Health

Back to School Tips

By Leah Berthold, RN, CDE
MassGeneral Hospital for Children Pediatric Endocrine Unit

Blank Chalk Board

Have you begun getting ready to send your child back to school?  As the beginning of the  school year comes closer, here are some important things to remember:

  • Make sure you have a current Diabetes Medical Management plan (school orders) in place before the first day of school.
  • Make an appointment with the school nurse to review the plan and bring all supplies needed to school before school starts. Meeting the nurse before school starts will help build a relationship and confidence for you, your child and the nurse.  Refer to the box below for a list of supplies to keep at school.
  • Be sure your child has a 504 plan in place. Review this plan every year.
  • Give the school a hypoglycemia or “low” box with glucagon/glucose tablets/juice or whatever you prefer to treat low blood sugar
  • Be sure all school personnel, including bus drivers and coaches, are educated about Type 1 Diabetes and know what to do for low blood sugar.

 

School Supplies Box

Nutrition, recipes

Be Fit Basics : Mango Black Bean Salad

This easy salad recipe from the MGH Be Fit Program is a great use of the leftover grain from last night’s dinner. If you don’t have a cooked grain, substitute fresh or frozen corn kernels instead.  If you can’t find fresh mango, look for frozen cubed mango in the freezer section of your grocery store.  Dislike cilantro? Substitute another green herb, like parsley.

Ingredients:
1 mango, chopped and peeled (or about 1½ to 1¾ cups)
½ cup thinly sliced green onions (scallions), the white and green parts
½ cup cooked grain (use leftover rice, quinoa, etc.) or corn kernels
¼ cup finely chopped cilantro
2 tbsp fresh tomato salsa (or diced tomato)
1-15 ounce can low- sodium black beans, rinsed and drained
juice of 1 lime
2 tbsp olive oil
½ tsp salt (or to taste)
¼ tsp black pepper

Instructions:
In a large bowl, combine all ingredients and toss gently to mix.

Yield:  Serves 6

Nutrition Information per Serving (about 2/3 cup – nutrition information calculated with brown rice):  Calories:  160 • Protein:  5g • Sodium:  250mg
Carbohydrate: 27g • Fiber:5g • Fat: 5g • Sat Fat:1g

Recipe adapted from Cooking Light.  Originally posted on mghbefit.com
Guest Post, My Story

My Story: Nothing Holding Me Back

By Anne-Maria

I’ve had Type 1 Diabetes for 49 years – next April will be my 50th diaversary.  When I was diagnosed in the 60’s/70’s, there wasn’t as much information about diabetes out there as there is now.  But still, having diabetes never held me back from anything I wanted to do.  I still travel, and I stayed out late in my 20’s and 30’s like any other young person would.  I strongly believe that diabetes is just a part of life.  The key is to accept it and make it part of your routine.

There are professional hockey players who have diabetes.  Gary Hall, Jr. has Type 1 Diabetes and he swam the 50-meter freestyle at the Olympics.  They didn’t let diabetes stop them; they made it work.  Put your sight on what you want to do and figure out how to do it (I just don’t know if they can send you into space yet).  People are happy to work with you if you talk to them about your needs.  When I was still in school, we went on ski trip to the Alps.  At the time, they didn’t have refrigerators in the hotel rooms so I stored my insulin in the one in the kitchen.  I got to know the kitchen staff pretty well and they were happy to accommodate me.  Nobody has ever said “no” when asked to help.

The only time my health factored into any of my life choices was when I decided not to become a physician.  Sleep is very important for me and I knew I wouldn’t be able to function with the little bit of sleep med students get.  But again, it was my choice based on what I needed to take care of my own health.  I know my body inside and out, so I know when something isn’t right and how to adapt.  When I have late meetings, I’ve learned to check my blood sugar and drink some juice before it starts so I don’t go low.

My biggest piece of advice for parents or anyone who has been diagnosed with Type 1 diabetes is:  take a deep breath and relax.  If you were diagnosed as an adult, know there’s nothing abnormal about what you have.  You can maintain your regular routine without much extra effort.  The only time I need to pay more attention to my blood sugar is when I’m sick.  I might have to take some extra time off from work to recover these days, but that could be because I’m getting older.

If you’re a parent, let your kids be kids.  Let them have fun at parties and eat a small piece of cake like the other kids (maybe take of some of the frosting first).  Don’t stress too much about what they eat.  You don’t have to make big formal meals.  Sometimes when I get home late I’ll have cereal and fruit for dinner.  Just use common sense and think about what you need to do to cover it with insulin.

 

 

 

 

 

 

Health, Nutrition

Diabetes and A Healthy Microbiome

By Christina Badaracco, Dietetic Intern 

What Is the Microbiome?

The human microbiome includes all the bacteria, both good and bad, that live in our organs. There are actually about 10 times as many bacterial cells in the body as human cells! Bacteria play many important roles in keeping us healthy, such as protecting us from invading bad bacteria and breaking down (or fermenting) the fiber in foods like vegetables that our own bodies can’t digest.

Our microbiome includes many different types of bacteria, and more diversity is typically a sign of good health. Many diseases, such as diabetes, can reduce the diversity in our gut and create environments that are better for bacteria that produce substances that cause inflammation or other harmful effects.  In this figure you can see many of the things that cause the microbiome to become imbalanced (such as taking antibiotics or poor diet) and some of the health problems that might result.  The microbiome is such an important factor in our health that the National Institutes of Health have launched two versions of the Human Microbiome Project, granting hundreds of millions of dollars into research about the connection between changes in the human microbiome and disease.

Is there a Link Between the Microbiome and Type 2 Diabetes?

Type 2 diabetes can be caused by genetics as well as diet and lifestyle.  Eating a healthy diet (one with lots of fiber-filled fruits and veggies and low in sugar and saturated fat) and exercising regularly can help keep your microbiome healthy and might help reduce the risk of developing diabetes.  The short-chain fatty acids that good gut bacteria produce when breaking down fiber can increase your body’s metabolism and how quickly glucose in the blood is used up, which can help manage blood sugar.  A recent study showed that a diet rich in fiber could improve diabetes management because it produces the short-chain fatty acids the cells of our gut lining need to be healthy.  Fiber also reduces inflammation and keeps you feeling full, which helps with managing portion sizes and keep blood sugar steady after meals. The types of bacteria in the gut also shifted to the species that love a high-fiber diet, promoting health long into the future.

How Can I Feed a Healthy Gut Microbiome?

  • Eating a diet rich in fiber keeps your good bacteria happy. They break down molecules like cellulose found in fruits, vegetables, and whole grains.
  • Limit high-sugar and high-fat meals. Bad bacteria thrive when we eat a high-sugar and high-animal fat diet. Try to limit foods like sodas, candy, large servings of fast foods, sugary baked goods, red and processed meats.
  • Try to eat some foods with probiotics. Foods that are already broken down (or fermented) contain good bacteria that can colonize and thrive in our guts. As a bonus for people with diabetes, these bacteria have already broken down some of the glucose for you! Some examples of fermented foods include:
    • Dairy: cheese or yogurt
    • Bread: sourdough
    • Grains: injera (found in Ethiopian cuisine), idli (found in Indian cuisine), atole (found in Mexican cuisine)
    • Vegetables: sauerkraut, fermented pickles, curtido (found in Salvadoran cuisine) kimchi (found in Korean cuisine) and tempeh and miso (found in Japanese cuisine)
  • Your healthcare provider many suggest taking a probiotic supplement to increase your good gut bacteria, particularly if you have recently taken antibiotics.
Post content reviewed by Melanie Pearsall, RD, CDE
Health

Standards of Medical Care in Diabetes 2018

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NPThe American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people with diabetes. Beginning in 2018 the ADA will publish updates online as they become available if new evidence or regulatory changes require immediate incorporation. The new recommendations include the areas of cardiovascular health, health technology, screening , and patient centered care. These standards are meant to provide general treatment goals for people with diabetes. They are not meant to replace clinical judgment. I am going to briefly review some of the changes this year.  A more detailed explanation of the standards can be found here.  Please remember, that these are in no way meant to replace the individual care that you are participating in with your health care team.

Section 1: Improving Care and Promoting Health in Populations

Care for people with diabetes includes assessing for financial resources, access to care, stability of housing situation, ability to access healthy food, and medication use.  Additional support for diabetes self-management can come from community health workers, navigators (who help “navigate” health insurance and claims), and lay health coaches who help with self-management.

Section 2: Classification and Diagnosis of Diabetes

Certain medical diagnoses can make A1c test results less accurate. People with conditions that affect red blood cells, such as sickle cell anemia, may get an incorrect result. It is important to use other methods to test for diagnosis and control of diabetes such as fasting and postprandial (after meal) glucose levels.

Section 3: Comprehensive Medical Evaluation and Assessment of Comorbidities

Pancreatitis is now listed as a comorbid condition (another condition a person can have along with diabetes).

Serum testosterone should be checked in men with symptoms of hypogonadism.

Section 4: Lifestyle Management and Section 6: Glycemic Targets

Both sections address the ADA recommendations for using technology to help with diabetes management.  This could include teleconference, text messages, or email. The use of continuous glucose monitoring (CGM) for people with Type 1 Diabetes should start at age 18.

Section 8: Pharmacologic Approaches to Glycemic Treatment

Recent study data has shown that all patients newly diagnosed with diabetes should be following strict lifestyle changes and start metformin. People with heart disease should consider additional medication(s) that may reduce cardiovascular events/mortality.

Section 9: Cardiovascular Disease and Risk Management

People with hypertension (high blood pressure) and diabetes should monitor their home readings to help to identify white coat hypertension and to improve medication management and following directions for taking medications. The ADA defines hypertension as blood pressure of 140 or greater /90 or greater.

Lipid management recommendations were changed to group risk in two broad categories: with heart disease and without.

Section 11: Older Adults

It is very important to individualize medical therapy in older adults to achieve the best results without any adverse reactions, such as hypoglycemia. A1c target should be adjusted for age and other medical conditio

Nutrition

Asparagus Chickpea Quinoa Salad with Lemon Vinaigrette

Celebrate spring with this salad recipe from the MGH Be Fit program.  Leftovers work well for a quick lunch—just keep the dressing separate and add before eating, so the greens don’t wilt.  You can also add a hard-boiled egg to further increase the protein in this recipe.

Ingredients

For the lemon vinaigrette
¼ cup lemon juice
½ cup olive oil
2½ teaspoons Dijon mustard
Kosher salt and black pepper, to taste

For the salad
1 cup uncooked quinoa, rinsed and drained
1 bunch asparagus (15 to 20 spears), cut into 1-inch pieces
1 tablespoon olive oil
1 (14-ounce) can chickpeas, rinsed and drained
3 large handfuls of arugula
2 scallions, thinly sliced
½ cup crumbled feta cheese

Instructions:
To make the vinaigrette:
Place all ingredients in a small jar with a lid and shake until thoroughly combined (or whisk together in a small bowl). Taste vinaigrette; add salt and pepper as needed.

To make the salad:
In a medium saucepan over medium heat, combine the quinoa with 2 cups of water. Bring to a boil, then cover and lower the heat to a simmer. Cook for 15 minutes or until the quinoa is tender. Let sit for 5 minutes then fluff with a fork. (If your quinoa still has water in it simply strain it out.) Set aside until ready to assemble the salad.
While the quinoa is cooking, sauté asparagus in olive oil in a medium skillet over medium heat until cooked through, about 7 minutes.

To assemble the salad:
Combine the cooked quinoa with asparagus, chickpeas, arugula, and scallions. Top with vinaigrette and feta cheese.

Yield: 6 servings

Nutrition Information per Serving:
Calories: 390 • Protein: 10g • Sodium: 240mg • Carbohydrate: 31g • Fiber: 7g •
Fat: 26g • Sat Fat: 5g

Recipe adapted from Two Peas & Their Pod
Nutrition

Eat Balanced by Pairing Your Carbs with Protein

By Lisa Keovongsa
Dietetic Intern

There is a common misconception that once a person is diagnosed with diabetes they need to cut out all carbs. This is not the case! Carbohydrates are very important because they serve as the main fuel source for the body and give the brain and muscles the energy needed to carry out daily activities. Carbs, protein, and fat all play essential roles and can be incorporated into your meals and snacks to keep you feeling your best. Also, eating carbs with protein at every meal will help manage your blood sugar and help your body best utilize the nutrients in your food.

Carbohydrate Foods
Many foods with carbohydrates raise blood sugar.  Eating carbohydrate with a protein or fat can keep your blood sugar steady.  Foods with carbohydrates include:

 Starchy vegetables*/legumes:  Pumpkin, squash, all potatoes, yucca, beans, corn

Dairy: Milk, yogurt

Grains: Breads, pastas, tortillas, rice, crackers/snack chips, cereals, quinoa

Fruit: Apples, oranges, pears, bananas, mangoes

*Non-starchy vegetables have fewer carbohydrates.  Examples of non-starchy vegetables include: Carrots, lettuce, broccoli, cabbage, tomatoes, any leafy green, cucumbers

Protein Foods
There are many options when it comes to eating protein. These foods include meats, poultry, eggs, fish, cheese, cottage cheese, nuts, nut butter, and tofu.

Why do we need to eat protein with carbs?
During digestion, the food we eat gets broken down into simple sugars that are delivered to our muscles and liver through the bloodstream.  Insulin is the “key” that “unlocks the gate” for sugar to leave the blood and enter the cells. When someone with diabetes eats large portions of carbohydrate-rich foods, too much sugar is released into the blood stream and, because there’s either not enough insulin or they have insulin resistance, their body is unable to use this sugar for energy effectively.  This can cause high blood sugar, which, if it happens consistently over time, can lead to complications.  Proteins (and fats) take longer to digest than carbs, so eating protein along with the carb slows down digestion in the stomach and absorption in the intestines. This will help slow the rate of sugar entering the bloodstream, keeping blood sugars steady and preventing blood sugar spikes (and crashes).  Check your blood sugars 2 hours after a meal to see the effects.

Snack Ideas
Pair one item from the protein list with an item on the carbs list to make a balanced snack that will keep your blood sugar in check:

Protein                                                 Carbs

Handful of nuts                                 Whole fruit (apple, ½ banana)

1 cup Greek yogurt                           5 Whole wheat crackers

2 Deli turkey slices                           1 whole grain tortilla

1 oz beef jerky                                  1 oz whole wheat pretzels

Hard-boiled egg                                1 cup regular yogurt

½ cup cottage cheese                       ¼ cup granola

1 tbsp Peanut butter                        3 cups popcorn

2 Tbsp Hummus                               ½ cup dried fruit

1 oz cheese                                       1 cup raw vegetables

Post content reviewed by Melanie Pearsall, RD, CDE