Diabetes Education Voices

Weight Loss Program Review

For those of you who had a New Year’s resolution to lose weight, by now you may already be back to old habits or on to your second attempt. I have friends and patients who see an ad on TV or the Internet and quickly jump to try it. We are always hoping for a quick fix and turn to the media for answers which can not always be the healthiest thing.

Of course, I am big proponent of seeing a dietitian individually to come up with a weight loss plan that fits your lifestyle. If you have diabetes, then you should make an appointment ideally with a Registered Dietitian (RD) and Certified Diabetes Educator (CDE). This specialization of being an “RD, CDE” is one way to tell that a dietitian has years of experience in counseling people with diabetes.

However, I am not against trying other weight loss plans and think there are several healthy ones out there. My recommendation time and time again for a classic proven weight loss program is Weight Watchers.

There are two things that stand out with Weight Watchers that make it so successful: ongoing support and the ability to eat ‘real food.’ In the 80s, I can remember attending Weight Watchers meetings with my mother and thought the group recognition and encouragement was really fun. It’s this weekly accountability that has been a huge part of their success rates. The concept of not having to buy special food helps with knowing what to do when you go out to dinner or to a party. It also is more economical in the long run if you can avoid buying special ‘diet’ foods.

There are a few things that I always caution my patients with trying programs like Weight Watchers if you have diabetes:

• The point system is set up to where you can save all your points potentially for one meal or have your points at any time in the day. If you have diabetes and are not taking medications or a set dose of medication or insulin everyday, then it is best to have consistent carbohydrates throughout the day. This means having about the same about of carbs for all meals and avoiding having large meals or skipping meals. With the point system, you have to look at which of your points that day are carbohydrate foods and space them out throughout the day instead of all at one sitting. The best thing to do is to plan out a few days of meals and count the carbohydrate and points for the meals.
• With a system like points, it gives you a lot of flexibility to choose what you want to eat, which can be wonderful. The downside is that it is up to you to choose to eat healthy foods. I would encourage you to choose whole grains, lean meats, low-fat milks, and fruits and vegetable with your points, especially if you have diabetes. You will also notice when you choose healthier foods with your points, you usually can have more volume of food because natural foods are more water and fiber-dense.
• As you start to lose weight with any diet, it is a good idea to increase the frequency of testing your blood sugar. Carrying excess weight is hard on your body and can make you more insulin resistant. When you start to lose weight, your body can be more sensitive to insulin and your oral diabetes medications. Long term this is great, but short term, you may experience more low blood sugars. If you are monitoring more frequently, you can see the trends in your blood sugars change and also see how low your blood sugars are getting. Notify your doctor when you start to notice these changes as your medication or insulin may need to be adjusted.
• Although the staff at Weight Watchers or other weigh loss centers can be very knowledgeable and most have done the program for years, they are usually not health professionals. For questions about their program you can ask them, but for any questions related to your diabetes, cholesterol, special health condition or food allergy, it is best to talk to your dietitian and doctor.

If you are currently in a Weight Watchers program and would like to network with others who have diabetes, I found this online site.  Are you currently trying a specific weight loss program or Weight Watchers? Please leave your comments or success stories below!

--Amy 

What's on your winter reading list?

For me, winter is a time to spend more time at home (thankfully!), and to delve into many books that have been on my reading list all year. My library and book store are a bottomless source for good reading.

Last month, I saw a woman who told me about her new route to improve her diabetes. She had gone through a long period of trying to lower her glucose, but her A1C remained over 10%. She found a book called Dr. Neal Barnard's Program for Reversing Diabetes, read it and started to incorporate some of the guidelines into her daily plan. And…she started to see improvements.

The same week, I found the book at my local library and decided to learn more. Dr. Barnard has evaluated and assimilated the current research of methods to improve diabetes – in short, he talks about what works. His plan suggests high fiber, low-fat food intake, a vegan diet and supplements that have been shown to be important in diabetes. Activity is also mentioned. Obviously, my client responded to the plan he outlines and has made progress.

But this plan may not be the one for you…or maybe it will be. Everyone is motivated by different things. Reading anything can introduce us to new ideas and concepts we have not considered. There is a lot to read out there. Visit your local bookshop or book websource, have a cup of tea and browse the diabetes-related books, and other books and magazines, too.

A few of my recent reads: Your Brain After Chemo, Our Life in Gardens,  Homer and Langley, and Strength in What Remains.

I have great thanks for the library and library supporters (people, foundations and government) for finding shelf space for some of the books that I read. My shelves are groaning and cannot fit one more book!

I encourage you to make use of these cold days and curl up with a good book. It could end up being good for your health!

--Sharlene

Feeling overwhelmed? I am.

I love the holidays, but this year it was just a bit too much. Everything just seemed to hit at the same time.

First, there were the typical Holiday preparations - putting up decorations, buying gifts for family and friends, baking a few Christmas goodies, and trying to participate in a few holiday events to get into the mood.

At the same time, my youngest son reported to boot camp in mid-December, so I spent a lot of time helping him get ready and organized.

On top of that, my 88 year old mother had her knees "fixed" - I am still not sure if they were actually replace or just repaired because I never got to talk with her doctor. My sisters and I took turns staying with her at the hospital, helping her with meals, and keeping her entertained.

My family put off Christmas until she got home. On the day she was to be dismissed, I went to her house to get it ready - she had been in such pain for the past 8-12 months that she had put off basic house cleaning chores. So, I cleaned the bathrooms, mopped the kitchen, stripped the beds and opened all the windows for a good airing out – all while started to prepare our late Christmas dinner.

My sister was supposed to pick up my mom from the hospital, but – can you believe it?? – she called to say she thought she broke her ankle and was on her way to an ER.

Thankfully, my family is all doing well…but man, these past few weeks were an emotional roller coaster.

All this activity certainly makes it challenging to continue to eat right - some nights it is very tempting to just grab a couple of burgers, but I don’t want to fall into that trap. I have been using more prepared meats and supplementing them with frozen or fresh veggies. I try to include salad at every evening meal – at least that comes washed and chopped, making it easy to dump on a plate.

Gym time has also been cut way back, so I have been trying to work extra activity into my daily routine by parking even farther away at work, taking the stairs whenever possible, walking over memos rather than calling, taking an extra spin around the grocery rather than going straight to my items. It remains a daily challenge to try to follow a healthy life style but definitely worth it in the long run.

When I start feeling overwhelmed with all of the things going on in my life, I just turn on the T.V. and see all of the horrible news coming from Haiti. It helps to remind me that no matter how bad I think my life is, it could be worse, and I’m trying to find ways that I, in my small way, can help.

--Barbara

Stay Safe this Winter

In many parts of the country, a white blanket of snow is covering the ground. While it can be beautiful, there are some things to keep in mind to protect you from illness and the dangers of winter weather.

1. If you enjoy cold weather sports like skiing, be sure to bring a friend with you. Make sure your friend knows your symptoms of a low blood sugar such as dizziness, sweating, slurred speech, and shakiness. Bring some glucose tablets in your jacket in case the added activity has a lowering effect on your blood sugar. Wearing a diabetes medical identification bracelet is always a smart idea.
2. If you find yourself shoveling snow and you are not used to that level of activity, you blood sugar could potentially drop up to 24 hours after increased activity. You may want to monitor your blood sugar a little more often that next day to catch your blood sugar from falling too low. Read some tips for snow shoveling.
3. If you have peripheral neuropathy (nerve damage), talk to your doctor about participating in winter sports or being outside for a prolonged period. With peripheral neuropathy, comes decreased circulation and you could be more susceptible to frost bite.
4. Be sure to dress in layers covering exposed skin. Check your layers, especially socks for wetness and change into dry clothes to prevent chaffing.
5. Have gallons of drinking water in storage in case your pipes freeze and the water is turned off.
6. You may want to invest in a generator for your house. Last winter, in Kentucky, we had an ice storm that weighed down power lines and we had massive power outages. Some people were out of power for several days in freezing temperatures.
7. It is important to have food supplies for you and the members of your family in case you are snowed in for a period of time. Stock up on shelf-stable things like packs of tuna and chicken, canned beans and vegetables, puddings, dried fruit, powered milk, peanut butter, and soups. If you have an additional freezer, it would be good to buy extra healthy frozen meals and bags of frozen vegetables. To my patients with diabetes, I recommend having a supply of meal replacement supplements like Glucerna. Meal replacement drinks have a long shelf life and provide balanced nutrition. There are both bars and drinks.
8. Now is a good time to check inventory of your medicines and insulin to see if you need refills.
9. Keep your skin moisturized. Find a good body lotion that does not have irritating fragrances. I use a basic all over body moisturizer and then I have a thicker hand lotion to prevent cracked skin since my hands get dry from washing them frequently. It is very important for someone with diabetes to take good care of their skin. If blood sugars are elevated, it will be harder to heal cracked skin making it more at risk for infection. Humidifiers are great to have indoors in the dry winter months to keep skin hydrated.
10. Blood glucose monitors and strips are sensitive to cold temperatures. Most meters and strips have an ideal temperature range of 20-104 degrees Fahrenheit. Make sure you do not accidently leave your meter in your car. If you do happen to leave it there, run a control test (with control solution) to make sure your strips are not damaged.

Read more winter weather tips.

Enjoy the winter, and stay safe!

--Amy

Faith in Diabetes Management

Several times a week, I hear people refer to God or faith in relation to their health. It might be something like, “Thank God” or “I’m going to pray about this.” Recently, I’ve been thinking about the role that faith plays in diabetes management. Two new patients came in my office independently last week, and each had something to say about their health and faith-based beliefs.

Everett, a recently retired guy in his early 60s has had poorly controlled diabetes for several years (A1C-10.2%). He came in for diabetes education because his doctor asked him to, but also because he is searching for ways to avoid the use of medications to control his diabetes.

The doctor has prescribed medications more than once, but Everett has chosen not to use them. This time the doctor’s message was that his diabetes needs treatment NOW, so that motivated him to my office.

I asked if he had started one of his prescriptions - even though two or three medications might have been needed at this point. He answered that he had not started the medication because he believes that his faith in God can help manage his diabetes, and he shouldn’t need any medication.

His response didn’t surprise me, but it made me ask myself a few questions. Why hasn’t he had glucose control in the last few years if he is truly faithful? Must we ask for help to change the situation? What about the provenance of modern health care, medications and treatments: might these be within the realm of your faith? I sure can’t answer these questions, but it feels like blasphemy that I am typing the words. I believe that prayer, faith, and religion CAN have very positive effects on health.

Whether it is the power of positive thinking and problem solving that we are doing when praying or the power of our faith to improve our being – prayer, faith and religion can help health outcomes.

In Everett’s case, I encouraged him to follow his faith, his healthy eating plan, and to add activity. If there is not an appreciable improvement in glucose control in 3 months, I’ve asked him to strongly consider the divinity of prescription medications and other health care interventions that could make a difference.

Different people bring different backgrounds, experiences and beliefs to their health management. Another patient of mine, Clara, discussed how her faith influenced her diabetes management. She said, “I get strength to take care of my diabetes everyday. God helps me through this and has given me so many opportunities to take better care of myself through my doctor and you and my family.” She was opening new doors to take better care of herself, and in her view, “We don’t always live up to his model.”

Once again my work has brought light to my life. It has helped me to ask questions, to accept help and to be open to interventions from wherever they come - in health, in work and at play. In this New Year that we are lucky to begin, I hope that you find answers that fulfill your life and improve your health and relationships...from wherever the providence.

--Sharlene