Patient Guide
Diabetes Patient Handbook
This is your True Health guide to understanding diabetes. After reviewing
your True Health lab results with your clinician, you can use this booklet to
understand your results and nd a plan of action for your best health.
Table of Contents
What is Diabetes? An Overview .......................................#
What Happens to My Body When I Have Diabetes?..............#
Take action Against Diabetes...........................................#
Questions to Ask My Clinician..........................................#
Track My Biomarkers......................................................#
Diabetes-Friendly Recipe................................................#
Glossary: Diabetes and Prediabetes Biomarkers..................#
Health Management Program at True Health.......................#
Diabetes is an acute or chronic disease characterized by increased blood levels of glucose, a type of sugar
or carbohydrate, that occurs when the beta cells in the pancreas, slow or cease the production of the main
glucose (sugar) regulating hormone called insulin. Think of insulin as a key that unlocks the entry doors of
your cells, allowing glucose to eciently enter.
There are two types of diabetes: type 1 and type 2. Type 1 diabetes,
previously called juvenile diabetes, occurs when your beta cells
quickly stop producing insulin caused by many factors including
genetic, toxic, infectious, traumatic, or autoimmune. In type 1 diabetes,
your beta cells do not make those keys.
1. Awareness of Prediabetes – United States, 2005-2010. Centers for Disease Control and Prevention. rhtml/mm6211a4.html
1 in 2 Americans have
prediabetes. Only 11%
know they have it.¹
The total number of people
with diabetes is projected to
rise from 285 million in 2010
to 439 million in 2030
In Type 2 diabetes, due to many factors, the cells in your body stop responding to insulin in the normal
way. This is called insulin resistance. Imagine that the locks on the doors of your cells no longer recognize
a majority of the keys. Years or decades of insulin resistance forces beta cells to overproduce insulin.
Ultimately, the pancreatic beta cells become dysfunctional and lose their ability to produce insulin. Over
time, you can progress from normal blood glucose levels, to prediabetes, and then to type 2 diabetes.
Knowing and managing your blood glucose levels is critical to successful management of diabetes.
Sudden and severe increases in blood glucose can be life threatening and may require urgent
treatment. With more chronic glucose increases as seen
with prediabetes or diabetes, even with no symptoms you
are more prone to develop other ill-health conditions such
as high blood pressure and damage to multiple organs
such as the heart, brain, kidneys, nerve endings, and eyes
(retina).damage in multiple organs such as the kidneys,
heart, brain, arteries, nerve endings, and eyes.
Diabetes Patient Handbook
Lifestyle, nutrition, and genetics all impact the
balance of glucose and insulin in your body.
Over time, the eects of these factors can
put you on a path towards developing insulin
resistance, prediabetes, and type 2 diabetes.
What are carbohydrates?
How do they impact glucose levels?
There are three major nutrients you eat: proteins, fats, and carbohydrates. Carbohydrates are made of
mostly of simple sugars like glucose, fructose, and sucrose (a combination of glucose and fructose found
in table sugar), starches and soluble and insoluble ber.
Simple sugars are found virtually in all processed foods like candy, soft drinks and rened grains such
as bread and pasta. These enter your blood stream quickly, leading to a faster rise in blood glucose and
insulin levels. Starches, often referred to as complex carbohydrates are in foods like whole grains and
vegetables. Complex carbohydrates require intestinal breakdown and digestion delays glucose’s entry into
your blood. It is important to understand how foods impact the rise and fall of your blood glucose levels
when managing insulin resistance, prediabetes, and diabetes.
1 2
Blood Glucose Levels
Simple carbohydrates
When your body detects a rise
in blood glucose, your beta cells
respond by making insulin
Complex carbohydrates
Diabetes Patient Handbook
Insulin Resistance and Beta Cell Function:
Precursors to Type 2 Diabetes
Remember the lock and key? In insulin resistant states, your cells slowly
and progressively resist insulin’s ability to unlock the door to your cell
to let glucose inside. This creates an increased demand on your beta
cells to make insulin. Over long time periods, your beta cells will begin to
tire, become dysfunctional, and unable make enough insulin to control
blood glucose. Detection of insulin resistance, even before blood glucose
levels rise, may be an early sign that you are on a path to developing
prediabetes or diabetes. A variety of blood tests are often used by
clinicians to discover early insulin resistance and beta cell impairment;
alpha-hydroxybutyrate, adiponectin, insulin, C-Peptide and others. These
tests may be red or yellow on your True Health report, even if your
glucose and other glycemic control markers are green.
Detecting these early warning signs allows you to make lifestyle changes
that can delay or prevent type 2 diabetes.
Normal Insulin Resistant Dysfunctional
Glycemic Control
After years of working overtime trying to overcome insulin resistance your beta cells will be dysfunctional
and their insulin production will be low or stopped. When there is little or no insulin, glucose cannot be
eectively removed from your bloodstream. Abnormal glucose and other glycemic biomarkers takes
decades to develop and the progression from insulin resistance, prediabetes to type 2 diabetes is dierent
for everyone. Your clinician may use laboratory tests such as fasting glucose and hemoglobin A1C (HbA1C)
to diagnose prediabetes or type 2 diabetes. It may be helpful to re-test these markers regularly to make
sure your diabetes is being controlled. Talk to your clinician about the best plan of action for you.
Type 1 diabetes, or autoimmune diabetes, accounts for about 10% of people with diabetes. It is usually
diagnosed in children, but may also be diagnosed in adulthood. In Type 1 diabetes, your immune
system may be triggered to go into overdrive, attacking beta cells in your pancreas abruptly stopping
the production of insulin. In other words, with type 1, your body is simply unable to make insulin, the
“key” needed to unlock the door to your cells and move blood sugar inside. As with type 2 diabetes,
this leads to chronic and often dangerously high levels of glucose in the blood. About 5-10% of
patients originally thought to have type 2 diabetes actually have a variant of type 1 is called Latent
Autoimmune Diabetes in Adults, or LADA. This is a slower type of autoimmune beta cell destructive
process, that occurs in adulthood. Both type 1 diabetes and LADA are diagnosed by measuring
pancreas-related auto-antibodies in the blood.
Despite having dierent causes both types of diabetes are
controlled, in an attempt to reduce the long-term complications by
maintaining a healthy lifestyle and following your clinician’s care plan.
Only 10% of people with
diabetes have type 1
FG: < 100 mg/dL
PPG: < 140 mg/dL
HbA1c: < 5.7%
FG: 100 - 125 mg/dL
PPG: 140 - 199 mg/dL
HbA1c: 5.7 - 6.4%
FG: ≥ 126 mg/dL
PPG: ≥ 200 mg/dL
HbA1c: ≥ 6.5%
Diabetes Patient Handbook
Take Action Against Diabetes
It’s important to talk to your clinician to nd the best plan of action for your health needs.
Here are some general guidelines.
Nutrition and weight management play a vital role in preventing or managing insulin resistance,
prediabetes, and diabetes. Studies have shown that losing just 5-7% of your body weight—and keeping
it o—can have positive impacts on your blood sugar levels, lipids, and blood pressure.
Eat Healthy
Eat foods rich in nutrients, such as whole grains, vegetables, fruits, legumes, dairy,
and lean meats, nuts, and seeds.
Eat protein with complex carbohydrates, such as whole grains. It may improve
insulin’s ability to move glucose into the cells.
Limit sugar-sweetened beverages, such as soft drinks and fruit juices.
Avoid processed foods with rened grains and added sugars, especially in foods
labeled as “low-fat” or “non-fat”.
Eat foods with healthy fats in moderation, for example olive oil, avocado, fatty
shes, and coconut oil.
In general, trans fats should be avoided.
Limit sodium to <2,300 mg/day.
Walk, dance or run— it doesn’t matter
where you exercise, as long as you do.
In general, aim for 150 min/ week of
moderate-intensity exercise. Talk to
your clinician before beginning any
exercise plan.
If possible, try not to sit for more than
30 minutes at a time.
Quit Smoking
If you use tobacco products like
cigarettes or e-cigarettes, quit. For
help quitting, talk to a Tobacco
Cessation Specialist, or ask your
clinician about the best ways to quit.
Control Stress
Chronic stress, illness, and sleep
disturbances may have negative
eects on your blood sugar.
A Mental Health Specialist familiar
with diabetes may help you identify
your stressors and developing a plan
to cope with your stress.
Try stress-busting tactics such as
getting better sleep or breathing
Some people with diabetes take
medicines to help control blood sugar.
Talk to your clinician to see if
medicine should be part of your
treatment plan.
Call True Health at 1.877.443.5227 to enroll in our health management program. Our health
and wellness professionals can help you make a plan of action to prevent or control your diabetes.
Take Action Against Diabetes, cont’d.
Diabetes Patient Handbook
Questions to Ask My Clinician
If I have insulin resistance or prediabetes, how can I prevent diabetes?
What happens if I don’t control my condition?
How can I change my diet and lifestyle to be manage my diabetes?
Can I reverse diabetes? Is there a cure?
Do I need insulin to control my blood sugar?
How often should I test my blood sugar, and what should I do if it is too high or too low?
Why do I need to take my medications even on days that I don’t feel sick?
What time should I take my medication? With food or not?
How often should I visit my dentist? Eye doctor? Foot doctor?
My Biomarker Tracker
Biomarker Date / Result Date / Result Date / Result
Diabetes-Friendly Mason Jar Salad Recipe
Making salad in a mason jar can be fun, healthy and convenient. Follow this guide to make
your low-glycemic salad at home.
LAYER 1: Salad dressing (1-2 tablespoons, preferably olive oil based).
LAYER 2: Hearty vegetables that can be tossed in dressing without getting soggy
(i.e. cucumbers, cherry tomatoes, red onion, broccoli, cauliower).
LAYER 3: Other vegetables, fruits, and beans (i.e. mushrooms, zucchini, berries, apples).
LAYER 4: Lean meats and cheeses (i.e. tuna, chicken, boiled eggs, feta, or goat cheese).
LAYER 5: Nuts and/or seeds (i.e. sunower seeds, pumpkin seeds, walnuts).
LAYER 6: Leafy greens (i.e. spinach, arugula).
Don’t be afraid to stu your ingredients to keep the jar compact!
Salad dressing
(1-2 tablespoons, preferably olive oil based)
Nuts and/or seeds
(i.e. sunower seeds, pumpkin seeds, walnuts)
Hearty vegetables
that can be tossed in dressing without
getting soggy (i.e. cucumbers, cherry tomatoes,
red onion, broccoli, cauliower)
Leafy Greens
(i.e. spinach, arugula)
Other vegetables, fruits & beans
(i.e. mushrooms, zucchini, berries, apples)
Lean meats & cheeses
(i.e. tuna, chicken, boiled eggs, feta, or goat cheese)
Don’t be afraid to stu
your ingredients to keep
the jar compact!
Diabetes Patient Handbook
Glossary: Diabetes and Prediabetes
reported in the same units that
glucose meters use to help you
understand your HbA1c value.
Fructosamine is a measure
of glucose that is bound to a
type of protein in your blood.
This test shows how well your
blood glucose levels have been
controlled over the last 2 to 3
weeks. It can help predict risk
for developing diabetes, and
can also measure
Glycation Gap
The glycation gap is calculated
from your HbA1c and
fructosamine levels. Elevated
levels could mean you are
at greater risk for health
complications related to high
blood glucose and diabetes.
If you already have diabetes,
this test can tell your physician
how well your treatment plan is
1,5-Anhydroglucitol (1,5-AG)
1,5-AG shows how well your
blood glucose levels have been
controlled over the last 1 to 2
weeks. It is especially useful for
detecting more recent changes
in glucose, such as large
increases that may occur after
you eat. These glucose “spikes
can be harmful to your body and
increase your risk for diabetes.
Insulin Resistance
Insulin resistance is a condition in which the
body cannot eectively respond to insulin in
the bloodstream. This causes blood glucose
levels—also known as “blood sugar”— to
rise, which over time may lead to diabetes.
Alpha-hydroxybutyrate (α-HB)
α-HB is a small molecule produced by the
liver during energy production, especially
when your body is under stress. High levels
of α-HB are an early indicator of insulin
resistance and may signal increased risk of
progression to prediabetes and diabetes.
Linoleoyl-glycerophosphocholine (L-GPC)
Low levels of L-GPC are an early sign of
insulin resistance. Over time, decreasing
L-GPC levels may indicate that insulin
resistance is progressing to prediabetes or
full-blown diabetes.
Oleic acid
Oleic acid is a fatty acid that is stored in
body fat. High oleic acid levels are linked
to insulin resistance and diabetes. They
also reveal damage to your body caused by
excess intake of carbohydrates, a risk factor
for metabolic syndrome and diabetes.
Free Fatty Acids (FFA)
Free fatty acids are released from body fat
as a source of energy. Elevated FFA levels
can impair your body’s response to insulin
and cause your blood glucose levels to
rise. If you have high FFA levels, you may
be at increased risk of developing insulin
resistance or metabolic syndrome.
Glycemic Control
Maintaining the right amount of
sugar in your blood is important
for good health. Blood sugar
levels that are too high, or that
change drastically after you eat,
can be harmful to your body and
lead to diabetes.
Our body’s main source
of energy is in the form of
glucose or blood sugar. Excess
glucose in the blood can
lead to diabetes and other
complications. Regular glucose
testing will aid in the prevention
or management of diabetes and
reduce your risk of long-term
HbA1c is used to predict or
diagnose diabetes. It is also
used to indicate how well
your blood glucose has been
controlled over the last 3 to 4
months. In people who already
have diabetes, it can tell you
how well treatment is working.
Estimated Average Glucose
eAG is calculated from your
HbA1c levels. Like HbA1c, eAG
measures how well your blood
glucose levels have been
controlled over the last 3 months.
The dierence is that eAG is
Ferritin is a protein that binds iron and
transports it through the bloodstream. Very
high ferritin levels can indicate problems
with your body’s ability to store iron.
Increased ferritin levels can also occur when
insulin resistance and/or inammation are
present in your body, indicating increased
risk for diabetes and heart disease
Adiponectin is a protein produced by body
fat that protects against insulin resistance
and inammation. Adiponectin levels are
low in those who are verweight or obese. If
you have low adiponectin levels, you are at
greater risk of diabetes and heart disease.
Leptin is a hormone that acts on the brain
to regulate appetite, energy balance, and
fat storage in the body. Its levels rise with
weight gain because it is produced by body
fat. High levels of leptin may put you at
increased risk of developing diabetes.
Adiponectin is a protein produced by body
fat that protects against insulin resistance
and inammation. Adiponectin levels are
low in those who are verweight or obese. If
you have low adiponectin levels, you are at
greater risk of diabetes and heart disease.
Leptin is a hormone that acts on the brain
to regulate appetite, energy balance, and
fat storage in the body. Its levels rise with
weight gain because it is produced by body
fat. High levels of leptin may
put you at increased risk of
developing diabetes.
Leptin: BMI Ratio
The leptin: BMI ratio is a good
measure of leptin resistance, a
condition where the body no
longer responds properly to
leptin. If you have a high leptin:
BMI ratio, you may often feel
hungry and nd it dicult to lose
The HOMA-IR index, which
combines fasting blood glucose
and insulin levels, predicts
insulin resistance better than
insulin alone. If you have a low
HOMA-IR index, you have an
increased risk of developing
diabetes and heart disease.
Beta Cell Function
Beta cells are insulin-producing
cells that are found in your
pancreas. Beta cell dysfunction,
which occurs when these cells
stop working correctly, is a
critical stage in the development
and progression of diabetes.
Insulin is a hormone responsible
for regulating blood glucose
levels. High levels may indicate
a problem with your body’s
ability to control blood sugar.
Insulin is created from a non-
active form called proinsulin.
High levels of proinsulin may be
one of the earliest warning signs
of damage to your beta cells.
This test can help your physician
decide whether medication is
needed to protect your beta
cells or help your body better
respond to insulin.
C-peptide is a small protein that is
released when insulin is created
from proinsulin. High levels may
indicate that your beta cells are
not secreting insulin properly.
If you have high or low blood
glucose levels, this test can help
your physician understand the
cause. Increased C-peptide levels
may put you at greater risk for
developing heart disease.
Proinsulin: C-peptide Ratio
The proinsulin: C-peptide ratio
shows how well your beta cells
are working. A high proinsulin:
C-peptide ratio means that your
beta cells are having diculty
creating insulin from proinsulin.
This increases your risk of
developing diabetes.
Diabetes Patient Handbook
For many people, adopting a new lifestyle can be daunting. True Health’s health management
program is designed to support you on your journey for health.
We encourage all True Health patients to join our health management program. You can think
of our health and wellness experts as your partners in health, working with you to help you
understand your True Health lab results and take action.
Lab Results Information
Customized Diet and Exercise Plans
Medication Reminders
Stress Reduction
Tips to Quit Tobacco
Follow-Up for Ongoing Lifestyle Support
How to Get Started
Before joining our health management program, it is important to review your True
Health lab results with your clinician. If you both agree that this program is right
for you, call True Health to schedule an appointment. Your rst call with one of our
health and wellness specialists will take about 30 to 45 minutes. Follow-up calls
take just 15 to 25 minutes. It’s a commitment worth making.
To make an initial appointment, call us at 1.877.443.5227.
You may also log on to the Patient Portal, or connect online:
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