New Dietary Guidelines for Americans

The U.S. Department of Health & Human Services and the U.S. Department of Agriculture have recently released their guidelines for healthy eating. These guidelines are meant to help people prevent health problems.

The guidelines emphasize the importance of eating a “wide variety of fruits, vegetables, grains, and dairy products, while staying away from  processed foods heavy in saturated fats, sugar, and cholesterol” (and trans fats). They also recommend significantly reducing the amount of added sugars and sugar-sweetened beverages from the American diet.

They really highlight the importance of eating a wide variety of foods. They also acknowledge that focusing on “small shifts in what we eat and drink” makes it easier to eat healthy. Another way to make a change is to focus on patterns and not just individual food choices.

These “common sense” guidelines are equally aimed at and important for lay people and health care providers. Although they don’t contain drastically different or new information, they make a basic point about healthy eating for everyone.

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Changing diabetes management in older and elderly people

The results of the DCCT and the UKPDS studies changed lives. They also changed health care practice. Since 1993 we have been carb counting and using basal-bolus insulin dosing (type 1 diabetes). We’ve been starting insulin earlier and/or using a combination of medications (type 2 diabetes). We know the importance of healthy food choices and exercise in managing both type 1 and type 2 diabetes and keeping A1Cs below 7%.

Now that we know what we know, it’s hard to think about backing off on this “intensive management” when we get older. Older people take on new risks as they age (yucky things like decreased hearing, cognitive impairment, worsening eyesight and manual dexterity). If we continue to strive for A1Cs below 7% at this point in life, we risk hypoglycemia, which can lead to falling. While low blood glucose is a nuisance for younger people, it’s downright dangerous for the elderly. Falling could mean breaking a hip or worse yet, there may not be anyone around to help us get up.

It takes the whole team – health care providers, family members and people with diabetes – to accept loosening up blood glucose and A1C numbers in older and elderly people. The trick is to do it in a way that’s not simply “throwing in the towel.” We still want to feel good and have energy, so we don’t want to run high all the time.

This is something to think about as you or your loved one with diabetes ages. And be sure to discuss it with health care providers so you get their buy-in as well. Here are the American Geriatrics Society’ Choosing Wisely treatment guidelines (#3).

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Individualizing care is the opposite of adherence

Both the American Diabetes Association (ADA) and the United Kingdom’s National Institute for Health and Care Excellence (NICE) have recently placed greater emphasis on individualizing care. The ADA uses “patient-centered care” in their standards, and NICE supports having individuals involved in diabetes-related decisions. We’ve been discussing putting people with diabetes at the center of their care for years, and it’s very exciting that these prestigious organizations are getting behind it.

So why are we still seeing and hearing the word “adherence”? It seems like these messages of patient-centeredness are going in one ear and out the other when health care providers still use terminology that is outdated and inappropriate in diabetes care. Adherence, like compliance, means “sticking to” something that someone else wants us to do. How is that patient-centered?

It’s time for health care professionals to take a look at our spoken and written language and figure out how we can align it with the messages we are meaning to send. If we want to give patient-centered care, then let’s also use patient-centered language. Let’s send messages that reflect an empowerment, strengths-based approach.

Some examples include “she is taking her medication about half the time” or “he takes insulin when he can afford it” rather than “she/he is not adhering to the plan” (or even “she/he is non-compliant”). And how about “medication taking” rather than “medication adherence”? These small changes add up to focusing on a person’s strengths, instead of their weaknesses.

Groups like the ADA and NICE have made giant steps toward improving care for people with diabetes, and this is to be commended! The next step is to adopt language that sends messages consistent with a patient-centered focus.

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Diabetes and Surgical Site Infections

Hopefully if you or someone you love has diabetes you already know that high blood glucose leads to infection. High blood glucose also contributes to slower healing wounds. If someone with diabetes has surgery, their risk for infection at the surgical site is higher, especially if their blood glucose level is elevated.

Many hospitals have pre-operative nurses who counsel surgery patients about what to do with their medications on the day of surgery (or the day before). They may also discuss with patients the importance of coming into surgery with a blood glucose level in (or as close as possible to) the normal range (70-110). Regardless, it’s important to have this information tucked away in your head so that if you or your loved one ever needs surgery you can plan.

Surgical site infections are a risk to everyone who undergoes surgery, but those with diabetes have a higher risk. High blood glucose puts people with diabetes at even greater risk. You can lower your risk for surgical site infection by managing your blood glucose prior to surgery.


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The Adolescent-to-Adult Transition in Diabetes Care

There is something referred to as “the adolescent transition,” which is actually the transition to adulthood. “Emerging adulthood” is sometimes defined as ages 18-30.

(Being an adult is mandatory; acting like one is optional.)

The point is that as a teen with diabetes, you will at some point have to “grow up” in terms of your health care. You will communicate with health insurance (oh, and get health insurance coverage), make appointments, see adult health care providers, pay bills, and other fun things like those.

Research has shown a high number of hospital admissions for DKA in those who are transitioning to adult care. There is also a tendency for A1C to go up, office visits to go down, and rates of getting kidney function checked can go down as well.

When you become an adult you get to manage your diabetes on your own. You also get to manage all aspects of your health care. Get a strong handle on how diabetes works now, while you’re still at home. Ask your parents to teach you how to navigate health insurance. Start taking a lead at your appointments while you’re a teen-ager, so it won’t be scary or foreign when you are on your own.

Use your resources. College Diabetes Network is an organization that supports emerging adults with diabetes who are heading to and attending college. The Diabetes Online Community is chock-full of support and camaraderie. Another fabulous option is to get involved in a diabetes camp. And some endocrinology offices have providers who specialize in the transition to adult care, so be sure to ask if yours does.

Most important, stay on top of your diabetes care so that you will feel good, be productive, and live well now and far, far into the future.

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Show up and do diabetes

Or check BG. Or exercise. I’m sure you’ve heard of writer’s block. Kids in school, authors, bloggers – everyone experiences it at some point. Same with diabetes block. This stuff gets old and we sometimes hit a wall. But showing up and getting it done really does have benefits.

How many times have you gotten diabetes block? Making diabetes management a habit – committing to it and doing it over and over every day (even when we don’t feel like it) can help. Sometimes we get the results we want and sometimes we don’t, but if we keep showing up and doing the work, it will pay off, even in small ways.

It doesn’t matter what your spouse, friend, mother-in-law, health care provider thinks. Do it for yourself. Do it for your body, your strength, your long-term health and quality of life.

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Common Diabetes Questions

If you’ve read any of my blogs you know I’m passionate about the language (words) we use in diabetes care. I’ve mostly been focused on ways health care professionals can speak in order to empower people with diabetes, but it’s important for those of us with diabetes to be aware of the words we use too.

I recently came across a list of “Common Questions Asked by People with Diabetes.” The list contains 12 questions, and here is a breakdown of the words used in these questions:

  • Do I have to… (3)
  • Can I… (4)
  •  Should I…(4)
  • Do I need to… (1)

All 12 questions that people commonly ask health care providers about diabetes contain the words that people with diabetes don’t want to hear. Yet this is what we know and hear every day, so we perpetuate it, without even thinking about it.

Some other ways we can ask questions include

  • What (are the recommendations for…)
  • How (do I learn more about…)
  • Where (is more information about…)
  • Who (might help me with…)
  • When (does a support group meet…)
  • Why (might I be experiencing this…)

By asking questions that lead to empowering answers, we can actually empower health care providers at the same time! They won’t even know what hit them!

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Stop Doing What Isn’t Working

Some things are pretty simple and straightforward, yet we still don’t pay attention.

If something isn’t working, stop doing it. It may not seem that simple, but if we really look at every angle and use a little creative energy, it might actually be. There’s probably another way to do it, or at the very least another way to think about it.

Figure out what’s not working and change it. Even if that takes courage, or balls, or it’s really scary. Because the process of stopping what’s not working and changing it to something that does work provides hope. And it’s worth the effort.

Challenge yourself. Surprise yourself. Impress yourself.

You deserve it.

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Diabetes management is all about choices

It’s unlikely you have no choice. More likely: There’s no easy choice. When we say we have no choice, we feel trapped and we are powerless. That’s no way to do our work every day. – Seth Godin

This is so true with managing and living well with diabetes. We make choices every minute of every day. Diabetes affects everything and everything affects diabetes. But here’s the good news: we get to choose how we integrate diabetes into our lives!

We get to choose…

  • what we do
  • what we say
  • how we respond
  • our attitude
  • what meds we take
  • what we eat
  • what we drink
  • how we advocate for ourselves
  • what we share with others
  • the questions we ask
  • the information we seek

The first step is to accept that diabetes is about choices. They may not be easy – or inexpensive – but they are choices. Although we certainly didn’t choose to have diabetes, thinking of diabetes management as a series of choices puts us in charge. It gives us strength and power and helps us live well. I choose that!

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Diabetes No-Shame Day

Today is Diabetes Alert Day. Everyone knows someone with diabetes, but millions of people who have diabetes don’t know they have it. So the person you know with diabetes may not even know!

Unfortunately many people who are at risk for diabetes (or already have it and don’t know it) are reluctant to find out because

  • they are embarrassed
  • they are ashamed
  • they are afraid

It’s time to take the shame out of diabetes. If you have or are at risk for diabetes, it’s not your fault. There are many factors involved with developing diabetes, and most of them are not things you can change (like your genes, for example).

Fear is understandable – you may have heard scary things about people who have/had diabetes; you may worry about what changes are in store; you may fear that people will shame you.

My hope for the future of diabetes care is that professionals will put a stop to the shame that has gone with diabetes for so long. I also hope that with this bring a new mindset for the general public.

But in the meantime, don’t hurt yourself by staying uninformed. If your blood glucose is elevated there are things you can do to lower your risk of developing full-fledged type 2 diabetes, or at the very least delay its onset. And knowing your health status can prepare you to take better care of yourself going forward.

Please consider getting checked for diabetes if you have any of the risk factors. Encourage your family and friends to do the same. There is no shame in advocating for your health. You are worthy of a full, happy, and healthy life. Take the first step today!

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