Tags: blood sugar, blood sugar spikes, Diabetes, DSME, fruits and vegetables, healthy eating, satiety, weight management
By Elizabeth Daly
In today’s society, we are constantly tempted by food. Whether we are commuting to work, out with friends or watching TV at home, we are influenced by messages encouraging us to eat more. Living in an environment surrounded by food can make it challenging for people to make healthy choices, lose weight and manage their diabetes. There are many different weight-loss diets advertised in the media, but dieting often leaves us feeling hungry, deprived and ultimately defeated. How can we better control our intake without feeling the need to eat all the time?
Satiety is the feeling of fullness that comes after eating. If we feel satiated after a meal, we are less likely to snack between meals or eat large portions the next time we sit down to eat. Learning how to feel more satiated after a meal may help us better control how much we eat, aid in weight loss and better control blood sugar levels.
Feeling satiated takes time, often up to 20 minutes after eating a meal. It is controlled by a number of factors that begin once we take our first bite of food. When we eat, our stomach expands, we begin absorbing and digesting nutrients and the brain receives signals that lead to feelings of being full.
Not all foods produce the same level of satiety. Here are a few tips to help you feel fit and full:
- Add lean protein to meals and snacks
Adding protein to meals or snacks helps keep you full for longer and control blood sugar levels. Meals that only contain simple carbohydrates are digested quickly, spike blood sugar, and make you feel hungry again soon after.
~Ex. 1 oz low fat cheese or ¼ cup hummus or 1-2 tablespoons peanut butter or 1 oz nuts
- Add fruit and vegetables to meals
Fruits and vegetables are high in fiber and water. Both of these help you feel full. They are also good sources of important nutrients and contribute to overall good health.
~Ex. Add a side salad with meals, add berries to cereal or yogurt, add vegetables in soup
- Limit sugary beverages
Sweetened beverages are high in sugar and calories but low in nutrients. They do not cause your body to feel as full as solid foods do, and can lead to spikes in blood sugar and weight gain.
~Try swapping sugar sweetened beverages with water at meals to curb your hunger!
Content reviewed by Melanie Pearsall, RD, CDE
Tags: A1C, American Diabetes Association, Diabetes, DSME, insulin, kidneys, Medications
Eileen B. Wyner, NP
Bulfinch Medical Group
I recently reviewed updates to the American Diabetes Association’s (ADA) Standards of Care for 2017. In this post, I’ll review Section 8 of the standard that talks about different medications for treating diabetes. I will also discuss some of the newer medications used to treat diabetes.
Type 1 Diabetes is always treated with insulin, either through multiple injections or an insulin pump. Type 2 Diabetes can be treated with oral medications (pills by mouth), injections, or both. The ADA recommends that people with Type 2 diabetes start patients start with the pill metformin, as long as it safe for them to take it. Taking metformin for a long time may lead to not getting enough Vitamin B12, stomach symptoms, and can affect how well the kidneys work (your care team will monitor your kidneys to be sure they are working properly).
If someone is taking one oral medication at the highest possible dose but their A1C is still not at goal, providers should consider adding additional medications: another oral medication, long acting insulin (injection), or a non-insulin injectable medication called glucagon-like peptide 1 receptor agonists (GLP-1 receptor agonists).
Examples of GLP-receptor agonists are exenatide (Byetta), liraglutide (Victoza), and dulagultide (Trulicity). These medications cause food to move through the stomach slower so people feel full sooner. This leads to less glucagon (another hormone made by the pancreas) being released after meals and lowers appetite, which helps with weight loss. These medications need glucose to work, so there is little chance of hypoglycemia. Side effects include nausea, vomiting and acute pancreatitis. They may also cause medullary thyroid cancer in animals. It should be noted that these medications are expensive.
People with poorly controlled diabetes and atherosclerotic cardiovascular disease (ASCVD aka heart disease) may benefit from a new medication called empagliflozin (Jardiance), a type of medication called SGLT-2 inhibitor. These medications work by preventing the body from reabsorbing glucose. This lets more glucose leave the body through urine. People may have lower blood sugar values after eating and lose some weight. Studies show empagliflozin helped reduce deaths caused by heart attack, stroke, and cardiovascular disease. Empagliflozin is the only SGLT-2 inhibitor with these results, but other medications are being studied (liraglutide [Victoza] may have the same results, but other GLP-1 receptor agonists are not used this way). Potential side effects include hypoglycemia, low blood pressure, dizziness, urinary tract infection, needing to urinate a lot, and increased LDL and creatinine (a waste product filtered out by the kidneys). Again, these medications are very costly.
There are many medications available for the treatment of diabetes. These standards are general recommendations for medical care. Always discuss questions about your care plan with your healthcare provider.
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: American Diabetes Association, care plan, Diabetes, Diabetes management, DSME
By Eileen B. Wyner, NP
Bulfinch Medical Group
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.
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.
Tags: Diabetes, DSME, goal setting, healthy eating, healthy habits, healthy living, New Year, portion size, SMART goals
By Annabella He
MGH Dietetic Intern
It’s 2017! At the start of year, you may be making a New Year’s resolution to better manage your diabetes by eating healthier and exercising more. In order to stick to the plan, your New Year’s resolutions should be specific, measurable and reasonable. The following are some specific tips to get you started. Pick one or a couple to work on!
- Cut down on portion size: The amount of food you eat for each meal has a huge impact on your blood glucose and weight control. Having a smaller meal keeps your glucose and insulin levels more stable. Also research shows that lowering total calorie intake helps with long-term weight loss, so portion control is the key. Use food labels and measuring cups to accurately gauge your intake.
- Eat breakfast: Have a filling breakfast to keep yourself full for longer. Eating breakfast reduces your hunger levels later in the day. A balanced breakfast like whole-wheat cereal with low fat milk and nuts, or scrambled egg with some vegetables are good options. Instead of topping the toast with butter, try avocado to make it tasty and healthy.
- Make a balanced plate: Fill half plate with fruits and vegetables, especially brightly colored ones, ¼ plate protein, ¼ plate starch.
- Eat more non-starchy vegetables: We always say eat more vegetables, but the kinds of vegetables we eat also matter. Starchy vegetables like corn, green peas, winter squash and potatoes are high in carbohydrate. Eating too much of those will increase your blood sugar, so it’s important to moderate the portion size of these vegetables. Non-starchy vegetables like carrots, broccoli, salad greens and beets contain little or no carbohydrate. Eating more of those vegetables not only stabilize your blood sugar level, but also help fill you up without gaining much weight.
- Choose healthy snacks: It’s okay to have some snacks throughout the day to keep your blood sugar stable and promote energy levels. Again, make sure to control the portion size and make healthy choices. Here are some examples of healthy snacks: whole fruits, cut vegetables, almonds, Greek yogurt and low-fat popcorn.
- Learn a new healthy recipe every month: Search for new healthy recipes and practice. Cooking at home is fun and it saves money. You are in full control of what’s in your meal. Also, by December, you will master cooking 12 recipes. How exciting is that?!
- Drink more water: The daily recommendation is 8 cups of water or other non-caffeinated beverages. Drinking enough water helps you stay hydrated and energetic. Sometimes you may feel hungry, but actually you are dehydrated. Drinking water helps you to not get hunger and thirst confused.
- Go to bed early and get enough sleep: Going to bed early keeps you from eating too late at night. Also, getting a good night sleep helps your body process carbohydrate and has a positive effect on weight control.
- Exercise more: Try different types of exercise such as walking, running, hiking, yoga or a group class at the gym. Get a pedometer or use phone app to record your steps while walking. Recording your steps can motivate you to try to reach a higher goal by walking more miles.
- Stay up to date with medical appointments: See your provider regularly to make sure everything is going well with your diabetes and that you are up to date on your health screenings (including eye exams).
Content reviewed by Melanie Pearsall, RD, CDE
Tags: clam chowder, Diabetes, DSME, healthy eating, recipe
Warm up this winter with a bowl of this Be Fit clam chowder. Pair with a salad to round out the meal.
2 bacon slices
2 small onions, chopped
1¼ cups chopped celery
¼ tsp kosher salt
½ tsp dried thyme
2 garlic cloves, minced
6 (6½ ounce) cans of chopped clam
5 cups diced potato
32 ounces bottled clam juice
1 bay leaf
3 cups low fat milk
½ cup all-purpose flour
Cook bacon in a large saucepan or Dutch oven on medium heat until crisp. Remove bacon and set aside. Add onion, celery, salt, and thyme to pan and cook for 2 to 3 minutes; add garlic and cook until vegetables are tender, 1 to 2 minutes more.
Drain clams, reserve the liquid, and set the clams aside. Add clam liquid, potatoes, bottled clam juice, and bay leaf to the pan and bring the mixture to a boil. Reduce heat and then simmer until the potatoes are tender, about 15 minutes. Discard bay leaf.
In a medium bowl, combine milk and flour, stirring with a whisk until smooth. Add flour mixture to the pan and bring to a boil. Cook for 10 to 15 minutes more, or until the mixture thickens slightly; stirring occasionally. Add clams. Crumble bacon and divide among soup bowls.
Yield: Serves 6
Serving Size: 2 cups.
Nutrition Information Per Serving:
Calories: 345 • Protein: 20g • Sodium: 675mg • Carbohydrate: 40g • Fiber: 4g • Fat: 9g Sat Fat: 2g
Recipe adapted from Cooking Light. Originally posted on clubsatcrp.com.
Tags: balanced plate, blood sugar, Diabetes, healthy eating, insulin, insulin resistance, nutrition, snacks, weight gain
By Felicia Steward, Dietetic Intern
Blood Sugar Defined
Blood sugar is the measurement of the amount of glucose, or sugar, in your bloodstream. This is important because it tells us how much energy our cells and tissues are receiving from the food we eat. Some foods affect blood sugar more than others. Any food that is mostly carbohydrates will affect blood sugar levels. These include dairy (milk and yogurt), all fruits and fruit juices, starches (pasta, bread, rice, and tortillas), and starchy vegetables (corn, peas, beans, potato, and butternut squash). Eating more carbohydrates at a meal can raise blood sugar, so it’s important to think about portion size along with when we eat and what food items we choose to eat together.
Why Care About the Amount of Sugar in My Bloodstream?
Glucose provides our body with energy, and is needed for the brain to properly function and process information. Therefore, it is important that we choose foods containing small amounts of carbohydrates whenever we have a meal or a snack throughout the day so there’s enough glucose to support our tissues and 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. It builds up in the blood stream, causing damage to the body. Over an unhealthy extended period of time, the body will eventually store much of the excess sugar as fat, which can lead to weight gain. Therefore, it is important to be aware of how the food we eat influences the amount of sugar in our bloodstream and how it affects our weight.
How is Blood Sugar Managed?
A healthy eating pattern that includes balance and portion control is an important part of managing the amount of sugar in the bloodstream. Pairing whole grain, carbohydrate-rich foods with protein and fiber helps maintain healthy blood sugar levels. Eating a meal or snack that contains foods that increase blood sugar with those that do not affect blood sugar means the glucose is absorbed slowly into the blood and prevents blood sugar from spiking too high. Paying attention to portion size will also ensure that we are providing our body with exactly what it needs each time we eat. What the body doesn’t use for energy right away can be stored as fat and cause weight gain.
Balanced Lunch Examples:
- PB&J on whole wheat bread + 1 cup carrot and celery sticks dipped in plain yogurt
- 2 cups tossed salad + 3 oz. grilled chicken + oil/vinegar dressing + 1 banana
- 3 oz. salmon + 1 cup brown rice + 1.5-2 cups cooked green beans
- 2 oz. tuna salad (with light/mayo), lettuce, and tomato on whole wheat bread + 1 small apple + 8 oz. of skim milk
Content reviewed by Melanie Pearsall, RD, CDE
Tags: appointment, Diabetes, DSME, healthcare, office visits, preparation, team
By Eileen B. Wyner, NP
Bulfinch Medical Group
A medical appointment is a really big investment. It takes time from our busy lives that may impact our employment or family commitments. It costs us financially through transportation costs, parking fees, childcare expenses and copays. It also can cause anxiety and uncertainty because of worry about the outcomes of tests (on top of all of the other things I mentioned). Even so, a medical appointment is the single best investment you can make in your healthcare. The best way to gain the most from this investment is studying the night before. That’s right, just like preparing for that all important math test it’s worthwhile to prepare for your upcoming medical appointment.
Remember, you and your health care provider are teammates working for the same goal: the best health you can achieve. Using the tips below to prepare for your appointment will help you both get the most out of your time together.
- Review your prescriptions and see if you need any refills on medications or supplies. It is also important to have updated pharmacy contact information so your prescriptions are not delayed, and check to see if you need any specialty referrals.
- Make sure that you have your updated insurance information and photo ID with you. Medical offices do not automatically receive insurance changes, so it is important to check this information at each appointment to prevent issues with bills and referrals. You can update your address and phone number at this time if they have changed since your last office visit.
- Allow plenty of time to get to your appointment and park so you are not late. We try to accommodate people who are late but sometimes it can’t be done.
- Please be patient with me if I am running late. I work very hard to keep on time because I value YOUR time, but if I have a very sick patient, I may run behind. I promise that I will still give you the time you need for your care.
- Don’t forget to bring any results from home such as blood pressure, weight, and blood sugar checks. The information I get during the office visit is just one snapshot in time; seeing it along with your home results gives me a clearer picture of your health.
- Write down any questions and concerns you want to talk about during your appointment.
- Take notes during the appointment and use the same notebook for each visit. This will help keep all of your information organized and in one place if you need to review something you’re unsure about.
I know being a patient is a full time job for many people, and it can be daunting to keep track of everything that goes into good self-care and good health. I think that preparing for your appointment, just like studying the night before the math test, can make this process less overwhelming and as successful as possible.
Tags: Diabetes, Diabetes management, Holidays, moderation, nutrition, portion size, treats
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 Pancakes: Combine 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
Are you newly diagnosed with diabetes, or struggling to control your blood sugar? If so, DMSE/S programs can help!October 17, 2016 at 9:43 am | Posted in Announcements | Leave a comment
Tags: Diabetes, DSME, health, healthy lifestyle, Medications, nutrition
Diabetes is a chronic, complex disease. Self management is key, but what does that even mean? Where do you start? Self Management is the ‘taking of responsibility for one’s own behavior and well being.’ Living well with diabetes means you need to learn new skills and behaviors. This can seem overwhelming during an already stressful time. DSME/S programs teach you the self management skills you need to truly thrive.
You will first see a nurse or nurse practitioner (who is often usually a Certified Diabetes Educator or CDE). You will either continue to see that clinician by yourself or attend group classes with other people just like you. Group classes are a great way to learn and be supported by people who know what you’re going through. You are not alone! During appointments or classes, you will learn about important topics like nutrition, exercise, medications and more. You will also set specific behavioral goals to work towards between each visit.
Research has shown that DSME/S works. It can lower your A1C and stop complications from happening or getting worse. Attending can also improve your quality of life and keep you out of the hospital. Major organizations like the American Diabetes Association, American Association of Diabetes Educators and the Academy of Nutrition and Dietetics all believe that everyone with diabetes should have DSME/S at some time in their life.
Mass General DSME/S programs are offered at Chelsea, Revere, Charlestown, Internal Medicine Associates, Diabetes Associates and Bulfinch Medical Group. For more information, contact Jen Searl at firstname.lastname@example.org.