February 17, 2012

Research Corner: Why is it often difficult to begin insulin once it has been prescribed by a doctor?

Tip to take away:  When used as prescribed, insulin can be a safe and effective part of your diabetes treatment plan.  If you have questions about recommendations your health care provider has made, ask for clarification or find another trustworthy source of help such as a Fit4D diabetes coach.  Education is the key to staying healthy with your diabetes.

Article Summary:  As part of the TRIAD (Translating Research Into Action for Diabetes) study, interviews were conducted with participants with poorly controlled type 2 diabetes who were each already taking at least two oral medications. This study compared the responses of those had never used insulin but for whom it had been recommended and prescribed by their health care provider (69 people) with those participants who had recently begun using insulin (100 people).  There was a significant difference in a number of areas.

Compared with those people who had begun insulin, the subjects who had not begun their prescription were significantly more likely to blame themselves for their health problems and to believe that using insulin caused health problems such as blindness, amputations, kidney disease or heart attacks.  They were more likely to be concerned about their ability to use insulin correctly, about the injections being painful, and about the ways in which insulin would impact their work and their social life, and reported both a lack of information being offered and difficulty understanding written information they had been given.  Significantly fewer of these subjects reported receiving insulin training from their doctor or other health care provider.

The authors conclude that lack of information and poor communication between patients and their doctors or other health care providers is a primary reason people may not be receiving adequate treatment for their diabetes.

Reference: Barriers to insulin initiation: the translating research into action. Crosson, JC , Karter AJ, Marrero DG, Moffet HH, Parker MM, Saha C. Diabetes Care. 33.4 (Apr. 2010): p733.

For more information about insulin:  

http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/

To read about myths and facts concerning insulin: http://clinical.diabetesjournals.org/content/25/1/39.full

Fit4D’s Research Corner is a feature section where we summarize the latest research studies in diabetes management and provide practical tips based on the findings. Check back regularly for more Research Corner updates!


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Posted by: Maria Curcio, MS, RD, CDE
Categories Heart, Research Corner | Tagged , , , , , , , , , , , , , |
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February 10, 2012

Does Checking My Blood Sugar Really Matter?

Written by Maria Curcio, MS, RD,CDE
Fit4D Nutrition Coach

A study recently came out titled “Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin”. It said that if you are not on insulin, that regularly checking your blood sugars does not make a significant difference in your diabetes management.  As a CDE, my initial reaction was shock, and that’s why you’re reading this.  So before you throw away your meter let’s consider a few facts.

Without going into detail about clinical research, it’s difficult to control cause and effect, such as checking blood glucose (BG) when the participants have the liberty to check or not to check their BGs. It’s also difficult to know if the outcome, in this case lowering A1c, is due to differences in how study participants in both groups followed instructions such as checking BG, eating healthier, exercising and adherence to taking medications.   So that’s it for the research jargon!

Why do I need to check my blood sugars when I have diabetes?

As health care providers, we are always looking at the evidence – does the outcome of an action like checking your blood sugars result in enough of a benefit to keep doing it?  It’s unknown whether self-monitoring is effective in lowering A1c if you are taking oral medications. Because that part is unproven, let’s review what we do know. 

  • There is a prediabetes phase to this condition when your BGs are elevated causing damage to your blood vessels before diagnosis.  
  • If your doctor prescribed diabetes medication, then your BG is elevated.  Usually when medication is prescribed, lifestyle changes such as a healthy diet and exercise are recommended, too.
  • The best way to know whether the medication and lifestyle changes are working is SMBG.  It isn’t a good idea to assume the medication is lowering your BGs because that might be happening, but the only way to know if it’s low enough is to check your BG.  Let’s say that you’re eating healthfully, walking more and have been on metformin for 2 months. You’re checking your BG once per day and it’s always above 160 upon awaking which is above the recommended 130.  You speak with your  HCP who increases your dose of medication, and it comes down to the 100 range which is within the target goal. This is actually a true story of how blood glucose monitoring can help people with diabetes who are not taking insulin.
  • There are no early symptoms that high BGs are damaging the blood vessels of the eyes, kidneys and feet until it’s too late.
  • Keeping your BG within target range (ADA recommends fasting between 70 and 130 and  post meal of under 180) significantly decreases the risk of developing diabetes-related complications.  And how would you know if your BG is within the target range? That’s right, by checking your BG!
  • SMBG on a daily basis is useful for adjusting your food choices, exercise and for knowing if have to contact your HCP to adjust your medication between appointments.  I had as a patient a middle-aged woman who had been taking glimeperide for almost 1 year when she started to experience ‘dizzy’ spells several hours after eating.  She was on the lowest dose possible.  When she checked her BG it was in the 60s. This happened on several consecutive days.  After she called her doctor, he took her off the medication.  She’s been diet and exercise-controlled since.
  • You can know your A1c before your next doctor’s visit by comparing your 1 week, 14 day or 30 day average BG reading from your meter using the estimated average glucose chart (eAG). This is a great and reliable way to estimate how well you’re managing your diabetes.  For example, if your 30 day BG average from your meter is 169 mg/dl, using the chart below you know that your A1c is 7.5%. 
A1C% eAG mg/dl A1C% eAG mg/dl
 5 97 8.5 197
5.5 111 9 212
6 126 9.5 226
6.5 140 10 240
7 154 10.5 255
7.5 169 11 269
8 183 11.5 283
  • Feeling is not the best gauge of how high or low your BGs are.  By the time you ‘feel’ your BG is high, it is causing damage.  One patient, whom I knew very well, was speaking with me on the phone and was more irritable than usual.  I asked Mrs. Jones (not her real name), “Are you feeling okay?  Have you checked your BG today? You don’t sound like yourself.”  She was so busy that she’d completely forgotten.  While I was on the phone with her she checked—it was 270.
  • By the time you feel your BG is low, it might be declining too quickly for you to intervene. Unfortunately, I have had my share of patients who take their morning glyburide, eat breakfast and in the middle of running errands, develop hypoglycemia  (low blood sugar) that would have been picked up if the BG had been checked that morning.  This can be a dangerous situation that can be prevented with a quick BG check.
  • Class of medications called scretagogues lower BGs by stimulating insulin release, and can
    cause hypoglycemia.  These medications include glyburide,  glimiperide, repaglinide and nateglinide.  Exenatide is a different class of medication that also has the potential to cause hypoglycemia. 
  • And of course, if you’re taking either short or long-acting insulin you want to check your BGs daily as your HCP recommends.

A little number reaps huge rewards

I have had the pleasure of counseling young and older folks alike who have diabetes.  None of them have ever said that they enjoy sticking their finger or forearm or other chosen site.  But no one has ever said that knowing their BG wasn’t useful in helping them either lower or increase their carbs, knowing if a little snack is needed before they take that walk or splitting that metformin dose to help lower their after dinner BGs.  However, I have had several folks ask me why they aren’t checking their BGs at home instead of waiting the 3 or 6 months before their doctor’s appointment.   The ‘worse’ thing that can happen is you’ve stuck your finger.  Now compare that to the benefit you get of knowing that your BG is on target. 

How has checking your blood glucose helped you? Share your experience with us in the comments section!


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Posted by: Maria Curcio, MS, RD, CDE
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January 27, 2012

Research Corner: The role of yoga in the management of type 2 diabetes

Yoga may be a worthwhile addition to your treatment plan to manage your type 2 diabetes.

Tip to Take Away: Yoga has been found to have significant health benefits for many people living with type 2 diabetes.  As an addition to your regular exercise program, yoga can help you lose a few pounds and keep your blood glucose in check. Be sure to check with your healthcare provider to be sure yoga is right for you.

Study Summary: A 3-month study assessed the effect of yoga for people living with type 2 diabetes on weight, blood pressure, blood glucose management, and oxidative stress, which is a measure of the physical stress on the body associated with aging.  The 123 participants, ages 40-75, were assigned to receive either standard care with general information about diet and exercise or standard care plus yoga at least 3 times weekly for 3 months.  People with a variety of health complications and with no health complications were included in the study.

After three months, there were no differences between the groups in changes to waist circumference, waist-to-hip ratio, blood pressure, or two of the blood markers for oxidative stress.  The group who participated in yoga in addition to standard care, however, had a greater improvement in Body Mass Index (BMI, a ratio of weight to height), blood glucose control, and reduction in three of the blood level markers for oxidative stress.  The authors concluded that yoga can be helpful in reducing oxidative stress in type 2 diabetes.  In addition, when used in addition to standard diet and exercise care, it may help slightly reduce BMI and improve blood glucose control.

Hegde SV, Adhikari P, Kotian S, Pinto VJ, D’Souze S, D’Souza V.  Effect of 30-Month Yoga on Oxidative Stress in Type 2 Diabetes With or Without Complications:  A controlled clinical trial. Diabetes Care. October 2011; Vol34(10);2208-2210.

Abstract available at: http://care.diabetesjournals.org/content/early/2011/08/05/dc10-2430.abstract

For more information about yoga and exercise: http://www.joslin.org/info/diabetes_and_yoga.html

http://www.joslin.org/info/exercises_to_avoid_when_you_have_diabetes.html


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Posted by: Maria Curcio, MS, RD, CDE
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January 9, 2012

Exercise 101: Getting Started with a Fitness Routine (Part 2)

Written by:  Isa Carani, RD, CDE
Fit4D Nutrition Coach

This article is the second part to our guide on getting started with exercise. This week, we will talk about setting goals, fitting activity into your day, and how to choose the best type of activity for you. Click here for Part 1, which defines different kinds of exercises and how to get them, whether you belong to a gym or not.

Sometimes, the hardest part about exercise is putting on your sneakers. We all need a little help with motivation so here are some tips about setting goals and achieving them.

Creating a FITT plan and setting exercise goals

Exercise goals give you direction on the exercise components we discussed last week in Part 1, and help measure progress.  As each fitness goal is achieved, the following will help you create the next step in your current exercise plan so that it remains interesting and challenging.

Frequency – This goal is to increase how often you are including one of the fitness components weekly. For instance if you are doing cardio two times per day how can you increase it to three times a day?

Intensity - How hard are you exercising? Checking your heart rate is a great way to tell how hard you are working when doing cardiovascular exercises. 

  • You want to increase the rate at which your heart beats per minute to increase your strength and endurance without causing injury. Raising your heart rate to 60 percent of your maximum heart rate is a great place to start.  Your maximum heart rate per minute is 220 minus your age.  According to the American College of Sports Medicine if you can talk comfortably while exercising you are likely exercising at a very light intensity. A good indicator of when to increase your cardio intensity is if you are not reaching your target heart rate goal.
  •  How to calculate your target heart rate range:
    • 220 – your age =  maximum heart rate  X 0.60 to 0.85 =  your target heart rate range between 60 and 85%
    • The above calculation gives you your heart rate range when calculated between 60% and 85% which is the recommended range for most adults
  • You can also increase intensity in weight lifting by increasing your weights.  If you can do 8-12 reps with moderate difficulty it may be time to increase your weights to increase your intensity.  Make sure you can complete 12 reps in proper form before deciding to increase the intensity to avoid risk of injury.

Time- This focuses on how much time is spent doing the exercise. If you walk or weight lift for 20 minutes you can make it a goal to increase it to 30 minutes. You want to set your pace based on what works for you.   

  • Depending if muscular endurance or muscular strength is your goal when weightlifting you can increase your time by adding another exercise for the same or different part of the body or increase your reps or sets of an exercise you are already doing. 
  • If you can do 8 reps with moderate difficulty it may be time to increase your reps, sets or add another exercise.

Type- Vary the types of exercises you do to work different areas of your body and to increase your overall strength. For instance if you walk but want to change up your cardio add biking.  Or maybe you don’t want to change your cardio but want to add flexibility.  

  • Include some stretches right before cardio and you’ve just added another fitness component.
  • You can do all the fitness components on the same day or different day as long as you make it a goal to incorporate a little bit of everything weekly.  

When increasing your FITT goals it is common to experience muscle soreness the same day or a few days after.  To avoid injury work on one FITT goal at a time as well as one exercise component.

Seeking professional help

As a reminder, if you are starting an exercise program for the first time or if it’s been a while since you have been physically active, it is important to consult with your doctor first and get medical clearance.

At times, starting an exercise program on your own can be daunting. If you’d like a professional to help direct you and keep you motivated, look for a qualified experienced certified personal trainer who understands and has worked with overweight people or those who have conditions such as respiratory problems, who may struggle with functions of everyday living. Several  reputable organizations are the American College of Sports Medicine (ACSM), American Council on Exercise (ACE) and  Aerobic Fitness and Association of America (AFAA). When inquiring about the personal trainer’s experience and educational background ask if he or she has had experience working with people with diabetes who have been cleared for physical activity by their healthcare provider.

Make everyday routine activities count

Daily we come across decisions to increase or decrease our physical activity. Perhaps you are overweight or have a condition such as neuropathy that makes it difficult for you to move your body weight.  Retrain your mind to take advantage of every opportunity to be physically active.  These additional small steps really do make a difference. Here are a few examples of daily activities that make a positive impact on your health:

  • Park your car further away in the parking lot so you walk a few extra feet.
  • Take the stairs instead of the elevator.
  • Walk while talking on the phone.  Sitting and doing leg lifts while talking may be another option to increase your segment of exercise to 10 minutes.
  • Do you use your television as background noise? Turn it off and turn on your favorite tunes instead.  You will get a cardio workout as you dance or move to the beat whether you are sitting or standing.
  • Get off the bus or train one block earlier than your original stop and walk the rest of the way. You can start by doing it once a week, and increase the frequency as the activity becomes easier.
  • While watching your favorite shows exercise a different part of your body during the commercials or just march in place.   This is a great way to add different types of fitness components.
  • Set a timer or a reminder on your computer or phone every hour or so to get up and walk or stretch for a few minutes.  Go for a 5 minute walk during your lunch or break. You will start to feel better and be motivated to increase the time.
  • Do a chore once a day and increase the type or time of these activities that can get your heart pumping and improve your range of motion. A few examples are dusting the house, vacuuming, doing laundry, gardening, mopping, sweeping and mowing the grass.
  • If you have children create a list of fun physical activity games that are family friendly. Write each idea on separate small pieces of paper. Fill up a container or jar with these small pieces of paper and pick one out every day to do together after dinner.

The best type of activity is one that works for you!  

Daily exercise is possible even if you are just starting out or overweight.  The best exercise is any type of physical activity that gets you moving, will improve your daily function and your quality of life.  Studies show that the less time one spends sitting reaps large health benefits!  Challenges can be overcome by taking one step at a time. Create a physical activity plan that works for you and reward yourself for each goal achieved.  As you continue to set goals to challenge yourself and to keep your exercise routine interesting, you will start to feel better and improve your health.

What combination of activities help keep you motivated? What’s your biggest challenge when it comes to exercise? What other creative ways do you have to stay fit that you would like to share in the comments? 

For more information:

A Little Bit of Exercise Makes a Big Difference

American College of Medicine Exercise Article Archives


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Posted by: Maria Curcio, MS, RD, CDE
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Exercise 101: Getting Started with a Fitness Routine (Part 1)

Written by:  Isa Carani, RD, CDE
Fit4D Nutrition Coach

This article is the first part to our guide on getting started with exercise. This week, we will talk about different kinds of exercises and how to get them, whether you belong to a gym or not. Tune in next week for Part 2, where we will talk about setting goals, fitting activity into your day, and how to choose the best type of activity for you!

You’re out of shape and you’ve heard it before, especially through the advice of well meaning relatives and friends.  Exercise is important for your health. You’ve made the attempt. You even have the membership fees to prove it.  You know the benefits and it’s not that you don’t want to.  You may have even made it your New Year’s Resolution! The next steps necessary to lose weight can come in conflict with personal barriers especially for individuals who are overweight and have tried exercising or are just starting an exercise program.  The following are solutions to help you get started on overcoming those exercise barriers.

Create a low impact workout routine

So you are motivated and ready to start. Where do you go from here?   A good place to start is using the following components of physical fitness for a well-rounded exercise program recommended by the American College of Sports Medicine.

Cardiovascular

  • These types of exercises increase your heart rate and improve your ability to repeat a movement for a long period of time before exhaustion. Because people who are overweight are at an increased risk for injury to their bones or joints, non-weight bearing low-impact cardiovascular exercises are best. Several examples include biking, walking and water exercises such as water aerobics or swimming.
  • The American College of Sports Medicine as well as the American Heart Association recommends at least 30 minutes of moderate-intensity physical activity most days of the week. Health professionals also recognize that three 10 minute cardio exercise segments are just as effective as activity for 30 minutes . This is good news if you are just starting a cardio routine. It makes it easier to gradually increase the amount of time you exercise.  Also, it is a convenient way of fitting in exercise on days you are limited on time and want to incorporate activity into your day.
  • Individuals who are overweight and have a difficult time with cardio exercises can use activities of daily living as a cardiovascular goal.  For example your goal may be to climb the stairs at home without pausing or running out of breath, or increase the frequency that you get up from your chair.

Muscular Strength

  • Use weights, elastic bands or your body weight as resistance to strengthen different parts of your body.  Research shows increased muscle mass increases metabolism, reduces heart rate and blood pressure and decreases risk for diabetes.
  • If you are struggling with the strength to perform everyday tasks like getting up from a chair, including a difficult everyday task as part of your workout routine to increase strength is a good place to start. For instance do between 10-15 reps of getting up and sitting down in a chair or on the floor.
  • According to the Center for Disease Control if you will be using weights or floor exercises start out with one set of 10 to 15 repetitions (reps) working the major muscle groups (back, shoulders, chest, abdominals, arms and legs) 2 to 3 days per week.  The amount of weight you use should allow you to complete the repetitions without sacrificing form and reduce risk of injury.
  • According to the American College of Sports Medicine if your goal is muscular strength do 8 to 12 reps.  If muscular endurance is your goal then do 10 to 15 reps of at least one set for each exercise.

Check out this video of Fit4D Exercise Coach Abby Herrick, RD, LD, RCEP demonstrating a strength exercise that you can do in your own home:

 

Please check with your healthcare provider before starting any exercise program.

Flexibility

  • Start off slow and focus on stretching the major muscle groups that support range of motion.  Research shows a greater increase in mobility and flexibility when holding the stretch for 30 seconds.
  • Although there is no evidence in reducing injury during or after exercise it does improve range of motion for daily activities. Extra weight may limit mobility and flexibility but by taking a few minutes before starting your day or right before bed, 2 to 3 days per week can be enough to improve flexibility.

Starting and Ending a Workout

Remember no matter what physical component you want to start with, it is always important to warm up and cool down for about 10 minutes. This should not be confused with stretching and should not be as intense as your cardio. Examples are marching in place while swinging your arms, walking, or imitating some of the exercises in your routine at a slower, less intense pace and without weights.  When you warm up your heart rate slowly goes up, blood flows to the muscles you are working and there is an increase in body temperature. When you are cooling down your heart rate and body temperature should be decreasing.  Although the evidence for health benefits in warming and cooling down is mixed, there is little risk in doing so and may help you prepare for your exercise and reduce injury.

Now that we’ve laid out the basics, it’s a good idea to think about where you would like to exercise. A gym is a great option because of the variety of equipment and staff on hand to help you out. The costs can be an issue, but some people feel that paying a monthly fee keeps them motivated to keep going! Others cannot afford a gym or do not live close to one. If that’s the case, there are other options.

Solutions at the fitness center

Are you unfamiliar with the equipment or where to begin? It’s important to know that everyone at one point is new to exercise, nor is there any reason to be embarrassed about being overweight.   If that’s you here are some suggestions that may help.

  • Hire a personal trainer. Even if it is short term, a personal trainer can help you become familiar with how to use the equipment or provide direction in creating a workout routine. Many gyms have trainers on staff. Not only is it helpful to have that guidance, but sometimes just having someone there can relieve some of the negative feelings or thoughts.  This brings me to my next suggestion.
  • Bring a buddy. Having someone there while exploring and becoming more familiar with the gym may be all the support and motivation you need to get through the first few days.  Many gyms will give you passes to share with friends or family. Use that as an opportunity to invite someone as you begin to adjust to your schedule or routine and become familiar with the gym.
  • Find the right gym for you. Some women are intimidated going to a unisex gym and would feel more comfortable exercising in a gym with other women. Maybe you prefer a smaller gym because the bigger gyms overwhelm you.  Or you might want variety in your exercise routine and enjoy what bigger gyms offer.  If your work hours allow you to only exercise early in the morning or late at night, then a 24-hour gym may be right for you.  You may also be interested in a community center where you can bring your family like a YMCA that offers a pool and a variety of activities. These are a few things to think about when searching for a gym that fits your needs. So before you sign up for a gym think about your lifestyle and what motivates you.

If going to the gym is not an option

If the gym is too intimidating or not an option, no worries, you can still get a good workout and achieve your fitness goals.

  • Exercise DVDs: These you can rent from your library, video store, download it or take advantage of your “on demand” options at home.  The types of exercise DVDs can range from strength training to yoga.  You can even read reviews online to help you in your purchasing decision.
  • Personal trainer at home: Having a personal trainer allows you to have someone there to guide and motivate you.
  • Video and audio chatting and other apps or websites with personal trainer via the internet are other options to meet your needs.  Below are examples of what’s available:
    • ACSM.org - great and reliable source for exercise and fitness information.
    • I pump and fitness builder -smartphone apps that help you create a variety of workouts and keep track.
    • Sparkpeople.com - create a personal workout routine, exercise demos and printable workouts.
    • Videofitness.com - to review a wide variety of exercise DVDs.

This week, we encourage you to add one type of activity to your schedule. For example, a walk in the park, gardening, or stretching along with a yoga DVD are great starting points. Remember not to start a physical activity routine without first talking to your healthcare provider.  Tune in next week for Part 2 – we’ll talk about setting goals and staying motivated to fit activity into your life!

If you’re just starting an exercise program, share with us what has been working for you.  What is your favorite combination of exercises?  Share your ideas in the comments section!

For more information:

A Little Bit of Exercise Makes a Big Difference

American College of Medicine exercise article archives

CDC Physical Activity Guidelines for Everyone


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Posted by: Maria Curcio, MS, RD, CDE
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December 28, 2011

A New YOU for a New Year

Contributed by Amy Grobe, RD, CDE
Fit4D Diabetes Coach

Happy New Year! It seems that images of the New Year have changed somewhere along the line from those of confetti and noise-makers to constant reminders of our need to lose weight.

This year, I challenge you to make a resolution to change your mindset about how you approach your goals. Rather than making lofty goals for the entire year, I encourage you to focus on each day as a new opportunity to get just a little closer to your ultimate destination.

Let’s take a few minutes to think about your long-term goals.

-How would you achieve a 50 pound weight loss this year?

-What can you do on a daily basis to achieve this goal?

  • Reduce portion sizes and use the information on the nutrition facts label to make healthier choices
  • Decrease fat and calorie intake by simply changing to lower fat foods
  • Incorporate 30 minutes of physical activity into your daily routines
  • If you’re short on time do 3 - 10 minute segments in one day
  • Rather than trying to limit your intake of nutrients (as we try to limit fat, sodium, carbohydrates, sugar) reverse your thinking and try to add as many nutrients to your meal.
  • Choose foods high in dietary fiber (at least 3 grams per serving)
  • Select a variety of fruits and vegetables of many colors to maximize intake of natural antioxidants
  • Choose foods that combine many nutrients. The following snack suggestions all contain calcium, protein, antioxidants, fiber, and heart healthy fats:
    • Yogurt with berries and ground flax seeds
    • Apple with peanut butter, dried cranberries, and soy milk
    • Low fat cheddar cheese cubes (such as Cabot® 50% or 75% reduced fat cheddar) with grape tomatoes and kalamata olives

Stay focused on your goals and if you encounter challenges or difficulties, get back on track as soon as you can. Remember this Chinese proverb: “It is possible to move mountains by carrying away one stone at a time.”

Share a realistic health goal that you’d like to accomplish by March 2012 in the comments section!


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Posted by: Maria Curcio, MS, RD, CDE
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December 17, 2011

Holiday Planning for Diabetes Part 2:How to Prevent Roller Coaster Blood Sugars During the Holidays

Written by: Sejal Dave
Fit4D Nutrition Coach

This article is the second part to our guide on managing your diabetes during the holidays.  This week, we will talk about maintaining your blood sugars in target range during the busy holiday season.  Click here for Part 1, which shows how you can easily create a healthy diabetes plate during the holidays.

For most of us the joys of the holiday season come from spending time with family, shopping, entertaining, hosting house guests, and perhaps traveling to see friends and relatives.  Ironically these same activities can add stress to already busy lives.  Although tempting, try not to put diabetes “on hold” in order to get through the demands of this season.   Even minor changes to your usual diabetes management routine can affect your health, so take the few minutes daily during the holiday season to take care of one your most valuable gifts – your health.

How Does Stress Affect My Diabetes?

Stress may affect your blood glucose in two different ways:

  • Additional activities and inconsistent schedules could displace your usual diabetes care activities.  For example doing holiday errands may replace your walk, or you might forget to check your blood glucose because you’re rushing.
  • Hormones are released by the body during times of stress that directly lead to high blood glucose levels.

While most people with type 1 diabetes may experience hyperglycemia (high blood glucose) with stress, few may have hypoglycemia (low blood glucose).  People with type 2 diabetes are more likely to experience hyperglycemia when they are stressed.

It’s easy to see how the hectic and inconsistent holiday schedule can play havoc with your blood glucose levels.  The good news is with just a little planning you can keep them on target.

Making Time for Diabetes Care During the Holidays

The best way to reduce your stress and manage your blood glucose levels at this time of year is to come up with a plan that makes diabetes care your priority.  Here are a few sample strategies that will help you adhere to your diabetes plan:

  1. Check your blood glucose levels regularly to determine if you need to adjust your meals, insulin or your schedule.  The stress of the holiday season can impact your blood glucose levels differently.  It’s helpful to monitor your blood sugars throughout the day to determine if your medications or diet need to be adjusted.
  2. Make time to be active. Even 30 minutes of physical activity each day at least 5 days a week can help manage your stress. If you’re in a time crunch studies show that being active in 10 minute segments 3 times a day is equally as effective as a 30 minute block.
  3. It’s important to take your medications as prescribed to help keep your blood glucose in the target range.  If your schedule gets hectic, set reminders on the bathroom mirror or any other place where you are most likely to see it.  You can also place your medication at the table where you eat breakfast. (Click here to see more tips on remembering your medications)
  4. Carry your blood glucose meter and medications with you in a travel pouch or a kit that’s compact.
  5. If you are using an insulin pump and notice your blood glucose is more frequently out of its target range, speak with your health care provider (HCP) about adjusting your basal rate.
  6. If you are using insulin to carbohydrate ratios and your post meal blood glucose is elevated more than usual, speak with your HCP about adjusting your insulin dose.
  7. Don’t skip meals.  Stick to your meal plan as closely as possible. Be prepared for the unexpected delay by packing a lunch or snacks “to go” (more on this below).
  8. Be organized.  If you can take care of one or two holiday details each day, you are less likely to feel overwhelmed as holiday events approach.  This will also allow you to maintain your daily diabetes management care.
  9. Change your mindset. Instead of getting stressed by all of the running around remember that it also counts as physical activity!
  10. Utilize pharmacy services such as automatic refills or home delivery of diabetes strips and medications. That’s one less thing you’ll have on your mind.
  11. Delegate errands and chores such as house cleaning to other members of the family, or at least ask them to pitch in. Turn decorating the house into a family event. More hands make less work, and more time for you to take care of your diabetes needs.
  12. When going to a potluck, take a dish to share that fits your own meal plan such as a veggie platter, green salad, bean salad, or low fat chili. That way you know you’ll have one good choice when it’s time to eat.
  13. Plan a type of activity after the holiday meal such as dancing, walking or building a snowman after dinner to help burn off those calories.

Diabetes strategies for healthy eating on the run

A busier schedule can jeopardize your usual meal routine and lead to erratic blood glucose levels.  Is it realistic to think that you can avoid eating out while you’re busy running holiday errands?  Probably not! However, with a little preparation you can still eat healthfully.

  • If you’re headed out early, eat a quick and healthy breakfast such as a small toasted whole grain bagel with almond butter or whole grain cereal with nuts, berries and skim milk.
  • Pack a healthy lunch to go. A peanut butter sandwich on whole wheat bread and an apple or a salad topped with lean protein are better alternatives to fast food and will give you the energy you need to keep going.  Meals packed from home are generally lower in fat and calories than foods that are purchased from food courts and fast food establishments.
  • Keep healthy snacks with you so that you’re eating regularly.  You’ll also have the energy you need to keep up with the demands of the season.  Fasting for prolonged periods of time will cause certain hormones in your body to rise that will also cause your blood sugars to increase.
  • Here are several examples of snacks that you can keep portioned and ready to go with you before you head out the door. Measure snacks into plastic sandwich bags for the perfect serving size!
Portable snacks with less than 5 grams of carbohydrate
  • 3 celergy sticks plus 1 tablespoon of peanut butter
  • 5 cherry tomatoes + 1 tablespoon ranch
  • 1 hard-boiled egg (peel beforehand for easier eating on-the-go)
  • 1 cup cucumber slices + 1 tablespoon ranch dressing
  • ¼ cup fresh blueberries
  • 1 cup salad greens, 1/2 cup diced cucumber, tossed with vinegar and oil
  • 1 cup light popcorn
  • 2 saltine crackers
  • 10 gold-fish crackers
  • 16 green olives
  • 1 string cheese stick
  • 2 tablespoons pumpkin or sesame seeds
  • ¼ of a whole avocado
  • If you forget to take something with you, then it’s better to buy something than to skip eating altogether.  Luckily many restaurants offer healthier food options.  Grilled chicken sandwiches are better alternatives to fried chicken. Other good choices include veggie wraps, soups and smaller sized meals (even a kid’s meal).  If you prefer to keep moving while eating, a yogurt parfait or fruit smoothie can also be good choices for food on the go.
  • Limit your caffeine intake.  It may seem like a jolt of java will get you through the first few hours of the day, but if you keep drinking caffeine without eating you could end up having large shifts in your blood sugar levels.  This effect is more pronounced for individuals who have type 2 diabetes.  Stick with water to keep you hydrated.
  • Limit alcohol. Too much alcohol during the holidays can jeopardize your judgement and your blood glucose management . (See Holiday Planning for Diabetes: Part 1 for more on alcohol management.

Simplify & Enjoy the True Spirit of the Holidays

Taking a few extra minutes to focus on keeping your blood sugars in check will help protect your most important asset – your health.  Then you will enjoy the social aspect of the holidays, which is the most fulfilling part of the holiday season.  Simplifying and setting realistic expectations when it comes to gifts and food will help you enjoy and celebrate what makes special this time of year.

What helps you cope with stress during the holidays? Share with us your ideas on making diabetes care your priority during the busy holiday season. Please respond in the comments section!

Additional Resources:

http://blog.joslin.org/2011/11/holiday-time-and-diabetes-eleven-common-sense-rules/

http://www.diabetes.org/food-and-fitness/food/planning-meals/holiday-meal-planning/tips-for-fending-off-holiday-stress.html

http://my.clevelandclinic.org/healthy_living/stress_management/hic_coping_with_holiday_stress.aspx
http://www.diabetes.org/living-with-diabetes/complications/stress.html


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Posted by: Maria Curcio, MS, RD, CDE
Categories Depression, Special Occasions | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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December 7, 2011

Research Corner: Pre-diabetes and Insulin Resistance are Linked to Muscle Mass

Higher muscle mass can increase insulin sensitivity and decrease the risk for pre-diabetes.

Tip to Take Away:  Maintaining fitness and building muscle through exercise reduces insulin resistance and may prevent type 2 diabetes.  The American Diabetes Association recommends 150 minutes/week of moderate-intensity aerobic physical activity or 75 minutes/week of vigorous aerobic physical activity plus muscle-strengthening activities (resistance training) 3 times/week.

Study Summary:  Data from 13,644 participants aged 20 years and older in a national study were evaluated.  The goal was to determine whether increasing muscle mass was associated with improved glucose regulation.  Muscle mass is associated with insulin sensitivity and pre-diabetes risk.  For every 10% increase in skeletal muscle, there was an 11% reduction in insulin resistance.

This research suggests that higher muscle mass is associated with better insulin sensitivity and lower risk of pre-diabetes.  This is good news for those who are overweight and struggle with weight loss, as any effort to get moving and keep fit is a benefit and may contribute to improved metabolic change.  Further research is needed to determine the effect of exercise  programs designed to increase muscle mass  and how exercise may prevent the onset of type 2 diabetes.  

Reference:  Srikanthan P, Karlamangla AS.  Relative Muscle Mass is Inversely Associated with Insulin Resistance and Prediabetes.  Findings from the Third National Health and Nutrition Examination Survey (J Clin Endocrinol Metab, 2011;doi:10.1210/jc.2011-0435)

Abstract available at:

 http://jcem.endojournals.org/content/early/2011/07/14/jc.2011-0435.abstract

For help with information on exercise and fitness, visit these websites:

http://www.shapeup.org/

www.fitness.gov

National Diabetes Education Program

GymGoal ABC and Lose It! - iPhone or iPad apps

Fitting activity into your day


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Posted by: Maria Curcio, MS, RD, CDE
Categories Exercise, Research Corner | Tagged , , , , , , , , , , |
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November 21, 2011

Holiday Planning for Diabetes Part 1: Simple Holiday Meal Planning

Written by: Amy Grobe, RD, CDE
Nutrition Coach

Oh, holiday season!  Does that phrase make you smile with anticipation or cringe with dread?  Many of us feel added pressure of trying to make everything “perfect” for the holidays.  When you add managing your diabetes to your “to do” list, it’s understandable if you feel overwhelmed, especially when it comes to trying to follow a healthy meal plan.

Let’s be realistic this year when it comes to holiday dining

Do I recommend keeping an eye on your plate and watching your portion sizes?  Absolutely! Should you show up for Thanksgiving dinner with pumpkin pie in one hand and a measuring cup in the other?  Of course not!  Rather than creating more stress for yourself by worrying about what you should and should not eat, follow these simple tips so that no matter where you are eating this holiday season, your meal is balanced and your blood sugars are on target!

Nutrition 101

Foods that have similar nutrient content are typically grouped together to make meal planning easier. For example, a one-ounce serving of most breads contains about 80 calories, 15 grams of carbohydrates and 1-3 grams of fat.  When it comes to meal planning for diabetes management, classify the foods you plan to eat into their correct food group in order to use this portion control technique, called the “Plate Method.”

The foods that contain carbohydrates—grains, breads and starches, fruits, dairy and combination foods –are the foods that will affect your blood sugar, so this is where portion control is essential.

Portion control at your finger tips—no tools required!

To begin building a balanced holiday meal, imagine a line drawn down the middle of your 9-inch plate, dividing it in half.  Next, imagine one of the halves divided in half again so that you have three sections (one half and two quarters).  Foods in the grains and starches group (breads, pasta, rice, stuffing, potatoes, corn, peas, beans) go in one of the smaller sections of the plate, which is about 1/4 of the size of the plate. Since starches and breads affect blood sugar levels, it is important to limit your portion size.  This serving is about 1 cup or roughly the size of your fist.  A serving of protein (turkey, ham, beef, fish, lamb, eggs, tofu) goes in the other smaller section of your plate.  Proteins do not generally affect your blood sugar levels, but portion control is still important to help prevent holiday weight gain!

Fill the large section of the plate with salad greens, broccoli, carrots, green beans, cucumbers, peppers or other non-starchy vegetables. Since these vegetables are so low in carbohydrates and calories, your portion size can be larger than your serving of starches.  Your balanced meal when completed would look like this:

Try eating your vegetables at the start of your meal; they are generally very bulky and will help fill you up quickly, which leaves less room in your stomach for those high-calorie foods!

Filling Your Holiday Plate

Now let’s apply this principle to some holiday examples using the “Plate Method.”  The chart below are examples of several typical holiday meals, and how they are classified by food groups.  Keep in mind that combination foods are generally counted as carbohydrates.


Once we’ve figured out which section of the plate each food should go, it’s time to fill the plate!  The great thing about using the Plate Method is no foods are off limits or forbidden, but rather all foods are okay in moderation.  And you are not limited to only one food from each category; you can taste a little of everything as long as it fits into its section on the plate.

What about dessert?

Don’t think I forgot about the pumpkin pie or fruit cobbler!  Since most desserts tend to be rich in carbohydrates, plan ahead and factor that into your total carbohydrate allotment for the meal.  Perhaps you can take a smaller serving of a food in the grain group such as stuffing or mashed potatoes and skip the fruit with your meal in order to have a small serving of pie for dessert.  So after you put your plate together, it would look like this:

Now you see how we the Plate Method was applied for Thanksgiving, and how it also can easily be adapted for Hanukkah, Christmas, New Year’s or other holiday meals!

Can I use the Plate Method to estimate carbohydrates if I’m taking insulin?

If you take insulin with your meals, it is best to speak with your physician and diabetes educator to ensure you can correctly adjust your insulin dosage. The most accurate way to know exactly how many carbohydrate grams you are eating is by measuring your portions.  However, if you will be using the Plate Method to estimate your carbohydrate intake and adjust your own insulin dosage based on the amount of carbohydrates you eat, you may want to practice eyeballing portion sizes ahead of time to make it easier on the holiday.

Some general carbohydrate estimating tips:

  • One cup of pasta, rice or stuffing (about the size of a baseball) each contains 45 grams of carbohydrates.
  • A half-cup serving of mashed potatoes, corn or peas (about the size of an ice cream scoop) contains 15 grams of carbohydrates.
  • A baked potato (about the size of a computer mouse) contains 30 grams of carbohydrates.
  • Keep in mind that the carbohydrate recommendation for most female adults is 45-60 grams and for most male adults is 60-75 grams per meal.

See the end of this article for several websites that can help with estimating carbohydrates.

How can I categorize a combination food like lasagna using the Plate Method?  It has noodles (grains), tomato sauce (vegetable) and cheese (protein) so I’m not sure which part of the plate it fits into.

If the food contains any form of carbohydrates, it’s best to put that food in the ‘grains’ section of the plate since it will affect your blood sugar.  A safe way to account for meals like this is to limit the serving to about 1/4 to 1/3 of your plate and then fill the remaining part of your plate with non-starchy vegetables.

How does alcohol fit into the Plate Method?

Although you may find this surprising, alcohol is not considered a starch or carbohydrate!  When alcohol is digested by the body, it is metabolized more like a fat than a carbohydrate, so you would not count alcohol as part of your carbohydrates.  In terms of calorie content, alcohol is more similar to fat than to carbohydrates or protein.

Here are some popular alcoholic drinks, along with their calories and carbohyrate counts:

Drink                                                   Calories                      Carbohydrates (grams)

Cider, 12 ounces                                   150-200                      12-27
Egg nog, 8 ounces                                 343                             34
Hot buttered rum, 8 ounces                   316                              11
Tom & Jerry, 8 ounces                           358                              50-60
Kahula & Cream, 4 ounces                    260                             32
Peppermint Hot Chocolate, 6 ounces    203                              32
Red wine, 4 ounces                              100                              4
White wine, 4 ounces                            85-95                          2-4
Champagne, 4 ounces                           85                                2
Mimosa, 4 ounces                                  65                                7
Cosmopolitan                                         215                              12
Frozen daiquiri                                      140-155                       4-6
Margarita                                               160                               7

Is it ok for me to have alcohol with my meal if I have diabetes?  How does alcohol affect my blood sugar?

Drinking alcohol with diabetes can put you at risk for having hypoglycemia, or low blood sugar, especially if you are taking oral medications and/or insulin. Your liver stores carbohydrates in the form of glycogen (or stored carbohydrates), and when your blood sugar level starts to drop, the liver is signaled to release the glycogen into the blood stream to bring the blood sugar levels back up.  However, when there is any alcohol in the body, the liver is working to metabolize the alcohol and is not able to regulate blood sugar levels at the same time, meaning that if your blood sugar is low, it will continue to drop.

To be safe, always ask your doctor if it is safe to drink alcohol.  If your doctor gives you the go-ahead, make sure to eat something that has carbohydrates to prevent hypoglycemia.  Lastly, since the effects of alcohol can last hours, test your blood sugar before going to bed.  If it is under 100 mg/dL, have a snack that contains around 15 grams of carbohydratesto maintain your blood sugar levels overnight.  Here are a few  good snack choices:

  • whole wheat crackers with peanut butter
  • 1 slice whole wheat bread with either peanut butter or 1 slice cheese
  • ½ cup high fiber cereal with ½ cup low fat milk

The true meaning of the holidays

The true holiday spirit means being surrounded by loved ones and giving thanks for all of life’s blessings, including health.  And let’s be realistic: food is a big part of the festivities.  Having diabetes does not mean that you cannot or should not participate in such happy times; you deserve to enjoy your time as much as anyone else!  Using the Plate Method adds to the simplicity of managing your food portions and blood sugars so that you can spend more time enjoying the holidays.

And let us not forget the true meaning of the holidays: “We can only be said to be alive in those moments when our hearts are conscious of our treasures.”  ~Thornton Wilder

How do you simplify your carbohydrate portions, and keep your blood glucose on target during the holiday season? Share your ideas in the comments section!

For more information about holiday meal planning:

http://www.diabetes.org/food-and-fitness/food/planning-meals/holiday-meal-planning/?utm_source=WWW&utm_medium=GSA&utm_content=keymatch-Holidays&utm_campaign=CON

For more information about carbohydrate counting:

www.calorieking.com
www.dietfacts.com
www.myfooddiary.com

http://www.diabetes.org/food-and-fitness/food/planning-meals/carb-counting/

For more information about alcohol and diabetes:

http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/alcohol.html


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Posted by: Maria Curcio, MS, RD, CDE
Categories Glucose Monitoring, Nutrition, Special Occasions | Tagged , , , , , , , , , , , , , , , , , , , , , , |
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November 14, 2011

World Diabetes Day: Act on Diabetes. Now.

Today is World Diabetes Day. 300 million people have diabetes and there are many more who are unaware that they have it. It is silent and does not discriminate.  You can safeguard the health of family and friends through a routine blood glucose test.  When high blood sugars are detected early, diabetes can be avoided or delayed along with its complications. Add your voice to increase diabetes awareness to ‘Act on Diabetes. Now’. The International Diabetes Federation represents over 170 countries whose 5-year focus is to increase diabetes knowledge through education that empowers those who live with this condition.

To learn more:

http://www.idf.org/worlddiabetesday/2009-2013

http://www.diabetes.org/diabetes-basics/prevention/


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Posted by: Maria Curcio, MS, RD, CDE
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