Food Label Reading Made Easy

Don't you ever wonder which cereal truly helps to lower your cholesterol? Or what exactly "sugar free", "no sugar", "net carb", "low carb" and just plain "regular" means? Why is 2% milk referred to as "reduced fat" when years ago it used to be called "low fat"?

Are we confused or are we made to feel that way? Don't feel alone. Here are my top 10 pointers for reading and understanding the food label:

1. What is the serving size? Do you realize that the serving size for a pickle is for ⅓ of a large pickle. Are you eating the whole pickle or even two pickles? Therefore, the sodium is 3 times higher if you eat the entire pickle (which is highly likely).
2. What does 42 grams of protein mean when I am looking at a can of tuna? I am told to eat 3 ounces of protein at lunch so how does that translate? Every 7 grams of protein is equal to ONE ounce. There are 6 ounces of protein or 42 grams in a can of tuna. Divide 7 into 42 = 6.
3. If there's 8 grams of total fat and 3 grams of saturated fat where's the rest of the fat coming from? 5 grams would be coming from monounsaturated or polyunsaturated. Trans fat is now required to be listed under total fat.
4. If I have diabetes, do I have to just watch the sugar? Total carbohydrates include the fiber and sugar and other carbohydrates. Everything except the fiber breaks down into sugar. The sugar listed is natural or processed sugar.
5. How do they figure out the calories from fat? There are 9 calories of fat per serving. Multiply the grams of total fat by 9 and round it to the nearest number. 8 grams of total fat x 9 calories per gram = 72 or 70 calories from fat.
6. Why is ice cream referred to as "no sugar added" instead of "sugar free"? Sugar free products means there is no natural sugar or processed sugar in the item. For ex: a cookie is sugar free because the sugar is replaced with sugar alcohol - the part you are not being told about is that the flour in the cookie breaksdown into sugar and will effect blood sugar levels. Ice cream is referred to as "no sugar added" because, although the sugar is still being replaced by the sugar alcohol, milk contains lactose (milk sugar) so sugar is naturally occuring.
7. What's my budget of sodium, fat, saturated fat, etc. for the day? If you look at the box within the label you will see the recommendations for people on a 2,000 or 2,500 calorie diet. If you eat fewer calories then you can deduct an estimated amount or see your dietitian for precise recommendations for you.
8. I bought light olive oil. What's the benefit? Light olive oil may be lighter in color. If you compare the total fat on all kinds of oils, you will find that there is always 14 grams per tablespoon serving size. This is true whether or not it is light or regular. If you are ever unsure of a product, pick up another similar product and compare. The breakdown of fats, whether they are from saturated, monounsaturated or polyunsaturated may be different on the label of various types of oils.
9. When a food is labeled "whole grain" or "can help lower cholesterol" what should I watch out for? Look out for the sugar, brown sugar syrup, high fructose corn syrup, honey and a long list of ingredients. The sugar added to cereals diminish their worth. Try plain oatmeal and add fruit (natural and higher nutritional sugar).
10. Why is my 2% milk called reduced fat instead of low fat? Low fat foods must be 3 grams of fat or less per serving. 1% milk meets that criteria with 2.5 grams of total fat per serving (8 ounce glass).

People at Risk for Diabetes

March 24, 2009 marks the 21st Annual American Diabetes Alert Day. The statistics are staggering: 8% of our population has diabetes. Approximately 90-95% of those with diabetes have Type 2 and 5-10% have Type 1. However, due to the prevalence of obesity among children, 45% of the youngsters with diabetes have Type 2 (previously known as the "adult diabetes"). Over 23 million Americans have diabetes and 57 million have pre-diabetes.

Diabetes could lead to heart disease, stroke, blindness, kidney disease, nerve damage and even amputation. There are treatments and many of them are within your control, if you learn how from your support team of health care providers and diabetes educators. If you have pre-diabetes, you may be able to slow down the progression of, or even put to a halt to, diabetes if you address it early enough. Properly managing your diabetes may reduce or delay the risk of developing diabetes-related complications. It is also possible to avoid diabetes if you know the risk factors and follow good diet and exercise programs.

American Diabetes Wholesale, in support of the American Diabetes Association, wants to alert those people with and without diabetes about the seriousness of this disease. Many people have no symptoms of high or low blood sugar, and they tend to disregard their disease until complications arise. Some people may unknowingly have pre-diabetes and don't find until out after it has already progressed to diabetes and done damage to the body.

Some factors that increase the risk of developing diabetes:

1. Overweight, sedentary, over 45 years old, family history of diabetes
2. African American, Latino, or Native American ethnic groups
3. Having had gestational diabetes (diabetes while you are pregnant)
4. Having PCOS (polycystic ovary syndrome)

Some conditions associated with diabetes include: high blood pressure, high triglycerides, low HDL (healthy) cholesterol and high LDL (unhealthy) cholesterol. Request an HbA1c test from your doctor at your next annual physical exam. The HbA1c test indicates your 3-month average blood glucose.

Go to American Diabetes Association for more information and take the risk test. Prevention is always safer and easier than having to treat a disease.

Love Your Heart

Trying your best to control glucose levels and reducing your cardiac risk factors can save your life. Over 65% of people with diabetes die of heart disease or stroke.

How can you love your heart? Below are some tips I encourage my diabetes patients to try. If you are doing some or all of these, then I congratulate you!

• Control your diabetes with nutrition, exercise, medication (if needed), testing, relaxing, support teams and knowing your numbers.
• Control your blood pressure by including foods with higher potassium (cantaloupe, honeydew, bananas, tomatoes, potatoes), magnesium (whole grains, nuts), higher calcium (dark green vegetables, seaweed, low-fat & low-sodium cheese, almonds, low-fat milk) and lower sodium (processed, packaged, sauces, gravies, soups, dressings, pickled foods).
• Eat heart healthy with high fiber/wholesome foods, monounsaturated and omega 3 fats, and reduce trans and saturated fats.
• Control weight by balancing food groups while consuming whole grains, vegetables, lean protein and healthy unsaturated fats.
• Move! Do some activity each day.
• Do not smoke – and try not to breathe in anyone else's second-hand smoke.
• Reduce stress by meditating, reading a good book, visiting with family or friends, taking a stroll, watching a funny movie, laughing and looking at the positive aspects of your life.
• If you consume alcohol, do so only in moderation: one drink per day for women and 2 drinks per day for men (4 ounces wine, 12 ounces beer, 1-1 ½ ounces of liquor). Try red wine for it's high resveratrol content. Resveratrol is a heart healthy antioxidant found in red wine and red grapes in greater concentration, blueberries, cranberries and peanuts.
• Know your numbers: HbA1c, total cholesterol, HDL (healthy cholesterol), LDL (lousy cholesterol), triglycerides, blood pressure and weight.
• Love your heart, love others and most of all - love yourself!

10 Daily Essentials for a Healthier You

You've probably heard this time and time again - take care of your body, and your body will take care of you. Here are my 10 daily essentials for a healthier you:

1. Blood sugar testing. Out of control blood sugar can have a damaging affect on your body. It is very important to test your blood sugar at varying times each day to see how your routine (meals, activity, medication, sleep, etc.) affects your blood glucose levels.
2. Keep a log to know your patterns. Keeping track of your blood sugar results in a logbook or downloading it on your computer allows you (and your doctor or nurse) to see your glucose patterns. Make testing count! Consider tracking your meals, exercise activities, and even your stress levels.
3. Treat possible low blood sugars with glucose tablets. Always have glucose tablets ready should you experience low blood sugar. You don't want to put yourself in danger with a low blood sugar that can't be treated immediately.
4. Blood pressure self-monitoring. Controlling blood pressure protects your heart and your kidneys – two possible complications of diabetes. There are affordable and convenient BP monitors which allow you to measure your blood pressure at the best, most convenient times.
5. Feet TLC. With diabetes, you may lose some feeling in your feet and wounds may heal more slowly. You need to check them each day for cuts or any other kind of wound. To give your feet tender loving care, I recommend that you keep these foot care items handy:
   
   • Telescopic mirror to examine your feet.
   • Moisturizing foot cream to prevent dryness and cracking. (Look for a medicated foot cream if you are experiencing foot pain.)
   • Sensory test kit that you can self administer to test sensation in your feet.
6. Watch out for wounds. With diabetes, wounds heal more slowly so be careful and be alert of any cuts, scrapes, blisters, or other wounds that are not healing properly. If so, don't delay, see your doctor!
7. Teeth TLC. Due to the high blood sugar, there is bacteria overgrowth, tartar and plaque build-up that exceeds what a person without diabetes would produce. A proper Teeth TLC program includes brushing, flossing, rinsing and having check-ups at the dentist and/or periodontist.
8. Body TLC. Try to weigh yourself daily with a regular scale or a body fat scale. Be active every day – including exercise (if your doctor approves). Think of using a pedometer to count the steps you are taking. Consider using a heart monitor to gauge yourself and make sure you are working your body in your target range. Example: 220 minus your age x 60% (low end) to 85% (maximum heart rate).
9. Snacking. Keep your blood sugar as even as you can! Try to avoid fluctuating glucose levels by eating every 3-4 hours. If that's difficult, try carrying "diabetes-friendly bars or shakes" like Extend® or Glucerna®. They come in various flavors and taste great!
10. Be Stress-Less. I love giving this advice. Watch a funny movie. Play a game. Do anything that takes you away from daily stress. Stress may affect your blood sugar and your health in general. Take time for yourself - you're worth it!

Although you don't need to incorporate the following in your daily routine, they are important to taking the best care of YOU!

• A1c home test. An A1c test measures the Average Blood Glucose (ABG) in the body over the previous 90-120 days.
• Fresh glucose control solution. Be sure you are using up to date glucose control solution (It expires 3 months after opening).
• Sick days "care kit." Be ready to take extra special care of yourself with a sick day kit which includes ketone test strips (primarily for Type 1 diabetes), thermometer, sugar free/alcohol free cough syrup and/or cough drops, sugar-free versions of over-the-counter remedies and products, regular and sugar-free soda and Jell-O®, unsweetened applesauce, soup, and crackers.

Healthier Holiday Season Tips

The holiday season is upon us, and many of us are looking forward to the festivities that this time of the year brings. Holidays are often centered on food so it’s no surprise that people tend to gain weight at this time of year – in addition to having their blood sugar run higher than usual. People eat and drink to celebrate with their friends and family and also in attempt to satisfy themselves if the holiday brings them sadness. If your blood sugar is consistently elevated during this time of year it not only wrecks havoc on your body but it may make you feel sluggish and moody, both are not conducive to enjoying a very festive time of the year!

You can enjoy the holiday season without gaining weight and mismanaging your blood sugar. But how?

• Think! Before sitting down to the feast, consider what will raise your blood sugar and decide what foods are most important to you.
• Eat a consistent amount of carbohydrates at your meals and snacks. If you want the pumpkin pie or ice cream cake then replace your potato and bread with the dessert or have a more moderate amount of the dessert, bread and potato.
• Use salads and vegetables (non-starchy ones) as a filler to supplement all the starches you will most likely have.
• Take a walk between courses to bring your blood sugar down and help with digestion.
• Exercise prior to your large meal so your blood sugar will be in better control.
• Try to take your blood sugar before your meal and 2 hours later so you can make the best choice at future holiday meals.
• Be aware of the portion sizes. Look over the food exchange list so you don’t pile too many mashed potatoes on your plate.
• Eat more slowly to allow yourself to savor the flavors. Remember, it takes 20 minutes for your body to realize it is full. Give your body a chance to be full.
• Pre-plan your meals and decisions. Once you smell the food it’s harder not to overindulge.
• Have fun and enjoy this special time!

Healthier Year Is Easy As Pie

Use these pieces of the pie to help set your goals for the best diabetes control in the New Year. Each component is necessary to start the year off right and achieve your health goals for the whole year.

• Relaxation: Stress may affect your blood sugar levels, therefore I suggest these ways to help you during these times: meditating, deep breathing, visiting with friends or family, taking a long walk, or watching a funny movie.
• Support Team: Here is your "A" team for your diabetes management:
  • Primary doctor

  Specialists such as:

  • Endocrinologist
  • Podiatrist
  • Ophthalmologist
  • Psychologist
  • Certified Diabetes Educator
  • Dietitian
  • Nurse
  • Exercise specialist
  • Family and friends
• Exercise: Keeping active will help to lower your blood sugar and allows your body to function more efficiently. Start with 10 minutes a day and build it up. With your physician’s approval, partake in cardiovascular and strength building exercises.
• Weight Control: A healthy weight provides an optimum environment for the body. Balance out food groups by consuming high fiber carbohydrates (in moderation) + lean protein + unsaturated fats = controlled blood sugar and make your food count!
• Know Your Numbers: Watching your progress is quite motivating. Ask for a copy of your latest blood work! Important numbers to know: HbA1c Triglycerides, HDL cholesterol, LDL cholesterol and Blood Pressure.
• Testing: Understand the effect of your behavior or lifestyle patterns on your blood glucose levels. Test at various times of the day and keep a log book. Note and understand the effects of food, exercise, emotions and medications on your blood sugar.
• Physician Check Ups: Be monitored by these health professionals to avoid complications and to improve your health: Primary care doctor, Podiatrist (foot care), Endocrinologist (diabetes care), Ophthalmologist (eye care), Psychologist (emotional health care) and Nephrologist (kidney care)
• Healthy Eating: Healthy food choices keeps your body strong and in balance. Increase high fiber carbohydrates, non-starchy vegetables, monounsaturated and omega 3 fats and lean protein. Decrease refined and processed carbohydrates, sweets and saturated and trans fats.

The Scoop on Stevia

In December 2008, the U.S. Food and Drug Administration (FDA) approved Rebiana, also known as Reb A or rebaudioside A, found in the stevia leaf. Stevia is derived from the leaves of a South American shrub and has been used to sweeten foods in Brazil, Paraguay, Japan, South Korea and China for many centuries. Reb A is one of two compounds; the other being stevioside, found in the stevia leaf. Reb A is less bitter and sweeter than stevioside. Rebiana is approved by the FDA as "generally recognized as safe" (GRAS).

Stevia previously had been sold only in health food stores as a dietary supplement. Due to some studies indicating that stevia may reduce fertility or cause genetic mutations that could lead to cancer, it was banned as a food ingredient in the US and approved only as a dietary supplement. Supplements, similar to GRAS substances, are not required to be scrutinized as much as foods are.

Today, Truvia and PureVia are available in packets similar to other sugar substitutes such as Splenda, Equal and Sweet n' Low, and will soon be seen in a growing number of sugar-free products. The main ingredients are Reb A (from the stevia leaf) and Erythritol (a sugar alcohol with no effect on glucose levels and little or no laxative effect).

Truvia™

Truvia can be found at Whole Foods, Walmart and other grocery stores.

• A Coca-Cola and Cargill product
• Over 200 times sweeter than sugar
• Ingredients: Rebiana, Erythritol, natural flavors
• Rebiana or Rebaudioside is the sweet extract from the stevia leaf – for sweetness
• Erythritol is a sugar alcohol derived from fruits like grapes and melons to improve taste and reduce bitterness
• Natural flavors to enhance flavor
• Found in products such as: sweetener packets, Sprite Green and Odwalla juice drinks
• Zero calories and no effect on glucose levels

PureVia™

PureVia can be found at grocery stores.

• PepsiCo and Whole Earth Sweetener co-product
• Over 200 times sweeter than sugar
• Ingredients: Rebiana, Erythritol, natural flavors
• Rebiana or Rebaudioside is the sweet extract from the stevia leaf to improve sweetness
• Erythritol is a sugar alcohol derived from fruits like grapes and melons to improve taste and reduce bitterness
• Isomaltulose (found in honey and sugar case juice)
• Cellulose powder is a dietary fiber to enhance texture
• Natural flavors to enhance flavor
• Found in products such as sweetener packets and SoBe Lifewater
• Zero calories and no effect on glucose levels

Use moderately. Moderate use is 4 servings a day: 4 packets or food servings similar to food exchanges (8 ounce drink, etc.)

12 Steps to Diabetes Control

24 million Americans have diabetes and ⅓ of them don’t even know it! Diabetes can lead to many complications – since it is a disease of the vessels: heart disease, kidney disease, blindness, nerve damage and amputation are some of the problems that can result from uncontrolled diabetes. The good news is that diabetes can be managed by you! With proper education, you have the power to avoid or reduce the severity of these complications.

You can make a life-changing difference by following these guidelines:

1. Limit carbohydrates (starch, fruit, milk, sweets) at each meal or snack.
2. Consume approximately 30-60 grams of total carbohydrate per meal (depending on your calories for the day and how your glucose is running).
3. Consume approximately 15-30 grams of total carbohydrate per snack combined with a lean protein and/or unsaturated fat such as a yogurt with nuts or a fruit with low-fat cheese.
4. Evenly distribute carbohydrates throughout the day to avoid fluctuations in blood sugar and to achieve a level blood sugar.
5. Consume slow-digesting foods or food combinations to assist you in achieving a more level blood glucose. Consume the following foods in combination:
   a. High fiber carbohydrates (30-50 grams a day) like brown rice, whole grain breads or cereals, grains such as kasha, barley or millet.
   b. Lean protein such as fish, shellfish, poultry, lean meat and low-fat cheese.
   c. Unsaturated fat such as nuts, nut butters, avocado, oils.
6. Test your blood sugar before meals and 2 hours from the start of the meal to determine if your body can handle the amount of carbohydrates you’ve eaten. If not, decrease the amount of carbohydrates or you may need a medication adjustment. For example: Test at 8:00 am before beginning breakfast and then again at 10:00 am.
7. Look for the following results when testing blood sugar:

a. Before meals blood sugar should be 90-130 mg/dL (American Diabetes Association - ADA guidelines*) or 80-110 (American Association of Clinical Endocrinologists – AACE guidelines**)
b. After 2 hours blood sugar should be under 180 mg/dL * or under 140 mg/dL**.
c. Blood sugar can expect to rise about 30-50 points from a meal.

8. Eat every 3-4 hours so your blood sugar doesn’t drop or fluctuate too much. This may determine whether a snack is necessary or not. Eating more frequently prevents over-eating at the next meal or snack and keeps your metabolism higher so you burn more calories!
9. Wait 2 hours between meals and snacks so the blood sugar has a chance to come down before you send it back up with your food consumption.
10. Have your doctor do a blood test to determine your 3-month blood sugar average. HbA1c also known as glycohemoglobin or hemoglobin A1c shows the progress you are making every few months with controlling your diabetes. Look for a number of 7% which is equivalent to154 mg/dL * or 6.5% which is equivalent to 140 mg/dL **, for best control. Fructosamine is a similar test that averages two weeks worth of blood sugar results.
11. Remember to exercise at least 5 days a week for 30 – 40 minutes. This includes walking, bicycling, strength training, etc. Exercise helps insulin work more efficiently to lower your blood sugar.
12. Be sure to meet with a team of diabetes experts. They will provide you with the knowledge you need to control your blood sugar. There may need to be adjustments with times of exercise, medications or food choices for best glucose control.

There are no secrets when managing diabetes. You have all the tools you need to find out how food, exercise, medications and even stress affects your glucose readings. In time, you will learn how to fine tune and better manage your disease. The HbA1c will tell you what range your blood sugar is in. Your glucose monitor will provide you with critical information so you can find out how daily living affects your blood sugar. Don’t allow the diabetes to rule your life when you are in charge!

Diabetes & Sick Days

Everyone gets the flu or a cold or an upset stomach from time to time. Minor illness will alter your blood sugar and will require some changes in your daily diabetes routine. It is difficult to control your blood sugars when you are ill. It is especially important to test your blood glucose level frequently to know where your level is.

You should suspect that your blood glucose level is high when you experience any of the following: flu, nausea or vomiting, diarrhea, fever, infections, physical injury, dental problems, or emotional stress.

When you have days of sickness, you need to make the appropriate choices, which include the following:

• Do not omit any medications.
• Check blood glucose levels every 4 hours.
• Drink fluids every hour. If unable to eat your usual meals replace them with the same amounts of carbohydrates in crackers, regular puddings, fruit, Jell-O, soup, ice cream, etc.

CONTACT YOUR PRIMARY HEALTH CARE DOCTOR IF:

• Fever is worse or longer than 24 hours.
• Vomiting or diarrhea longer than 24 hours.
• Ketones are present in your urine.
• Experiencing unusual symptoms.
• Unable to eat for 24 hrs or keep medications or replacement food down.

IF VOMITING/POOR APPETITIE INTERFERES WITH NORMAL FOOD INTAKE:

• Replace food with liquid, semi-liquid or soft foods with carbohydrates similar to your usual food choices.
• Consume protein and fat as tolerated.
• Replace lost electrolytes by having broth, vegetable juice, saltine crackers, pretzels or orange juice.

Feel better!

Diabetes & Travel

Traveling is exciting and diabetes should not stop you from enjoying your trip. Here are my guidelines for a worry-free trip:

• Wear or carry a form for identifying your diabetes such as a card in your wallet or a medical identification bracelet.
• Test blood glucose more frequently since your normal routine will likely change while traveling.
• Keep your diabetic supplies with you, especially if traveling by plane—supplies such as medication supplies (syringes, test strips, lancets) or even an extra battery for your meter!
• Do not leave supplies in the car in either cold winter or hot summer weather. Use a cooler with a gel pack.
• Carry a fast-acting form of glucose with you such as glucose tablets or hard candy. Carry some food with you in case meals are delayed.
• Carry medications for illness such as diarrhea, vomiting, and sugar-free cough syrup and lozenges.
• If traveling over time zones ask your healthcare team about guidelines regarding medication and meal adjustments.
• Carry a letter and prescription from your physician for your diabetes medication and supplies.
• Check your feet regularly. Do not wear new shoes that may give you blisters.

Bon voyage!

Diabetes Medications

Oral Medications

Combination Medications

Injectible Medication – Non-Insulin

Insulin

Pre-mixed Insulin – Combinations of the above types:

Ideal Diabetes Day

Diabetes can be controlled and self-managed, however, it requires you to think about it everyday, throughout the day. What is a typical day in the life of a person with diabetes?

8:00 am

You get up in the morning and test your “fasting” blood glucose
Today, it reads 105 mg/dL (excellent reading!)

8:30 am

You prepare and consume your breakfast of 30 – 60 grams of carbohydrates and 1-4 ounces of protein and maybe 1-2 fat servings ** such as: ½ bagel with low-fat cheese and a slice of tomato or 1 cup cooked hot cereal with nuts and cinnamon and a poached egg or 1 cup high-fiber cold cereal with ¼ cup berries and ½ cup low-fat milk and a scoop of low-fat cottage cheese or perhaps two pieces of bread/English Muffin (anything but white) with an omelet.

Medication must be taken as directed. Some pills need to be taken before a meal, others during or after a meal.

10:30 am

Test your blood glucose to see how your breakfast choice and medication regimen affects YOUR body. Does your glucose remain the same? Drop? Or rise less or more than 50 points? If it drops then perhaps you are taking too much medication or you need to eat more carbohydrates. You never want to eat to feed your medication. If you need to gain weight you can eat more. If you are trying to lose weight then speak with your doctor about possibly lowering your medication if the numbers drop consistently around this time of day.

12:00 noon

Time for lunch! Test your blood sugar. How has the medication and your morning routine affected your blood glucose? Prepare and consume 45 grams of carbohydrates and 3 ounces of protein and 1 fat serving ** such as: 2 slices rye bread, 2 ounces turkey and 1 slice low-fat cheese with 1 Tbsp light mayonnaise, lettuce, tomato and 10-15 baked potato chips.

2:00 pm

Test your blood sugar. How did lunch affect you, along with your medication regimen and your daily routine?

3:30 pm

Snack time! Since you need to eat every 3-4 hours to maintain the most level blood glucose (see “12-Steps to Control” article) your snack can be a combination of carbohydrate and protein or fat for best results. Try a yogurt and chopped walnuts or 10-15 tortilla chips and guacamole.

6:00 pm

Time for dinner. Check your blood glucose at this point. You may need to take more medication if that was advised by your doctor. Choose 45 grams of carbohydrates, 6 ounces of protein and 3 fat servings such as 6 ounces wild salmon teriyaki, 1 cup cooked barley, 1 cup of cooked broccoli, salad with 1 Tbsp. olive oil and vinegar.

8:00 pm

Check your blood sugar to see how your dinner choice and medication regimen affects you.

9:00 pm

Snack (optional). Have a healthy snack such as a fruit and nuts or low-fat cheese.

11:00 pm

It’s time for bed! Check your blood sugar one last time for the day. This will enable you to see the difference in glucose readings at bed vs. first thing in the morning (fasting).

With all of this information you will assist your team of diabetes experts in making the best recommendations for you and to fine-tune your disease. Remember, everyone’s body works differently so you are unique and must be treated as an individual. When you get to know how your body is affected by the diabetes and your lifestyle and daily routine, you won’t need to test as often.

To control your diabetes you need to exercise, eat right, take the appropriate medication regimen (if medication is needed at all), monitor your blood sugar, stay on top of your HbA1c number (3-month blood sugar average percentage), visit your diabetes team and always remember that

Making Time to Exercise

Morning, noon or night, just try to fit in your 30-60 minutes at least 5 times a week for best diabetes control. And remember to be careful if your blood sugar is dropping during exercise, perhaps due to your diabetes medication peaking or because you had not eaten in several hours.

With your doctor’s approval, try a mix of cardiovascular exercise such as the treadmill, riding a bicycle, walking or running, aerobics AND strength training such as lifting weights and toning and endurance exercises like Pilates or Yoga.

Exercise is over and now you want to see how many points your blood sugar changed from exercising. Did it drop? OK, exercise can lower your blood sugar because you are using energy to get you through the exercise. Remember, sugar IS energy. The more energy you expend the lower your sugar should drop. Did your blood sugar remain the same? Some people maintain their blood glucose for various reasons: the liver stores sugar and sends it into the bloodstream as needed (and sometimes it sends more than is needed).

If your blood sugar starts to drop, the liver will protect you and try to help balance the sugar level. HOWEVER, for some, the blood sugar rises. In this case, if your blood sugar is dropping too dramatically because you have expended a lot of energy in your particular exercise and/or your medication is still working or even peaking during exercise, your liver will overcompensate and send out too much sugar into the bloodstream which results in higher glucose.

BE CAREFUL not to exercise when your medication is peaking (working it’s hardest).

YOU are the most important part of your diabetes care team!

**See diabetic food exchanges list. The amount of carbohydrates and protein are determined according to your height, weight, age, activity and gender.

It Takes A Team

I know this is called "Do-It-Yourself Diabetes Management." I firmly believe that you are the #1 person who can control and manage your diabetes. However, you cannot do it alone.

People with diabetes need a team to work with to help manage their disease. Your team should consist of these key people to support your health and wellness:

• Your primary doctor and possibly an endocrinologist (diabetes specialist)
• Nurse
• Dietitian who specialize in diabetes education
• Exercise specialist
• Psychotherapist (can be a psychologist, social worker or psychiatrist)
• Dentist and periodontist, podiatrist and ophthalmologist
• Family
• Friends

Also, a cardiologist (to monitor heart disease), nephrologist (to monitor kidney disease) or neurologist (to monitor nerve damage) would be needed at some point.

After finding out you have diabetes from your primary care doctor you should request to be referred to a certified diabetes educator. The diabetes educator will teach you how to control your disease with meal planning, exercise, medication (if applicable), blood glucose testing, and basically answer all the questions you might have. These visits may be individual or in small group classes and are usually covered by insurance.

Once you understand how to control your diabetes, you may want to attend support groups to keep updated about possible changes or to help you stick with your plan.

Your next step is to make appointments to see a podiatrist, ophthalmologist, and endocrinologist. Since different parts of the body can be affected by diabetes, it is critical to have annual or bi-annual exams to protect yourself against serious complications.

YOU are the most important member because diabetes is self-managed. This means that you make food and exercise choices, you control the times you test your blood sugar to determine the effects things you do have on your body and you also choose to reduce stress in your life with helpful techniques such as support groups, deep breathing, spending time with family and friends and if necessary, a therapist.

Why Test Blood Sugar

Blood sugar (glucose) testing is essential to successful diabetes management. Here’s why you should be testing:

• To understand your daily blood sugar pattern. Example: what readings do you typically have fasting or at bedtime or after your favorite meal or snack?
• To find out how a particular meal or snack affects your blood sugar.
• To indicate how your body processed the carbohydrate/sugar. Test before a meal/snack and 2 hours after your first bite of that meal/snack, if the reading goes up 50 points or less it means your body was able to adequately process that particular meal at that time of day.
• To inform you of the effects food, exercise, stress, medications, hormones and alcohol have on your body by providing additional information for fine-tuning.

When testing your blood sugar, here are some important points to remember:

• Test blood sugar right before eating a meal/snack and 2 hours after the meal.
• Blood sugar should not rise more than 50 points from a meal.
• Code machines (some machines do not need to be coded).
• Use control solution – test one strip per vial to ensure the test strips are working properly (shake the solution before using).
• Testing in the finger or palm of your hand will provide the most accurate reading. Alternate site testing (on the arm or leg) should only be done prior to meals for most accurate readings. After meals, alternative sites may display lower readings.
• Alternative site results may differ from fingertip results when blood sugar levels are rapidly changing.

Target Blood Sugar Levels
*According to the American Diabetes Association (ADA)
** According to the American College Of Endocrinology (ACE)

The hemoglobin A1c is a 3-month average blood sugar test that may be included in your annual, bi-annual or quarterly blood work:

• Gives you an overview of the extent you are controlling your diabetes.
• A blood test that measures the amount of sugar attached to your red blood cells.
• KNOW YOUR NUMBER to determine your progress.

How to compare A1c to blood sugar

4% =	65 mg/dL	10% =	275 mg/dL
5% =	100 mg/dL	11% =	310 mg/dL
6% =	135 mg/dL	12% =	345 mg/dL
7% =	170 mg/dL	13% =	380 mg/dL
8% =	205 mg/dL	14% =	415 mg/dL
9% =	240 mg/dL	15% =	450 mg/dL

One Week Meal Plan

C = carbohydrates servings/exchanges
P = protein servings/exchanges
F = fat servings/exchanges

Day One

Breakfast

• 1 cup cooked oatmeal made with water (2 C)
• 2 walnuts, chopped (1 F)
• 1 poached egg (1 P)
• Cinnamon

Lunch

• 2 slices whole-wheat bread (2 C)
• 3 ounces turkey, tuna or other lean protein (3 P)
• Lettuce, tomato
• Mustard

Snack

• Baked apple (1 C)
• 4 walnuts, chopped (2 F)

Dinner

• Salad with 2 tsp. olive oil plus
• vinegar (2 F)
• 1 medium size sweet potato (2 C)
• 1 cup broccoli, steamed with ½ cup no-salt canned diced tomatoes (1 C)
• 5 ounces salmon, grilled with garlic and 1 Tbsp. of light teriyaki sauce (5 P)

Snack

• 1 fruit (1 C)
• 6 almonds, slivered (1 F)

Day Two

Breakfast

• 1 ½ cups Wheatena made with water (3 C)
• 1 fruit (1 C)
• 2 walnuts, chopped (1 F)
• Cinnamon

Lunch

• 1 large slice pizza plain or with vegetables (2 C) (2 P) (2 F)

Snack

• 1 fruit (1 C)
• ¼ cup cottage cheese (1 P)

Dinner

• 6 ounces fish, poultry, or lean meat (6 P)
• 3 cups vegetables (2 C)
• 1 slice low-fat cheese melted on top (1 P)
• 2 Tbsp. avocado (1 F)

Snack

• 2 fruits (2 C)
• 12 almonds (2 F)

Day Three

Breakfast

• 1 cup cooked Wheatena or grits or oatmeal (2 C)
• 4 walnuts, chopped (2 F)
• 1 slice whole grain bread (1C)
• ¼ cup 1% cottage cheese or 1 slice low-fat cheese (1P)

Lunch

• Large salad: 3 cups salad/veggies (1 C)
• Add 4 ounces shrimp (4 P)
• 2-4 Tbsp low-fat dressing (2F)
• 1 small roll (1C)

Snack

• 12 ounces low-sodium V8 or tomato juice (1 C)

Dinner

• Large Salad (1 C)
• 4 ounces of chicken (4 P)
• 2 Tbsp. light dressing (1 F)
• 1 fruit (1 C)

Snack

• 1 fruits (1 C)
• 6 cashews (1 F)

Day Four

Breakfast

• 1 slice whole-grain bread (1 C)
• ½ cup fat-free or 1% cottage
• cheese (2 P)
• 1 cup fresh fruit (1 C)

Lunch

• 2 slices rye bread (2 C)
• 2 slices low-fat cheese (2 P) or 2 ounces turkey, tuna, salmon
• 2 slices tomato

Snack

• 3-4 cups of popcorn (1 C)

Dinner

• Salad with 2 Tbsp. light dressing (1 F)
• 10 low-sodium black olives (1 F)
• 5 ounces fish or poultry (5 P) grilled with spices
• 1 whole grain pita bread (2 C)
• 1-2 tsp. olive oil for bread (1-2 F)

Snack

• 2 fruits (2 C)
• 12 almonds (2 F)

Day Five

Breakfast

• 1 English muffin (2 C)
• 1 egg fried in butter spray (1 P)
• 1 slice low-fat cheese (1 P)
• 1 slice tomato (optional)

Lunch

• 2 slices whole-wheat bread (2 C)
• 2 ounces shrimp or chicken salad (2 P)
• 1 Tbsp. light mayonnaise (for salad) (1 F)
• lettuce, tomato

Snack

• 1 light fruit yogurt (1 C) (1 P)
• 12 almonds (2 F)

Dinner

• 1 Tbsp. olive oil (3 F) to sauté 3 cups vegetables (2 C)
• 4 ounces fish, poultry, or lean meat (4 P)
• ½ cup cooked brown rice (1C)

Snack

• Sugar-free Jell-O (free)
• 1 fruits (1 C)
• 25-calorie fat-free hot cocoa (free)

Day Six

Breakfast

• 2 frozen whole-grain waffles (2 C)
• 2 Tbsp. sugar-free syrup
• 1 cup berries (1C)

Lunch

• Large salad (1 C)
• 3 ounces chicken (3 P)
• 10 peanuts (1 F)
• 1 Tbsp. olive oil plus vinegar (3 F)

Snack

• 1 cup carrots and celery (free)

Dinner

• 2 cups vegetables steamed with 2 Tbsp. salsa (2 C)
• ½ cup black beans and ½ cup brown rice cooked (2 C) (1P)
• 4 ounces shrimp grilled or baked with spices (4 P)
• 1 ounce low-fat shredded cheese melted on top (1 P)

Snack

• Homemade Trail Mix: ¾ cup high fiber cereal (at least 3 grams), low sugar cereal (under 5 grams) (1 C)
• 3 dried apricots (1 C)
• 12 cashews (2 F)

Day Seven

Breakfast

• 1 cup cooked oatmeal made with water (2 C)
• 1 small banana (1 C)
• 2 walnuts, chopped (1 F)
• Cinnamon

Lunch

• 2 slices rye bread, sour dough, whole grain (2 C)
• 2 ounces turkey, chicken
• 1 ounce low-fat cheese (3 P)
• Lettuce, tomato
• 1 Tbsp lite mayo (1 F)

Snack

• 1 fruit (1 C)
• ½ cup low fat cottage cheese (2 P)

Dinner

• 4 ounces shrimp (4 P) sautéed with 1 Tbsp. olive oil (3 F)
• 2 cups non-starchy vegetables
• 1 small potato (2 C)
• 1 Tbsp. whipped butter (1 F)

Snack

• Sugar-free Jell-O (free)
• 1 mini popcorn bad (4 cups) (1C)

Related Files: 

Destination Diabetes DIY One Week Plan

Calorie Diets by Marci Sloane

I’ve developed an easy way to plan your meals around calories. Although, these are especially designed for people who have diabetes, they are just plain healthy diets for anyone. I’ve included suggested foods and serving sizes for breakfast, lunch, dinners and snacks for an entire day for the following daily calorie intakes.

Just how many calories are correct? Read the this article that includes the FDA’s Counting Calories Chart, or contact your doctor or dietitian.

Related Files: 

Marci Sloane's 1200 Calorie Diet

Marci Sloane's 1400 Calorie Diet

Marci Sloane's 1600 Calorie Diet

Marci Sloane's 1800 Calorie Diet

Marci Sloane's 2000 Calorie Diet

Daily Food & Exercise Log

Keeping a food and activity log, as well as blood sugar records, is critical in determining our individual patterns. This will help to fine-tune your diabetes control. Try to keep up with these logs throughout the day if possible since, as human beings, we tend to truly or conveniently forget what we have consumed unless we write it down! Don’t forget to record your beverages or that extra piece of cheese or pretzel!

Download and print your daily food and exercise log as many times as you need.

Related Files: 

Destination Diabetes Food & Exercise Log

Diabetes & Alcohol

Alcohol is high in calories and has few nutrients. If you drink and this is approved by your doctor, please drink wisely and moderately.

Moderate drinking is 1 drink per day for women (1 ounce liquor, 4 ounces wine or 12 ounces beer) and 2 drinks per day for men.

Alcohol is metabolized similar to fat in the liver. Your liver supplies you with glucose for energy when you are not eating. When you drink alcohol and have not eaten any food, your body concentrates on breaking down the alcohol and forgets to send out glucose into the bloodstream. This can cause you to have hypoglycemia (low blood sugar). Try to eat some food, like cheese and crackers) if you indulge moderately in alcohol. With mixed drinks, use diet soda, diet tonic, club soda, or vegetable juice (low-sodium).

Keep in mind that red wine contains high levels of resveratrol – a heart healthy antioxidant – and may help to increase HDL (health cholesterol) levels. If you choose beer, try light beer. The calories and carbohydrate amounts are significantly different from regular beer. Regular beer has 145 calories per serving and 13 grams of carbohydrates. Light beer has 99 calories and 4 grams of carbohydrates. All distilled spirits (liquor) per ounce has about 100 calories and zero carbohydrates. Wine (per 4 ounce glass) has about 75 calories and 1-2 grams of carbohydrates.

Diabetes & Dining Out

When you dine out, please continue to use your common sense. Make reasonable choices for continued success. Take a moment to consider all the foods that will have the most impact on your blood sugar and be moderate with them. Also, think heart health! Here are some suggestions:

Chinese Food

• Shrimp, chicken, pork or beef with vegetables.
• Do not get breaded or fried choices.
• Ask for your food dry, with little sauce or get it steamed with the sauce on the side for dipping.
• The sauce has hundreds of calories, lots of salt, sugar, fat, and cornstarch.
• Get white rice (or brown when available) and don’t eat more than ⅔ cup (cooked).
• Each ⅓ of a cup of cooked rice is about 80 calories and 4 teaspoons of sugar (and that is for steamed rice not fried!)
• Eat the inside of the egg roll and watch all the extra sauces like duck sauce (sweet) and soy sauce (salty) that you add.
• Have the soup, but only have a few fried noodles if you must.
• Eat half the ice cream or a fortune cookie, if necessary.

Think: What is affecting my blood sugar from this meal?
Hint: Rice, sauces, noodles, egg roll wrapper, wonton wrappers and dessert.

Italian Food

• If you have Parmesan veal, chicken or shrimp, do not get the cheese on top! This saves an easy 500 calories (500 calories x 7 days a week is the pound you will lose at the end of the week). Remember that excess weight effects glucose levels.
• The cheese that restaurants use has a lot of sodium, fat and artery-clogging saturated fat.
• You can also choose a dish that is not fried or soaked in butter or cream sauce, like a broiled piece of fish, etc. Heart disease is a common complication of diabetes.
• Have your side dish of pasta and one roll, or forego the pasta and have a double order of vegetables. Have a salad with the vinaigrette on the side.
• The soup has additional carbohydrates, so you need to decide how you want to “spend your carbohydrate budget.”
• If your meal is large then bring some home, and wait until the next day to eat it!

Think: What is affecting my blood sugar from this meal?
Hint: Breading, bread, pasta, sauce, beans and dessert.

Mexican Food

• Forego the nachos or share them with friends.
• Try to limit cheese and/or fried dishes. After all, full-fat cheese is 100 calories per ounce with sodium and saturated fat that clogs your arteries.
• Choose shrimp, vegetable or chicken fajitas.
• Ask them to leave off the sour cream (saturated fat), and provide only one or two tortillas instead of 4 (then there is no temptation to overeat the carbs).
• You may have guacamole, but not the sour cream, which is artery clogging! Instead of refried beans, ask for black beans.
• The cheese, meat, avocado and sour cream have many, many calories.
• The avocado (guacamole) is the healthiest of the choices - enjoy it without all the rest. You want to be heart healthy!

Think: What is affecting my blood sugar from this meal?
Hint: Nachos, tortillas, beans, chips and dessert.

Japanese Food

• Sushi, or even better, sashimi (sushi without rice)
• Steamed dumplings
• Teriyaki dishes (sauce on the side)
• Do not overuse the soy sauce or any sauces – remember that sauces carry the majority of fat, salt and/or sugar. In this case, soy sauce has about ½ of your daily sodium allowance in one tablespoon so please use the lower sodium soy sauce and use it sparingly.
• Have a miso soup (salty) or a salad with your entrée
• Japanese food is usually one of the better lower-calorie choices you can make, but watch the salt!

Think: What is affecting my blood sugar from this meal?
Hint: Rice, dumplings, teriyaki sauce, noodles and dessert.

Continental Cuisine

• Always have a salad to fill up on.
• If you have a piece of bread or a roll, do not eat your potato.
• Order your protein with a double order of vegetables, and make sure they are not swimming in butter. Don't be shy or ashamed to ask for it the way you want (or need) it.
• Do not have dessert just for the sake of having it. After a full meal, you should not be hungry! Therefore, there is no need for dessert! Get out of that habit. Have coffee or a skim-milk latte instead (if you have some carbs left in your dinner budget).

Think: What is affecting my blood sugar from this meal?
Hint: Bread, potato, pasta, rice, corn, peas, beans, soups with beans or rice or noodles and dessert.

Diabetes Nutrition

The most important nutrition message to take away from this material is to consume wholesome, slow-digesting, high fiber carbohydrates in combination with healthy choices of protein and fat.

My Do-It-Yourself diabetes nutrition guidelines will assist you in avoiding fluctuations in blood sugar and the highs and lows that are dangerous to you and result in low energy levels.

"Carbs"

Carbs, short for Carbohydrates, are starch (including vegetables), fruit, milk and sweets that turn 100% into sugar within 1 to 2 hours (except for the fiber part). They have the greatest impact on your blood sugar.

"Blasters"

Blasters are quick-digesting or high glycemic carbohydrates that BLAST sugar into your bloodstream. Blasters make your blood sugar spike. Blasters make your insulin work harder to bring the sugar from the bloodstream into the body’s cells like the brain, muscles, organs and tissues so the body can have energy to live and function.

"Tricklers"

Tricklers are slow-digesting foods or low glycemic carbohydrates that TRICKLE sugar into your bloodstream. Tricklers make your blood sugar level out. Tricklers make your insulin work much easier to bring the sugar (energy) from the bloodstream into the body’s cells.

Equation for Best Blood Sugar Control

Here is my equation for controlling your blood sugar. It will also help with weight loss and reduced hunger!

HIGH FIBER CARBS
+ LEAN PROTEIN
+ UNSATURATED FATS
= CONTROLLED BLOOD SUGAR

• Protein contains little or no carbohydrates, however due to the processing, 50% turns into sugar within several hours. Therefore, the impact on your blood glucose is minimal. In fact, the slow digestion of protein (like eggs, cheese, poultry, meat, fish, shellfish), when combined with carbohydrates, will help to level out your blood sugar, thus, reducing fluctuations.
• Fat contains no carbohydrates, however, 10% turns into sugar within several hours. Therefore, fat (like protein) has minimal effect on blood glucose and will help to slow digestion of the carbohydrates it is mixed with.

Diabetic Food Exchanges

Carbohydrates

CARBOHYDRATE is a macronutrient that turns completely into sugar within 1-2 hours. Below you will find 15 gram carbohydrate portions.

Starch carbohydrates - 15 grams of carbohydrates and approximately 80 calories:

• ½ cup cooked cereal (ex: oatmeal), grain (ex: barley or kasha) or starchy vegetable (ex: peas, corn, beans, potatoes, winter squash like butternut or acorn)
• ⅓ cup cooked rice/pasta (preferably brown rice or whole-grain pasta)
• 1 slice of bread, 2 slices of reduced-calorie bread, ½ English Muffin, ¼ large bagel, ½ mini bagel, 6 crackers, 2 rice cakes, 1 waffle, ¾ piece matzo, 1 pancake
• 1 ounce of snack foods (15 chips or pretzels)

Fruit carbohydrates - 15 grams of carbohydrates and approximately 60 calories:

• 1 cup fresh fruit
• ½ cup canned fruit, in own juice, drain out juice
• ½ cup (4 ounces) fruit juice
• 1 small fresh fruit or ½ large fresh fruit
• 2 Tablespoons dried fruit

Milk carbohydrate - 12 grams of carbohydrates:

• 1 cup (8 ounces) skim, 1%, 2%, whole milk, soy milk, rice milk
• ½ cup evaporated milk
• ⅓ cup dry milk
• 6 ounces plain, fat-free yogurt, or flavored with artificial sweeteners
• ½ cup ice cream

Dessert carbohydrates:

When/if choosing these foods please be moderate since processed sugar will spike your blood glucose quickly. There are lower fat versions and no sugar added or sugar free that might reduce the rise in blood sugar.

Try to more often choose a fruit and combine with nuts, nut butters or low-fat cheese or plain/fat-free yogurt with nuts or wheat germ/flaxseed meal/psyllium husks or other high fiber type of topping.

Examples of 15 grams worth of carbohydrates:

• 1 small ice cream scoop
• ½ cup of "sugar free"pudding (should be called "no sugar added" since there is milk in the pudding)
• 1 Tablespoon of syrup
• ¼ cup sherbet
• ⅓ slice of pie
• 3 gingersnaps
• 8 animal crackers
• 1 small donut or 1 small brownie

These foods may contain high amounts of unhealthy fats, therefore, choose wisely.

Protein

PROTEIN is a macronutrient that turns 50% into sugar within several hours. Therefore, the effect on your blood glucose is minimal. Choose the leaner types of protein so you are heart healthy.

• One ounce of protein has 7 grams of protein.
• 3 ounces is about the size of a deck of cards and would have 21 grams of protein.

Very lean protein has 35 calories per ounce and 0-1 gram of fat. Examples of hearth health proteins are:

• Most fish
• Shellfish
• Low-fat soft cheeses
• Egg whites or substitutes
• Beans - beans such as kidney beans, black beans, garbanzo beans all contain 15 grams of carbohydrates per ½ cup and 1 ounce (or 7 grams) of protein.

Lean protein has 55 calories per ounce and approximately 3 grams of fat.

• Beef: sirloin, flank steak, tenderloin, rib, chuck, rump roast, T-bone, porterhouse, cubed steak, ground round
• Pork: ham, Canadian bacon, tenderloin, center loin chop
• Lamb: roast, chop or leg
• Veal: lean chop, roast
• Poultry: chicken or turkey (dark meat without skin)
• Fish: Herring (no cream), oysters, salmon, catfish, sardines

Medium-fat protein has 75 calories per ounce and approximately 5 grams of fat.

• Beef: ground beef, meatloaf, corned beef, short ribs, prime rib
• Pork: top loin, chop, cutlet
• Lamb: rib roast, ground
• Veal: cutlet (ground or cubed, unbreaded)
• Poultry: chicken (dark meat with skin), ground turkey or chicken (is ground with skin), fried chicken with skin – all of these choices provide artery clogging saturated fat and are not heart healthy – please refrain or have infrequently.
• Fish: any fried fish
• Cheese with under 5 grams of fat per ounce
• Eggs
• Tofu/Tempeh

Fat

FAT is a macronutrient that turns 10% into sugar within several hours. Therefore, the effect on your blood glucose is insignificant. Each fat serving has 5 grams and 45 calories. Eat mostly unsaturated fats in your diet to reduce heart disease risk.

Monounsaturated fats are the most heart healthy. Examples are:

• Avocado (2 Tbsp)
• Canola or olive oil (1 tsp)
• Olives (8-10) – Try unsalted olives if possible
• Most nuts (6)
• Nut butters (½ Tbsp)
• Sesame seeds (1 Tbsp)

Polyunsaturated fats are relatively heart healthy. These are in most processed foods. Examples are:

• 1 tsp. margarine, corn, safflower or sunflower oils
• 2 walnuts (these contain heart healthy omega 3s as well as the cancer preventive compound/antioxidant called ellagic acid)
• 1 Tbsp. pumpkin and sunflower seeds

Saturated fats are not heart healthy. They clog your arteries and encourage your liver to produce more cholesterol. Use these infrequently and choose the unsaturated fats more often. Examples are:

• Butter
• Cream sauces
• Skin on poultry
• Fat on meats
• Sour cream
• Regular cheeses
• Coconut

Trans fats are not heart healthy. They work similarly to saturated fats and may produce carcinogens. They are most often found in processed foods listed in the ingredient list as partially hydrogenated fat. The polyunsaturated oils are hydrogenated (hydrogen is added) and heated to create a solid fat that is trans.

Food Portions

Since we don’t always carry around measuring cups and food scales, here are my "handy" food portion guides. You can carry these measuring tools every where you go!

Glycemic Index

It is most important to understand the concept behind glycemic values (Glycemic Index, or GI). In order to level out your blood sugar and avoid fluctuations in glucose you must eat slower digesting foods. These foods typically have a low glycemic index or load.

The glycemic index is a system in which a number is given to a particular carbohydrate food to determine how quickly or slowly the food breaks down into sugar in the bloodstream.

This number is important since people tend to consume many high-glycemic index foods such as refined carbohydrates (white pasta, white bread, white rice) that turn quickly into glucose (sugar) in our bodies. These foods do not sustain your appetite or energy (blood sugar) level and people end up overeating them.

If you incorporate low-glycemic index foods (foods that turn into sugar slowly), you can sustain a more even energy level and you also will not get hungry very quickly. This is due to non-fluctuating blood sugar. You know that sugar equals energy.

When you eat refined or high-glycemic index foods, your blood sugar quickly climbs and then drops. When the blood sugar drops, you feel hungry since your brain signals your body to eat in order to maintain your energy level. However, if you consume mostly low-glycemic index foods, your blood sugar tends to level out and not fluctuate. This results in diminished appetite and a more sustained level of energy! In addition, by metabolizing sugar more slowly and over a longer period of time we have a chance to utilize the sugar or glucose before it gets stored as fat (triglycerides)!

Glycemic Load is a newer and more accurate term. The glycemic index tells you how rapidly a particular carbohydrate turns into sugar. It does not tell you how much of that carbohydrate in grams is in a serving of food. The Glycemic Load is the amount of carbohydrate grams in a food multiplied by the GI of that carbohydrate.

Glycemic Index Values

Source: Wikipedia http://en.wikipedia.org/wiki/Glycemic_index

Additional Resources:

Harvard Medical School's Glycemic Load for 100 Foods
"The Glycemic Index debate: Does the type of carbohydrate really matter?" American Diabetes Association

Go Nuts!

Go nuts with nuts, reasonably!

Nuts are high in calories and loaded with nutrients so please use them and do not abuse them. However, nuts offer many healthful benefits primarily from unsaturated fats, fiber, protein and carbohydrates plus they taste great.

Nuts also contain many heart healthy vitamins and minerals as a bonus! Added to meals or snacks these nuts help to sustain the appetite and maintain a healthy level of blood sugar while satisfying the desire to crunch.

Nuts can be used to replace the more typically consumed refined carbohydrate snack foods that have a tremendous effect on your blood sugar them like pretzels and other chips that offer little nutritional value and simply encourage your appetite.

Nuts have many calories, about 150-200 calories per ounce. For a delicious, healthy snack try:

• 20-24 almonds
• 6-8 Brazil nuts
• 18-20 pecan halves
• 155 pine nuts
• 45-47 pistachios
• 8-11 walnut halves
• 10-12 macadamias
• 18-20 hazelnuts
• 16-18 cashews

Why not try mixing one ounce with a lower calorie carbohydrate like fruit or yogurt.

So like I say, "go nuts" and reap all the benefits.

My Favorite Foods

Carbohydrates

Starch:

• Nature’s Own Double Fiber Bread (50 calories/5 grams fiber per slice)
• Thomas’ Light Multigrain English Muffin (100 calories/8 grams fiber)
• La Tortilla Factory tortillas (100 calories/12 grams fiber)
• Back to Nature rice crackers (no trans fat and low sodium)
• Wasa crackers
• Jolly Time low-fat butter mini serve popcorn (90 calories/9 grams fiber)
• Whole wheat matzoh
• Cereals: look for high fiber and low sugar and try mixing different cereals together!
• All Bran Cereal
• Cheerios
• Puffed wheat, corn, rice
• Shredded Wheat n’ Bran(high carbohydrates so be careful of your amount)
• Hot cereal like oatmeal, grits, wheatena, farina
• Psyllium husks, flaxseed meal, unprocessed bran, unprocessed oatbran (fiber to add to cereals or yogurt, etc.)
• Kashi Go Lean frozen multigrain/blueberry/banana waffles
• Sweet potatoes (try Ore-ida steam and mash sweet potatoes – mash or even roast!)
• Gia Russa Whole Wheat Pasta (healthier and higher fiber than white pasta)
• Dreamfield Pasta (may have less of an effect on your blood sugar)
• Shiraki (soy pasta noodles) – only 20-25 calories per serving and very few carbohydrates
• Guiltless Gourmet tortilla chips (lower fat, lower sodium, lower calories and best taste!
• Joseph’s Sugar Free cookies (without any artificial sweeteners)

Fruit:

• Fresh fruit (be careful of juicy fruits that may raise blood sugar more quickly)
• Berries: blueberries, raspberries, blackberries, strawberries (high in antioxidants and lower in sugar)
• Apples, pears

Milk:

• Organic Skim or 1% milk
• Silk soy milk
• Almond milk, rice milk, oat milk
• Soy egg nog (try during the holidays!)
• Fage Greek Plain and fat free yogurt (most of the sugar is strained out! – higher in protein)
• Edy’s low-fat, no sugar added ice cream
• Slim Bear No sugar added 100 calorie ice cream sandwiches

Protein

• Fish high in heart healthy omega 3’s: wild salmon, sardines, herring, mackerel
• Sea Pak frozen fish: Ahi tuna, wild salmon, wild salmon burgers
• Bumble Bee wild salmon in a can
• Larger fish carry more mercury so limit swordfish, king fish, shark, tuna
• Cheese – look for lower sodium, lower saturated fat and lower calories
• Jarlsburg Lite
• Smoked or mini Gouda lite
• Low fat, low sodium cottage cheese, ricotta cheese or farmer’s cheese
• Cabot Monterey Jack, Cheddar or Pepper Jack 50% or 75%
• Laughing Cow Lite
• Knight Swiss Lite
• Low-fat string cheese
• Kraft Fat free shredded mozzarella or Cheddar cheese
• Shellfish, especially scallops (low cholesterol and zero saturated fat)
• Morningstar low-fat garden vegetable burgers
• Boca Veggie Burgers
• Dr. Praeger’s frozen products
• Marjon Tofu
• Smart Dogs (soy hot dogs)
• Pork tenderloin
• Poultry
• Omega 3 eggs or egg whites or egg beaters

Fat

• Walnuts, almonds and other unsalted or lightly salted (if you must) nuts
• Wholly Guacamole
• Nut butters: peanut butter, almond butter, cashew butter (without trans fat – partially hydrogenated fats or added sugar/molasses)
• Low sodium black olives
• Extra Virgin Cold Pressed Olive Oil
• Cold Pressed or First Pressed Canola Oil
• Grapeseed oil
• Smart Balance Light margarine
• Land O’ Lakes whipped regular butter or light
• Take Control/Benechol margarine (for heavy users)
• Spritzer salad dressings: Paul Newman’s, Ken’s Wishbone
• Ken’s Lite dressings
• Paul Newman’s lite dressings
• Bolthouse Farms Chunky Blue Cheese

Miscellaneous

• Low sodium V-8 juice
• Mrs. Dash 10-minute marinades
• College Inn can of low sodium/fat free broth
• Imagine soups
• Health Valley Soups
• Pritikin soups
• Progresso 50% reduced sodium soups
• 25 calorie fat free Nestle Hot Cocoa
• International Delights sugar free coffee – 30 calories
• Light whipped cream
• Del Monte Diced No Salt Added Tomatoes
• Gia Russa marinara sauce (or other low sodium sauces)
• Red peppers (high in vitamin C)
• Broccoli sprouts (high in antioxidants)
• Shitake mushrooms (anti-cancer)
• Beansprouts (low-calorie filler in veggie mixes, salads, omelettes)
• Angel hair shredded cabbage (mix in veggie sautee)
• Turmeric and giner (anti-inflammatory spices)
• Walden Farms No Calorie Dressing
• Jello Brand Dark Chocolate Pudding
• Sugar free jello
• Sugar free fudgicles
• Herbal iced or hot tea

Reading Food Labels

I’ve taken a typical food label and "deconstructed" it to help you make healthy choices. Take a look at the following food label and then follow along with the numbered bullets below it to better understand what is in the food you’re eating and how your food choices, based on their labels, meet your daily dietary goals.

1. Nutrition facts: This tells the consumer that the FDA has approved the label.
2. The serving size represents all the quantities of nutrients listed on the label. If you're consuming 2 cups of this particular food, there will be 16 grams of fat. The grams in parenthesis indicate how much the serving size weighs.
3. Calories from fat are usually rounded off. By multiplying the total fat (in this case, 8 grams) by the number of calories in each gram of fat (9 calories) the result will be the total calories from fat. 9 x 8 = 72 calories from fat. This number was rounded down to 70.
4. % Daily Value is explained near the (*) asterisk. It is based on a 2,000 calorie diet. This may not be suitable for everyone — it may be too high or too low. On a 2,000 calorie diet, your total fat intake should be less than 65 grams. Therefore, the total fat of 8 grams listed is 13% of the total daily value of fat or 13% of 65 grams is eight grams.
5. The total fat figure includes all fats: saturated, polyunsaturated and monounsaturated. These three fats should add up to the total. If they don't the remainder can be from trans fat (only if there is partially hydrogenated oil in the ingredient list) or from a smaller amount of fat (.5 or ½ a gram) that is not required to be listed.
6. Cholesterol should not exceed 300 mg per day. If you have heart disease, limit your cholesterol intake to 200 mg per day. The yolk of one egg has 215 mg of cholesterol. Eggs do, however, contain ample vitamins and minerals. Consume fewer than four a week if you have heart disease or diabetes.
7. Total carbohydrate turns completely into sugar except for the dietary fiber part. In this case, nine grams of fiber may be subtracted from the total carbohydrate to find the amount of sugar this product will actually breakdown into. Only 13 grams of total carbohydrate will turn into sugar in your bloodstream within one to two hours. The four grams of sugar listed come from refined/processed sugar like high fructose corn syrup, molasses or honey or (natural sugar: milk (lactose) or fruit (fructose) found in this product. The number of grams of carbohydrates you would count is 13 grams, which would include the refined sugar while subtracting the non-digestible fiber.
8. Protein is listed in grams. However, we think of protein in terms of ounces. Seven grams is equal to one ounce in terms of ounces. Seven grams is equal to one ounce of protein on the food label. In this case, there are 25 grams of protein. This is equal to approximately 3 ½ ounces of protein.
9. This product offers six percent of your total calcium allowance for the day.
10. See #4.
11. There are more than twice the calories in each gram of fat than in each gram of carbohydrate or protein.

Some additional food label reading how-to's:

• All bolded words contain the categories underneath them. Total fat contains all types of fat indented and in lighter print underneath it whereas Total Carbohydrate contains dietary fiber and sugar.
• A low-fat food has three grams of fat or less per serving.
• A low-sodium food has 140 mg per serving or 400-600 mg per meal. Limit sodium consumption to 1,500 - 3,000 mg per day and at least 500 mg per day. If you are on a low-sodium diet due to hypertension or kidney disease consume fewer than 2,000 mg.

When looking at food labels, be sure to look at total carbohydrate, NOT SUGAR, when trying to determine what will breakdown into glucose in your bloodstream. The sugar listed is included in the total carbohydrate. It refers to natural sugar, like fruit sugar (fructose) or milk sugar (lactose) or refined/processed sugar like table sugar.

The total carbohydrate encompasses everything in that food that will eventually become sugar. Dietary fiber, however, may be subtracted from the total carbohydrate, since fiber is a non-digestible part of the carbohydrate.

Try one of Marci’s convenient diabetes-friendly "Calorie Diets" based on the daily calorie intake recommended by the FDA or your doctor.

Related Files: 

Just how many calories are correct? Read the FDA’s Counting Calories Chart, or contact your doctor or dietitian

Sugar Free Foods

In sugar free, no sugar added or low carb foods, the sugar (quick digesting "blaster") is replaced with sugar alcohol (a slow-digesting "trickler"). Sugar alcohol has fewer calories than sugar, is not as sweet as sugar and has a significantly less impact on blood sugar levels than regular sugar. Some common sugar alcohols are: sorbitol, xylitol, mannitol, lactitol, maltitol, and isomalt. As you see, most of the names end in "ol" just as alcohol does. Sugar alcohol is derived from fruits and vegetables. Some people who eat sugar alcohol in excess experience a laxative effect.

Sugar Free Foods

There is no sugar in the food but there may be carbohydrates that turn completely into sugar. (starch, fruit or milk). For example: sugar free cookies are not made with sugar but the flour is a starch that turns completely into sugar. The sugar is replaced with sugar alcohol and, typically, artificial sweeteners to enhance sweetness. What effects your blood sugar in the sugar free cookie is: the flour and the sugar alcohol (to a minor extent). However, if you eat a large portion due to the food being "sugar free" you will see more of a rise in blood sugar.

No Sugar Added Foods

There is no sugar added to the product that already contains some natural sugar. For example: no sugar added ice cream that has milk (lactose is natural milk sugar) already in the product. The processed sugar that is usually found in ice cream will be replaced by sugar alcohol. If you eat a large portion due to the food being "no sugar added" you will see more of a rise in blood sugar.

Net Carbs or Low Carbohydrate Foods

These foods have fewer carbohydrates and therefore less sugar as well. Again, slow-digesting sugar alcohol replaces the quick-digesting sugar so there will be less of a rise in blood sugar levels. Be aware of other macronutrients (carbohydrate, protein or fat) that may be harmful like saturated fat. Saturated fat clogs your arteries and makes your liver produce more cholesterol. The maximum amount of saturated fat recommended for the day is 15-20 grams. More than this amount may contribute to heart disease risk.

The Bottom Line

You may eat sugar free, no sugar added or low carb foods moderately or you may help to slow-digestion by eating a more moderate amount of the low-fat or regular food item and combine it with healthy protein and/or fat. For example, you may have a scoop of low-fat ice cream with chopped nuts. The ice cream may breakdown into sugar quickly, however, the nuts (protein/fat) will help to slow the digestion down and level out the blood sugar. A more healthful choice would be to eat a fruit (carb) with a piece of low-fat cheese (protein and fat) to help to level out blood sugar and avoid spikes and dips.

Additional Resources:

Diabetes Nutrition
Diabetic Food Exchanges
Glycemic Index
Sweetners

Sweeteners

Sugar with other names – HAVE an effect on blood sugar levels

Natural Sweeteners with nearly ZERO calories – HAVE NO EFFECT on blood sugar levels **
May all be used in cooking and baking

Artificial Sweeteners – HAVE NO EFFECT on blood sugar levels

Vitamins & Supplements

According to the National Center for Complementary and Alternative Medicine at the National Institutes of Health (NCCAM/NIH), dietary supplements were defined in a law passed by Congress in 1994. A dietary supplement must meet all of the following conditions:

• It is a product (other than tobacco) intended to supplement the diet, which contains one or more of the following: vitamins, minerals, herbs or other botanicals; amino acids; or any combination of the above ingredients.
• It is intended to be taken in tablet, capsule, powder, soft-gel, gelcap, or liquid form.
• It is not represented for use as a conventional food or as a sole item of a meal or the diet.
• It is labeled as being a dietary supplement.
• They are regulated as foods, not drugs, so there could be quality issues in the manufacturing process.
• Supplements can interact with prescribed or over-the-counter medicines, and other supplements.
• "Natural" does not mean "safe" or "effective."
• Consult your health care provider before starting a supplement, especially if you are pregnant, nursing or considering giving a supplement to a child.

Vitamins, Supplements & Herbs

The following vitamins, supplements and herbs may have some specific benefits for people who have diabetes. Please check with your pharmacist or doctor before considering any of these supplements – especially pregnant women. There is not strong evidence to support any of the claims listed below so use with caution. Be extra careful if you are already taking diabetes medications to lower your blood sugar and you add some supplements that can also help to lower your blood sugar. Carry glucose tablets or some form of sugar with you at all times.

• Chromium GTF (Glucose Tolerance Factor): may play in role in regulating blood glucose by helping insulin transport sugar into cells. 300-400 mcg twice a day.
• C0Q10 (co-enzyme Q10): a powerful antioxidant that may help maintain a healthy heart. Take a soft-gel (100 mg) with your largest meal.
• Magnesium – vitamin to help promote healthy insulin production, take 500 mg a day. (may have laxative effects at higher doses). 25-38% of people with diabetes have lower magnesium levels. This deficiency may result in an inability to use insulin properly. Nuts, whole grains, green vegetables and beans have higher levels of magnesium.
• Vitamin E – due to the controversy, try eating foods containing this powerful antioxidant: spinach, sweet potatoes, seeds/nuts, and wheat germ.
• Bitter melon - may help to lower blood sugar. Take as directed on bottle. Be very cautious since it may lower blood sugar excessively – especially when taking other diabetes medications.
• Gurmar (Gymnema Sylvestre, or "sugar-destroyer") – an Indian herb used to help to lower blood sugar. Take as directed. Be very cautious since it may lower blood sugar excessively – especially when taking other diabetes medications.
• Prickly-pear cactus – may help to lower blood sugar. Take as directed. Be very cautious since it may lower blood sugar excessively – especially when taking other diabetes medications.
• Cinnamon – controversial but shouldn't hurt you! Try one gram (¼-½ tsp. each day) and see if it helps.
• Fish oil (omega 3's) — 3,000 - 4,000 mg a day may decrease triglycerides (many people with diabetes have higher triglyceride levels). Be careful! Monitor cholesterol - omega 3's may cause a slight increase in LDL (lousy) cholesterol.
• Vanadium: is a substance that may improve blood sugar. There is little data.
• Fenugreek – a seed you can use in foods that will slow down digestion and therefore reduce spikes in blood sugar. The fiber content in fenugreek may decrease the absorption of medications so don't take at the same time as your other medications!

Peripheral Neuropathy

Peripheral neuropathy affects the legs, feet, and toes, and to a lesser extent, the arms and hands. Peripheral neuropathy causes pain or loss of feeling in the affected areas. Some people with diabetes experience burning or prickling sensations, become very sensitive to touch, or lose balance or coordination. Foot injuries must be given particular attention for people with peripheral neuropathy. The following vitamins, supplements and herbs may provide a benefit:

• B-100 complex – a water-soluble vitamin that works in conjunction with alpha-lipoic acid to relieve nerve pain.
• Alpha-lipoic acid – an antioxidant that can enhance glucose uptake and help maintain eye and nerve health. 600mg/day
• Capsaicin: (get the new roll-on) – a topical treatment (cream) made from hot chili peppers to promote circulation and reduce painful neuropathy.
• Vitamin C – a water-soluble vitamin. A study from University of Massachusetts in Amherst found that vitamin C supplementation of 250-500 mg per day blocked an enzyme that has been implicated as one possible cause of peripheral neuropathy in diabetes patients. Dietary sources are tomatoes, red peppers, dark green vegetables, fruits.
• Ginkgo Biloba – may help with circulation to extremities and improves blood flow to brain to improve memory and concentration if one is lacking in those areas. Be careful if taking other blood thinners. This will thin your blood!

Please consult your doctor and/or pharamcist prior to taking supplements. You should be monitored if you take a combination of blood thinners: Coumadin, Plavix, aspirin, CoQ10, Ginkgo Biloba, fish oil, Vitamin E.

Also, Reiki, which is a healing touch that is not hands on, may help to relieve symptoms of neuropathy.

For more information: Visit the NCCAM/NIH Clearinghouse

Diabetes & Dental Care

High blood glucose levels increase your risk for tooth and gum problems. Just think of what happens to your teeth when you eat too much sugar!

• Brush and floss your teeth at least daily
• Schedule regular dental checkups and periodontal checkups if necessary
• Tell your dentist that you have diabetes
• Between checkups, call your dentist immediately if you have unusual pain, swelling or excessive bleeding
• Of course, keep your blood sugar in the best control

For additional information about keeping your teeth and gums healthy:

"Prevent diabetes problems: Keep your teeth and gums healthy," National Diabetes Information Clearinghouse (NDIC)

Diabetes & Exercise

Exercise can help you stay healthy, control blood sugar, maintain a healthy weight, and to increase energy levels. Always consult your doctor before starting an exercise regimen. Here are some tips and guidelines that people with diabetes should follow when exercising:

• Exercise increases the use of insulin and lowers blood sugar during and after exercise.
• Test blood sugar before, during and after exercise.
• If your blood sugar is above 250 mg/dL, do not exercise. Your body will not have enough energy to exercise properly or efficiently (remember sugar is energy).
• If your blood sugar is under 100 mg/dL, then do not exercise. Eat 15 grams of carbohydrates with protein/fat, and wait about 30 minutes to exercise. Wait 1-2 hours to exercise after eating a large meal. Make sure your blood sugar maintains at least 100 mg/dL throughout your exercise.
• It is best to eat a meal with high-fiber carbohydrates mixed with lean protein and healthy fat to carry you through the exercise. This type of eating will provide energy for a prolonged period of time. You will exercise most efficiently this way.
• If you exercise too soon after eating your blood is pooling in your stomach to assist with digestion and will not be as available to your extremities (arms and legs).
• If you experience low blood sugar symptoms during exercise STOP and check blood sugar and treat symptoms.
• Always carry some form of low blood sugar treatment (food, glucose tabs) since you are more prone to having low blood sugar during or after exercise.
• Drink fluids before, during and after exercise, since your blood glucose can be affected by dehydration.
• Be careful if your medication is peaking or working its hardest during exercise. This may cause a pronounced drop in blood sugar.

Diabetes & Gastroparesis

Gastroparesis (stomach paralysis) is a condition sometimes associated with diabetes when there is a delay with the stomach emptying its contents. This delay is due to stomach nerve damage caused by high blood sugars over a long period of time.

The result of gastroparesis is that instead of contractions pushing the food through the stomach, the food stays around in the stomach until acid and digestive enzymes break it down and gravity helps the process. When food lingers in the stomach too long, it can cause bacterial overgrowth from fermentation of food – flatulence. The food can also harden and cause nausea, vomiting and obstruction in the stomach.

How do you know if you have it?

You may feel full or bloated after only a few bites of food. You may experience vomiting, heartburn, nausea or excessive belching after eating.

Common treatments for gastroparesis:

• Keep blood sugar in the best control
• Eat small, frequent meals
• Limit food that are hard to digest (high fiber, high fat, citrus fruits)
• Replace some solid meals with liquid meals
• Limit/avoid alcohol and caffeine
• Exercise to increase motility

Please consult your doctor to determine if you have this condition to avoid serious complications.

Diabetes & Heart Disease

One of the most common and serious complications of diabetes is heart disease. Diabetes is a disease of the vessels. High blood sugar damages your blood vessels by building a plaque which leads to clogged arteries or atherosclerosis. More than 65% of deaths in diabetes are due to heart disease. In fact, when you have diabetes, you're 2-4 times more likely to have a heart attack or stroke, you’re more likely to die from a heart attack, complications from heart disease results at an earlier age, and your risk of sudden death from a heart attack is the same as for someone who has already had a heart attack.

The good news is that even after your diabetes diagnosis you have the power to prevent heart disease.

Here’s how:

• Manage your blood sugar (Read "12-Steps to Controlling Your Diabetes")
• Keep your blood pressure lower than 130/80
• Control cholesterol and triglycerides, making sure your HDL (healthy cholesterol) is at least 50 mg/dL for women and 40 mg/dL for men and your LDL (lousy cholesterol) is under 100 mg/dL or even lower than 70 mg/dL if you have other heart disease risk factors and take cholesterol-lowering medication. Triglycerides should be under 150 mg/dL.
• Stay active
• Stop smoking
• Maintain a healthy weight
• Use alcohol moderately
• Eat healthier

What's a heart healthy way to eat?

• Avoid over-consumption of saturated-fat foods (cheese, meat, high-fat/whole-fat dairy products, sauces, gravies, butter, and some low carbohydrate foods) and foods containing trans fat (mostly in processed foods with partially hydrogenated oils). These fats clog your arteries and encourage your liver to produce extra, more harmful cholesterol. 15-20 grams of saturated fat and trans fat combined for the day should be the maximum amount you consume. Consume mostly monounsaturated-fat foods (olive oil, nuts, avocado). These fats increase healthy cholesterol and decrease unhealthy cholesterol levels.
• Eat high-fiber foods (at least four or five grams per serving) to total 30-50 grams each day. Build your fiber intake up gradually. Look for fiber in cereal (beware of the sugar!), grains (kasha, barley, millet), fruits, vegetables, and beans.
• Consume cold-water fish that is high in omega-3 fats. This includes salmon, tuna, sardines, and mackerel. These omega-3 fats are found to thin the blood (therefore reducing clot formation and possibly a heart attack or stroke), boost good cholesterol and lower triglycerides. Fish is also an excellent replacement for higher-saturated-fat foods such as meat or poultry. You may also take up to 3,000 mg of fish oil daily. Always check with your doctor first.
• Take a multivitamin or a B-complex supplement.
• Consume foods with flavonoids, an antioxidant found in red grapes, blueberries, red wine, onions, citrus fruits, tomatoes, and black and green tea. Flavonoids thin blood and prevent damage from cholesterol.
• Antioxidants like vitamin C, E, selenium and beta-carotene reduce free radical damage. Free radical damage may promote heart disease by stimulating blood to clot and plaque to build in the arteries. Free radicals are produced when oxygen is broken down by radiation exposure, air pollution, ozone, cigarette or cigar smoke, rancid fats or by-products of our foods and medications. They then allow disease to begin in our bodies. Oxidation in our bodies is similar to a rusted iron pipe. When a pipe is exposed to oxygen over time, it will rust. This rust is similar to the plaque buildup in our arteries. Antioxidants (anti-oxygen or against oxygen) do not allow oxygen to be broken down, so they neutralize these free radicals so they don’t lead to diseases such as heart disease, cancer, arthritis, and aging by damaging the cells. Eating foods rich in whole grains, fruits, and vegetables is preferable in addition to taking vitamin C, E, beta-carotene and selenium supplements.
• Vitamin C (250-500 mg per day) or consume peppers, citrus fruits, broccoli, Brussels sprouts, cauliflower.
• Vitamin E (400 IU per day as d-mixed-tocopherols) or consume vegetable oils, almonds, soybeans, wheat germ, sunflower seeds.
• Beta-carotene (5,000-10,000 mg per day) or consume orange fruits and vegetables, dark leafy green vegetables, sweet potatoes, carrots, dried apricots, collard greens, spinach, kale.
• Selenium (100–200 mcg per day) or consume Brazil nuts, grains, seafood.
• Selenium and vitamin E taken together with a meal with some fat increases absorption in the body. Take apart from vitamin C, which may hinder absorption.
• Coffee: If it’s brewed in French press machines, unfiltered or served as espresso, coffee maintains two compounds that may raise cholesterol. Cafestol and kahweol tend to raise LDL (lousy) cholesterol levels. Filtered coffee has not been shown to have these effects.
• Garlic has antioxidant properties. Onions, shallots and leeks, like garlic, are from the allium family and contain compounds to help prevent heart disease.
• Avoid over-consumption of animal protein. Most of us need only six to ten ounces of protein a day. Americans easily consume 15-20 ounces or more daily. Most of the protein we consume comes from meat or poultry that contain the highest amounts of saturated fat and cholesterol. Substitute fish or soy products when possible, or combine beans and grains for a complete protein (please count the carbohydrates!)
• Beware of fat-free foods. They usually contain more carbohydrates (sugar) and/or sodium. Excess sugar or carbohydrates turn into fat (triglycerides) since they can't be stored in abundance in the body. Choose low-fat food instead.
• Shellfish is a good choice. It has slightly higher amounts of sodium, but it has virtually no saturated fat! Shrimp and crayfish have higher levels of cholesterol than other shellfish. When compared to meat or poultry that do contain saturated fat, however, even the shrimp and crayfish come out on top. When you weigh out the portions typically eaten of shrimp vs. meat the cholesterol is identical. There is still the saturated fat issue, however. Remember that saturated fat raises your cholesterol. Scallops have minimal cholesterol and are an even better choice.
• Sodium needs to be consumed in lower amounts. It may contribute to high blood pressure. A low sodium food has 140 mg per serving and a low sodium daily budget should be under 2,000 mg.
• Excess body weight certainly may contribute to heart disease, especially if stored in the chest and abdomen (apple shape).
• Ask your doctor for the following blood tests to predict your heart disease risk: C-reactive protein, homocysteine, triglycerides, cholesterol (HDL/LDL), glucose, HbA1c and blood pressure.
• Consume diabetes and heart healthy snacks like fruit and nut butter or low-fat cheese or yogurt and nuts.
• Consume diabetes and heart healthy meals that emphasize non-starchy vegetables like broccoli, green beans, spinach, tomatoes, have moderate amounts of grains like quinoa, barley, kasha, and incorporate fish with high levels of omega 3 fats like wild salmon. Focus on adding many colors and dark colors of foods for a variety of nutrients in your meals and snacks.

Here's to your good heart health!

Diabetes & Kidney Disease

Diabetes affects all the small blood vessels in your body, including your kidneys. Kidneys filter the blood. Waste products that have collected in the blood are removed and leave the body in the urine. Over a long period of time, the small blood vessels that are vital to proper kidney function can be damaged by exposure to high blood glucose levels and high blood pressure.

When damaged, the kidneys can no longer filter the blood as well as before, so the waste products stay in the blood and products that the body needs are lost in the urine. This is called nephropathy, as the nephrons, which are small filter in the kidneys, are damaged.

Please remember to request a copy of your blood work. Microalbumin is a test that can show the beginning of kidney problems. BUN or blood urea nitrogen and creatinine are two tests, when elevated out of range, show some damage already may be done to the kidneys. GFR, or glomerular filtration rate, shows how well the kidneys are functioning as filters.

In the early stages, the kidneys work harder to compensate for the damage, and there are no symptoms. Over many years, as the kidneys deteriorate, they lose their ability to repair themselves. When this occurs, kidney damage can be life-threatening and may require a kidney transplant or regular treatment with an artificial kidney machine called dialysis.

You can help prevent kidney problems and possibly avoid serious kidney disease by:

• Controlling your blood glucose levels
• Controlling your blood pressure levels
• Seeing your doctor once a year for a urine test and a microalbumin test
• Cutting back on sodium
• Exercising regularly
• Maintaining a healthy weight
• Treating bladder or urinary tract infections right away. Symptoms include: fever and chills, frequent urination or burning sensation, blood in the urine, cloudy and foul smelling urine, lower back pain.

Diabetes & Nerve Damage

Diabetes can damage all parts of your body, including your nerves. This is called neuropathy. Neuropathy is partly due to the effects of blood sugar.

There are two types: Peripheral neuropathy and autonomic neuropathy.

• Peripheral neuropathy is the most common nervous system complication associated with diabetes. If affects your legs, hands, and arms. Neuropathy has to do with your sense of touch, and your nerves in these parts will either be more sensitive or less sensitive. The way you feel depends on what nerves are affected.
• Autonomic neuropathy affects your stomach, your bladder and your digestive system. Signs of this damage include: nausea, diarrhea, vomiting, and difficulty emptying your bladder. Your doctor will prescribe medications to help alleviate these symptoms.

Less sensitive nerves do not send feelings of pain, heat or cold to the brain as easily. There may be a feeling of numbness or pins and needles in your feet. You may injure your feet and not be aware, due to the decreased sensitivity to pain. You must take extra care not to injure your feet and you must check your feet daily to see if an injury has occurred.

Your nerves may also develop increased sensitivity at times. When this happens, you may feel burning, numbness or tingling, or shooting pains in your legs and feet. You may not be able to tolerate the touch of clothing or sheets on your legs and feet.

Neuropathy can also affect the nerves that control sexual function. This may result in impotence for men and vaginal dryness or difficulty to achieve orgasms for women. Discuss these symptoms with your doctor.

Common treatments for diabetic neuropathy:

• Maintain healthy blood sugar levels
• Medications such as Lyrica, Cymbalta and others are available with a prescription from your physician
• Capsaicin is a topical cream made from hot chili peppers (roll on available) that can dull the discomfort
• Walk to decrease leg pains
• Relaxation, exercise, acupuncture, hypnosis
• Pain clinics
• B-complex and alpha lipoic acid
• Take care of your feet and report any signs of infection or foot injury immediately.
• Have a podiatrist care for your feet

Diabetes & Sleep

If you are sleep deprived, your chances for diabetes increases since your insulin will not work as well as you need it to for lowering blood sugar. In fact, your cortisol levels (stress hormone) will rise and that causes your liver to produce more sugar.

Remember, if your insulin is not working 100% efficiently (“insulin resistance”), then the extra sugar your liver is producing will cause an even higher blood sugar reading. In addition, your brain, which seeks energy primarily from glucose or sugar (carbohydrates), will not function at its highest level.

Think about how “foggy” your head feels after having a sleepless night.

The symptoms of sleep deprivation are:

• Constant tiredness
• Snoring
• Poor concentration
• Depression
• Lack of energy
• Weight gain or loss
• High blood pressure

The risk factors of sleep deprivation are:

• Endocrine and metabolic disorders (diabetes, pre-diabetes, etc.)
• Obesity
• Male gender
• Increasing age
• Alcohol or sedative use
• Smoking
• Anatomic abnormalities of the upper airway

Diabetes and sleep statistics:

• 50% of males with Type 2 diabetes have sleep disorders
• 20% of females with Type 2 diabetes have sleep disorders
• 97% of obese people with diabetes have sleep disorders
• 30% of patients attending sleep clinics are found to have pre-diabetes or diabetes

Sleep apnea is a common sleep disorder that is associated with fatigue, weight gain, high blood pressure, diabetes and heart failure. Answering YES to 2 or more questions below indicates that you may have sleep apnea.

• Do you snore?
• Are you excessively sleepy or fatigued during the day?
• Have you been told you stop breathing during sleep?
• Do you have a history of high blood pressure?
• Is your neck size greater than 17” (male) or 16” (female)?

Diabetes & Vision

Diabetes can affect eyesight. Elevated blood sugar levels may cause changes in the body’s blood vessels, the veins and arteries that carry blood throughout your body. It can cause cataracts, glaucoma, and damage to the blood vessels inside the eye.

Diabetic retinopathy is a complication of diabetes caused by changes in the tiny blood vessels of the retina. The retina is the light-sensitive nerve layer at the back of the eye that sends images to your brain. Without a retina, the eye cannot communicate with the brain, making vision impossible.

There are two types of retinopathy:

• Background retinopathy: An early stage when blood vessels in the retina are damaged. Fine blood vessels become narrowed while others enlarge to form balloon-like sacs. They may leak fluid or blood causing the retina to swell. Sight is not usually affected. In some people the fluid collects in the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, blurring our vision. This is known as macular edema. Reading and close work may be difficult.
• Proliferative retinopathy: New abnormal vessels may grow fragile, brush-like branches and scar tissue as the disease progresses. These new blood vessels may rupture and bleed into the vitreous, the clear gel-like substance that fills the center of the eye. Scar tissue may form and pull the retina away from the back of the eye causing a detached retina. Abnormal blood vessels may also grow around the pupil causing glaucoma by increasing pressure within the eye. This is the most serious form of diabetic retinopathy and affects up to 20% of diabetics, and can cause sever loss of sight, including blindness.

Diabetic retinopathy is the leading cause of new blindness among adults in the USA. People with untreated diabetes are said to be 25 times more at risk for blindness than the general population.

There are no early warning signs with diabetic retinopathy. At some point you may have blurring. If new blood vessels form, they can hemorrhage and may leave spots floating in your vision. This can also be as severe as only being able to tell dark from light.

A medical examination by an ophthalmologist is the only way to find changes inside your eye. This includes visual acuity testing, pupil dilation, ophthalmoscopy, and tonometry (tests fluid pressure). Further testing may include fluorescein angiography - dye given intravenously to obtain color photographs of the retina.

The most significant treatment is laser surgery. This seals the leaky blood vessels. A small burst of light is beamed on the damaged retina. This reduces macular edema. Laser surgery retards vision loss. Other treatment such as cryotherapy and vitrectomy may be recommended for persistent hemorrhaging.

Early detection of diabetic retinopathy is the best protection against loss of vision. People with diabetes should schedule examinations by an ophthalmologist at least once a year.

Diabetes Foot Care

Peripheral neuropathy and decreased circulation can lead to serious foot problems. Please be sure to:

• Check your feet daily, top and bottom. Check for swelling, scratches, cuts, reddened areas, blisters, cracks, calluses or sores. Check for areas of increased warmth or changes in color. If you find any of these conditions, notify your doctor.
• Do not walk barefoot at any time. If you have a loss of sensitivity in your feet and step on something that causes a wound or infection, you may never know it until it becomes severe.
• Wear comfortable shoes that fit well (same reason as above).
• Dry your feet well especially between your toes. Apply lotion or cream to the tops and bottoms but not between your toes.
• Do not use sharp objects or chemicals on your feet. Trim nails with clippers and smooth with an emory board. Cut your toenails to match the contour of your toes.
• Schedule regular visits with your podiatrist. It is preferable to let the podiatrist trim your nails and remove corns and calluses.
• Ask your healthcare team about “diabetes shoes” covered by Medicare and some insurance companies.

Foods & Wound Healing

People with diabetes do not heal as efficiently as people with normal blood sugar levels. Certain foods can also help keep your blood sugar optimal.

Protein helps to repair tissue:

• Fish
• Shellfish
• Eggs (egg whites have protein and no cholesterol)
• Cheese (low fat is better for your heart)
• Poultry
• Lean meat
• Nut butters (peanut butter, almond butter, cashew butter, etc.)

Carbohydrates give you energy:

• Starch (bread – whole grains are best – cereal, noodles, rice, barley, kasha)
• Starchy vegetables (sweet or white potatoes, corn, peas, beans)
• Non-starchy vegetables (broccoli, green beans, asparagus, salad greens)
• Fruit
• Milk (drinking milk, soymilk or yogurt)

Fat allows you to absorb your fat soluble vitamins – A, D, E, K:

• Oil (olive and canola oil are best for your heart)
• Nuts (are good for your heart and health)
• Avocado (is good for your heart)
• Margarine (pick one without trans fat)
• Butter (use more sparingly)

The following vitamins are excellent to heal wounds most efficiently:

• Vitamin C – foods with high levels:
  • Peppers (especially red)
  • Kiwi fruit
  • Tomatoes
  • Citrus fruits (oranges, grapefruits)
  • Broccoli
• Vitamin A – foods with high levels:
  • Orange colored fruits/vegetables
  • Dark green leafy vegetables
• Vitamin E – foods with high levels:
  • Whole grains
  • Wheat germ
  • Dark leafy green vegetables
  • Eggs**
  • Nuts and seeds
• Vitamin B – foods with high levels:
  • Whole grains (wheat and oats)
  • Fish and seafood
  • Poultry and meat
  • Eggs**
• Zinc – foods with high levels:
  • Oysters (very high)
  • Protein
  • Beans

** Egg yolks contain vitamins and cholesterol while egg whites contain protein

High Blood Pressure

Hypertension, or high blood pressure, is the force that moving blood puts on the artery walls. As the heart muscle pumps out blood, the aorta (main blood vessel) is stretched until a peak pressure is reached. This peak pressure is called the “systolic pressure.” As the heart rests between beats, the arteries are more relaxed but maintain enough tension to allow smooth blood flow. This tension is called the “diastolic pressure”.

• Systolic pressure (top number) should range between 90 and 140 mmHg.
• Diastolic pressure (bottom number) should range between 60 and 90 mmHg.

If you have high blood pressure it means the heart is under pressure to pump blood and there is an increased tension on the artery walls. This may cause damage to the arteries since any injury causes plaque to build up. This ultimately weakens the heart muscle because hypertension requires the heart to work much harder.

Essential tips for getting to and maintaining healthy blood pressure levels.

• Lose weight if overweight (10 pounds results in lower blood pressure)
• Limit alcohol intake to no more than 1 drink a day for women and 3 drinks per day for men (12 ounces beer, 1 ounce liquor, 4 ounces wine)
• Exercise at least 4-5 times a week for 30-60 minutes if approved by your doctor.
• Follow the DASH diet: Dietary Approaches to Stop Hypertension
• Reduce sodium intake to 2,000 mg (less than 1 tsp. salt)
• Maintain adequate amounts of potassium, magnesium and calcium (nuts, tomatoes, yogurt, cantaloupe, honeydew, grains)
• Reduce dietary saturated and trans fat
• Eat at least 25 grams of fiber each day
• Avoid high sodium foods: cold cuts, cheese, processed or convenience foods, canned foods, soups, olives, pickles, soy sauce and other sauces, bouillon
• A low sodium food contains 140 mg per serving

Please consult your doctor before starting an exercise program or changing your diet.

A to Z Inspiration

Diabetes & Depression

Understanding the diabetes and depression is like asking the question: What came first the chicken or the egg?

Stress can affect blood sugar levels and having diabetes can add stress to people’s lives. Experiencing stress for a prolonged period of time may result in depression.

Many people newly diagnosed with diabetes go through stages of mourning:

• Denial
• Anger
• Depression
• Acceptance

Many people are in denial about their disease. “Oh, it’s just a little sugar,” some might say or “I feel fine, I’ll just cut back on my sweets,” or “I’m only borderline.”

Sometimes these people who are in denial will end up with a complication of diabetes, like nerve damage, and then they start to take it seriously and become angry.

While angry, they acknowledge how much of a responsibility diabetes is and the devastating complications they may suffer from if they choose to ignore it. For many, the next stage is acceptance. They accept their disease and make strides in controlling it the best way possible. Others, become depressed.

Are you depressed?
People with diabetes tend to have a greater risk of depression than people without diabetes. This may be due to the responsibility of managing a disease that requires a lot of thought, daily. The possible complications may add stress to your life. Even fluctuating blood sugars can affect your moods.

If you have been feeling very sad, or if you worry that you may be depressed please seek the help of a professional – a psychologist, psychiatrist or social worker, or:

• Speak with your doctor
• Talk with family, friends, support groups for diabetes
• Exercise or walk to clear your head of negative thoughts
• Find fun hobbies
• Use meditative tapes to help you deeply breathe and relax

At The Gym

You joined the neighborhood gym months ago and now you think it’s a good idea to attend. You push, push, push yourself to go and there you are in your “gym get-up” (aka oversized T-shirt and shorts) ready to work out. You look around at all the cute girls in their fancy “work-out gear” with tons and make-up and perfume, flirting with the cute guys and you think to yourself, why am I here? Then you spot an older gentleman who is kind of hot, focusing on his exercise, and that gives credence to your decision to stay.

You proceed to the exercise machines where you first eye the stairclimber and think this is what your rear-end needs to perk it up a bit. You get on, but before you start climbing, you think about your fasting blood sugar – 95 mg/dL and the breakfast you ate – a bowl of cereal, milk and fruit - and when your medication is going to peak – RIGHT NOW!

You jump off the machine before you start to break a sweat – or even climb one step for that matter – and you run to the bathroom and check your blood sugar. 85 mg/dL! Are you kidding? It’s going down……….You think to yourself before you head to the smoothie bar to decide between a vanilla almond milk with peanut butter smoothie or a blueberry, banana, kiwi smoothie with extra whey protein and flaxseed meal to take you through the exercise – this is NOT a good time to exercise! But you’re here anyway, so you relax with your delicious and sweet, but slow digesting, smoothie, knowing you made a better choice by throwing in the protein and fiber to slow down fruit sugar from blasting in your bloodstream and you’ll be ready to go in about 30 minutes.

Thirty minutes pass and you test your blood sugar again and now it is 120 mg/dL. Mission accomplished! You get some water to take with you and start climbing. Sixty minutes after drinking and sweating you take a break and re-check your blood sugar. You haven’t worked out this hard in years and you feel so out-of-shape. Oh no, the sugar is now 250! What happened? Oh yeah, you remember that diabetes educator telling you that your liver stores glucose and will overcompensate in some instances – like now!

When your blood sugar is dropping it protects you by sending out glucose into the bloodstream. The bad part is that it is overly generous……your liver did such a good job that now you have high blood sugar! You drink more water to hydrate yourself and learn from this incident. Obviously, your body can not exercise with blood sugar in the low hundreds when your medication is peaking. Next time, you will exercise at a different time or ask the doctor to adjust your medication(s). Perhaps your doctor can cut back on your medication, suggest that you take it at different times, or you may not even need it on those exercise days!

At The Restaurant

You've desired it for awhile now. You've thought about it almost every day. You've longed for that "forbidden food." You have truly wanted it so badly and for so very long that you could taste it. You find it difficult to understand how Billy Joel sang such a romantic tune about it and yet all you can equate it with is dreadfully high blood sugar.

But, the antipasto wins out and you finally convince your friend to accompany you to your favorite Italian Restaurant. You walk in knowing this could be trouble. The scent of the garlic rolls follow you from the front door all the way to your seat. Before you even look at the menu you can hear that dietitian/certified diabetes educator’s song ringing in your ears about testing your blood sugar before the meal and about 2 hours later so "it will either give you peace of mind or you’ll know you better not do that again" and you can make a better choice next time.

Alright, so she was reasonable and never told you to refrain from your favorite food, just find out things. And then you remember – oh, that voice again – she also said to sit down, peruse the menu and think of every food you would like that might have a dramatic effect on your blood sugar. Minestrone soup or salad? How many garlic rolls? Side of pasta or full plate? Breading on the chicken parmigiana or chicken cacciatore? The tomato sauce? Dessert?

Decisions, decisions. You get angry for a moment because you really want to just eat what you want and not think so much about it. Just then, your friend comments about her desires and how she needs to choose carefully because she is trying to keep her weight in control and that she works so hard exercising and making healthy choices. She decides to order the salad with dressing on the side, shrimp parmigiana – hold the cheese (saturated fat, 100 calories an ounce and tons of sodium) – and sautéed spinach. As she orders, she munches on one garlic roll and pushes the rest aside. "I'll have the same", you say, as you indulge in a delicious meal at your favorite Italian restaurant knowing you can come back here as often as you like.

Body Mass Index (BMI)

Body Mass Index (BMI) assesses your body weight relative to your height. The American Dietetic Association uses the following BMI formula: multiply your weight in pounds by 700. Then divide
that number by your height in inches two times.

For example: a person weighs 135 pounds and stands 5’7” tall. 135 pounds x 700 = 94,500. Divide that twice by 67” (5’7”). 94,500/67 = 1,410 divided by 67 again = BMI is 21

BMI was designed to determine how your weight affects the status of your health. Too high of a BMI means that you are more prone to illnesses such as heart disease, cancer and diabetes. A pear-shaped person, who has excess weight in their hips and thighs, is at a much-decreased risk of many diseases than is an apple-shaped person, who has much of his or her weight in the chest and abdominal area.

What number do you hope to see?

Carb to Insulin Ratio

A carbohydrate to insulin ratio is the amount of insulin used to lower the blood sugar from a particular amount of grams of carbohydrates eaten. For example, some people have a 15:1 carbohydrate-to-insulin ratio or they take 1 unit of insulin for every 15 grams of carbohydrates they eat. But other Type 1s need 1 unit of insulin for every 10 or even 8 grams of carbohydrates. Every person responds a little differently to insulin.

The 450/500 rule goes as follows:

If a person is taking rapid-acting insulin such as Humalog, Novolog or Apidra they would follow the 500 rule which states:

Divide 500 by the total daily dose of insulin. The result is the grams of carbohydrates that are approximately covered by 1 unit of insulin. For example, add up all the insulin you take for the day and divide by 500. If your total daily dose was 45 units, you would divide 500 by 45 and your ratio would be 11:1.

If a person is taking short-acting insulin such as Humulin R or Novolin R (Regular insulins) they would follow the 450 rule which states:

Divide 450 by the total daily dose of insulin. The result is the grams of carbohydrates that are approximately covered by 1 unit of insulin. For example, add up all the insulin you take for the day and divide by 450. If your total daily dose was 45 units, you would divide 450 by 45 and your ratio would be 10:1.

http://www.insulin-pumpers.org/howto/ratio.cgi (calculator)
http://www.bddiabetes.com/US/main.aspx?cat=1&id=303 (chart)