Diabetes Education Voices

Maximize your ZZZzzs

It isn't often that I hear "Sure, I've had enough sleep." Most people are running on empty: their batteries and tanks are not recharged when they start another day. It is a feeling I have had all day after listening to three great bands last night...in bed way too late, off schedule and feeling like a bear not quite out of hibernation--slow and not focused.

As an essential element of health, sleep is something that we need every night (if you are lucky enough not to work the night shift). Sleep is necessary for the health and development of our brain. Lack of sleep affects many organ systems. The science is fairly young, but there are some points that are known to be important. There is some data to suggest that sleep deprivation may increase risk for diabetes and affect glucose control.

Two hundred years ago if you were having difficulty sleeping, you could have gotten up, lit a candle and had a glass of milk. Today you have other options, but you also have many more diversions from sleeping.

There are many sounds not associated with the night: traffic, sirens and sounds from industry. TVs and other media are enmeshed in our lives. You might be watching a stressful or violent TV show just before going to bed or even worse, in bed.

Foods, caffeine and medication may interfere with sleep. Your Facebook page, chat rooms and interesting blogs may stimulate you and keep you from getting back to sleep. The more frequently that your sleep pattern is interrupted, the longer it will take to get it back to normal.  

Here are some tips for getting a restful night's sleep:

Test for your health!

Diabetes has an effect on your whole body...so in addition to checking your blood sugar daily, there are certain tests that you also need to have on a regular basis in order to maintain your good health. Here are some of them:

Hbg A1C – most health care professionals recommend that you have this test done every 3 months. This test tells you your average glucose for the past 3 months. A healthy A1C is around 6.5%. However, this is an average of your glucose numbers and it can be a little misleading. For instance, even if your A1C is at a goal of 6.5%, which indicates an average glucose of 140, you might still be experiencing wide swings in your glucose values. For example: glucoses of 55, 204, 42 and 263 is still an AVERAGE of 140 – and that is not exactly accomplishing the goal. It is important that you continue to monitor your glucose levels to achieve the goals you and your health care professional have established.

Lipids – this test should be done at least every 6 months. Elevated values increase your risk of coronary artery disease and stroke.

Blood pressure – you should have your blood pressure checked at least every 3 months or more often if it is abnormal or not well controlled. Many people buy a home blood pressure monitor so they can check it daily.

Eye exams – if you have diabetes, you should have your eyes checked once a year to make sure that if any problems occur they are caught quickly. You can take the guidance of your eye care specialist to give you more exact information regarding your individual condition.

Kidney tests – these should also be done yearly. Kidney health can be screened through a blood test or by doing a urine test.

Foot exams – people with diabetes should be checking their feet daily – often when neuropathy is present, problems may occur without causing any pain and so people are not aware of the seriousness of the problem. Often times, people with diabetes are instructed to take off their shoes at every health care visit, just so any problems can be caught early. It only takes a minute. Ask your health care provider to check for sensation in your feet at least one time a year. It is a good thing to know if the feeling in your feet is abnormal or absent.

There are other tests that your healthcare professional might recommend. Also, occasionally the frequency of these tests is dictated by what your insurance company will pay for (sad but true). Just make it your business to keep up to date with your tests, make sure everything is working the way it should be and if not, seek assistance in correcting the problems.

Remember, you are the best person to keep track of your health!

--Barbara

What's in what you eat out?

Nine out of 10 people underestimate calories in fast-food menus by an average of 600 calories. Even dietitians like myself have a challenging time trying to guess how something is prepared and trying to estimate calories, fat, or carbs.

If you have been to New York or Los Angeles recently, you may have noticed that the menus of restaurant chains now include a list of calories. Menu labeling is required in California, Seattle and New York City. Legislation has been passed, but not yet implemented in Maine, Oregon, Massachusetts, New Jersey, Philadelphia and three counties in New York state. Fifteen states, including Kentucky, have proposed legislation.

In Kentucky where I live, we are proposing a bill that would require chain restaurants that have 20 or more stores nationwide to list calorie information on menus. More detailed nutrition information would be made available at cash registers for customers who request it. Currently there are no requirements to provide consumers nutritional information.

Americans spend half of their food dollars eating out. We spent $156 billion on fast food in 2008. The fact is, people eat more calories when they eat out. Fast-food intake is associated with obesity, thus leading to an increase in Type 2 Diabetes.

Does menu labeling really make a difference? Would you look at the calories listed on a menu and would that influence your food choices? I have been to two restaurants where the calories were on the menu, and it was very shocking. I had to slow down and do some math before I ordered to make sure I wasn’t going to end up with a 1000+ calorie combination of sandwich and salad. It very much made a difference in my choices and I felt better after I ate it knowing how many calories I had for lunch.

Seventy-eight percent of Americans say they use these labels; 48 percent of these people say the information prompts them to make healthier selections. When calories are on the menu, parents order 20 percent fewer calories for their children. Studies in 14 scientific journals found that customers order an average of 52-105 fewer calories when calories are posted on menus. Cutting 100 calories a day saves 10 pounds of weight gain a year!

Fuel efficiency labels on cars, care labels on clothing and energy efficiency stickers on appliances are just a few examples of point of purchase information that has been mandated to protect consumers. Why should food labeling be any different?

I see this as the first step in being better educated about restaurant foods. Once calories are on all foods at restaurants, maybe they will be more open with making information available on carbohydrates. The more we know about the food we are buying, the better we can work it into our healthy meal plan.

If your state has not yet passed legislation, I encourage you to reach out to your legislators to start conversations about menu labeling. For more information about menu labeling, go to the Center for the Science in the Public Interest.

Until then, make healthy choices!

--Amy

Why do I need more than one medication?

When you have diabetes, keeping track of your medication can be overwhelming. There are so many medications used to treat diabetes and its complications, and more are released each year. And most of the time, people have to take a combination of meds to manage their condition.

One medication might be prescribed to treat pre-diabetes and on initial diagnosis of diabetes. And because diabetes is progressive—with insulin production and insulin sensitivity decreasing over time—your healthcare provider adds additional prescriptions to help maintain control of the glucose levels in your blood.

Different diabetes medications have different ways of working (we call it mechanism of action).

The ways that diabetes medications work to improve your glucose:

• Some drugs make your cells more receptive to insulin
• Some drugs make the insulin work better
• Some drugs make the pancreas make more insulin
• Some drugs decrease the amount of glucose your liver makes.

A plan to improve glucose control often includes a drug from more than one group or mechanism of action.

A very common misconception is that one medication will control diabetes or that once someone goes on insulin, they no longer need oral medications. This is not the case!

Because of the different mechanisms of action, even with insulin, it is common to take several oral medications to treat diabetes. (However, the oral medications that are available now are not effective for type 1 diabetes, so insulin and pramlintide are the main medications prescribed.)

Try to learn more about how your medications work. Ask when you get a new prescription if you should make any changes to your current medication plan. Continue the on-going discussions with your healthcare provider about your treatment plan.

And, of course, continue to make healthy lifestyle choices as part of your management plan. This includes: regular physical activity, control of carbohydrates and fats, and weight loss if needed.

--Sharlene

Gift ideas for your Valentine with Diabetes

Can you believe it's almost Valentine’s Day!!?? What to do for your sweetie?? Maybe it’s just your best friend or sister or mom – lots of people fit the description of who you want to honor on this special day.

And if that special person has diabetes, maybe you are looking for gifts that will show your affection AND support their diabetes management. However, it can be hard to find gifts that help them achieve their behavior change goals and won't throw off their glucose control.

Here are some gift ideas for your loved ones with diabetes: 

1. A gift certificate for a car wash. Every one likes a clean car, especially with all the weird winter weather we have had recently. It can either be from an actual place of business or maybe just a hand made certificate stating that you will clean their car for them, maybe a time or two, once the weather gets a bit warmer.

2. An “outing” to someplace they like. It can be someplace special for now, like maybe a special shopping trip or a certificate for in the future to someplace like an arboretum or botanical gardens once it gets warmer. They can also get in some exercise out in the warm sun.

3. Speaking of exercise, how about a membership at a gym? Now, guys – you need to be careful with this one. Make sure your sweetie does not think this means that you think she needs to lose weight. Maybe you can do a joint membership – as a way for both of you to get more healthy. Or think about treating your sweetie to a yoga class instead.

4. Jewelry is always nice. I like jewelry but I have young adult sons and I have learned from them that you have to be careful with jewelry, especially if it is a “new” relationship. If you are still not sure about the relationship, you don’t want to seem too committed – at least that is what I have been told!!

5. There is always a nice dinner out with flowers. Or with the economy the way it is, maybe a nice steak from the grocery would fit the budget better. It can be a lot of fun to plann a healthy meal and to grill out.

6. Items of clothing are good IF you know their size. If not, maybe buy a nice accessory like a soft scarf, a watch, or a wallet. 

Remember, no matter what you choose to give your loved ones on Valentine's Day, one of the best gifts is the gift of your time and friendship. Find something to do together and just enjoy each other's company.

Have a wonderful Valentine’s Day!!

--Barbara