Fitness

Low-cost Fitness Options

A regular exercise routine is a powerful tool in your diabetes management plan.  Exercise can lower blood sugar, and helpful for losing/maintaining a healthy weight.  Going to the gym or health club isn’t a great fit for everyone, though.  They can be intimidating for one (especially if you’re just getting started), and the closest gym might still be too difficult to get to often enough to make it worthwhile.  Then there’s cost.  Memberships can be expensive, and some places charge extra for certain fitness classes.  If you’re trying to save money, exercising at home may be a better fit.

But what about access to equipment like weights and exercise machines?  If you have space you can purchase your own exercise machine or a set of weights, but again this might not be an option if saving money is a concern.  If you do have a little budget for fitness equipment, a set of resistance bands (with a door anchor), jump ropes and a stability ball are versatile, low-cost choices.  In reality you don’t need any equipment to exercise (a routine made of bodyweight exercises can be effective and challenging), or you can incorporate some items you probably already have at home into your routine.

Hand weights => Canned goods

Cans of soup are a good option for arm raises or other upper body exercises that use light hand weights.  If you need more challenge you can use a milk jug filled with water.  The more water you add, the heavier the weight. 

Gliding Disks => Paper plates

Gliding discs are circular plastic discs used to slide hands or feet (depending on the activity) along the floor when doing body weight exercises like mountain climbers, lunges, or.  A set of paper plates or a dish towel will work just as well at home.

Squat machine => Wall

Yes, even a blank wall can be used as a piece of fitness equipment!  To do a wall squat, stand with your back against the wall and slide down until your thighs are parallel with the floor, moving your feet out so your knees are bent at 90 degrees.  Hold.  As you get stronger, you’ll be able to hold the squat longer.

Stair machine => Stairs

Another piece of fitness equipment you probably already have in your home or office.  Skip the elevator and take the stairs whenever possible.

Post content reviewed by the Clubs at Charles River Park
Nutrition

Personalized Nutrition- Is the Future Here Yet?

By Robert Dunn, Dietetic Intern

Is the secret to a perfect diet hidden in your own body?

Personalized nutrition is a modern approach to nutrition that aims to prescribe specific diets based on biomarkers. Biomarkers are substances that provide information on a person’s condition, and can be used to measure disease risk. By assessing their impact on nutrition, medical professionals may be able to precisely determine the best diet for improving a person’s health.

The role of personalized nutrition is evolving quickly. Many researchers are optimistic that it may provide a breakthrough in the treatment of certain diseases. One of the diseases being closely studied is diabetes, a condition that affects over 29 million people in the United States. Additionally, over 80 million people are estimated to have prediabetes, putting them at risk for developing diabetes later in life. Diet and lifestyle have always been important for diabetes management, and personalized nutrition may soon play a key role in this process.

Researchers in Denmark recently published a study on personalized nutrition in diabetes treatment. Their goal was to determine the most effective weight loss diet for people that were diabetic, pre-diabetic, or neither (healthy group). To do so, they divided patients from prior weight loss studies into those groups based on two biomarkers: fasting insulin and fasting blood glucose. Once the patients were assigned groups, the researchers could then compare weight loss data to determine if any diet had a particularly strong effect on any specific group.

After comparing the data, several trends became clear. Patients in the diabetic group lost more weight on a low-carbohydrate diet that was high in plant-based fats like olive oil. Meanwhile, the healthy group was more successful with a low fat, high-carbohydrate diet. Finally, pre-diabetic patients who followed a diet high in fiber (fruits, vegetables, whole grains) lost more weight than those who followed a control diet. Based on these results, the researchers concluded that biomarkers like fasting blood sugar could be helpful in planning diet interventions for patients with either diabetes or pre-diabetes.

The results of this study seem promising, and may offer insight into weight loss strategies for people with diabetes or pre-diabetes. However, personalized nutrition is an emerging area of research and it is important we don’t make conclusions based on limited evidence. The study’s authors stated that next steps include “research to explore additional biomarkers…which may help to more effectively customize the right diet for specific individuals.”

In the meantime, people with diabetes and pre-diabetes should be encouraged to optimize their nutrition and physical activity. Nutrition counseling with qualified professionals has been shown to improve the health of people with these conditions. Anyone interested nutrition for diabetes management should consider meeting with a Registered Dietitian (RD).  Registered Dietitians are nutrition experts who help people of all backgrounds use diet to meet their medical needs.

To schedule an appointment with an RD from Massachusetts General Hospital, contact the Department of Nutrition and Food Services by calling 617-726-2779.

Content reviewed by Melanie Pearsall, RD, LDN, CDE
Health

Understanding Emotional Eating

Have you ever come home after a stressful day and ended up eating a pint of Chunky Monkey?  Or maybe you’ve mindlessly eaten a bag of chips at your desk willing the workday to go by faster?  Both of these examples are types of emotional eating:  eating for reasons other than hunger.  While eating when you’re  hungry addresses a physical need (providing the body with food in order to function), emotional eating uses food to satisfy an emotional need.  Some common causes of emotional eating include stress, anger, boredom and loneliness.    Emotional eating can affect your diabetes management because often the foods eaten are high in sugar, fat and calories.  This can raise blood sugar and make it hard to lose weight.

So how can you tell if you’re eating because you’re hungry or because you’re stressed out?  Physical hunger comes on gradually and can be satisfied by any type of food. You stop feeling hunger when you have eaten enough to feel full.  Emotional “hunger” comes on very quickly and is focused on a strong craving for a particular food, taste or texture. Emotional eating is also often mindless and can lead to feelings of guilt afterward.

Now that we know the difference between physical and emotional hunger, here are some strategies to help manage emotional eating:

  • Know your triggers – If you know what it is that causes you to eat (e.g. boredom, stress), you can take action to prevent mindless munching before it begins. Use another activity to distract yourself from wanting to eat. Try going for a walk, talking to a friend or loved one, or listening to music.
  • Pause – Before reaching for the bag of chips, stop and think: am I hungry, or am I bored? Wait 10 minutes and see if you are still truly hungry.
  • Eat smaller portions –   If you wait 10 minutes and still can’t stop thinking about those chips, have a smaller, individual portion to keep you from overeating.
  • Practice mindful eating – Slow down and take the time to really enjoy the smell, tastes and textures of your favorite foods. Try not to multi task – make eating your only activity.
  • Seek help if you need it – Emotional eating can sometimes be a symptom of depression or anxiety.  If you feel this may be the case, talk to your healthcare provider, a diabetes educator or a mental health specialist.

Post content reviewed by Jen Searl, MLS, CHWC

Nutrition

Low-Calorie Options for Adding Flavor to Water

By Melanie Pearsall RD, LDN, CDE
Sr. Clinical Nutritionist

Water is the healthiest drink for people of all ages. Drinking enough water is an important part of helping your body “detoxify,” and even mild dehydration can cause problems with concentration.  Americans tend to drink a lot of beverages other then water. Many of these drinks have a lot of added sugars and fat’s which are high in calories and cause weight gain. But the one thing these beverages have is flavor!   Many people know it’s important to drink water and stay hydrated but hate to drink “plain” water. Here are some suggestions to help even the pickiest water drinker succeed:

  • Flavor your water with orange or lemon slices, cucumber slices, berries or fresh herbs like mint or basil
  • Try flavored or plain seltzer waters! Sometimes that added fizz is enough to tickle your taste buds.
  • Herbal teas are a great way to flavor water. I often add an herbal tea bag to my cold water bottle and let it steep slowly, flavoring the water. Tea also provides an extra health benefit from anti-oxidants.
  • Add small amounts of sugar free type flavorings like Crystal Light to your water. I suggest people start off with just enough to add some flavor but without making it overly sweet.
  • Buy a water purifier for your home or individual bottle. This can make the water taste clean and refreshing as it removes some of the impurities that cause an aftertaste
  • If you like to drink pre-flavored water just double check the label to make sure it is low calorie (fewer than 10 calories per serving)
Article originally appeared in Summer 2013 DiabetesViews
Health, Uncategorized

Standards of Medical Care in Diabetes 2017 (Part 2)

Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

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.

Health

2017 Standards of Medical Care in Diabetes (Part 1)

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

The American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people diabetes. I will review the standards that have had changes made in them for 2017.  Section 8 (Pharmacologic Approaches to Glycemic Treatment) is a very important section with a great deal of information, so it will be covered in a separate post.

This year the Standards of Care have been updated to address psychosocial issues in all aspects of care.  This includes the importance of assessing self-management capabilities, mental health status, and complications and comorbidities.  These standards are meant to provide general treatment goals and are not meant to replace clinical judgment.   This post is a brief overview of the changes to the standards; click here to access a full list and descriptions.  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 2: Classification and Diagnosis of Diabetes

There is a new consensus on staging Type 1 Diabetes. Three stages have been identified:

  • Stage 1 – no changes in the blood glucose values and no symptoms are present
  • Stage 2 – some impaired fasting blood glucose and possibly some impaired glucose tolerance, too
  • Stage 3 – the stage that most people are diagnosed. They may appear with dangerous hyperglycemia and have symptoms such as excessive thirst, hunger and urination

Investigators hope to use this staging system as a research road map to help better plan intervention strategies.

A new risk test has been developed to help to identify people with prediabetes and undiagnosed diabetes as soon as possible. Click here to see the test and share with loved ones.

Dentists are also are important in identifying people with diabetes. One study shows 30% of people over 30 that are treated for periodontal disease have abnormal glucose levels. Educating dentists to refer these individuals to their health care providers for formal assessment will be helpful in identifying at-risk people sooner.

Birth weight of infants is no longer a risk factor for Type 2 Diabetes. Women who had gestational diabetes should have their fasting glucose test done 4 to 12 weeks after having their baby (instead of 6 to 12 weeks).  The hope is that most women will have the test done before the 6 week checkup so they can discuss results and implications with their provider.

Section 3: Comprehensive Medical Evaluation and Assessment of Comorbidities

This is a new section highlighting screening for, and management of, comorbid conditions in people with diabetes. Assessment of sleep pattern and duration has been added as well as HIV, autoimmune diseases, depression and anxiety, and disordered eating patterns. Please refer to the full standards to see the entire list of conditions.

Section 4: Lifestyle Management

People following a flexible rapid acting insulin schedule should work closely with a registered dietician for education on counting fat and protein values as well as carbohydrates to be sure they are using correct insulin amounts.

Sitting is the new smoking! Stand up and move a little every 30 minutes. Aim for 150 minutes of exercise per week and try to do strength training 2 to 3 times a week. Balance and flexibility are priorities for older adults, and activities like yoga or Tai Chi are recommended.  There is also a table providing information about situations that may require referral to a mental health professional.

Nutrition, recipes

“Everything in moderation!”

By Melanie Schermerhorn, Dietetic Intern

Most of us have heard the phrase, “everything in moderation.” Many say moderation is the key to success; for someone who has diabetes this phrase is especially true when it comes to what you eat. Moderation in relation to healthy eating habits, especially portion control, can have a huge effect on your overall health! To break the phrase “everything in moderation” down further, let’s talk about what it means. What your healthcare providers are saying is:  eat a balanced diet most of the time, but do not deprive yourself of the not-so-healthy things you enjoy. In other words, it’s alright to eat them but be sure to have them less frequently and in a smaller portion.

With diabetes this is important for your blood sugar management. The goal is to not completely deny yourself things like chocolate chip cookies, but instead maintain a healthy lifestyle while still treating yourself.  A tip to do this is buy smaller portion sizes, so having one small cookie won’t have as much of an effect on your blood sugar as a larger one would.  Another great way to keep track of your portions is reading the labels on packages for serving sizes. Sometimes a package could be more than one serving!  Sharing a baked good with a friend instead of eating the whole thing can help you consume less as well. You could make homemade treats with healthier ingredients like in the recipe below so you aren’t consuming a heavily processed carbohydrate.  So aim to keep your portions in check and when it comes to sweets “Everything in moderation!”

Recipe: Healthy Banana PancakesCombine 1 ripe banana, 2 large eggs, and a few shakes of cinnamon in a bowl until smooth. Heat up a pan on medium heat and spray with cooking spray. Put a few spoon fulls of the “batter” into the pan. Cook until lightly brown on each side and serve.

Post content reviewed by Department of Nutrition and Food Services