Tags: depression, Diabetes self-management, DSME, Massachusetts General Hospital, mental health, self care
By Christina Psaros, Ph.D
Department of Psychiatry
Depression is a medical illness characterized by pervasive feelings of sadness and/or the inability to experience pleasure or joy. Other symptoms of depression include feeling tired or without energy, reduced appetite, difficulty concentrating or making decisions, feelings of worthlessness or guilt, and hopelessness. People with diabetes have relatively high rates of depression, which can interfere with their ability to manage their diabetes.
Effectively managing diabetes requires a number of complex steps that may include regular meetings with a health care provider, monitoring of blood sugar, taking medications, and adhering to diet and physical activity guidelines. Depression may interfere with some or all of these behaviors. For example, difficulty concentrating may make it difficult to remember to take medications. Feeling tired or without energy can make it difficult to engage in physical activity or prepare healthful meals, while changes in appetite may it difficult to eat healthful foods. Feelings of hopelessness can make people feel like giving up rather than continue with self-care efforts.
Help is available! Research shows that psychotherapy can help alleviate symptoms of depression and help individuals with diabetes better adhere to their self-care regimen. Antidepressant medications can help. Talk to your Certified Diabetes Educator or primary healthcare provider if you are struggling with your diabetes self-care or if you think you may be depressed. They may refer you to the Massachusetts General Hospital Behavioral Medicine Program, which consists of a team of psychologists specializing in helping individuals with chronic illnesses like diabetes. If you are interested in making an appointment yourself, call the Psychiatry Access Line at 617-724-5600 or visit our website.
Tags: Diabetes, FDA, food label, healthy eating, nutrition
By Aubrey Brophy, Dietetic Intern
The United States Food and Drug Administration (FDA) is proposing new updates for the current Nutrition Facts label that appears on most food and beverage items. The new food label is meant to reflect the current nutrition issues Americans face, primarily overweight and obesity, lack of certain vitamins and minerals and increase readability and comprehension
What are the main changes?
- Serving Sizes – The serving sizes seen at the top of the food label will reflect the actual portions most Americans consume. For example, food packages and beverages that can typically be consumed in one sitting, like a 20 oz bottle of soda, will reflect only one serving. Also, “Amount per Serving” will now be listed by the actual serving size, such as “amount per 1 cup.”
- Format Changes – The calorie and serving size section will now be larger and bolder to emphasize the amount of calories that are actually in the item. Additionally, the percent daily value will be shifted to the left to help consumers understand the nutrient content of the item compared to the estimated daily needs.
- Added Sugars – A new “added sugars” section will be included to help consumers identify which sugars are not naturally found in food items.
- Fat – “Total Fat,” “Saturated Fat,” and “Trans Fat” will continue to be required, but “Calories from Fat” will be removed from the food label because it does not distinguish between healthy and unhealthy fats.
- Potassium and Vitamin D – The new food label will now be required to list the amounts of potassium and vitamin D in the food or beverage item because these have become nutrients of concern in the U.S.
- Vitamin C and Vitamin A – These vitamins will no longer be mandatory due to lack of concern for deficiencies (they may still be listed voluntarily).
- Calcium and Iron – These nutrients will continue to be required on the food label because they are still of concern for the general population.
Below is a comparison of the current Nutrition Facts label and the proposed food label.
The new Nutrition Facts label is still under review by the FDA, so an official launch date is unknown at this time. Once the changes are effective, manufacturers will have two years to comply with any of the final requirements.
(Post content reviewed by MGH Department of Nutrition and Food Services)
Tags: cooking, Diabetes, healthy eating, portion size, save time, vegetables
Research shows that cooking more meals at home encourages healthy eating, but many people feel they don’t have time to cook dinner during the week. If time (or lack of it) is what’s holding you back, here are a couple of time-saving tips for getting a jump-start on your meal. Dedicate some time during the weekend to plan your menu and chop all the veggies you will need for the coming week. If you need to pull a meal together quickly, frozen veggies are a good choice since all the chopping and peeling has been done for you.
Cleaning up after the meal can sometimes be just as time-consuming as the prep work. Save time on the dishes by making meals that can be cooked in one pot or skillet. For example: stir-fry strips of chicken breast or other lean protein with seasonal veggies with a little olive oil in a large skillet for a quick and easy summer meal. A Croc-Pot® or other slow cooker is another great tool for making a variety of easy, one-pot meals.
Okay, now that we have a game plan, here are a few good reasons for making a habit out of cooking more at home:
- Healthy Options: Many restaurant meals are high in calories, sodium, and fat. Not to mention the portions served are often larger than the recommended serving size. Cooking at home means you have control over what goes on your plate and can easily substitute in healthy ingredients (and even experiment with different flavors). Using measuring cups/spoons and kitchen scales can also help you keep an eye on portion size.
- Save Money: Eating out several times a week can be expensive! Making more meals at home will save money in the long term. In many cases, leftovers from dinner can be easily reheated for lunch the next day. During the winter, you can easily make an extra batch of soup or chili and freeze in serving-size portions. Defrost later for an easy workday lunch or weeknight dinner.
- Involve the Whole Family: Sharing a meal is a favorite way to bond with loved ones. Think of cooking at home as another opportunity for spending time with friends and family by making meal prep a group activity. This way one person isn’t expected to cook the whole dinner for everyone. Plus, involving kids in the kitchen has been known to help with develop healthy eating habits later in life.
If you’re new to cooking at home, start small. Try making just one meal a week at first. As you practice skills in the kitchen, you’ll develop confidence to cook more often. Bon appétit!
(Post content reviewed by MGH Department of Nutrition and Food Services)
Eating seasonal fruits and vegetables has many benefits. For starters, fruits and vegetables are often cheaper and tastier when in season. Click below for a list of fruits and veggies that are in season for July and August.
Tags: Diabetes, Diabetes Education, diagnosis, lifestyle change, metformin, prediabetes, symptoms, treatment, Type 2 Diabetes
By Eileen B. Wyner, NP
Bulfinch Medical Group
What is prediabetes? Does it become diabetes? How is it diagnosed? How can it be treated? Do medications work? I feel like I have more and more patients asking me these questions and with recent statistics stating that over 54 million people in the US have prediabetes, I’m probably right. Prediabetes is a condition where the blood sugar is elevated but not so elevated that it’s diabetes. It typically does not have any symptoms, but there are instances where people might have symptoms of problems commonly associated with diabetes, such as retina changes or neuropathy. Some people may have a change in their skin called acanthosis nigricans. This means that the skin is darker in color in places like the armpit, behind the neck, or on the elbows, knees or knuckles.
Prediabetes is diagnosed with the same blood tests as those used to diagnose diabetes but the result parameters are different. Prediabetes is diagnosed when the A1C is between 5.7% and 6.4%; fasting glucose is between 100mg/dl and 125mg/dl; or when the 2 hour oral glucose tolerance test is between 140mg/dl and 199mg/dl. People that have a positive test are advised to have the test rechecked every 1 to 2 years to monitor for type 2 diabetes.
The cause of prediabetes is not known but it is thought that genetics may play a part and that there is increased insulin resistance. Musch like with diabetes, there are established risk factors for the development of prediabetes. These risk factors include: age; positive family history; being of African American, Asian, Pacific Indian, and Hispanic ethnicity; overweight (especially with an increased abdominal girth); being sedentary; and PCOS (polycystic ovarian syndrome). A diagnosis of prediabetes does not mean an automatic progression to type 2 diabetes, but many people will progress to diabetes within 10 years of initial diagnosis.
There are many things that can be done to improve your health and possibly help the blood sugar values revert to normal range. There are some instances where metformin (Glucophage), a medication commonly used to treat type 2 diabetes, may be started, but that is an individual decision between the patient and their health care provider. The mainstay of treatment consists of lifestyle changes. For example: eating smaller portions, avoiding sugary beverages and fried foods, and walking most days of the week for 30 minutes at a moderate pace. I always tell my patients that they don’t have to join a gym or run a marathon, but they do have to move a little bit more each day. Remember, walking is the least costly form of exercise and will yield great benefits for your physical and mental health. I hope I have provided answers to your questions and some healthful tips to try and incorporate into your daily life. Now, I think I’ll take my own advice and leave the laptop behind so I can go take a walk in this gorgeous sunshine.
Tags: Diabetes, DSME, home cooking, omega-3, recipe, salmon, summer, weeknight meal
This recipe comes together quickly and makes for an easy, nutritious entree. Canned salmon is low in mercury and is a fairly inexpensive dietary source of vitamin D and healthy omega-3 fats. Tip: Canned salmon comes in varieties with or without bones; purchasing canned salmon with bones is a good option if you are looking for ways to increase your calcium intake.
3-6 ounce cans canned salmon, drained
¼ cup green onions, chopped
¼ cup mayonnaise
2 tbsp dry breadcrumbs
1 tsp Cajun seasoning blend
2 tsp Dijon mustard
½ cup cornmeal
1 tbsp canola oil
Combine salmon, green onions, mayonnaise, breadcrumbs, Cajun seasoning and Dijon mustard together in bowl. Divide mixture into 6 equal portions and shape into patties. Dredge patties in cornmeal and shake off any excess. Heat a skillet over medium heat. Add 1 tbsp canola oil and place patties in pan. Cook patties about 3-5 minutes on each side or until golden brown.
Yield: 6 cakes or patties (1 per serving)
Nutrition Information per Serving:
Calories: 230 • Protein: 32g • Sodium: 840mg • Carbohydrate: 21g • Fiber: 3g •
Fat: 15g • Sat Fat: 2g
Recipe adapted from Cooking Light
Tags: Diabetes Education, fitness, health, hydration, summer
By Marjorie Clapp, MGH Dietetic Intern
The human body is comprised of roughly 60-70% water. For this reason, maintaining proper fluid balance can dramatically influence how well our bodily systems work, including nerves and muscles, cognition, and immune function. Unfortunately, staying hydrated isn’t always easy. In fact, about 70% of Americans are chronically dehydrated. Here are some tips and tricks to help keep you hydrated this summer.
How do I know if I’m dehydrated? Feeling thirsty is the most obvious indicator that you need to drink more. The color of your urine can also help determine your hydration status. Your urine should be pale yellow or clear. If it’s darker than that, it’s time to drink! Other common signs of dehydration include headache, dizziness, fatigue, confusion, and irritability.
Hydration Tip: Keep a tall glass of water on your bedside table and drink before getting ready for your day.
How much fluid do I need? Although fluid needs depend on many factors, including size, activity level, and climate, a good goal is to consume no less than 64oz each day, although some research estimates needs to be much higher (~90oz/day for women, ~125oz/day for men).
Hydration Tip: Exercisers require additional fluids to replenish water lost through sweat and respiration. Weigh yourself before and after working out and aim to consume 3 cups of water for every pound lost during exercise.
When is the best time to hydrate? Anytime! Aim to sip fluids throughout the day to prevent dehydration. Although it’s recommended to consume the majority of your fluid from water; milk, juice, soda, and caffeinated beverages count towards your fluid goal. Just remember to read labels. Calories from sweetened beverages can add up quickly! Food can also help you reach your fluid goals. Water-rich foods include lettuce (96% water), watermelon (92% water), grapefruit (91% water), broccoli (91% water) and yogurt (89% water).
Hydration Tip: Keep a water bottle on hand in your bag or purse to encourage hydration throughout the day.
What about sports drinks? Most sports drinks contain electrolytes (sodium, potassium, chloride, phosphorus) and added sugars to help your body refuel after strenuous exercise. If you’re sweating heavily or exercising for more than 60 minutes, a sports drink may be appropriate. However, most people can rehydrate appropriately with water and a balanced post-workout snack such as an apple with string cheese, hummus and whole grain crackers, or a banana with 1-2 Tablespoons of nut butter.
(Post content reviewed by MGH Department of Nutrition and Food Services)
Tags: Diabetes, DSME, health, insulin, my story, overcoming fears, Type 2 Diabetes
Writing a blog post on “Overcoming Fears of Starting Insulin” turned out to be harder than I thought. I mean, who knew writing something like this would be that much more difficult than composing an e-mail at work or posting a snarky comment on Facebook? And to be completely honest, after extending (read: missing) my deadline a few times I was starting to feel a bit hopeless that I could actually pull it off.
But then I saw Steve Martin, the actor, comedian, author, and banjo virtuoso (don’t believe me? Check this out, I think you’ll like it) on Late Show with David Letterman and inspiration struck. Martin’s appearance on Letterman reminded me of one of my favorite scenes from his 1986 comedy ¡Three Amigos!
To set the scene, at this point in the film The Amigos (played by Martin, Chevy Chase, and Martin Short) have decided that although they are merely Hollywood actors who play hero gunfighters in the movies, they will help the inhabitants of a small Mexican village confront and defeat the very real bandits and their ruthless leader, El Guapo (played by Alfonso Alau), who have terrorized the town for years. Lucky Day (Martin’s character) attempts to inspire the villagers with this speech.
What on Earth does this have anything to do with “Overcoming Fears of Starting Insulin”? Well, I think for most people with Type 2 diabetes, like yours truly, our “El Guapo” is starting insulin. It’s something we will have to face eventually and something that once we do, we will be better and healthier for it. For me, when my endocrinologist suggested insulin five years ago, there were two very different fears I had to overcome.
The first was the fear of admitting failure. The suggestion that it was time to start insulin was, for me, like admitting that I had failed myself, my wife, my family – everyone who cared about me. If I had eaten better, I wouldn’t need insulin. If I had exercised more, I wouldn’t need insulin. And now if I needed insulin, then clearly I failed at managing my diabetes.
When I met with my diabetes educator, however, she reminded me that Type 2 diabetes is a progressive disease, moving on to insulin was merely the next step in my treatment, and that it was my previous treatments that were failing to adequately treat the disease. In short, it wasn’t me it was my treatment that was failing. Once I heard this I was much more accepting of insulin as an option. I wanted to feel better than I was feeling at the time, and insulin was just the next phase of my diabetes management.
The second fear was about the administration of insulin. I had visions of not being able to do anything spontaneously with friends or family anymore (“Sorry I can’t make it, I forgot my insulin so I need to head home.”). I was pretty nervous (and admittedly still am) about hypoglycemia after a previous episode with another class of drug. And while not generally afraid of needles, I had never self-administered an injection. How long is the needle we’re talking about here? I thought it was going to be about six inches long. Would it hurt? I was sure it would be agonizing.
Again, a little education went a long way to allaying these fears. Injecting insulin turned out to be pretty anti-climactic, really. It’s had no negative impact on my life whatsoever. Being on insulin has not limited me socially. With help from my health care practitioners I have had no issues with hypoglycemia. The mini-pen needle is about as long as my pinky fingernail and causes no pain at all.
And most importantly, I’m healthier and happier ever since I faced the Type 2 diabetic’s “El Guapo” – and won.
Tags: DSME, flavor, nutrition, taste
By Madeline Quinn, Dietetic Intern
Have you ever heard of the buzzword, umami, but aren’t quite sure what it exactly means? Most people generally do not recognize the umami flavor while eating due to its subtle and mild taste. Umami, discover in 1908 by Japanese Dr. Kikuknea Ikeada, is a Japanese word meaning “pleasant savory taste.” Presently, it is the fifth taste among the original tastes of sweet, sour, bitter, and salty.
As a result of receptors for the amino acid called glutamate, we are able to taste umami. Glutamate occurs naturally in fish, meat, vegetables, and dairy products. It’s also available as its salt form in MSG. Cooking and fermentation helps release this amino acid to experience the umami flavor. Similar to glutamate, the umami flavor is conveyed by certain compounds found in meats and vegetables. When combined in a dish, such as a mouthwatering cheeseburger with ketchup, umami complexes heighten the flavor.
Umami has distinct taste receptors found all over the tongue – now that’s impressive! A remarkable amount of foods are rich in umami, including: tuna, cod, seaweed, shellfish, tomatoes, truffles, soybeans, carrots, shiitake mushrooms, green tea, soy sauce, parmesan cheese, meats, poultry and even breast milk. Thus, umami is an extraordinarily diverse taste category, and impacts a vast majority of one’s daily food intake. Next time you cook up some shiitake mushrooms or have the urge to lather your sushi with soy sauce, remember, your meal would not be the same without the savory umami flavor.