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ffirs.qxd 7/11/06 2:14 PM Page iii

American Medical Association

Guide to
Living with Diabetes
Preventing and Treating Type 2 Diabetes—
Essential Information You and Your
Family Need to Know

American Medical Association

Boyd E. Metzger, M.D.

John Wiley & Sons, Inc.

ffirs.qxd 7/11/06 2:14 PM Page ii
ffirs.qxd 7/11/06 2:14 PM Page i

American Medical Association

Guide to
Living with Diabetes
ffirs.qxd 7/11/06 2:14 PM Page ii
ffirs.qxd 7/11/06 2:14 PM Page iii

American Medical Association

Guide to
Living with Diabetes
Preventing and Treating Type 2 Diabetes—
Essential Information You and Your
Family Need to Know

American Medical Association

Boyd E. Metzger, M.D.

John Wiley & Sons, Inc.

ffirs.qxd 7/11/06 2:14 PM Page iv

This book is printed on acid-free paper.

Copyright © 2006 by the American Medical Association. All rights reserved

Published by John Wiley & Sons, Inc., Hoboken, New Jersey

Published simultaneously in Canada

Design and composition by Navta Associates, Inc.

Credits: Bar graph on insulin sensitivity adapted from the work of Richard N. Bergman,
Ph.D: 11; National Eye Institute, National Institutes of Health: 184; © PhotoDisc: 72, 177; Think-
stock/PunchStock: 116 (right); USDA photos by Ken Hammond: 116 (left), 198, 225, and 244.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise,
except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without
either the prior written permission of the Publisher, or authorization through payment of the
appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA
01923, (978) 750-8400, fax (978) 646-8600, or on the web at www.copyright.com. Requests to the
Publisher for permission should be addressed to the Permissions Department, John Wiley &
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at http://www.wiley.com/go/permissions.

The recommendations and information in this book are appropriate in most cases and current as
of the date of publication. For more specific information about a medical condition, the AMA
suggests that you consult a physician.

Limit of Liability/Disclaimer of Warranty: The information contained in this book is not

intended to serve as a replacement for professional medical advice. Any use of the information in
this book is at the reader’s discretion. The author and the publisher specifically disclaim any and
all liability arising directly or indirectly from the use or application of any information contained
in this book. A health care professional should be consulted regarding your specific situation.

For general information about our other products and services, please contact our Customer
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Library of Congress Cataloging-in-Publication Data:

The American Medical Association guide to living with diabetes : essential information you and
your family need to know about preventing and treating type 2 diabetes / American Medical
Association.
p. cm
Includes index.
ISBN-13 978-0-471-75023-9 (cloth)
ISBN-10 0-471-75023-9 (cloth)
1. Non insulin-dependent diabetes—Popular works. I. American Medical Association.
RC662.18.A44 2006
616.4'62—dc22
2006005496

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1
ffirs.qxd 7/11/06 2:14 PM Page v

Michael D. Maves, MD, MBA Executive Vice President,

Chief Executive Officer
Bernard L. Hengesbaugh Chief Operating Officer
Robert A. Musacchio, PhD Senior Vice President, Publishing
and Business Services
Anthony J. Frankos Vice President, Business Products
Mary Lou White Executive Director, Editorial and
Operations

Boyd E. Metzger, MD Medical Editor

Donna Kotulak Managing Editor/Writer
Pam Brick Writer
Mary Ann Albanese Art Editor
ffirs.qxd 7/11/06 2:14 PM Page vi
ftoc.qxd 7/10/06 9:53 AM Page vii

Contents

Introduction 1

PART ONE
Type 2 Diabetes: A Modern Epidemic
1 What Is Diabetes? 5
2 Are You at Risk? 19

PART TWO
Preventing Type 2 Diabetes
3 Maintaining a Healthy Weight 33
4 Nutrition Basics for Staying Healthy 45
5 Exercise Your Way to Better Health 69

PART THREE
Diagnosing and Treating Type 2 Diabetes
6 How Do You Know If You Have Diabetes? 87
7 Reaching a Healthy Weight 97
8 Eating a Healthy Diet 107
9 Your Exercise Regimen 123
10 Medication and Blood Sugar Testing 131
11 Experimental Treatments and Special Situations 143

vii
ftoc.qxd 7/10/06 9:53 AM Page viii

PART FOUR
Complications of Diabetes
12 Acute Complications 159
13 Chronic Complications 165

PART FIVE
Diabetes in Children
14 Type 2 Diabetes in Children 195

PART SIX
Diabetes during Pregnancy
15 Gestational Diabetes 243

Glossary 253
Index 267

viii CONTENTS
cintro.qxd 7/10/06 10:07 AM Page 1

Introduction

M ore than 19 million Americans have diabetes—a condition that

can produce life-threatening complications. Of the two major
forms of diabetes—type 1 and type 2—type 2 comprises 90 to 95 per-
cent of all cases in the United States. An additional 13 million people
have the precursor to type 2 diabetes, called prediabetes. Worldwide,
type 2 diabetes affects more than 190 million people, and some experts
predict that if the current trends continue that figure could surge to
over 300 million by the year 2025.
Diabetes is one of the leading causes of death and disability in the
United States, and annual diabetes-related medical costs total more
than $100 billion. The predicted future increase in the number of cases
is fueled by several factors. Americans are becoming increasingly seden-
tary and overweight; being overweight is the major risk factor for type
2 diabetes. Age is another factor—most cases of type 2 diabetes develop
after age 45. In addition, Hispanic Americans and other minority
groups who have a high incidence of type 2 diabetes make up the
fastest-growing segment of the US population.
The good news is that type 2 diabetes can often be prevented, mainly
by eating a healthy and balanced diet, getting regular exercise, and
keeping your weight within a healthy range. If you are overweight, los-
ing just 5 to 7 percent of your weight (that’s 10 to 14 pounds if you
weigh 200 pounds) and keeping it off can cut your risk in half.

1
cintro.qxd 7/10/06 10:07 AM Page 2

If you already have diabetes, close monitoring of your blood sugar

levels along with healthy eating and regular exercise can help you man-
age your condition and avoid serious complications. Even small changes
in your lifestyle can produce big health benefits. This book is designed
to help you learn how to make those changes in your daily life that can
help you avoid type 2 diabetes or, if you have type 2 diabetes, maintain
good control of it and reduce your risk of complications.

2 AMERICAN MEDICAL ASSOCIATION GUIDE TO LIVING WITH DIABETES

c01.qxd 7/10/06 10:09 AM Page 3

PART ONE

Type 2 Diabetes:
A Modern Epidemic
c01.qxd 7/10/06 10:09 AM Page 4
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