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This is part two of a two-part discussion of diabetes.

Lack of insulin production by the pancreas makes type 1 diabetes particularly difficult to control. Treatment of type 1 diabetes requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home blood-glucose testing several times a day and multiple daily insulin injections.

Treatment of type 2 diabetes typically includes good diet control, exercise, home blood-glucose testing and, in some cases, oral medication and/or insulin. (About 40 percent of people with type 2 diabetes are better off with insulin injections.)

People with diabetes must manage the disorder daily. Much of the daily management involves trying to keep blood sugar levels from going too low or too high. When blood sugar levels drop too low -- a condition known as hypoglycemia -- a person can become nervous, shaky and confused. Judgment can be impaired. Eventually, the person could pass out. The treatment for low blood sugar is to eat or drink something with sugar in it.

On the other hand, a person can become very ill if blood sugar levels rise too high, a condition known as hyperglycemia. Hypoglycemia and hyperglycemia, which can occur in people with type 1 diabetes or type 2 diabetes, are both potentially life-threatening emergencies.

An important part of managing diabetes is learning what, how much and when to eat. People with diabetes should eat more starches (including breads, cereals and pasta), more vegetables and fruits, moderate amounts of protein foods (which include red meat, poultry, seafood and eggs), enough low- or no-fat dairy foods to meet calcium needs, less sugar and more low-fat foods.

If individuals with diabetes will be joining you at your holiday table this year, consider some of the following:

-- Offer whole grain breads or rolls.

-- Use low-fat or fat-free yogurt in recipes.

-- Replace sour cream with fat-free sour cream.

-- Offer mustard instead of mayonnaise for leftover turkey sandwiches.

-- Provide your guests with low-fat or fat-free substitutes such as low-fat mayonnaise or light margarine for breads and rolls.

-- Use vegetable oil spray instead of oil, shortening, butter or margarine.

-- Cook with fat-free or low-fat (1 percent) milk.

-- Offer no-sugar jelly, low-fat or fat-free cottage cheese.

-- Offer low-fat or fat-free salad dressing on raw vegetables or salads.

-- Provide guests with low-sugar, sugar-free and low-fat desserts.

-- Offer small pieces of fresh fruits or sugar-free desserts.

The National Diabetes Information Clearinghouse has a three-booklet series on diet and nutrition for people with diabetes. For a free set of booklets, contact the clearinghouse at 1 Information Way, Bethesda, Md. 20892-3560; fax: (301) 907-8906. The Diabetes Nutrition Publication Series can also be accessed on the World Wide Web at The National Diabetes Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases.

For more information on diabetes, contact the American Diabetes Association on the World Wide Web at or call (800) 232-3472.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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