My husband was diagnosed with diabetes as few months ago and has been working hard to lose weight and control his blood sugar.  Each year we have a family gathering for thanksgiving that includes lots of food (large turkey dinner with all the trimmings and assorted pies & cakes for dessert).  What are your suggestions to ensure my husband doesn’t overeat but also does not feel deprived this Thanksgiving?

Turkey time is almost here! The holidays are upon us, which to many, may mean a time to pull out the stretchy pants.  For those with diabetes, it can be  mixed feelings of delight and after-meal guilt. It does not have to be this way however. Portion control and counting carbohydrates are the best ways to enjoy a little bit of everything without making your glucometer cry.

I do believe it is okay to indulge a little during times like this. It is a time to be surrounded by friends and family to eat and enjoy yourself. Just plan ahead. If you know that sweet potato casserole is your absolute favorite, make this one of your carbohydrate choices (15 grams of sweet potato= 1/2 medium potato) and skip perhaps, the mashed potatoes. Although the recommendation is 3-4 carbohydrate servings per meal, you can try to spread additional carbohydrates at a later time. Just make sure that you pair it with a protein or fat.

Turkey, the star of the feast, is a protein and has a neglible amount of carbohydrates. You consider this a “free” food in glucose control.  Having a good serving with your meal will also make you feel fuller faster, decreasing your craving for starches and sweets.

Do not skip meals. Many feel that by skipping breakfast or lunch in anticipation of a huge Thanksgiving dinner, will allow them to eat more during the feast. If you do this, your blood sugar will dramatically fluctuate. Spacing out three even meals will keep things under control and prevent you from dropping or spiking.

Push fiber. The more fiber a food has, the less it will raise your sugar. Green beans, sweet potatoes, acorn squash, and whole grain stuffing all are rich in fiber.

Having diabetes puts you at higher risk for heart disease, so be heart healthy conscious too. If you are cooking, try to reduce the amount of butter you use, use reduced fat milk, avoid a lot of heavy cream, and research recipes that cut down on the fat.  This will help cut a large amount of calories too.

Bring a sugar-free dessert. If you know you can’t resist digging into the sweets, there are several recipes to try that will have a lesser impact on your blood sugar. Check out http://splenda.tastebook.com/ . If no sugar-free desserts are available, that is ok. Take small amounts, and  only eat after you had a protein beforehand, such as turkey or ham.

Take a walk! Go out for a stroll in the crisp autumn air with your friends or family. Exercise will help lower your blood sugar after a carb-heavy meal.

Always check your blood sugar, especially on this day. When you are off of your typical routine and are spending most of the day snacking, it is good to to keep track and adjust your intake that day accordingly.

If you do “fall off the wagon,” do not beat yourself up. Just get back on track for black Friday, so you feel energized to hit the shopping!

  Happy Thanksgiving!

I have diabetes and work long hours.  I usually eat lunch at my desk while working.  I’m struggling with what I can have for lunch.  Could you give me some tips on what to pack for lunch at work?

I can relate! Despite even the best intentions to eat healthy, lunch time is tough when you are faced with work-day challenges and deadlines.  There are ways to overcome and conquer, however. Now is the time to embrace the art of meal-planning.

What I have found often helpful is preparing my lunch the night before.  It takes a few minutes of your time, but saves you from scrambling for carb-friendly choices in the morning.  Prepare sandwiches with whole wheat bread. Toss a salad together with grilled chicken, mixed greens, and non-starchy vegetables. If you would like to pack left-overs from the night before. make sure you portion your meal so that you are consuming no more than 3-4 carbohydrate choices, whether it is bread, rice, potatoes, pasta, or fruit. Remember 1 serving of carbohydrate is 15 grams.

Try to keep your meal balanced when planning. Always include a source of protein with your meal, as it slows down the rate of glucose absorption into your blood stream. It will also give you a greater feeling of satiety before you tackle the rest of your day. Examples are poultry, lean meats, nuts, eggs, or tofu.

Make one of your carbohydrate choices a piece of fruit, because they are easy to throw in your lunch box and contain nutrients and fiber that something quick from the vending machine does not.

Frozen dinners can be very convenient, however always read nutrition labels before purchasing. You want ones that are reasonable on the amount of carbohydrate, sodium, and saturated fat. Try to aim for ones 45 grams of carbohydrate or less.

If you are extremely strapped for time, break your meal up into smaller snacks. Incorporate your carbohydrate snack with a protein or healthy fat to prevent your blood sugar from spiking and to keep you from getting too hungry. Examples are fruit with a handful of nuts, or crackers with cheese. There are tons of products in your grocery for healthy on-the-go snacks such has cheese sticks, yogurt, cottage cheese,  or the 100-calorie packs of whole grain crackers.

With a little planning you may find yourself surprised at your increased energy level and improved glucose control for the rest of your day. In addition to bringing healthier choices with you,  stealing away from your desk to take a brisk walk around your building or up the stairs will further boost your energy and further improve your blood sugar readings.

My husband has diabetes and we always eat whole wheat bread but wanted something different for a change.  Is rye bread or sourdough bread as good of an option as whole wheat?

There are so many breads out there to choose from, it’s easy to find yourself stuck on the bread aisle pondering over things like, “which is the healthiest?” “which has more fiber?” “which has more carbs?” Although you may already know that wheat bread has more fiber and other nutritive benefits than white bread, I do have interesting news on rye bread.

According to the Lund University Faculty of Engineering, it has been recently discovered that consuming rye flour results in better blood glucose readings than compared to wheat flour. This is thought to be because wheat promotes a slightly higher insulin response than rye, which is impaired in diabetes. The American Journal of Clinical Nutrition reported another study that had similar findings. It also explained that rye is digested slower than wheat, another reason blood sugar readings were better with rye.  Although the rye we purchase here in America is made up of several types of grain, a variety of whole grains is actually recommended to receive the best nutritive benefits.

I am definitely still a pro-wheat dietitian, however you do have other options when looking for healthy grains.  The secret here is to always check ingredient labels for “whole grain,” that is, the whole kernel is incorporated. Other examples of whole grain besides wheat and rye are multi-grain and pumpernickel. Sourdough may or may not be made with whole grain, it is just dependent on the manufacturer.  The less processed and refined, the better. Check your ingredient labels and keep an eye on the carb count to know how much to serve yourself.

Check these out for more information!

http://www.sciencedaily.com/releases/2010/02/100212210212.htm

http://www.sciencedaily.com/releases/2010/02/100212210212.htm

I have diabetes and I’m having trouble staying consistent and motivated.  I’m usually good for about 2 weeks and then I go back to my old ways of eating and lack of exercise.  How can I stay motivated?

You are not alone. It is completely normal to fall back into old habits, or to ”fall off the wagon”.  Being diagnosed with diabetes is a life-changing event, and it often means a lifestyle change. Your current habits did not develop overnight, so it’s understandable that a new and improved lifestyle takes time too. Remember that by making these new habits you are taking charge of your health, something no one else can do for you. By doing so you are extending the quality and years of your life down the road.

Evaluate your current 2-week periods of healthy eating and exercising. Might you be restricting too much? Expecting too much from yourself too soon? Is it something you can realistically maintain with your schedule? These are questions to ask so you can figure out what is manageable.

This being said, I am definitely not saying that a healthy lifestyle is not maintainable. It is! The secret is baby steps. If you can’t get out and exercise every day at first, it’s alright, try every other day. Look at your schedule and see how exercise does fit in. Maybe you don’t have time to walk an hour at a time  but you can break it up 30 minutes in the mornings and 30 minutes in the evenings. This may feel more manageable and be easier to keep up with.

If you restrict your diet too much at first, you’re much more likely to feel deprived and want to eat more than usual later, which is harmful to your blood sugar.  You may also feel deprived if you are cutting back too much on carbohydrates and fats, which contribute to a sense of satiety.  Remember women can have 2-3 servings and men 3-4 servings of carbohydrates (1 serving=15 grams) each meal. If you incorporate healthy fats such as nuts, avocado, canola oil, olive oil, or maybe a little slice of butter you may also feel more satisfied In addition to protein, fats do not raise your blood sugar.

Maintaining healthy eating habits takes practice before it becomes routine. Planning your meals ahead of time is an important time-saver step, so you can grocery shop and cook when it is convenient for you. Once you become accustomed to this, it is common for to find unhealthy foods that you used to crave aren’t appealing anymore, and may even make you feel sick.

When it’s all said and done, a new healthy lifestyle takes committment, and practice. No one is perfect all the time. Taking small steps to reach your new lifestyle goals of diet and exercise will help you meet your goals and will more likely be maintained. This is a much better alternative than trying too much at once and then later feeling guilty for not keeping up with it.
Whenever you lose motivation, remember that YOU are taking charge of your life, and preventing these problems from slowing you down!

I attend a monthly book club with friends that includes a dinner potluck in which everyone contributes a dish.  I have type 2 diabetes and I struggle with what to eat at the potluck.  Could you offer me some tips?

I love potlucks. You often get a wide variety of recipes to try, and possibly some to add to your own repertoire if people share their secrets. It can, however, be unpredictable when it comes to carb counting and monitoring your blood sugar. Fortunately there are several ways you and your palate can still enjoy yourselves and not let it show in your blood sugar levels. It just takes a little planning and forethought.

 Eat a little something before you go to the potluck. This seems counterproductive, but it may spare you from being tempted to dive into some carb heavy choices you may otherwise couldn’t resist.

Be a trendsetter. Bring veggie trays and light salads that you know you can enjoy guilt-free, and others can too. By setting an example you might see more healthy choices the next time around.

Go for grains. Anything you see that has more whole grain, whole wheat ingredients rather than refined sugars means more fiber. If you don’t see much in way of fiber, this is where you can again be a trendsetter.

Examine your plate. You take a little of this, and a little of that, but what is the biggest portion on your plate? It should be non-starchy vegetables, such as a salad.

Be sociable. Visiting is a great way to slow down your eating, which gives you time to feel full when you are actually full. If you allow the hungry beast within after a long day take over, you will eat faster and more of it.  This is where eating a little bit at home first can again help.

If you are dying for dessert, make room. They are understandably tempting, especially at a potluck. If you got to have it, that is okay, just keep it in mind when eating your meal. Make room for it in your carb selections so that you do not exceed  2-3 servings if you are female, or 3-4 servings if you are male.

Last but not least, have fun! You may discover you are not the only one that is diet conscious, and you may find someone to share new diabetes-friendly recipes with.

I was just told I am type 2 diabetic.  My doctor told me to try to control my numbers by diet.  I have noticed my blood sugar is high in the morning before I have eaten.  Could you explain why?

Although it seems ironic and kind of unfair for your blood sugar to be high before you’ve even had breakfast, it is not at all uncommon. Having high blood sugar when you wake up is commonly known as the “dawn phenomenon,” or “dawn effect.” It typically raises your blood sugar anywhere from 10-20 mg/dL from around 2am to 8am.

Why does it do that? Our bodies can naturally release growth-hormones at night, including glucagon, epinephrine, and the stress-hormone cortisol. These hormones trigger the liver to release more glucose, while  at the same time cause the cells to be more insulin-resistant. This combination leads to hyperglycemia, and is why you’re frustrated when reading your glucometer in the morning

There are also other reasons for high blood sugar in the mornings. Eating carbohydrates before bed, taking insufficient insulin, or an incorrect dosage of medication before bed can also contribute to this problem. Your doctor may ask you to wake up at 2 or 3 am to test your sugar, so that he might determine if your high blood glucose is related to the dawn phenomenon or something else.

The best dietary method to prevent the dawn phenomenon is avoiding high carbohydrate snacks right before bedtime, and monitoring your carb intake throughout the day. It is okay to have a carbohydrate as a snack if it fits into your daily carbohydrate allowance, just pair it with a protein or a fat to slow down the rate of glucose absorption. Eat your dinner or snack earlier in the evening rather than right before bed.  If you are still having difficulty, notify your doctor.  An adjustment in your medication timing or dosage may be needed.

It’s even prettier when you got good morning blood sugar to start the day with!

I have diabetes and a coworker was telling me I should be taking supplements such as cinnamon and chromium to help control blood sugar.  Are these safe and effective?

This is a great question. There has been an abundance of research conducted on these two forms of supplements because of their potential to improve blood glucose control.  Cinnamon has been found to delay gastric emptying, similar to the effect of fiber. When it takes longer for your food to empty from your stomach, it tends to prevent a dramatic spike in your blood sugar. Chromium, on the other hand, is a natural regulator of blood glucose in the body. It is often found to be actually deficient in those with diabetes, and appears to be beneficial when provided as a supplement.

So are the safe? Effective? My recommendation is to be careful when using supplements. Although some studies have found them to be effective, much more research must be conducted to determine adequate and safe dosing, side effects, and interactions with other medications. Everyone is very different and has their own healthy history, so these supplements can affect people very differently.  This does not mean you cannot try them, but make educated decisions. Do not take more than the recommended dosage, and check with your doctor before starting them.

Also keep in mind that it may take a while before any benefits appear.  One study found that chromium and cinnamon had no effect on glucose control until after 12 weeks. Remember that the best thing you can do for yourself, more so than any supplement, is eating right, exercising, and living a happy and positive lifestyle.

Examples of what you will see on the market.

Source:
Anderson, Richard. Chromium and Polyphenols from Cinnamon Improve Insulin Sensitivity. USDA. 2008.
http://etmd.nal.usda.gov/bitstream/10113/17044/1/IND44053555.pdf

I have type 2 diabetes and travel quite a bit.  My eating & exercise are unpredictable at best when I travel and I’m having a difficult time managing my diabetes.  What do you suggest?

This can be difficult, but it is not at all uncommon. Having a busy schedule such like this  might mean a little extra planning when you have diabetes, but it is certainly manageable.

Here are some tips to keep in mind when facing an unpredictable schedule when traveling:

Maintain regular physical exams with your doctor. Busy or not, getting regular exams is a must and can help you prevent major complications down the road.

Always carry a letter from your doctor describing your condition and what medications you are taking in case of an emergency. Carry your prescriptions on you as well, in cases of lost luggage.

If traveling long distances by air, request  diabetic-friendly meals about 2 days ahead of time. Many airlines will accomodate this. 

Pack snacks of your own. Preparing your own healthy snacks will keep your blood sugar from dropping and prevent you from grabbing a bag of chips or sweets from the vending machine.

Work your exercise into your day, rather than fretting about not making it to the gym. Waiting for a flight? Take a stroll around the airport. Driving? Make stops as you can in safe rest areas to stretch your legs. In a hotel? Some hotels have work-out areas or swimming pools. At the very least, you can always take a walk.  Just make sure to wear comfortable shoes to avoid any feet injuries.

Don’t skip breakfast. Although you are busy, skipping the most important meal of the day can set you back. Make time to get a nutritious breakfast and your blood sugar is less likely to sky-rocket later in the afternoon. If you must, eat something portable on the road, such as a tablespoon of peanut butter on a piece of whole-wheat bread.

Be conscientious when dining out. Traveling usually means a lot of  restaurants and fast food chains. You can make healthy choices by picking grilled or baked options instead of fried, choosing low-calorie dressings, and monitoring your carbohydrates by keeping the healthy plate model in mind (see my first post).

I just been diagnosed with diabetes.  Doctors say I have uncontrollable diabetes any tips on how I can get my sugar level down?

A huge positive aspect of diabetes is that you can have control of the disease rather than it control you.  By taking charge of your health you can prevent complications and improve your quality of life. You have the reins here, not the diabetes!

 Uncontrolled sugar can cause  damage to your eyes, kidneys, nerves, and lead to  heart failure, so it is essential  to get it controlled, and quickly. Fortunately, you can control your uncontrolled sugars. The first step is to evaluate your current lifestyle. Here are some tips to improve your glucose levels:

1. Limit carbohydrates per meal to 2-3 servings for women, 3-4 for men. Remember 15 grams is one serving. (See previous post on carbohydrate counting for more information)

2. Pick carbohydrates that are high in fiber, which does not raise your sugar and is good for your heart.  This includes whole grain breads, cereals, brown rice, fruit, and vegetables.

3. Get moving. Taking a brisk walk will lower your levels if too high. Regular physical activity is important for keeping sugar levels low and losing excess weight. If you lose weight, you may see significant improvements in your overall symptoms.

4.  Use artificial sweeteners instead of sugar. This includes switching to diet soda, or sweetening your tea or coffee with Splenda, Equal, Stevia, or Sweet-n-low, your choice.

5.  Read food labels. Becoming aware of what you eat, especially the carbohydrate and sugar contents, is a great way to make smart choices. Make sure you remember that the  nutrition facts label indicates the content per serving size, which will be listed at the top.

6. Stay hydrated. Avoiding dehydration prevents glucose levels from becoming too concentrated. It also flushes your body of toxins, keeps the kidneys healthy, and improves skin appearance.

7. Take your prescribed medications as directed. Missing doses, or taking insulin incorrectly can be dangerous. Consult your physician with any questions you may have regarding your medications, and make it a habit to take them as scheduled.

8. Avoid excessive stress, if possible. In our busy lives this is definitely easier said than done, however mental stress will raise your sugar. Physical stress, such as an infection or other illness, will also raise your levels. This is why it is important not to wait too long before seeing your doctor if you become ill.

Making a big lifestyle change can be difficult, but you are worth it. Your health is precious, and by starting now to regain control of your blood glucose will dramatically effect the rest of your life for the better. Think also of the positive example you will set for others who are in your shoes by making these changes. You can do it!

 Uncontrolled blood sugar is serious! Avoid these complications by taking control.

I have type 2 diabetes and am confused about carbohydrates.  Are all starches out completely?

Good news! Starches are definitely not out. I am a firm believer that elimination of any food group is not the way to go. While it is true that you must watch your carbohydrate intake (including starches) if you have diabetes, this does not mean you cannot have them ever.

Carbohydrates break down into glucose, which is a source of energy for our bodies. You still need some carbohydrates to maintain your blood sugar levels, whether you are diabetic or not. If you eliminate starches, which include whole grain breads, rice, starchy vegetables such as potatos, corn, or lima beans, and cereals, you will be eliminating a lot of essential vitamins and minerals and fiber, important for heart health. Starches also include your sugary baked goods, like cookies and cakes. These are higher in fat, sugar, and lack nutrition, so these should be limited.

Remember to keep in mind that your carbohydrate allowance per meal is 2-3 servings for women, and 3-4 for men. When eating starches, it is best to aim for the complex carbohydrates that add fiber, which include the whole grain breads and cereals, brown rice, fruit, and vegetables. Fiber itself does not raise blood sugar, so picking carbs with a higher amount of fiber tend to be better and not to mention more satisfying than one that does not, such as a sugary cereal or piece of cake.