. If they have a glucometer and they want to check it then I will tell them they can do a paired reading once a week, which means a fasting (before eating) reading and then another reading one to two hours after a meal (postprandial). Checking too often can lead to unwarranted panic over daily fluctuations, as well as unnecessary pain from too-frequent lancet pricks, he adds. The American Academy of Family Physicians is among the organizations advising that daily glucose self-testing has no benefit in patients with type 2 diabetes who are not on insulin or medications associated with hypoglycemia.

Meanwhile, keep an eye out for these nine key warning signs and symptoms that blood sugar is too high — and talk to your doctor about whether you need to adjust your management plan.

Being Extra Thirsty and Having to Urinate More Than Usual



This is a common but not-so-obvious sign of blood sugar that is too high: feeling really thirsty and needing to drink more than usual. Excessive urination, known as polyuria, occurs when glucose builds up in your blood, and your kidneys begin working harder to get rid of the extra glucose, says Zanini. If your kidneys can't keep up and adjust blood sugar so that it returns to a normal level, the excess sugar is flushed out of your body through urine, she adds. You may become dehydrated and get dizzy.

You’re Hungrier Than Usual but Losing Weight



Many people with uncontrolled high blood sugar find that they're hungrier than usual, which signals a symptom called polyphagia, MedlinePlus notes. And although you're eating more, you may be losing weight for no apparent reason if your blood sugar levels are too high, according to the Mayo Clinic.

Since your body is not getting energy from the preferred source, glucose, it has to turn to muscle and fat, Zanini explains.   When your body starts breaking down muscle and fat for energy, you experience unintentional and unhealthy weight loss. In addition to these changes in weight and appetite, you may notice weakness in your muscles and experience more frequent falls, Emanuele adds.

You Feel Tiredness and Fatigue Constantly



Fatigue and extreme tiredness are symptoms of uncontrolled blood sugar, the ADA says. Simply put, when your body is not processing insulin properly or it doesn't have sufficient amounts of insulin, the sugar is staying in our blood rather than getting into our cells to be used for energy, Zanini says. Also, frequent urination can lead to dehydration, which Bandukwala identifies as another contributing factor to fatigue.

You Have Noticeably Blurry Vision and Frequent Headaches



You may notice that your vision isn't as clear as it used to be and that things may appear a bit blurry. High blood sugar levels can lead to swollen lenses in your eye from fluid leaking in, according to the Joslin Diabetes Center in Boston. This changes the shape of the lens, which makes it unable to properly focus, causing blurred vision. You may also find yourself struggling at work, having difficulty driving, and suffering from frequent headaches, Emanuele notes.

You Develop Sores That Tend to Heal More Slowly Than Usual



Cuts, scrapes, bruises, and other wounds heal more slowly in the presence of uncontrolled blood sugar, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes causes nerve damage and affects circulation, especially in the lower legs and feet, which can delay healing because there isn't enough blood flow to the area. Even minor wounds are more prone to infections, which can become very serious and even result in amputations of the foot. You may notice drainage seeping onto your socks or an unpleasant smell if you develop a foot ulcer, notes the American Podiatric Medical Association.

You Notice Tingling and Numbness in Your Hands or Feet



As mentioned, uncontrolled blood sugar can cause nerve damage, also known as diabetic neuropathy. What you may notice is a tingling sensation or even numbness in your hands and feet. Some people experience pain in their hands and feet as well. Though neuropathy is most common in people who have had diabetes for a long time, it can occur in anyone with poorly controlled diabetes.

You're Developing Blisters, Dryness, or Other Skin Changes



Small pieces of extra skin, called skin tags, may form in the creases of skin, especially if you have diabetes and you're trying to find ways to manage your weight, notes the ADA. Dark, thick areas of soft skin (called acanthosis nigricans) may form on the back of the neck or hands, armpits, face, or other areas. These can be a sign of insulin resistance, Zanini says. Blisters, infections, dryness, itchiness, discolorations, and abnormalities of the skin can all be warning signs of high blood sugar. Check with your doctor if these skin changes develop.

You're Getting Yeast Infections More Often Than Usual



Hyperglycemia may lead you to get more frequent genital yeast infections. The culprit is often a type of yeast (a fungus) known as Candida albicans, per the ADA. According to the Centers for Disease Control and Prevention, in females the symptoms can include: vaginal itching, redness or soreness; pain during sexual intercourse; pain or discomfort during urination; and thick, abnormal vaginal discharge. While yeast infections are common in people who don't have diabetes, having more glucose in your blood puts you at higher risk of getting them. The yeast feeds off the glucose, and if your blood sugar is high there's more glucose in the urinary tract, explains Bandukwala. Uncircumcised men with hyperglycemia are also at risk, he says.

We're also seeing this happen a little more now with patients who take SGLT-2 inhibitors, which force the body to expel more glucose through the urine, the endocrinologist adds. The FDA has added a warning to the prescribing information for SGLT-2 inhibitors about a far more rare and potentially fatal genital condition, known as necrotizing fasciitis of the perineum, or Fournier's gangrene (commonly known as a flesh-eating disease).

Swollen or Bleeding Gums, Which Increase Your Infection Risk



Gum disease is a complication of diabetes, notes the National Institute of Diabetes and Digestive and Kidney Disease. It can also make diabetes harder to control, because the body's response to infection is to release more glucose into the bloodstream, according to the ADA.

Your saliva contains glucose; and the more it contains, the more there is to feed the bacteria that combine with food in your mouth to form plaque and cause gum disease. Symptoms can include red or inflamed gums at first. If they are unaddressed, they can progress to periodontitis, which can cause your gums to pull away from your teeth, the appearance of pus or ulcers, or even tooth loss, notes the Mayo Clinic. Get your blood sugar under control and see a dental professional to prevent damage to your gums and teeth.

In a clinical trial, the medication, whose generic name is dulaglutide, also reduced the risk for kidney problems by 15 percent. Trulicity is a once-weekly injection used to assist the pancreas in secreting insulin when blood sugar levels are elevated.

A drug typically prescribed to people with type 2 diabetes and heart disease may work as a prevention tool for heart problems and other diabetes complications, a large clinical trial suggests.

The study found that Trulicity (dulaglutide), which is approved for glucose management in people with type 2 diabetes, lowered the risk for stroke, heart attack, and kidney problems in adults with type 2 diabetes. Researchers published their findings in June 2019 in the journal The Lancet and presented them at the American Diabetes Association's (ADA's) 79th Scientific Sessions in San Francisco.

The study findings are good news for adults with type 2 diabetes, which number more than 30 million Americans in the United States, according to the Centers for Disease Control and Prevention (CDC). People with type 2 diabetes are 2 to 4 times more likely to die from heart disease compared with adults without diabetes, according to the American Heart Association. More than two-thirds of people ages 65 and older with diabetes die from heart disease and 16 percent die of stroke.



"Diabetes is an extremely common problem. One in 10 adults have the disease, mostly type 2 diabetes, and 1 in 5 people over 65 have diabetes," says lead study author Hertzel Gerstein, MD, a professor of medicine and endocrinologist of McMaster University and Hamilton Health Sciences in Hamilton, Ontario, Canada. "Diabetes is important because it about doubles the risk of cardiovascular problems in the future. Clearly, we need to identify therapies that address all of the problems related to diabetes."

Trulicity is an injection that's used once a week. It works by helping the pancreas release the proper amount of insulin when blood sugar levels are high. The drug may also help reduce appetite and aid weight loss, according to an article published in March 2015 in the journal American Health & Drug Benefits.



Understanding the Link Between Type 2 Diabetes and Heart Disease

Experts in the fields of diabetes and cardiovascular care have joined forces in recent years to acknowledge and study the intersection of the two diseases and find treatments that curtail the risk of both. Earlier this year, the ADA issued the 2019 Standards of Medical Care in Diabetes, which emphasizes improving cardiovascular health and included input from the American College of Cardiology.

We've been focused on reducing the risk of complications from diabetes for a long time. Now, we're getting better at doing it, says Jennifer B. Green, MD, a professor of medicine in the Duke University division of endocrinology in Durham, North Carolina. Dr. Green was not involved in the study. What's different and exciting in recent years is we're finding some of the newer medications that treat diabetes also demonstrate cardiovascular benefits, and sometimes kidney benefits, within a short period of use.



What Makes This Trial on Trulicity Different From Past Research

In Dr. Gerstein's study, researchers looked at the impact of Trulicity, a medication known as a glucagon-like peptide 1 analogue (GLP-1) agonist, in adults with diabetes who had not yet developed cardiovascular disease.

The trial, called REWIND (Researching CV Events With a Weekly Incretin in Diabetes), included 9,900 people in 24 countries. The study participants were randomized to take Trulicity or a placebo in addition to receiving standard care and were followed for more than five years to assess their overall health. While all participants had risk factors for cardiovascular disease — like extra weight, high blood pressure, and high cholesterol, per the Mayo Clinic only 31 percent of study participants had established disease.

The study showed that people taking Trulicity had a 12 percent reduction in heart attacks and strokes compared with those taking a placebo. The Trulicity group also had a 15 percent reduction in the development of kidney disease, another complication of diabetes.

It's really exciting to me because the trial enrolled people with type 2 diabetes who were at lower risk of cardiovascular events than we've seen to date in other trials, Green says.



This is the first trial that really recruited people with a broad range of underlying risks of CV (cardiovascular disease), Gerstein says. About 70 percent of people in the study had risk factors for heart attacks or strokes, but they had not yet had a heart attack or stroke. So the results are generalizable to large numbers of people  not just those who have already had heart attacks or strokes.

People taking Trulicity experienced modest weight loss and lower blood pressure. The most common side effects from the medication were constipation or diarrhea.

This was a long-term study half were followed for more than five and a half years," Gerstein says. "The effects of this drug on heart disease, blood sugar and blood pressure were apparent over the length of the study. This drug has a long-term effect on cardiovascular outcomes and other outcomes, including a modest weight loss and modest lowering of blood pressure and blood sugar. That is interesting and important."



Which People With Type 2 Diabetes Should Take Trulicity?

The findings raise the question of whether more people with type 2 diabetes should take drugs, like GLP-1 agonists, that have been proven to impact cardiovascular risk and kidney disease risk.

"Clearly these findings show this type of medication could benefit lots of people with diabetes," Gerstein says. "This is pretty high-level evidence. Should more patients take it? That's a conversation patients should have with their doctors. But this would be an important option."

Many previous studies looking at the impact of some of the new diabetes medication, such as GLP-1 agonists, were performed in patients at higher risk for heart attacks and strokes, Green noted. That doesn't mean they don't have use for a broader range of patients, such as those with early diabetes who do not have cardiovascular disease.

There seems to be a misunderstanding that these drugs should be reserved for people at very high risk, Green says. But they can be used at any time. I do hope that this study generates a lot of discussion of the value, or cost, of starting to use these newer classes of drug earlier on in the treatment algorithm.

Trulicity is the brand name of the injectable medicine dulaglutide, which is used along with diet and exercise to help control blood sugar levels in adults with type 2 diabetes.

Type 2 diabetes is a disease that happens because your body doesn't make or use the hormone insulin properly.

Trulicity is also prescribed to lower the risk of heart attack, stroke, or death in people with type 2 diabetes who have heart disease or multiple cardiovascular risk factors.

This drug is a glucagon-like peptide 1 receptor agonist (GLP-1 RA). It works by prompting the pancreas to release insulin when blood sugar levels are high and by slowing the movement of food through the stomach.

The U.S. Food and Drug Administration (FDA) first approved Trulicity in 2014. It's marketed by Eli Lilly and Company. It is the only GLP-1 agonist approved for primary prevention of cardiovascular events.

Clinical Trials



In clinical trials to test the effectiveness of this drug, people who took the 0.75 milligram (mg) dose of Trulicity lowered their A1C levels (a measure of blood sugar control) by 0.7 percent to 1.6 percent. Those who received the 1.5 mg dose saw an A1C reduction of 0.8 percent to 1.6 percent.

Additionally, in the phase 3 REWIND study, people with type 2 diabetes who took Trulicity experienced significantly fewer major heart problems.

Trulicity Warnings



Trulicity contains a black box warning because, in animal studies, it caused thyroid tumors, including thyroid cancer. It's not known if Trulicity will cause thyroid tumors or thyroid cancer in people.

Don't use this medicine if you or a family member has ever had medullary thyroid carcinoma (MTC; a type of thyroid cancer) or multiple endocrine neoplasia syndrome type 2 (MEN 2; an endocrine system condition).

Tell your doctor right away if you notice the following symptoms while taking Trulicity:

• Swelling or a lump in your neck
• Trouble swallowing
• Hoarseness
• Shortness of breath

Trulicity shouldn't be used to treat people with type 1 diabetes (a disease where your body doesn't produce any insulin) or diabetic ketoacidosis (a life-threatening condition that can occur if high blood sugar isn't treated). Before taking Trulicity, tell your doctor about all your medical conditions, especially if you have or have ever had:

• Pancreatitis (inflammation of the pancreas)
• Severe stomach problems, including gastroparesis (slowed movement of food from the stomach to the small intestine)
• Kidney disease
• Liver disease
• Diabetic retinopathy (a complication of diabetes that affects the eyes)

Tell your doctor you're taking this medicine before having any type of surgery.

Be sure to follow any diet and exercise plan your physician recommends while you're using Trulicity.
Keep all appointments with your healthcare provider. Your doctor will likely order specific tests to check your body's response to this medicine.

Trulicity may cause changes in your blood sugar. You should be on the lookout for symptoms of high or low blood sugar and know what to do if you experience them. Some common signs of low blood sugar include:

• Headache
• Hunger
• Weakness
• Sweating
• Confusion
• Dizziness
• Feeling jittery
• Fast heart rate
• Irritability

Check your blood sugar levels as often as your healthcare provider tells you to do so.

Illnesses, injuries, and stress can all affect your blood sugar. Talk to your doctor about what to do if you experience any of these events while taking Trulicity.

It's not known whether Trulicity is safe or effective for use in children. This medicine shouldn't be given to anyone under 18 years of age.


Common Side Effects of Trulicity

The most common side effects of Trulicity are:

• Diarrhea
• Nausea
• Heartburn
• Decreased appetite
• Tiredness

Tell your doctor if these symptoms become severe or don't go away.

Serious Side Effects of Trulicity

Seek medical help right away if you experience any of the symptoms listed in the warning section or if you have any of the following serious side effects:

• Vomiting or severe stomach problems
• Pain that starts in the upper left or middle of the stomach (and may spread to your back)
• Decreased urination
• Vision changes
• Signs of an allergic reaction, which may include itching; rash; hives; trouble breathing; or swelling of the lips and face

About Yoga

Yoga is an ancient Indian practice combining the body and mind. For many, yoga helps to improve the quality life. This starts by improving the physical and emotional well-being of oneself. 

Yoga can be practiced by anyone irrespective of age, sex, fitness level. All you need is yourself! No heavy equipment or extra money required.

Yoga and Diabetes



Yoga has been a growing trend in the Western world after hundreds of years of formation in the East. Now, more and more professionals are taking a unique look on how yoga helps patients suffering from many types of diseases. 

The study also found that people who have a regular yoga practice experienced short term improvements in fasting glucose and cholesterol levels.



Yoga can do another key thing for your body. Build immunity. A consistent yoga practice with correct techniques may bumps up the antioxidants throughout the body with a result of stronger immune functions. When this happened it can lead to a host of other great well-being like weight loss. 

If you are someone who wants to lose weight and maintain a normal weight, yoga can be quite effective. Power Yoga and Bikram, which both originated in America, are vigorous form of yoga that consumes calories resulting in weight loss.

Now you may be thinking, how can I start practicing yoga? Well, that's the easy part!

Here are 3 Yoga Poses specifically for Diabetes

1. Vrikshasana aka Tree Pose



Benefits: Stimulates the hormonal secretion on the pancreas.

Begin standing in with both feet flat, hip width a part, with your arms at your sides. 

Do not rest your foot against your knee, only above or below it.

2. Dhanurasana aka Bow pose



This is a back-bend pose that involves casting your body into a bowl-shape, opening up the chest and exciting the internal organs. It works out the hamstrings muscles, the quadriceps, pectoralis major and the gluteus maximus. How to do: Go down on your belly. 

Benefits: This pose brings about the much needed therapeutic effects that help to ease backache, insomnia and headaches. It also calms the mind and keeps your spine stretched.

4. Seated Forward Bend



It is also known as the Paschimottanasana pose.
It is a common but classic Yoga pose that gives a good stretch to your body right from behind your thighs up to your spine.

How to do:

• Sit on a doubled mat while stretching your legs straight in front of you
• Put a support pro under your knees to make you a bit more comfortable
• Let your soles point straight up in such a way that the toes are leaning towards the shins.
• Still seated, inhale and then straighten up your spine as you gently open up your heart centre.
• Let your breath out while hinging at your hips and lean forward.
• Bring your legs towards your feet as though your stomach and your thighs are coming to contact. Reach a comfortable pose and let your chest be folded into your legs.
• Rest your chin over your chest

Benefits:

• This pose will help you to helps you cut extra weight.
• During this pose, the erector muscles, gluteus maximus and the pelvic muscles all work out to help you feel relieved.
• It is a therapeutic pose that will help reduce the blood pressure and cast anxiety and general fatigue away.

5. Supported Shoulder Stand

It is also called the Salamba Sarvangasana. This is a powerful pose that works various muscles like the trapezius, rotator cuff and the rectus abdominis. It is an inverted-kind-of a pose where the body rests on a support, mostly a folded blanket. 

 How to do: Lay prostrate on a level g round and place a folded blanket under your shoulders so that the shoulders rest on it. 

Put your shoulders parallel to the blanket edges Align your arms along your body and let the back of your arms face down (palm should face up) Raise your legs up in the air. Keep them straight. Bring the legs towards the head gently still keeping them straight. 

Let your hands provide support by putting them on the lower back level with the fingers facing up. Lift up your legs now and make sure that you align the shoulders, hips and the spine all in a straight line position Maintain this pose for half a minute up to 3 minutes Gently release your spine down to the blanket followed by your legs and finally release your arms back to their first position (along your body)

Benefits:

This Yoga pose is well known to improve blood circulation, stimulate the thyroid gland. In addition, it also helps reduce stress levels and keeps your mind calm and serene.

6. Upward Facing Dog

The Urdha Mukha Svanasana pose is its original name. It's a pose where you give your upper body a powerful backbend. A lot of muscle strength is required for this, but it help you a great deal when it comes to the benefits. 

How to do: Lie down on a mat with your stomach facing down and your legs straight behind you. Put your palms down next to the chest area such that the forearms are perpendicular to the floor (as though you want to do a push-up). 

Push up your arms to lift your upper body and the legs at the same time. Press the top of your feet against the floor to lift your legs too. 

Slightly bend your elbows while letting your abdominal muscles work along with the arms and thighs. Keep your butt and shoulder blades tight while maintaining a straight-head gaze.

7. Ardha Matsyendrasana

It is commonly known as the Half Lord of the Fishes pose. It is a twisting pose that gives energy to the spine and increases your digestive power. 

 How to do: Sit on a mat and cross your legs, then dash your right leg outwards of the left hip. Breathe in and twist your body to the inside of the left thigh. 

Place your left hand on the floor right behind you. Let the upper part of your right arm be outside your left thigh and then lift your forearm into the air. 

During breathing in, maintain the stretch and the lifting. 

Exhale while twisting more into the right side. Turn your gaze over the other shoulder. Maintain this posture for one minute. Repeat this pose using the other side.

8. Supine Spinal Twist

This is a reclining twist that aims at energy restoration and stimulating the internal organs. It involves working out the rectus abdominis muscles, the trapezius, pectoralis major and the erectors spinae. 

 How to do: Lie on your back and raise the knees to the chest position Draw your arms to the sides and place your palms facing up. While still folding the knees now at the hip level, bring them to the left side. You may put some little pressure to your knees using the left hand. 

Maintain this pose for not less than 30 seconds Do this again now on the opposite side

9. Reclining Bound Angle Pose

t is also called the supta baddha konasana posture. This soothing pose is most suitable for groin and pelvic muscle resistance. 

Let's see how it works: How to do: Sit on a mat and fold your knees outward as you bring the soles of your feet to face and touch each other. Gently lean back to touch the floor using your back. Place your hands along the body and ensure the palms are looking up. 

Gently press in on your thighs to give your legs and hips a deep stretch Maintain this position to a maximum of 10 minutes. Drop of from this pose by lifting using your hands and pressing the knees together and back to a sitting position. 

 Benefits: It helps to stretch the groin and pelvic muscles to ease up any resistance. Its restorative nature helps to get rid of insomnia, depression, stress and their effects. 

Experts recommend this [practice to pregnant women to help boost energy to the pelvic area.

10. Corpse Pose

It is also called the Savasana pose and it is full of relaxation. Though it is challenging, it comes with loads of benefits. It is recommended to be done towards the end of your Yoga exercise. 

 How to do: Lay down on the floor using your back and spread your feet outwards further out of the hip level. Align your arms along your body and let both palms face up. 

Straighten your trunk so that the whole body takes a Y figure. Press your body gently to thefloor and while you do this, release any tension and be in a 100% relaxing mode. Maintain this position for 10 to 20 minutes. 

Benefits. It is known to help still the mind, get rid of the effects of insomnia, fatigue and mild headaches. It also reduces the blood glucose levels due to its restorative abilities.

11. Bridge Pose

This is a relaxing and energizing posture that is tailored to open up your upper arms, shoulders and your chest. It enhances spine flexibility and relaxes your mind too. 

 How to do: Lie on your back and place a folded blanket on the floor for support. Knees should be bent with soles touching the floor. 

Breathe out and push your sitting bones upwards keeping a firm butt while keeping your feet and arms on the floor. Raise the butt above the floor and keep the knees forward away from the hips. Keep the tailbone lengthened toward the back of the knees. 

Let your elbows be straight and your fingers interwoven under you. Bring your shoulder blades into your upper part of the back aligning it with your neck. Raise the chin farther from the sternum and tighten the shoulder-blades against the back. Maintain this pose for about half a minute to one minute. 

Drop off by gently bringing the spine down to the floor exhaling all the way. Benefits: It works out your hamstring and gluteus maximus muscles to strengthen them. This pose is a chest and shoulder-opener. It stretches the back, hip and thigh muscles. 

Experts also claim it calms the mind and keeps the spine flexible. From practicing these Yoga poses, you will realise that your Diabetes management experience will have improved with a great margin. 

Make Yoga Pose practice more of a regular thing for you and you will reap all the benefits discussed in this article. Whether you prefer to do it on your own or hiring a Yoga couch to help you through this, truth is these Yoga poses will improve your health a great deal. Let's Yoga Diabetes out of our system.

These yoga poses can help to control blood glucose levels. They also help with building immunity and weight loss if done regularly. Ready, Set,  Namaste!