Diabetes Education Voices

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

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