Diabetes Education Voices

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

One of my favorite quick holiday dessert recipes...

Almost everywhere I go during the holidays, I find an abundance of holiday treats- at work, the salon, for gifts, holiday parties, etc. I am even invited to cookie exchange parties to take home more treats for later. Research tells us that if food is readily available we are more likely to eat it. If there is a large quantity of a particular food, we will eat more. For me it is so true, I really didn’t need a study to validate. Even as a dietitian, it is so easy to fall victim to temptation. For more information on food psychology, check out interesting research by Cornell University (http://foodpsychology.cornell.edu/research/overeat/index.htm)

While occasionally indulging on higher calorie and carbohydrate food is okay, it is best to plan for it and adjust your lifestyle. It may mean increasing your physical activity to balance out the extra carbs and calories, especially if you have diabetes.

If you have ever peeked at the nutrition facts on some of the classic holiday desserts, you will most likely have to pick yourself off the grocery floor! The fat and sugar content is very high, which is why those foods are so palatable. Sometimes I will give in and have a small piece of a rich dessert, but if I am cooking myself I try to find a recipe with some of the similar flavor notes to help satisfy my craving.

I have always enjoyed all things pumpkin and many recipes are loaded with sugar and fat. Below is a recipe I found a few years ago from Diabetes Forecast (http://forecast.diabetes.org/) that is lower in calories, fat, and carbs than most desserts. I have made this recipe numerous times for diabetes classes and support groups and it is always a hit. You mix the pumpkin mixture then layer it with gingersnap crumbs and whipped topping creating a trifle. I either make individual servings in little plastic punch cups or make it in a trifle bowl.

Make it and leave a comment and tell me what you think. Or feel free to leave other healthy holiday recipes.

Pumpkin Trifle

Prep time: 35 minutes

3 cups cold, fat-free milk
2 (1 oz) pkgs vanilla sugar-free, fat-free pudding mix
1 (15 oz.) can solid packed pumpkin
3/4 tsp ground cinnamon
1/4 tsp ground nutmeg
1/4 tsp ground ginger
1 2/3 cups ginger snap crumbs, roughly crushed (you can also use sugar-free ginger snaps)
1 1/2 cups fat-free whipped topping

Place the cold milk in a large mixing bowl. Slowly add pudding mixes while mixer is running. Scrape down the sides of the bowl with a spatula and beat for 2 minutes on high speed. Chill pudding in refrigerator for 5 to 10 minutes.

Add pumpkin and spices to pudding and stir well with a spatula. Set aside.

To assemble trifle, sprinkle 2/3 cup of ginger snap crumbs in the bottom of a large clear, glass bowl. Gently spread about 2 cups of the pumpkin pudding over the crumbs. Spread 1 1/2 cups of whipped topping on top of the pudding. ( You should see nice, neat layers through the sides of the bowl.) Repeat procedure with another 2/3 cup of crumbs and remaining pudding.

Top with 1 cup of whipped topping in a neat, decorative circle and sprinkle with 1/3 cup of crumbs for a garnish.

Chill the trifle until ready to serve.

Nutrition Facts
12 Servings, Per 1/2 cup, Carb Exchange: 1.5, Fat exchange: .5

Amount per serving:
Calories 135, Total Fat: 2 grams, Sodium: 352, Total Carb: 26 grams, Dietary Fiber 1 gram, Sugars 9 grams, Protein 3 grams

Taken from Diabetes Forecast, November 2004

-- Amy

Manage your holiday stress

Sometimes stress levels get so high that there is no room in your head to concentrate on what has to be done. That seems to be a universal theme during holiday time and large family gatherings. I’ve been feeling it myself and hearing about stress from my co-workers and my patients who are dealing with the holidays and diabetes management.

Now is the time when holiday tasks are added and people get overwhelmed. People tell me their glucose log is showing signs of holiday eating, but I wonder how much of the glucose elevation is due to stress.

How do you deal with stress? Is this an overwhelming time because of the added responsibilities? Making time for stress reduction activities now seems like it might be one more straw on the camel’s back, but...reducing your stress levels today can help you maintain healthy glucose levels and enjoy the season more fully.

First, try to identify what is causing stress in your life. Here are some options that might help reduce your stress levels:

1. Think carefully when someone asks you to do something. Say “no” if you do not want to do it.
2. Try to organize your priorities. Recognize what is important and what doesn’t really need to be done just now. Identify the pressures that you are placing on yourself.
3. At all times, and especially when you are under stress, it is important to find time to sleep. Try to go to bed at the same time every night and to get at least 7 hours of sleep.
4. Take care of yourself by eating well, taking your medications and finding some time for a walk or other activity.
5. Share work with others with whom you like to spend time. Cook together, clean together, shop together, walk, etc. Then, these tasks are more pleasant and you have a chance to visit while you work or achieve your daily activity.
6. Are you too busy “making” the holiday that you cannot enjoy it? Step back and consider what you want from the holiday. Make a date to hear holiday music, attend a religious gathering, or donate your time or energy to something important to you.
7. Schedule at least 30 minutes a day of pleasurable activity. This helps you to put things in perspective.

These are only a few of the options that can help you to problem solve and to reduce stress. It is holiday time and near the start of a new year. This is the time to make small changes and to start thinking about changes you wish to make for a healthier you. 

Find out more about the symptoms and effects of stress and some tips for managing stress.

Have a happy and low-stress holiday!

--Sharlene

Five tips for surviving holiday parties

It is hard to believe that we are in the midst of the holiday season! Now, not only is it important to make sure we are following our diabetes plan – we also have to find time to do our holiday shopping, decorate the house and attend lot of parties!!!

I LOVE the party part. I think that is the best part of the season – spending time catching up with family and friends and seeing how much our “little” nieces and nephews have grown since last year. I love hearing about their accomplishments – who had surgery – who is engaged – what cool trips family and friends have taken.

But the hardest part of all this is trying to watch how much and what we eat. Statistics show that most people gain anywhere from 1 to 7 pounds during the holidays! Yikes! It is a lot harder to take off than it is to put it on!!

Some holiday party tips I have found helpful are:

1. Watch your alcohol intake. If you are going to have a Holiday Spirit drink, make sure you mix the alcohol with diet soda. Trying to reduce the overall amount you drink is hard when you are out with friends – and gets even harder after you have had a drink or two. Sip slowly – do not chug your drinks. Drink a non-alcoholic beverage between each serving of alcohol. You might want to tell the waitress up front to help you limit your intake to 2 drinks.
2. Try to eat a light snack before you leave for a party. Eat some low carb, low fat foods that will fill you up and not totally destroy your glucose control. When you arrive, look the foods over, make comments about how yummy everything looks and go park yourself somewhere away from the table.
3. Before you go, think of some good questions you can ask to start a stimulating conversation. If you can keep yourself busy visiting, you will not be so apt to stand around the food table. Do some homework - if you know the person is a sports nut, check out how their favorite team is doing. Ask about vacations, family members, and work. If you have not been keeping up with the movies, browse the entertainment section of the paper so you will have some idea of what movies are out there and the basic content.
4. When appropriate, bring a low carb, low fat snack for yourself to share with others. I have had really good luck with substituting fat free mayo, sour cream and cream cheese in dips and dressings. Take a platter of fresh veggies and some high fiber crackers – often times, if you don’t tell them, no one needs to know it is actually a bit healthy.
5. If you blow it – remember that tomorrow is always another day. Don’t give up – if you overindulge, get more active. Clean out closets to make room for all your new “loot.” Put on peppy music and clean the house.

Have a wonderful, healthy and happy holiday season!!

--Barbara

Ways to stay active during the winter

As the weather turns cooler, it is important to have a plan for exercise. I live in Kentucky, and there are still plenty of days in December that are decent for walking outside in layers, but I know know that snow is already falling in several parts of the country, resulting in slick sidewalks.

As I have shared with our blog readers before, I am a gym goer for most of my workouts, so the cold weather does not have much of an effect on my workout. The cold winds just make it harder to muster up the motivation to leave my warm house to venture out. For those whose exercise plan is walking or running outside, the cold weather can keep some indoors the entire winter, waking up in March with a few extra pounds around their middle - and potentially causing havoc on blood sugars for those people with diabetes.

Even though your preference may be to walk inside, there are numerous things you can do indoors to keep up your exercise routine:

Treadmill - I know this is not a new concept, but having a treadmill is a wonderful way to still get your daily walk indoors. The price of treadmills have come down over the years and now is the time to ask for them on your Christmas list. You may even find a great buy on one at a used sporting goods store. If you have one in the house in a not-so-convenient place, move it to a better spot that makes sense for you. I had my husband rig up a little TV and now I watch some of my favorite hour-long TV shows and barely notice all the calories I was burning.

Exercise videos - There are thousands of great exercise videos out there for all levels. Some of my favorite are by Leslie Sansone (http://www.walkathome.com/). She makes the “Walk at Home” series that are sold at major discount stores. We show segments of them during breaks at our diabetes education classes. Most of the video is just four basic steps: march in place, small front kicks, step side to side, and knee lifts. If you want to see clips of a video before you purchase, www.collagevideo.com is a great site where you can see before you buy. They also have a specialty section for chair exercises (http://www.collagevideo.com/exercise-videos/seated-exercise-exercise-videos-47) if you have a hard time standing for very long. I call them every year, and they always send me a big stack of catalogs to hand out to my patients so they can see all the options in exercise videos.

Indoor walking - I know malls are very busy this time of year, but there are certain non-peak hours that are a little calmer and great for walking. Take advantage of the extended holiday hours by walking earlier or later at night in the mall. Many malls open their doors before the stores all year round, but during the holiday season they may open even earlier. Just leave your wallet at home, put on comfortable walking clothes and good shoes!

Gym - It may be helpful during the winter to join a gym on a month-to-month plan and resume your outdoor workout when the weather warms up. There is a trend in gyms to have a basic gym with just equipment and no group fitness classes at reduced rates. They advertise monthly rates at $10-20/month. In the city where I live, there are several churches who have very discounted memberships to the public for indoor walking tracks, basic equipment, or fitness classes. Plan to spend some time calling around to find a place nearby that fits your budget and interests.

I would love to know other ideas you have to keep up your physical activity in the colder months! Please leave your comments below!

--Amy

Quick tip for saving money on insulin

More people than ever are visiting their primary care office with questions about how they might save money on their prescriptions. Here's one tip that might help.

Some people who use insulin run out of insulin before the month is over - requiring them to pay another co-payment to get more insulin. Prescribers sometimes write the prescription for one vial or one pen, not knowing how much you need to get through the month. Being a savvy consumer can help you get the right amount of insulin and perhaps avoid extra copays.

If you take insulin, you can calculate how much insulin you need every month and let your prescriber know what you need. Your prescriber or your pharmacist can do this too.

Use this formula to calculate how many units of insulin you need each month:
Dose x How many times a day x 31 days/month=Number of units every month

Example 1: Rebecca D. takes 42 units of Lantus every night.
42 X 1 X 31= 1,302 units every month
(Dose X How many times a day X 31 days= Number of units every month)

Example 2: David S. takes Novolog 70/30 35 units twice daily.
35 X 2 X 31= 2,170 units every month
(Dose X How many times a day X 31 days= Number of units every month)

Example 3: Sam H. takes 15 units Humulin R three times a day with meals.
15 X 3 X 31= 1,395 units per month
Dose X How many times a day X 31 days= Number of units every month 

Calculate your own dose:

_________ X_____________X 31 days = _____________ 
(Dose X Times per day X 31 =  Number of units needed every month)

Once you know the number of units you use per month, you can follow the chart below to determine how many glass vials or insulin pens you need and ask your provider for a prescription for a month or 3 month supply.

 

This is just one way you might be able to save some money this holiday season!

--Sharlene

Diabetes Month Isn't Over Yet

As you know, November is American Diabetes Month--and it's not over yet! Did you do anything to acknowledge the importance of diabetes education this month?

American Diabetes Month is a campaign which was started to increase awareness and knowledge about diabetes. Diabetes is a patient-managed disease, so it is vitally important that people with diabetes receive high quality education that is tailored to their particular needs. This is a key role of Diabetes Educators (people like me, Amy and Sharlene), a group of highly skilled health professionals – to help those with diabetes to learn the needed information and skills to better care for and manage their diabetes.

Type 2 diabetes can be prevented in many cases by helping and encouraging those at risk to maintain a healthy weight and get regular exercise. Diabetes Educators can help you and other people with diabetes:

• Know the risks and warning signs of diabetes.
• Know how to manage your diabetes and be in control.
• Know how to locate and use your resources when you need help.

If your community did not have any programs promoting diabetes awareness, some things you might do next year include:

• Organize public information meetings, seminars, and workshops.
• Contact a local hospital, nursing school or school of pharmacy about providing speakers.
• Contact local churches, schools or community centers as locations for the meetings.
• Arrange for free screenings for diabetes and its complications write an article for your local newspaper sharing your experiences.
• Seek local “celebrities” who might be willing to share their success stories.
• Organize a walk to help increase awareness and raise money for much needed research.

Do not wait for next November to help others in your community who might not have as much information or know about available resources. Start now to help yourself and others in the fight against diabetes!

--Barbara