Nibbling

Posted on December 16, 2011 by janekdickinson

I shared an article on twitter earlier today, and got an interesting mention afterward. My friend was upset that I shared information about nibbling between meals and how it may not affect BMI. In fact, he thought I should be ashamed. Of course, I immediately pulled up the article and read it thoroughly to see if, indeed, I should be ashamed. I am not.

The article – despite being based on a study with a very small sample size – raises some important points. What I got from this article is that people who nibble between meals may not do any harm to their weight, body mass index, blood glucose, etc. This study looked at women who were nibbling in a controlled way, meaning they were not overeating or binge eating.

Personally, I have had many experiences when nibbling has helped tide me over to the next meal. If I nibble on a couple of carrot sticks or a handful of nuts, there is no effect on my blood glucose. On the other hand, it is well-known that people who wait several hours between meals tend to overeat the next time they do eat. (This last link says people eat 52 calories more after 5 hours, and I know I can do a lot more damage than that the more time goes by between meals.)

There are definitely times when nibbling leads me to overeat. The longer I live with diabetes and the more tuned in I am to my body, the better idea I have of when this occurs. I know for a fact that nibbling leads me to overeat during PMS. It can also happen when I’m stressed or bored. These would be the times when nibbling would not be a good idea for me.

The point of the article (and they said it in their “Pass it on” message) is that planning snacks is probably a better approach. However, if you feel “in control” of your nibbling, it won’t necessarily hurt anything. Depending on your personality and approach to diabetes management, you might be worse off by withholding food from yourself. I also acknowledge that some people are more successful when they think of food as the enemy and just stay the heck away from certain types of food. We are all entitled to choose what works for us.

I am a firm believer that the more we know the better off we are. For that reason I am not ashamed of tweeting that article. Perhaps somebody read it and affirmed that what they are doing works. Maybe someone else read it and thought, “yea, nibbling is not in my best interest.” At the very least this whole ordeal has made me think, and diabetes is, after all, the “thinking person’s disease.”

I am new enough at blogging, twitter, etc., to not be used to attacks (does one ever get used to attacks?). In one day I’ve now been called a “drug-pusher” and an “ADA-minion who pimps high carb grains.” I hope from my blog posts it’s obvious what my approach actually is.

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GDM – part 3

Posted on December 14, 2011 by janekdickinson

Sometimes women who have gestational diabetes mellitus (GDM) need medication. Again, it’s not their fault. If the woman’s body cannot produce enough insulin to counteract the hormones of pregnancy, sometimes exercising and eating carefully are just not enough. There are two types of medication that can be taken for GDM: a pill called glyburide, or insulin.

Here’s an article about GDM that has a section on medication. Most pregnant women don’t want to experiment with medication. As a result there is not a lot of research on medications and pregnancy; therefore, many medications are considered not safe for pregnancy. This is often more because they haven’t been studied than because we know they aren’t safe.

At any rate, glyburide and insulin are both being used to manage GDM. The nice thing about glyburide is that it’s a pill. The nice thing about insulin is that it’s more effective for keeping blood glucose levels in the normal range. Whichever type of medication you decide to take, it is very important that you work with a diabetes educator or other health care professional who can teach you how to take it, how much to take, and how to manage the side effects (glyburide and insulin can both cause low blood glucose).

The purpose of managing GDM with exercise, healthy food choices and medication is to keep blood glucose levels in the normal range most – if not all – the time. High blood glucose levels can lead to problems for Mom and Baby. Because GDM develops later in pregnancy, the baby’s major organs have already developed. This means that there is much less risk to the baby than in pre-existing diabetes (more on that another time).

With GDM the risks to the baby include growing larger and having a difficult time being delivered. A large baby may have to be delivered by Caesarean section. Babies of moms with GDM are also at risk for jaundice and breathing problems. Here is an article that includes a section on risks to the baby.

If the mom’s blood glucose runs high, the baby will be “fed” extra glucose (calories) and grow large. The baby makes insulin in response to the mom’s blood glucose (the baby does not use the mom’s insulin) and insulin helps the baby store extra glucose as fat. During delivery, if the mom’s blood glucose level is high, the baby will make a bunch of insulin. Once the baby is out of the mom, the baby won’t have enough glucose for all that insulin; therefore, the baby is at risk for dangerously low blood glucose. For these reasons it is very important for the mom to keep her blood glucose in the normal range during pregnancy and delivery.

High blood glucose can also cause problems for the mom, including high blood pressure. Despite how scary all this sounds, the good news is that we know a lot about GDM and it is very possible to manage it, do very well and have a healthy baby. Stay tuned for GDM – part 4 coming up!

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GDM – part 2

Posted on December 12, 2011 by janekdickinson

Many women have a hard time with a diagnosis of GDM. They feel they did something wrong or that they have hurt their baby. They often experience very high levels of stress because of this. It is important to know that stress raises the blood glucose level, which is the last thing a woman with GDM needs. Therefore, it is very important to manage stress during this time.

The woman with GDM is not at fault. GDM occurs when a woman’s body cannot keep up with the high demand for insulin caused by the presence of pregnancy hormones. These hormones work against insulin (they raise the blood glucose level) and therefore, the body needs to make more insulin. Once the baby is born, the pregnancy hormones are gone and the body can once again handle making enough insulin.

If you have GDM, there are several things you can do to manage your blood glucose levels. The first step is to check blood glucose levels – you will need to meet with a diabetes educator and learn where to get the equipment and supplies, and how to use a blood glucose meter. The diabetes educator will provide guidelines for when and how often to check, and where your blood glucose readings need to fall.

Exercise is a very important part of managing GDM. Make sure to clear it with your OB first, and then make exercise a regular part of your day. Healthy choices in the food and beverage department will also help keep blood glucose levels in a safe range. A dietitian is the best person to help you with nutrition education; your diabetes educator also has great information about nutrition.

Besides cigarettes, illegal drugs and alcohol it’s a good idea to avoid fruit juices, regular soda and other sugar drinks. These drinks are packed with sugar and will raise the blood glucose level quickly and drastically. If you had healthy eating habits before you were pregnant, you’re probably doing great now. If you did not have healthy eating habits before, you may need to make a few adjustments for the sake of you and your baby. One tip for managing blood glucose levels is to combine healthy carbohydrate foods with healthy protein/fat. For example, if you’re about to have a piece of fruit, have a handful of nuts or a piece of low-fat cheese. This will help you avoid blood glucose spikes.

Work with your diabetes educator/dietitian to develop a reasonable eating plan. One more thing: it’s especially hard for pregnant women who are craving junk food to follow a strict meal plan, so remember to allow yourself some flexibility. Again, don’t stress! Remember that GDM does not mean you are on a “diet.” You still need plenty of calories to keep your energy level up and to provide for your baby. The trick is to balance what you eat with your exercise and possibly medication, if your body needs it. Stay tuned for more on GDM…

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GDM – part 1

Posted on December 9, 2011 by janekdickinson

When we talk about diabetes, we typically refer to “three main types,” and they are type 1, type 2 and gestational diabetes mellitus (GDM). More recently a lot of attention has been paid to type 1.5 diabetes, which I’ll blog about another day. Today I’m thinking about GDM.

GDM is a type of diabetes that occurs during pregnancy. Somewhere between 2 and 10% of pregnant women have GDM. Unless there is a reason to check a woman earlier, all pregnant women who don’t already have diabetes are checked for GDM between the 24th and 28th weeks. Women at higher risk for GDM include those with a family history of diabetes, or a history of GDM in a previous pregnancy; those who are overweight; those with symptoms of high blood glucose, or a history of high blood glucose; and those from certain ethnic backgrounds.

The test for GDM is called a “glucose tolerance test.” The gist of it is that the pregnant woman has a fasting blood glucose drawn, drinks a glucose drink and then has a series of blood glucose checks at different time points. The results of these determine whether or not she has GDM.

**If you are pregnant or thinking about getting pregnant, and you have type 1 or type 2 diabetes, the good news is that you do not have to be checked for GDM. Woo-hoo!**

If the glucose tolerance test shows that the woman has high blood glucose, she is diagnosed with GDM and given instructions for managing her blood glucose throughout the remainder of the pregnancy. It is very important for a woman with GDM to do the following things:

  1. do not panic or stress or beat yourself up – this is not your fault
  2. meet with a diabetes educator, if at all possible, or another health care provider who can teach you how to manage your blood glucose
  3. check your blood glucose level at least six times per day
  4. check urine ketones if your health care provider recommends you do so
  5. keep your blood glucose level as close to normal as possible for the remainder of your pregnancy
  6. if your blood glucose creeps up, take medication as directed by your health care provider
  7. exercise safely and regularly
  8. manage your stress
  9. make healthy eating/drinking choices
  10. make every effort to maintain healthy habits after the baby is born to prevent getting diabetes later in life
Stay tuned for Part 2.
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Exercise, again

Posted on December 8, 2011 by janekdickinson

I am very excited to share an article that says being fit may be more important than losing weight. We heard this a few years ago, and then the message seemed to go back to weight loss and food/portions being more important. Now there is yet another study showing that for cardiovascular health it’s just as, if not more, important to be fit. In fact, if you are working out – exercising – on a regular basis, you are likely to experience better health overall.

This is especially exciting to me because I have believed for quite some time that exercise is more important than nutrition. I know that’s a bold thing to say, and I’m not condoning eating junk all the time, regardless of how much we exercise. I’ve just had this gut feeling that being active – consistently – puts us in better shape (pun intended) than being a couch potato who eats only salads.

I’ve mentioned a few times lately that I’ve been trying to take off some extra weight. This weight found its way to me over the past year, and I know why: my eating habits got a little loose and I started a full-time job where I mostly sit. Although I increased my walking somewhat, I still wasn’t able to take off the weight. Last Saturday I started attending a pretty intensive exercise class, and I can already feel the difference.

There is absolutely, definitely benefit to mixing things up in the exercise department. Use those muscles that are getting a little rusty, and step things up a notch (gradually). I avoided taking this class for a very long time, and now I have to admit I am very glad I’m going.

One of the excuses I used to avoid this class for a long time was that I didn’t know how I could keep it up over time. I realize now that I just have to make it a priority. If I’m traveling, I will have to find a similar class, or work harder on a treadmill, etc. If I miss it for a week, I’ll just start back up when I return. Sometimes fighting off the excuses is more work than exercising!

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Lag Effective

Posted on December 5, 2011 by janekdickinson

I actually went to the exercise class on Saturday morning. It’s true – I ignored my excuses and exercised with a group. I also used a bunch of muscles that clearly haven’t been used in a long time, if ever. For that I am paying big time – two days later! And on Saturday I experienced the lag effect in terms of blood glucose levels.

As the link above explains, the lag effect is a situation where the stored glucose in our muscles and liver are released into the bloodstream and then burned for energy when we engage in moderate or intense exercise. This stored glucose is called “glycogen” and it can take several hours for the body to replenish it. During this time, which can last up to 24 hours, we can experience low blood glucose levels.

Exercise is a critical part of successfully managing and living with diabetes. Figuring out how to keep blood glucose levels in a safe and healthy range during exercise can be a full-time job and quite frustrating. When I exercise and then experience high blood glucose levels, I feel like all that work was a waste (even though I know it wasn’t). When I exercise and then have a low and have to chow down a bunch of extra calories, that’s pretty discouraging too. With some effort and enthusiasm, though, it is possible to make it work. A book that has been recommended to me (but I have not read yet) is called Your Diabetes Science Experiment by Ginger Vieira.

Back to the lag effect. On Saturday I took my insulin and ate breakfast (I never exercise on an empty stomach or without insulin). Those with type 1 diabetes need insulin working at all times, and we have to take it from an outside source. If we exercise without enough insulin working, we will go high. We have to be careful not to take too much insulin, or exercise will make us low.

Those with type 2 diabetes typically just see lower blood glucose levels with exercise, however, sometimes it takes a while for the blood glucose to respond. Just keep taking your medications as directed, make healthy eating choices and be consistent with exercise and you should start to see those numbers come down – especially with weight loss. If you continue to see elevated numbers despite all this effort, be sure to check in with your health care provider.

I checked my blood glucose about three-quarters of the way through the class and it was 99 (yea!!). Right after the class I was 152 (huh?) and then about 30 minutes after that I was 222 (what?!). It is likely that all that glycogen got turned into glucose and when I stopped exercising, the extra glucose was still hanging out in my bloodstream. However, muscles keep working after exercise, so we keep burning that glucose. Later that afternoon I had a low, so I probably didn’t need to take insulin to bring down the 222 (which I did). Throughout the evening my blood glucose level stayed right where I wanted to be (despite a rather large Chinese dinner). I’m chalking that one up to the lag effect. Next time I will know to take a little less insulin and eat a little less Chinese food.

As always, it’s a work in progress and a learning process. I often refer to diabetes as a “science experiment,” so I like the name of that book!

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Fit or Flop?

Posted on November 30, 2011 by janekdickinson

I’ve been busted. I kind of figured my exercise routine was losing its effect when I increased my walking from 4 to 6 days per week and didn’t really notice any changes. In fact, I’ve been having a hard time taking off the extra pounds I put on over the last several months.

An article I saw today has confirmed that I need to mix things up a bit. I’ve been thinking a lot about joining an exercise class – one that includes cardio and resistance training. My problem is that I am not a group exerciser. I’ve been thinking about working (individually) with a Pilates instructor once a week. My problem is that I’m not independently wealthy. And I don’t like exercising to videos – what if I’m doing something wrong? I don’t have enough time in my day/week to fit in all the types of exercise this article recommends.

WAIT! Do you hear all the excuses? I frequently have conversations with people who give me all these excuses and more. I can definitely relate, but I also know that there is a way to work it out (pun intended). I can find the time. I can deal with a group class. My long-term health and my immediate energy level and fitness depend on it, and I deserve it.

As soon as we get some more snow I will also add skiing and snow-shoeing. Watch out – this winter I may just end up an exercise goddess! What’s your excuse?

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Just when you think you’ve got it down

Posted on November 28, 2011 by janekdickinson

I realized, while walking my dog today, that training a dog and managing diabetes have some things in common. Up until about a week ago, I thought my dog really got the whole process. He went out in the morning, did his thing, then went out again around mid-day and once more at night. He was eating two meals a day with a few treats scattered in there.

Then about a week ago, for no apparent reason, he stopped eating breakfast and started going out at random times with or without success. Maybe he just got smart and realized he could live on treats so why bother with the real food. Maybe he’s sick (although he acts just fine). Or maybe he’s going through a phase.

This reminded me of managing diabetes, because just when you think you’ve got it down, something changes and it feels like starting over. Some of these management-upsetting changes can include puberty, pregnancy, medications, menopause, a new job/different schedule, major stress, going on or off an insulin pump, and many others.

Although the details of how you would deal with one or another of these situations would vary, here are some general suggestions for staying sane and managing your way through them:

  • check blood glucose levels more often, if possible
  • keep a record of your blood glucose readings
  • make regular appointments to see your health care providers (preferably ones who specialize in diabetes)
  • use whatever stress management techniques work best for you – don’t beat yourself up for unexpected blood glucose levels
  • be informed about whatever situation is happening (puberty, pregnancy, stress, etc.) and discuss it openly with your health care provider
  • if possible, find a friend who will support you through the process (most, if not all of these situations do not last forever)
  • be willing to make adjustments and find a new “normal” for your diabetes management
  • keep an open mind and be ready for the next phase that comes along.
Time to go walk the dog!
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Thanking and thinking

Posted on November 23, 2011 by janekdickinson

I’ve been thinking about Thanksgiving dinner a lot lately, mainly because we’re having it at our house this year. I’ve mentioned before that I don’t love to cook, but who doesn’t enjoy preparing for the Thanksgiving feast?

One of the stories I tell about Thanksgiving and growing up with diabetes is that we always ate at about three in the afternoon. As the years went by I found it more and more frustrating – 3 o’clock is not a mealtime! Eating dinner at 3 o’clock really messed up my blood glucose management for the day (not to mention all the carbs in the meal).

The way I handle it now – as an adult who is in charge of when the meal takes place – is that I serve Thanksgiving dinner at 6 o’clock. It would also make sense to eat around 1 o’clock. The nice thing about eating at six is that I don’t have to get up at the crack of dawn to put the turkey in (which will probably not be completely thawed anyway, knowing us), and I can treat it like a more usual supper (ok, I admit it’s not usual to have 8,000 different types of carb in one meal, but work with me here).

This morning I started thinking about tomorrow and what to do about breakfast and lunch. Should breakfast be a big, special deal because it’s Thanksgiving? I decided, no, I should stick with my usual breakfast, take my usual walk and have my usual lunch. That way, when “supper” (feast) comes, maybe I’ll be less likely to overconsume. Maybe – you never know.

Then I came across this article, which I think is fantastic. It addresses these very thoughts I was having. In addition to following my usual routine, I’m planning to take a walk after Thanksgiving dinner. Those will be my efforts to maintain blood glucose management during what the article calls one of the most “food-centered days of the year.”

Whether you’re the cook or the guest, the important thing is to enjoy yourself tomorrow. Happy Thanksgiving!

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Eat more (often); weigh less

Posted on November 21, 2011 by janekdickinson

People often get frustrated when they don’t lose weight despite eating like a bird. Some people report eating only one or two meals a day, yet nothing is coming off. We always talk about how the body can go into panic mode and hold onto the calories it does get, since it doesn’t know when the next meal is coming. I think of it as the body being less efficient.

An article I read today discusses weight loss and weight maintenance and the relationship to how often a person eats. Another tip often discussed in my office is the importance of not letting too much time go by in between meals. People who skip meals and let more than five hours go by before eating have a tendency to overeat. It really makes sense that if we haven’t eaten in six or ten hours that we will be “famished” and then chow down on whatever is available. Maybe we’re even subconsciously gearing up for the next six or ten hours!

Besides the value of eating smaller, more frequent meals, the other take-home message in the article is the importance of exercise in maintaining weight loss. For a long time I have believed, for a variety of reasons, that exercise is more important than meal planning in terms of weight loss. I am now convinced that eating choices are more important for losing weight and exercise plays an important role in maintaining weight. What tipped the scale (no pun intended) for me was hearing this at a conference (although I’ve heard it from health care professionals before, but always kind of thought it was a matter of opinion), reading articles about it, and most convincing of all…experiencing it!!

I know that over the past several months I’ve slipped in terms of eating more calories than I used to. My exercise, however, not only stayed the same but increased (I went from walking four days per week to walking at least five and often six days)! I found myself putting on weight, and the exercise was not enough to take it off. I am consciously consuming fewer calories by being aware of the types of foods I’m choosing to eat, and taking smaller portions.

It is not necessary to eat six times a day, although this works for some people. However, three evenly spaced meals with a healthy snack or two in between turns out to be an effective way to lose and/or maintain weight.

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