Carbohydrates

Posted on April 19, 2011 by janekdickinson

I am in New York City. That alone can be exhausting (in a good way, of course). I flew in very late last night and had to get up pretty early, which is also exhausting. But in addition to all that, I had very few carbs (carbohydrates) for lunch and dinner, and now I’m wondering if that has contributed to my fatigue.

Carbohydrates are starchy foods (or glucose/fructose-containing foods) such as potatoes, corn, rice, pasta, bread, grains, cereals, milk, fruits, etc. I had lunch and dinner with some folks who follow a low-carb meal plan, which is why I didn’t get much carb today. I typically eat at least 50% of my calories as carbohydrate.

The recommendation for the general public is that about half of your food come from carbohydrate. The reason for this is that carbohydrate is our main source of energy. Carbohydrate is “clean burning” and is quickly and efficiently broken down into glucose, which is used for energy. Our brains depend on glucose to do their work.

So why would anyone follow a “low-carb” meal plan? It is true that when carbohydrate is broken down into glucose, the body has to make more insulin. For those with a tendency toward type 2 diabetes (insulin resistance), the body does not process the glucose properly, because insulin doesn’t work properly, and the liver ends up making/releasing extra glucose causing the blood glucose level to rise. This is a vicious cycle.

For these people, eating fewer carbs can actually help keep the blood glucose level stable and for many people, this approach also leads to weight loss. Weight loss, in turn, helps manage blood glucose. Most people, however, cannot go for long periods of time without carbs (or with severely limited carb intake). Once they go back to eating carbs, there is a tendency to overeat them and put the weight right back on.

For these reasons, the best approach may be to eat carbs in moderation. Perhaps take it down to 40% (check out the Zone diet) if you want to eat fewer carbs, but still get your energy needs met. This may be a carb intake you can live with long-term. If you are very active and burn your carbs off, you can head more to the 60% range. If you have extremely strong will-power (or just don’t enjoy carbs) and can do without carbs long-term, that’s up to you (as always), but remember not to overdo high-fat protein or other saturated fats. One of the main arguments with low-carb meal plans is that they tend to steer people toward a high-fat one, which can lead to elevated cholesterol and heart disease.

It all goes back to “everything in moderation”. If you want to tweak things in one direction or the other, just be sure to work with a professional and do it safely. And don’t forget to exercise! How do you approach carbohydrates in your daily eating plan?

Posted in about diabetes, diabetes care | Tagged , , | Comments Off on Carbohydrates

What’s Your Target?

Posted on April 16, 2011 by janekdickinson

Do you have a blood glucose target? Mine is 100. I can’t even tell you how long my BG target has been 100, but it’s been a while. I wrote a while back about the Quest for 117 and that’s fun too, but when my blood glucose meter reads “100” it’s a bullseye! The purpose of having a target is to get in that range most of the time. We all know hitting one particular number all the time is not possible when your body is not functioning at full capacity.

I often work with patients who are setting blood glucose targets. I think it’s very important that it’s your target and not mine (or anyone else’s). This is slightly different if you’re the parent of a young child with diabetes. In that case, it’s the parents’ target until the child is old enough to set their own.

One thing to keep in mind when you set your target is that sometimes you might overshoot it (if you take insulin or other blood glucose lowering medications). It’s equally important not to spend too much time in the low (hypoglycemic) zone as it is to avoid high blood glucose (hyperglycemia). While high blood glucose over time can lead to diabetes complications, low blood glucose forces us to eat additional calories and can be dangerous. So be sure to choose a blood glucose target or a target range that gives you a buffer for safety.

If you manage your diabetes with meal planning, exercise and/or medications that don’t cause low blood glucose, you still can aim for a target. You can adjust your eating and exercise habits (and work with your health care provider to adjust medication doses) to reach your target blood glucose.

What is your target and why did you choose it?

Posted in diabetes care | Tagged , , , | Comments Off on What’s Your Target?

Join me for WEGO Health’s Webinar: Navigating Your Health Narrative!

Posted on April 15, 2011 by janekdickinson

I just registered for WEGO Health’s exciting new webinar and I wanted to share with everyone.  Here are the particulars:

What: Navigating Your Health Narrative Webinar

Who: Health Activist Panel with Lisa E, Erin B, Jenni P, and Amanda D

When: Thursday April 21st 8pm EST (the webinar will last one hour)

Where: Sign up here and you’ll get all the details

The webinar is for anyone from seasoned bloggers to blog-readers who want to start their own blog. The webinar will cover the basics of blogging and include more advanced tips and tricks for promoting posts, managing your time, and establishing your blog “voice” and how to raise awareness about your condition through blogging.

By signing up you’ll also have a chance to ask specific questions for the Health Activist panel that will be answered during the live Q&A portion of the webinar. You’ll get access to the archived version of the webinar!

Posted in diabetes blog | Tagged , | Comments Off on Join me for WEGO Health’s Webinar: Navigating Your Health Narrative!

Exchange System

Posted on April 14, 2011 by janekdickinson

Does anyone remember the Exchange System? This is an approach to nutrition management for people with diabetes that was put together by the American Diabetes Association and the American Dietetic Association many moons ago. When I was diagnosed with type 1 diabetes in 1975, my parents were taught to use the Exchange System.

The Exchange System puts foods into one of six categories (exchanges) or the “free food” category. The six are starch, milk, fruit, vegetables, protein (meat) and fat. We were given a “diet” with a certain number of exchanges per meal. I like this approach, not because it prescribes a certain amount to eat, but because it emphasizes a well-balanced eating plan and because it emphasizes healthy portions. The “diet” part is now more of “guidelines” for healthy caloric intake.

Because every starch, milk and fruit exchange is equivalent to a “carbohydrate serving” (approximately 15 grams of carb), transitioning to carb counting was extremely easy for me. Having grown up with the Exchange System I know how many crackers, grapes, etc. equal an exchange. I know that 1/3 cup of cooked pasta or rice is an exchange or carb serving.

I have noticed that many people who go straight to carb counting run the risk of hyper-focusing on carbs. For instance, I have had people call me and ask how to account for the carb in peanut butter. If they knew the Exchange System, they would know that peanut butter is a fat and therefore, the carb content is negligible. Also, straight carb counting can lead to ignoring how much protein and/or fat is eaten. It’s important, however, not to overeat protein and fat in order to stay healthy in the long-run.

I give everyone I meet (professionally) a copy of the Exchange Lists for Diabetes booklet. If nothing else it’s a great starter list of foods and their serving sizes and carb content. I encourage carb counting for insulin dosing, as this is a very effective way to manage diabetes. I just think that basing carb counting on the Exchange System is a healthier and more successful approach.

Does anyone still use the Exchange System in any way, shape, or form?

Posted in diabetes care | Tagged , , , | Comments Off on Exchange System

Diabetes of Extreme Duration

Posted on April 13, 2011 by janekdickinson

What does “diabetes of extreme duration” make you think? Anything with the word “extreme” in it makes me think it’s scary. A study published in 2007 (http://care.diabetesjournals.org/content/30/8/1995.full.pdf+html) actually showed that it doesn’t necessarily have to be so scary. These researchers found that out of their study population, almost one-half had no significant microvascular complications. They compared their finding that about 50% had retinopathy (eye disease) after 50-60 years of diabetes to the typical prediction that more than 90% of people with type 1 diabetes will eventually get retinopathy.

I have to admit that I have wondered about the complications statistics for a while. I struggle to believe that in this time, when we are able to manage diabetes so much more successfully, these rates wouldn’t go down.

The authors of this study mentioned that perhaps some people are protected from or experience much slower progression of retinopathy. They say this could result from a variety of factors (less hyperglycemia, more disease-inhibiting factors, or even a reporting bias – although they believe the latter is unlikely because of validated the findings with photographs of the eyeballs).

I think they left out a big one: attitude. I put attitude up there even before exercise (which is very high on the diabetes management list) and nutrition. I would love to see a follow up study that measures the attitudes of people who have lived successfully with diabetes for an extremely long time. This may even be one of the “factors that can neutralize the adverse effects of hyperglycemia” that the authors mention.

What do you think contributes to living successfully with diabetes?

Posted in about diabetes | Tagged , , | Comments Off on Diabetes of Extreme Duration

Diabetes Remission?

Posted on April 8, 2011 by janekdickinson

There is a conversation taking place regarding reversal vs. remission vs. cure of diabetes. This is referring to type 2 diabetes; however, that is not always made clear in the media. I read about one mom’s frustration with questions and messages about her son “outgrowing” his (type 1) diabetes. Not until there’s a cure. There is an article discussing a consensus among diabetes experts on this subject.

I have had many patients – with type 2 diabetes – ask if they can get rid of it. I always explain that by making healthy food choices, exercising, managing their stress and losing weight they can get their blood glucose level down. Once their numbers are consistently in the “normal” range (70-110 mg/dL before meals and less than 140 mg/dL 2 hours after meals) they will feel better, have a greatly reduced risk of long-term complications, and they will appear to not have diabetes. However, diabetes is still lurking there: if they were to return to their old habits/lifestyle, their numbers would go right back up.

The article linked above discusses the “remission” of diabetes after gastric bypass/banding. It is very common for diabetes to go away after someone has this type of weight loss surgery. If the person follows a healthy lifestyle consistently – healthy eating and regular exercise – they can keep their blood glucose levels down. Unfortunately, even in these people, returning to unhealthy eating habits and/or lack of exercise can land them back in diabetes-ville. I’ve had patients for whom this has happened.

Healthcare professionals historically used the term, “borderline” to describe what is now called “pre-diabetes”. To those of us in the field, this means type 2 diabetes is knocking on the door, and without sufficient lifestyle adjustments (changes), it’s going to come right in. We no longer say “borderline”, because people just didn’t take it seriously. How many times have you heard someone say, “I’m just borderline. I don’t have to worry about it.” Just as type 2 diabetes can be prevented with a healthy lifestyle, diabetes remission can be prolonged the same way. Regardless, I think it’s risky to call this a “cure” or even “reversal”. I worry that people might truly believe it’s gone, whereas even “remission” implies that it could come back. What do you think?

Posted in about diabetes, diabetes news | Tagged , , , , | Comments Off on Diabetes Remission?

Take a walk

Posted on April 7, 2011 by janekdickinson

Do you hate to exercise? If so, why do you hate it? How do you feel about walking? Walking has got to be one of the best – if not the best – forms of exercise that exist. You can sneak walks in all over the place. Of course, it helps that I love to walk, but I make walking a regular part of my week and it helps me manage my diabetes.

Science has shown that exercise – without a doubt – lowers blood glucose in people with type 2 diabetes. It is also very effective in managing gestational diabetes. For type 1 diabetes, exercise is still critical; it just takes a little more thinking. Therefore, regardless of what type of diabetes you have, exercise is one of the most important and effective ways to manage it.

Here are some ways you can work walking into your day: park far away at the store, mall, etc. and walk to the entrance; walk when you play golf; walk the dog; walk to the post office/mailbox/store, etc.; walk the perimeter of the soccer/baseball/lacrosse, etc. field at your kid’s game.

Once you get used to walking you might even get addicted. Walking is easy on your joints, gives you more energy, lowers your blood pressure, burns calories and leads to weight loss, lowers blood glucose, clears the mind, calms you down, gives you a chance to think, and on and on. Go ahead and start walking today! Spring is here (according to the calendar, anyway), so the weather will start to cooperate. Get in the habit while it’s nice out and then when summer heat and winter cold come, just keep doing it! Start small – just walk for a few minutes or a short distance – and work your way up. You may have to make some adjustments to your schedule to fit in a longer walk, once you’re up to that point. And it will be well worth it!

You never know, starting out with a short walk, one day you might become a competitive athlete. Even if you don’t, you’ll still reap all the benefits of walking. Let us know how you fit walking into your day/week/life!

Posted in exercise and diabetes | Tagged , , | Comments Off on Take a walk

How do you celebrate?

Posted on April 6, 2011 by janekdickinson

Last June marked my 35th anniversary of having diabetes. For some reason it felt like a really big deal. I once saw an article in a diabetes publication that described a little boy whose parents gave him a cake each year on his “diabetes day”. That’s one way to celebrate. I did a couple different things. One of them was to interview my family members individually to find out what it was like for each of them at my diagnosis. That was actually a very cool experience (and long overdue). I had no idea that my mother was disappointed in herself because she wasn’t comfortable giving me my injections. I only knew that she wasn’t very good at it and I preferred having my dad give them (until I learned how and then no one was allowed near me).

My older sister and younger brother had strikingly similar responses. They both immediately said they missed sugar cereal, because it was no longer allowed in the house after I was diagnosed. I am being completely honest when I say that I have absolutely no recollection of my parents ever having sugar cereal in their house when I was little. I do remember that when I came home from college, on breaks, there would be Golden Grahams in the cabinet. After hearing my brother’s recollection about the cereal, I wondered if he pleaded with Mom and Dad to buy the “good stuff” once I left home – he denies this vehemently.

The other thing I did, in honor of my 35 years with diabetes, was to visit the hospital where I was diagnosed. I only have a few memories of that experience – my amazing nurse, Sue, who let me follow her around while she took vital signs,; the five-year-old whose wheelchair was given to me when a door closed on my finger and I had to be wheeled to xray (for a finger); the same five-year-old who assured me as they put in an IV, “don’t worry, it hurts more when they take it out”; the food; my first diet soda; visits from my uncle and his fiancee; and presents. I also remember sitting through classes that my parents had to attend.

I had a little panic attack when I thought the building that I stayed in at the then Springfield Hospital was torn down (now it’s Baystate Medical Center and they are working on a huge, new building). Luckily, the original building was still there and I even got to go inside and see the lobby. It really did bring back a lot of memories. I’m sure the place is very different now (lots of new buildings and rearranged units). I don’t even know if any patients stay in that old building. I was reminded of quarterly trips to that hospital for “fasting” blood tests, followed by breakfast with my dad. Later the same day we’d go back for the “non-fasting” blood test and then meet with my endocrinologist. We did that for years.

I was recently called in to work to see a girl who was in ICU. I quickly discovered that she and her family were doing fine and did not have any questions for me. She figured out, while I was in the room, that that very day was her two-year anniversary with diabetes and we laughed at the irony. Her mom commented that had they been there even one year earlier they would have been a mess, but now they knew what they were doing and could get right back on track again.

Any excuse to celebrate is a good one. How do you celebrate your diabetes anniversaries?

Posted in about diabetes | Tagged , , , | Comments Off on How do you celebrate?

Technology vs. People

Posted on April 5, 2011 by janekdickinson

I saw a great advertisement for an insurance company, while traveling recently. It went like this: “Technology when you want it. People when you don’t.” (trademark: Esurance Insurance Company). I was immediately reminded of people with diabetes and all the fancy technology that’s available for downloading meters and insulin pumps, creating charts and logs and graphs and more. There was a discussion on another diabetes blog (diabetesmine) not too long ago, about phone apps for diabetes management. Many people who commented said they like gadgets and gizmos (technology) that help them “manage” their diabetes. In truth, technology doesn’t help us manage our diabetes, but can certainly help us organize information and make choices/decisions about our diabetes management.

Other people commented that they like the good, old-fashioned method of writing blood glucose readings in a log book. The nice thing about this approach is that it’s very easy to look for patterns. Health care professionals love it when patients bring a log book full of numbers with dates and times (in order, preferably) to appointments. Suggestions for adjustments to medications, food choices and exercise (amount or timing) can be made based on patterns that show up.

I commented that I used to faithfully record every blood glucose reading. I also used multiple meters (one at work, one in the car, one at home, etc.) Then I started seeing an endocrinologist whose office uses meter downloading software. I discovered that it was much more helpful to download one meter and see all the fancy graphs, charts, etc., than to see fragments of data from several meters on several printouts. I quickly changed to using one meter and never writing down blood glucose readings again (to date). When I’m working with a patient, I encourage them to write down their readings. I also let them know about the software that’s available. I will have to start telling them about phone apps as well, although the people who are likely to use phone apps will probably already have them on their phones before they ever meet me!

Which approach do you take? Do you use technology to assist you in managing your diabetes? Do you write down your numbers?

Posted in diabetes products | Tagged , , , | Comments Off on Technology vs. People

Pump-worthy

Posted on April 2, 2011 by janekdickinson

I probably should not have made it sound so easy to get on an insulin pump. For many people (and for a variety of reasons) it is not. Sometimes it’s a provider issue. Many providers have it in their heads that people have to prove something before they can get an insulin pump: enough time on injections, taking a certain number of classes, demonstrating that they check their blood glucose a certain number of times per day (for a certain length of time), high enough blood glucose levels, low enough blood glucose levels, etc.

I believe that everyone is worthy of a pump until proven otherwise.

People want/need insulin pumps for a variety of reasons. Some people want a pump for convenience – maybe they really hate taking injections. Other people need a pump to eliminate frequent and dangerous low blood glucose events (hypoglycemia). Still others choose pump therapy to bring down high blood glucose levels (hyperglycemia). The research shows that insulin pump therapy improves blood glucose management/levels and improves quality of life. While it is important for people with diabetes (or their parents) to understand and feel comfortable with injections (in case the pump fails), there is no magic period of time with injections that makes one “ready” for a pump. I’ve seen a kid go from injections at diagnosis to a pump in six months. I bet there are some who’ve done in sooner.

When someone initiates getting a pump, I take that as a very good sign. I think it would be much more dangerous to force someone to go on a pump (which I would never do). I’ve seen people who never checked their blood glucose, haphazardly took insulin, etc., go on a pump and thrive.

Having to jump through hoops just makes people angry and discouraged. Sometimes it even turns them off so much that they switch providers. If the provider is the roadblock, it may be time to consider a new one. That may not be straightforward either, but it’s worth looking into. I travel three hours each way to my diabetes care provider.

If health insurance is the roadblock to an insulin pump, it can be a much more challenging situation. When I was working on getting a pump (the second time), I had to provide various documents. I even had to have a c-peptide level drawn! When insulin is produced by the pancreas it starts off as “pro-insulin”. This consists of a c-peptide chain and an insulin chain. The c-peptide breaks off and the insulin goes to work. The blood test, therefore, measures the amount of c-peptide in the blood, which indicates how much insulin is produced. I was told by the lab people that it was a fasting test, and I almost started laughing right there. I honestly thought about eating a hot fudge sundae before the test, just to prove that my pancreas does not make insulin (and hadn’t for 28 years at the time). Sometimes health insurance companies need a compelling letter from a health care provider to convince them that an insulin pump is the best way to go. Sometimes it really takes a good (and long, drawn-out) fight. In my experience, the patient usually wins.

If you’ve struggled to get on an insulin pump – what was your experience and how did you resolve it?

Posted in diabetes products | Tagged , , , , , | Comments Off on Pump-worthy