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


Apple Barley Salad

Pearled barley cooks quicker than hulled barley (hulled barley still has the bran of the grain attached and takes about an hour to cook). Though pearled barley is technically not a “whole grain,” it is still a good source of fiber. Avoid buying white pearled barley, it is more processed; instead, look for the variety that is “lightly pearled.”  Lightly pearled barley will be tan in color and has more fiber.

½ cup lightly pearled barley, uncooked
1 tsp salt, divided
½ cup plain low-fat yogurt
1½ tbsp olive oil
1 tbsp freshly squeezed lemon juice
½ tbsp Dijon mustard
¼ tsp black pepper
2 stalks celery, diced
1 apple, skin intact, diced into ½-inch pieces
¼ cup fresh mint, chopped
2 bunches arugula (about 6 cups)

Combine barley in a saucepan with 1½ cups water and ½ tsp salt and bring to boil (or see directions for cooking barley on package). Reduce heat to medium-low, cover and simmer for about 30 minutes, until water is absorbed and barley is tender. Use a strainer to drain any excess water. Allow barley to cool.

Meanwhile, whisk together yogurt, olive oil, lemon juice, mustard, remaining ½ tsp salt and black pepper. Toss with celery, apple, mint and cooled barley. Divide arugula between bowls and top arugula with barley salad.

Yield: 4 servings

Nutrition Information per Serving:
Calories: 195 • Protein: 5g • Sodium: 650mg • Carbohydrate: 30g
Fiber: 6g • Fat: 6g • Sat Fat: 1g

Recipe adapted from Real Simple

2014 – 2015 MGH Central Flu Clinic Schedule

The 2014-2015 flu season is quickly approaching. Getting a flu shot is the best way to protect you and others from getting or spreading the flu.  We encourage all of our patients to consider getting a flu shot, especially those that are at high risk for getting the flu.  People who are high risk are:

  • People with medical conditions, like asthma and diabetes
  • Pregnant women
  • Children aged 6 months to 5 years
  • People older than  65 years of age
  • People who live with or care for others considered to be high-risk

Flu shots will be available on the MGH Main Campus on the following dates:

MGH Centralized Flu Shot Program
Wang Ambulatory Center Main Lobby
October 6th through November 21st
Monday-Friday:  8:00am-6:00pm
9:00am-3:00pm on Monday, October 13th (Columbus Day)


For more information, please call our flu hotline at 877-733-3737.  You can also visit or for more details.


Cranberry Gorgonzola Spinach Salad

This salad utilizes flavorful, seasonal ingredients without derailing your healthy diet and takes minimal effort to prepare. Add grilled chicken, salmon or flank steak to make it into a meal.

1 cup pecan halves
12 cups baby spinach
½ cup dried cranberries
1 cup gorgonzola (or other blue cheese), crumbled (about 4-5 ounces)
3 tbsp olive oil
1 tbsp balsamic vinegar
1 tsp grated orange peel (optional)
Salt and pepper

Preheat oven to 350 degrees. Bake pecans on an ungreased cookie sheet for 8-10 minutes or until golden. In a large bowl, combine spinach, cranberries and gorgonzola. Pour balsamic vinegar into a small bowl, whisk in olive oil and orange peel (if using). Pour over salad mixture and toss to combine.  Add pecans, season with salt and pepper to taste.

Yield: 6 servings

Nutrition Information per Serving (chicken, salmon or steak not included):
CALORIES: 300 • PROTEIN: 6g • SODIUM: 360mg • CARBOHYDRATE: 14g • FIBER: 3.5g •
FAT: 25g • Sat Fat: 6g


Fitting Fitness in Fall Twitter Chat

MGH logo with blue circle

The beginning of fall is a time of change. Changes in the foliage, changes to your schedule, change in the weather . . . changes in your exercise routine?

Join us on Monday, October 7th at 2pm EST for a chat on adapting your fitness routine to the change in seasons and strategies for fitting fitness into a busy fall schedule. Mike Bento, Personal Trainer at the Clubs at Charles River Park, will be leading the discussion and answering your questions.

Follow #MGHDSME for more details. If you’d like to submit questions ahead of time, contact


Pumpkin Soup

It just wouldn’t be fall without pumpkins and (pumpkin-flavored) dishes.  Make a satisfying meal that is light on calories, but heavy on flavor with this recipe from the MGH Be Fit program.


1½ tablespoon canola oil
2 medium onions, chopped
1 tbsp flour
4 cups chicken broth, low sodium
3 cups (~25 oz) pumpkin puree
1 clove, minced
½ teaspoon cumin
¼ teaspoon salt
¼ teaspoon pepper
¼ cup 2% Greek Yogurt (Try FAGE) ®
Pinch of nutmeg (ground or freshly grated)


Sauté onions in saucepan until translucent, approximately 5 minutes. Add flour and cook, stirring for approximately 2 minutes or until it thickens. Add remaining ingredients, except for yogurt. Bring soup to a simmer, whisking occasionally. Ladle soup into bowls and top with 1 tbsp yogurt per bowl and a dusting of nutmeg.

Yield: 4-2/3 cup servings

CALORIES: 193 • PROTEIN: 9g • SODIUM: 294mg • CARBOHYDRATE: 25g • FIBER: 6.5g •      FAT: 7g • Sat Fat: 1.5g

(Recipe adapted from Volumetrics, by Barbara Rolls)
Announcements, Health

UPDATED: Survival Kit for Cold & Flu Season * 2013-2014 *

Just Announced: Due to high demand for flu vaccine, the Central Flu Clinic has been extended to Friday, November 8th.


Your primary care doctor and the Massachusetts General Hospital want to do everything possible to keep you healthy during the flu season. People with certain chronic health conditions, even if the conditions are well managed, have a higher risk of becoming dangerously sick from the flu.

Here is what you can do:

• Get a flu shot every year*.
• The best time to get a flu shot is in the fall. The MGH will have a Central Flu Clinic in the Main Lobby of the Wang Building, Monday, September 23 – Friday, November 1, 2013. Monday to Friday, 8:00 AM – 6:00 PM (9:00 AM — 3:00 PM on Columbus Day, Monday, October 14).  No Saturday dates are planned for this year.  Please call the Toll Free Flu Shot Hotline at 1-877-733-3737 before you come in to confirm that we have vaccine in stock and that the clinic is open.
• If you live outside of Boston, your health center or primary care practice may have flu shot clinics as well. You may also get a flu shot at many locations in your community including boards of health, senior centers, or local drug stores.
For further information go to the MGH FluShot website at:
*if you think you are allergic to eggs, please contact your doctor

To protect your family’s health:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don’t have a tissue, cough or sneeze into your elbow, not your hands.
Wash your hands often with soap and water. You can also use alcohol-based hand cleaners.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Keep your home and work spaces clean.
Try to avoid close contact with sick people.
If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone except to get medical care. Keep away from others as much as possible to keep from making them sick.
If you think you have the flu, call your primary care doctor’s office for advice. They are here to help!

Spread the word! Don’t spread the Flu!


Your Fall Immunization Checklist

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen W

It’s hard to believe that the last few days of the lazy, hazy days of summer are upon us. I don’t need the calendar to clue me in on this. I just visit my backyard deck and notice the sun has moved so I don’t need the table umbrella anymore to deflect the sun. I do need a hard hat, though, because the acorns are dropping like rocks from the sky!  I don’t have any children I have to get ready for back to school, but I have always been a lover of the back to school mentality:  organization, new beginnings, and fresh notepads!  Now, revealing my love of notepads instead of iPads reveals my generation, so I will admit that Fall also gets me to thinking about my Winter health maintenance.  I want to briefly review some immunizations that should be regularly updated for people living with Diabetes that you can add to your list of things to discuss with your health care provider at your next visit. 

Prevention of illness is important for everyone, but people living with Diabetes may have more complications from some common illnesses.  Everyone with Diabetes should get the flu vaccination in the Fall.  Flu can be a very serious disease that could put you at greater risk for developing pneumonia, and there are reported fatalities due to complications.  The flu vaccine will not prevent other common cold weather illnesses, but it will greatly decrease the likelihood of developing flu.  The flu vaccine is developed each year based on the type of flu that was seen the previous year and projections of the type of flu anticipated in the present season – that’s why it needs to be given annually.

Prevention of pneumonia is also very important as this is another serious disease with the potential for significant complications and death. This vaccine should be given to all people with Diabetes at diagnosis. You will require a booster if it has been more than 5 years since you received the first immunization and if you were immunized before you were 65 years old. There is no scientific data available at this point that supports more frequent re-vaccination.

Tetanus shots might not be high on your list when it comes to preparing for Winter illnesses because rusty nails is what usually pops to mind.  When we received our tetanus immunizations as a child, it was meant to prevent tetanus (lockjaw), diphtheria, and pertussis (whooping cough).  Diptheria and pertussis were thought to be well controlled worldwide, but a tetanus booster would be given every 10 years primarily to protect us if we had a broken bone or a serious cut.  However in recent years, pertussis has increased across the country and a change in vaccine has been recommended.  The Advisory Committee on Immunization Practices (ACIP), the group that develops vaccination recommendations, updated their guidelines for Tdap in June 2012.  The new guidelines state that all adults receive a single dose of Tdap, regardless of the interval since the last dose of tetanus. Subsequent tetanus booster doses should continue to be given at 10 year intervals.

I hope that this review has given you a few topics to think about and to review with your health care provider at your next office visit.  Each person’s health status is individual to them, so take some time to make a list on one of your new notepads:  #1 My Health. You deserve to be #1.


Managing Sick Days and Diabetes

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

Although anyone can get sick at any time of year, it seems that as we approach fall and winter the chances for illness are greater. When you have Diabetes and get sick— to use a pop culture catch phrase— it’s complicated.

When people living with Diabetes talk about sick days, they’re referring to how they’ll take care of their Diabetes when they get a cold or flu. Illness puts additional stress on the body and your blood sugar levels can increase (or be hard to manage in general). But when you’re sick, the last thing you want to do is figure out how to control the fluctuations in your blood sugar!  Things can get very dangerous very quickly if you don’t know what to look for and how to prepare. That’s why it’s important to plan ahead for when you’re sick so you can try to avoid any additional complications, and why it’s a good idea to discuss sick day management with your provider at your next scheduled appointment (before you get sick).

Some common conditions that can require you to use your sick day plan include (but aren’t limited to) colds, flu, stomach bugs, urinary tract infections, and/or skin infections like an ingrown toenail.  Any illness with fever or gastrointestinal symptoms such as vomiting and diarrhea need special attention—even a mild case of any of these illnesses cans cause challenges with your blood sugar regulation.

I want to review a few key points to help you feel confident with your sick day management.  The first thing is you’ll need to check your blood sugar regularly.  At a minimum you should check before meals and bedtime, and you may need to check more often (especially if you’re using insulin).  Next, you’ll need to keep your dietary intake as close to normal as possible.  This may be difficult, especially if you aren’t feeling well enough to eat, but you need to try to keep your carbohydrate intake stable to help with glucose control.  I’ve included a list from the American Diabetes Association website to help you with some food choices (these foods contain between 10 and 15 grams of carbohydrates):


1 double-stick Popsicle
1 cup Gatorade
1 cup milk
1 cup soup
1/2 cup fruit juice
1/2 cup regular soft drink (not diet)


6 saltines
5 vanilla wafers
4 Lifesavers
3 graham crackers
1 slice dry toast (not light bread)
1/2 cup cooked cereal
1/3 cup frozen yogurt
1/2 cup regular ice cream
1/2 cup sugar-free pudding
1/2 cup regular (not sugar-free) Jell-O
1/2 cup custard
1/2 cup mashed potatoes
1/4 cup sherbet
1/4 cup regular pudding

It’s imperative that you continue to take your medications—however adjustments may need to be made. Dosages of sulfonylureas and basal and bolus insulin may need tweaking based on your intake and glucose values to avoid any hypoglycemia. Over the counter medications can be tricky and since many have added sugar in them, it’s always best to check with the pharmacist first (although there are sugar free cough medications and lozenges available).

It isn’t always necessary to call your provider when you’re sick, but it’s best to call them and let them know what’s going on if:

*You aren’t getting better after a couple of days

*You’re having persistent diarrhea or vomiting and can’t keep any fluids down

*You have a fever above 100.5°F that’s not coming down to normal

*You have ketones in your urine

*Your blood sugar readings are consistently above 240 mg/dl after checking twice over a few hours

The biggest thing about good Diabetes management is being as prepared as possible. Many things that may be required during illness are not the things that people with Diabetes might normally keep on hand. I suggest starting a “Sick Day Tackle Box” that has everything you’ll need so when you are sick, you don’t have to try to gather everything when you feel miserable.  Some items to keep in there include testing supplies (extra glucometer, batteries, test strips and lancets, ketone strips), glucose tablets and a thermometer; as well as some regular jello, juice boxes and small cans of regular soda.  Write an inventory list with the contents of you box and any expiration dates and review it every 6 months.  Also, keep an updated list of phone numbers with your health care provider, local emergency room, and family contact numbers on hand.

Living with Diabetes takes a lot of planning, but that planning can keep you healthier and able to enjoy your life to the fullest. Here’s hoping these suggestions are rarely ever needed and we all have a healthy fall and winter.