Tags: American Diabetes Association, Diabetes, Diabetes management, DSME, standards of care
Eileen B. Wyner, NP
Bulfinch Medical Group
This week is part two of my review of the revisions to the 2017 American Diabetes Association Standards of Care (click here to review Part 1). First, a quick reminder that these are guidelines; always discuss questions about your personal health care plan with your health care provider.
Section 6: Glycemic Targets
The International Hypoglycemia Study Group has recommended that serious, clinically significant hypoglycemia be defined as a reading of less than 54 mg/dL. People who have experienced such measurements need to notify their health care providers immediately and be prescribed a glucagon emergency kit.
Hypoglycemia measuring less than 70 mg/dL is still treated by the rule of 15: 15 grams of fast acting carbohydrate with a blood sugar check in 15 minutes for an expected increase by at least 15 points. Repeat the process if the result doesn’t improve.
Section 7: Obesity Management for the Treatment of Type 2 Diabetes
The best blood sugar results occur with weight loss early in the management of Type 2 Diabetes, before beta cells begin to stop working. For this reason, metabolic surgery (formerly referred to as bariatric surgery) is now recommended for people with a BMI of 30 (or 27.5 for Asians with poorly controlled diabetes).
Section 9: Cardiovascular Disease and Risk Management
Any of the medications for managing high blood pressure can be used (except for beta blockers) as long as the person doesn’t have protein in the urine (albuminuria). One or more medications should be used at bedtime to improve blood pressure control.
The goal for blood pressure for pregnant women is 120-160/80-105. When prescribing medications, providers should consider both maintaining the health of the mother and avoiding harm to the baby.
There is a discussion of new medications and the potential benefits for people with diabetes and cardiovascular disease: empagliflozin (Jardiance) and liraglutide (Victoza).
Section 10: Microvascular Complications and Foot Care
There is an increased risk for retinopathy in pregnant women with Type 1 or Type 2 Diabetes. Thorough eye exams should be a part of preconception counseling as well as during pregnancy.
Anyone being treated for neuropathic pain should be evaluated for the addition of medication therapy with pregabalin (Lyrica) and duloxetine (Cymbalta). They should also be fitted for therapeutic footwear by a podiatrist.
Section 12: Children and Adolescents
Preconception counseling should begin in puberty to help to avoid the risk for birth defects in unplanned pregnancies.
When diabetic ketoacidosis appears in children, it is important to know if the child has Type 1 or Type 2 Diabetes as 6% of these cases are actually Type 2 Diabetes, not Type 1.
Section 13: Management of Diabetes in Pregnancy
Insulin is the preferred treatment for pregnant women. Oral medications may harm the baby.
Targets for blood sugar are the same for gestational diabetes as for preexisting diabetes.
Section 14: Diabetes Care in the Hospital
It’s now recommended to use basal and/or basal bolus insulin regimes (instead of sliding scale insulin alone) when patients are admitted to the hospital.
Tags: balanced plate, DSME, fruits and veggies, health myths, healthy eating, nutrition, nutrition myths
By Josann Nichols
MGH Dietetic Intern
You don’t have to break the bank to have a healthy diet. Below you’ll find tips and tricks to eat well on a tight budget.
- Get produce in season. Buying produce in season and from local farmers is often less expensive. More corn on the market means competition, which drives prices down. For example: 4 ears of corn in season costs about $1 from local sources compared to $18 on Amazon during the winter. Produce you buy in season is also picked at peak ripeness, which packs in more flavor and nutrients.
- Try frozen fruits and vegetables. Frozen produce is a cheaper alternative to many fresh fruits and vegetables. They’re also picked at peak ripeness, meaning they have the same nutritional quality as fresh produce. You can also store it longer, leading to less food waste which saves money over time.
- Stock up on canned fruits and vegetables. Canned fruits and vegetables are a very cheap option and can be stored longer than either fresh or frozen produce. Make sure to buy fruit canned in its own juices to avoid added sugar. To reduce sugar and salt, rinse before eating.
- Don’t give up on meats. There are many cheaper cuts of meat available such as brisket, skirt, flank and top rump. Typically, these cuts are cheaper because they are a bit tougher but don’t be discouraged! Cooking meat like pot roast in fluid for a long period of time can make it so tender it falls off the bone! Another money saving tip: check with your local grocery store for sales on older meats. These should be used within a few days or immediately frozen.
- Substitute other protein sources for meat more often. Plant-based protein sources are inexpensive, contain fiber and higher-quality fat than meat and will last longer in the kitchen. Beans and lentils for example are usually purchased canned and/or dried. Use them as a substitute for meat in stews, salads, casseroles and side dishes to help your dollar go a little farther. Peanut butter, seeds and eggs are also excellent sources of protein. Add an egg to your breakfast for only $0.25!
- Try canned fish. A healthy diet includes seafood, which can often be pricey. Tuna is one cheap alternative, but if mercury is a concern try sardines. Not only are sardines rich in protein, they’re another source of anti-inflammatory fats. Again, watch out for added salt!
- Go whole grain. Fiber is your friend! It helps manage blood sugar levels and keep your digestive system healthy. Whole grains have more fiber than white flour products and can be affordable. Instead of expensive specialty grains, try switching to old-fashioned oats, whole wheat bread and brown rice.
- Buy in bulk. This can include frozen, canned or dried whole foods. The larger the quantity the cheaper the price per unit, so even though you pay more up front you end up saving money over time.
- Choose generic brands. These typically have significant price cuts. Check the ingredient list, though, to make sure you aren’t losing any quality of the product.
- Take advantage of sales and coupons. Stores frequently have deals on fresh, canned and dried foods.
- Don’t feel pressured to buy organic. Organic farmers do not use chemicals on their crops, but that doesn’t mean non-organic produce is full of chemicals. Many non-organic farmers use little to no chemicals on their produce and simply can’t afford to get the organic certification. Research has also shown that conventionally grown organic and non-organic produce does not differ in nutritional content. So you can be just as healthy eating non-organic foods while saving big bucks at the checkout line.
- Follow the Balanced Plate Model. Protein-rich foods tend to make the largest dent on your wallet, compared to starchy foods and vegetables. By maximizing plant-based foods and limiting your meat portions, you’ll improve the quality of your meals and make your dollar stretch farther.
Just follow the tips above to mix and match your protein, starch and vegetables to maximize your dollar and eat healthy!
Content reviewed by Melanie Pearsall, RD, CDE
Tags: cooking, Diabetes Education, DSME, healthy eating, home cooking, vegetables
I never used to cook at home. In fact I HATED cooking. I had no confidence in the kitchen and burned everything, even toast. Time was another reason I didn’t cook often. I always thought cooking a meal had to take a ton of time; I really just wanted my food to appear in front of me. At the same time, I wanted to eat healthier but had no idea where to start or what to do with things like vegetables and spices. Then a coworker mentioned she had signed up for Plated [a subscription meal service] and suggested I give it a try. It sounded like an interesting concept, so I went for it.
What I like most is that it saves time and effort. Everything you need to make the dish is included and portioned out for you. Some recipes use ingredients I never would have bought on my own because I didn’t know how to use them, so it’s a great way to try new things. I also discovered that cooking doesn’t take up as much time as I thought. We typically cook at home 3-4 times a week (usually dinner). We’re definitely eating as a family more often, and I enjoy getting to spend time with loved ones while preparing meals.
We’ve been using Plated for about a year now and I feel much better about my cooking skills. I know if I made a recipe once I can do it again. You get to keep the recipe cards, so we’ll usually do a little experimenting the next time we make the dish. I’m eating healthier now, too. Before, I never really ate vegetables (or if I did they were just raw). I’d go into the grocery store and see all these wonderful looking vegetables but feel intimidated not knowing what to do with them. Now that I have a better idea how to cook them, I include vegetables with my meals often.
I recommend signing up for something like Plated if you don’t have much confidence with cooking. The recipes are easy and they tell you about how much time it takes to make. You’ll learn how to cook new things and different types of vegetables. My parents actually signed up for another meal delivery service, Blue Apron, because of my experience with Plated.
Tags: Diabetes, DSME, health information, MGH
Jen Searl, MLS, CHWC
If you’re like the majority of Americans (over 60%), you use the internet to find health information. And why wouldn’t you? The internet is full of answers to any question you could possibly have. However it’s important to remember that not all websites are created equal. Just because you read something on the internet does not mean that is true! Read below for things to look for when evaluating health websites.
- Source: Who is the owner of the website? For example, is it a non- profit, federal government agency, pharmaceutical company or other? Often the ‘About’ section on a website will give you this information.
- Bias: Is the website trying to sell you something? Is it difficult to tell what an advertisement is and what is fact?
- Quality: Where does the information come from? Is it based on solid research or personal experience?
- Date: When was the website last updated? Is the information current? Are there broken links?
You can tell a lot about a website from how it ends:
.gov = This website is owned and operated by the government. An example would be medlineplus.gov, an excellent source of health information
.org =This website is owned and operated by an organization. When looking for diabetes information, a great reputable source of information is the American Diabetes Association at www.diabetes.org
.edu = This website is owned and operated by an educational institution, such as a college or university. An example would be www.health.harvard.edu, a division of Harvard Medical School
.com = This website is owned and operated usually by a commercial site. When looking at .coms, use the tips above. Some websites, like ours www.mghdiabeteseducation.com is a great source of health information! Others can be less reliable so use your judgment.
If you ever wonder if information you have read is true, make sure to talk with your diabetes educator. They know you and your diabetes best!
Tags: cholesterol, Diabetes Education, food label, healthy eating, nutrition, trans fats
Alison Bliven, Dietetic Intern
What is it?
Trans fat has been used since the 1950’s in order to add certain tastes and textures to packaged and prepared foods while also increasing their shelf life. These fats naturally occur in small amounts in some animal products and oils, but the product used in processed foods is man-made and differs slightly from the naturally found substance. Hydrogen ions are forced into oil in a process called ‘hydrogenation’ which turns the oil into a solid. This product is called partially hydrogenated oil (PHO for short) and is filled with trans fats. This PHO is what is used in place of butter or oil in a variety of processed foods in order to keep them fresher longer.
Why is it bad for me?
For half a decade trans fats were included on the Food and Drug Administration’s (FDA) Generally Regarded as Safe list. However, more recent studies have linked the consumption of trans fats to increased risk of coronary heart disease: by raising ‘bad’ cholesterol (LDL) and lowering ‘good’ cholesterol (HDL), trans fat contributes to the buildup of plaque in arteries which can lead to heart attack. Insulin resistance, a sign of Type 2 Diabetes, has also been shown to have strong connections with trans fat intake.
What foods contain trans fat?
Trans fats naturally occur in meat, dairy, and some oils. The amount of trans fats found in these sources make up an insignificant part of the American diet and are not considered a health concern. The majority of trans fats come from processed foods. For example: crackers, cookies, cakes, frozen pies, microwave popcorn, stick margarine, coffee creamer, biscuits, cinnamon rolls and ready to use frosting. Luckily, the number of foods containing trans fats is decreasing, and should soon be nonexistent.
What is being done to protect us?
As mentioned above, studies have overwhelmingly shown a direct connection between trans fats and certain negative health outcomes. This evidence has led to the FDA passing laws that will phase trans fats out of food manufacturing completely. The first step in this process is including the content of trans fats on the nutrition label. This allows the consumer (you) to know what the product contains, to an extent. Food companies are allowed to put ‘0 grams trans fat’ on their labels if the product contains less than 0.5 grams per serving. There are two problems with this: 1) foods with small amounts can add up to a significant intake when more than one serving is eaten and 2) the Institute of Medicine has concluded that there are no safe levels of artificial trans fats in the diet. Even though the FDA is attempting to preserve Americans’ health, there is only so much it can do during the lag time before trans fats are outlawed completely.
What can I do?
Read the label! Look for products that include the phrase ‘trans fat free’ – by law these products can contain no trans fats. Also, scan the list of ingredients for words such as ‘hydrogenated oils’, ‘partially hydrogenated oil’, ‘PHO’, and ‘vegetable shortening’. If the food contains any of these ingredients, there is sure to be some amount of trans fat in it. Other tips include choosing liquid oils or soft tub margarine over stick margarine, and avoiding or limiting commercially baked foods and packaged snacks. Filling up on foods naturally high in fiber (whole grains, beans, peas, fruits, vegetables) means there will be less room for foods containing trans fats and will help promote general health as well.
Remember, Trans Fat Free ≠ Healthy!
One very important takeaway from this article is that just because a food is trans fat free or has very low trans fat, it doesn’t automatically make the food well-balanced or healthy! Limiting trans fats is just one component of a healthful diet that includes lots of fruits and veggies, a focus on whole grains, and limited intake of higher fat meats and dairy products.
(Post content reviewed by MGH Department of Nutrition and Food Services)
Tags: circuit training, Diabetes Education, fitness, fun, New Year, Star Wars
By Chrisanne Sikora, Sr. Project Specialist
Diabetes Self-Management Education Program
Chances are “okay grab your lightsaber, get ready to move” is not something you’d expect to hear in a group fitness class. Gyms and health clubs often run special promotions after the holidays when many people begin setting up new fitness routines. Last week when I read an article about one of the nearby gyms offering a free class inspired by the new Star Wars movie, I thought it sounded a little silly but also like it could be a lot of fun. I figured why not? and called to sign up.
After we’d picked out a lightsaber and chosen our spots the instructor, Cassie, explained the class was designed around the idea of circuit training. We’d learn a sequence (or “circuit”) of about four exercises that we would do for a minute each. After we’d done each sequence three times, we’d start over with a new sequence. Cassie showed us the first sequence while a dance remix of the Star Wars theme played over the speakers, and we were off.
I couldn’t help but giggle along with the woman next to me as we swung our lightsabers side to side while doing lunges. Aside from thin disks used to slide our feet along the floor (and of course a toy lightsaber), there was no equipment used in the class. Most of the exercises were versions of basic moves like squats and push-ups that use bodyweight as resistance. Even so, the class was more challenging than you’d think! By the time we started our second sequence you could see several people were already getting tired – and we still had another whole sequence to go!
The second and third sequences were more challenging than the first, but Cassie always gave us the option of going back to an easier move if anything became too difficult. By the end of the class everyone was tired, sweaty, probably a little sore, but smiling. On the way out, I chatted with a couple of classmates about what we’d expected going in and how much fun the whole experience was. Maybe if we take the class again we’ll be able to float rocks with our thoughts.
The two key things I took away from the class were:
- You can get a really good, challenging workout with using just your bodyweight. No equipment (or even a gym!) required.
- The most important part of any routine is making it FUN. If you’re not enjoying yourself, it will be hard to stick with it.
Tags: balanced plate, carbohydrates, Diabetes, DSME, healthy diet
By Shannon Evins
With various medications, glucose tests, and protocols to follow, diabetes can seem an overwhelming subject to master. Doctors, nurses, dietitians, and other health professionals start throwing numbers and words like carbohydrates and glucose at you and telling you what you should and should not eat. By now, most people know that carbohydrates are at the center of what affects blood sugar. To get to the root of the problem and simplify the concept, it is important to understand the different kinds of carbohydrates. They can be split into two main groups: simple or complex.
Simple carbohydrates are the things you normally think of when someone mentions high blood sugar – candy, cakes, cookies, pies, pastries, etc. They are called simple because they are easy for your body to digest and so spike your blood sugar quickly. It is best to avoid or watch the portion size of simple carbohydrates. Here are some other simple carbohydrates that people often overlook although they have the same effect as table sugar on your body: brown sugar, honey, molasses, maple syrup, corn syrup, jams/jellies, fruit juice, and soda.
Complex carbohydrates, on the other hand, take longer to break down which means a slower release of energy and less of a spike in your blood sugar. They also often have a higher content of fiber and nutrients, so everyone, not just people with diabetes, should focus on eating complex carbohydrates. Common complex carbohydrates include whole-grain items (whole-wheat bread, whole-grain cereal, brown rice, whole-wheat pasta, etc.), corn, beans, lentils, peas, potatoes, winter squashes or pumpkin, and whole fruits.
To better understand the concept of simple versus complex carbohydrates, let’s go back to the days of arts and crafts and imagine carbohydrates this way: say you have some beads and string and want to make a necklace. You have to add the beads one-by-one to the string in order to make the necklace. Each bead represents a sugar molecule. Simple carbohydrates are the equivalent of just two beads on that string. It would take you no time at all to add those beads to the string. Complex carbohydrates, however, have several more beads on the string, meaning it would take longer to put together. Similarly, your body is doing this for digestion but in reverse – each bead is being removed from the string, meaning each sugar molecule is being broken down and digested. It takes only a short amount of time for your body to digest two molecules versus several.
Overall, carbohydrates are very important for bodily functions because they are the main fuel source for your body. Just remember that it is best to eat them as part of a balanced meal with a fat or protein source and vegetables in order to stabilize blood sugar. Simple (or complex) enough?
(Post content reviewed by MGH Department of Nutrition and Food Services)
Tags: breathe, DSME, Holidays, relaxation response, stress
The holiday season is “the most wonderful time of the year.” It’s also the time of year many feel the most stressed! The relaxation response is the body’s natural counter to the stress response. If you’re feeling holiday stress starting to creep in, take a few minutes to try this mini relaxation breathing exercise from the Benson-Henry Institute for Mind Body Medicine
INHALE, pause- 1,2,3 EXHALE, pause, 1,2,3
- After each inhalation, pause and count: 1,2,3 (breath is held in)
- After each exhalation, pause and count: 1,2,3 (breath is let out)
- Do this for several breaths.
Today we are celebrating World Diabetes Day, a day set aside each year to raise awareness of the impact of diabetes. All are invited to stop by our table near Coffee Central to learn more about diabetes from our Certified Diabetes Educators. Plus, games and prizes!
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. Much 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.