Diabetes – Tim's Diabetes Blog

Get Off the Couch

Muscles that are working are using more glucose than those that are resting. While this may be an obvious statement, it also follows that exercise helps with blood sugar control. This is why people with diabetes are encouraged to exercise regularly. Exercise leads to better blood sugar control. Another benefit is a reduced risk of cardiovascular disease. So, what sort of exercise should you be looking at?

Bear in mind that exercise comes in two kinds – aerobic exercise and weight training. This does not mean you have to run a four-minute mile. Nor does it mean that you have to train as if you were going to take part in an Olympic weightlifting trial. So, unless that really is something you really want to go for, don’t overdo it.

On the other hand, don’t underdo it either. My suggestion would be to make modest, achievable goals, such as walking at least 5,000 steps a day. And when you have achieved that, increase your goal to, say, 10,000 steps until you are feeling healthy. Many websites recommend at least that many steps a day. Here is a website that gives advice on How Much Walking You Need to Lose Weight.

As for weight training, this can be as simple as carrying a bottle of water with you on your walk, and just take occasional sips from it. Better yet, why not take up a hobby that needs you to move. How about gardening, for example? People rarely think of DIY tasks around the house and yard as exercise? Or getting the vacuum out and using it every day? Follow this link for some additional ideas for exercise around the home.

Please note that the content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease.

Foot Screening

Many people who have diabetes eventually develop neuropathy, which is a dysfunction of the nerves. It mostly affects the peripheral nervous system. Typically, this affects the feet, but can affect the hands as well. Common symptoms include a feeling of burning, numbness, or tingling. Apart from making it difficult to be aware that you may have injured yourself such as treading on a push pin, it can also lead to amputation of the toes, or even the entire foot. Neuropathy can be degenerative, so early diagnosis is extremely advantageous.

Self-testing using a monofilament should help to diagnose issues before they become serious. There used to be a free program from the Lower Extremity Amputation Prevention (LEAP) program, and some websites still state this is an active program, but online links appear to be inactive. However, they are not expensive, and I have seen them online for as little as a box of 25 for less than $4. A pharmacy would probably have them for just a few cents.

Here is a link to some Self-Testing Instructions. The link brings up a .pdf file, which is printable, so it would be very easy to keep track of your testing. If you do not have any symptoms of neuropathy you only need to test yourself once a year, but be sure to consult a doctor as soon as you detect a problem.

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Sugar by Any Other Name

Sugar is a carbohydrate which takes many forms. Food manufacturers are known to use many descriptions other than sugar, so even if an ingredient label does not mention sugar specifically, it does not mean that the food does not contain any.

Here are some of the more common descriptions for sugar, but this is notan exhaustive list:

Amazake
Brown sugar
Carob powder
Corn syrup
Dextrose
Evaporated cane juice
Fructose
Fruit juice concentrate
High-fructose corn syrup
Honey
Maltose

Having said that, every Nutrition Facts label does allow you to get a sense of how much sugar you are really eating and you can find this information under the Total Carb. category where sugars are listed in grams. Every 4 grams is roughly equivalent to a teaspoon of sugar.

To keep all of this in perspective, it’s helpful to remember the American Heart Association’s recommendations for sugar intake.

Men should consume no more than 9 teaspoons (36 grams or 150 calories) of added sugar per day.
For women, the number is lower: 6 teaspoons (25 grams or 100 calories) per day. Consider that one 12-ounce can of soda contains 8 teaspoons (32 grams) of added sugar! There goes your whole day’s allotment in one slurp.

Nutrition Hints and Tips I

Try to avoid eating a lot of sugar, or other carbohydrates, at one meal. An ounce is 28.35 grams. My suggestion would be to have no more than 25-30 grams (1 oz) of carbs at any given meal.
For the most part, avoid cereal at breakfast as it is usually high in carbs. There are exceptions, of course, such as oatmeal. Try something high in protein instead, such as eggs. Have a look at the Eat This, Not That website to get some great ideas for high protein breakfasts.
Check your blood sugar level 2 hours or so after meals. That way, you get to learn what foods work for you and you can plan menus accordingly.
Avoid white foods. This is definitely something you will want to experiment with. White food generally refers to foods that are white in color and that have been processed and refined, like rice, pasta, bread, cereal, spaghetti, and sugars. I usually substitute brown bread, brown rice, and brown noodles. I also find that I need smaller portions because they make me feel full for a longer period of time. On the other hand, I find that my body can handle potatoes quite well so this is not an exhaustive list by any means. Try and find out exactly what you can eat without spiking your blood sugar.
Fill half of your plate with vegetables – and eat them!

In Your Mind

If you were planning on starting a business, you would expect both successes and failures; ups and downs if you will. And you’ll do better in business if you try to plan for the failures. Managing diabetes is no different, and has a lot to do with mental attitude. And mental attitude, of course, starts in your mind, or in your head.

So, applying this to your situation, don’t expect perfection in your A1c results or in your blood sugar levels. Some days, you will have higher levels than you should. Just plan on ways to get back on track as quickly as possible. It’s the positive attitude that’s important. A positive mindset can help you to reduce stress, improve your mood, boost your immune system, and lower the risk of heart disease.

Think of yourself as a person with diabetes, not as a diabetic. View having diabetes the same way that you would view a sight defect. By and large, your eyesight can be corrected. Of course, you my have to wear glasses or contact lenses, but it is not going to define your life regardless of the fact that it is part of it. Think of diabetes in the same way. Taking your blood sugar level on a regular basis should be no more inconvenient than keeping your glasses clean. High A1c level? Work out a plan to get it lower again. After all, eating healthy should be the aim of everybody.

As a person with diabetes, you ought to have some goals, but they do need to be realistic. Try starting with realistic short-term goals that are specific, clear, andshort-term. For example, if you have only recently been diagnosed, taking your meds on time, and checking your blood sugar when you should, may be sufficient. If you know you need to lose weight, make a realistic goal of losing 5 pounds every month rather than a much more daunting like losing 60 pounds over the year. This cartoon from Randy Glasbergen sums it up pretty well.

Choose to fight. I love this quote attributed to Henry Ford: Whether you think you can, or think you can’t, you’re right. You have not been handed a death sentence. I am reminded of some neighbors I once had. They were both smokers, and the husband had to have his foot amputated because of it. He was warned that if he did not significantly cut down on his smoking and start to exercise, he could lose his entire leg. His attitude was “I’d rather die than give up smoking.” If that’s your attitude about food and exercise, you do have a problem. But there is absolutely no reason, other than your own mental attitude, why you cannot live a healthy lifestyle and live to a ripe old age.

Spinach & Mushroom Omelet

As far as I am concerned, omelets can be eaten any time of the day. They are very versatile, and can have almost any filling. This one is very tasty. Of course, the fact that mushrooms are one of my favorite veggies may mean my opinion is not entirely unbiased. This recipe is for one person, so double the quantities for two. I prefer to get the egg mixture ready before I start so that I can add it to the pan as soon as I remove the veggies, mainly because I do like my omelets to be hot rather than lukewarm, and definitely not rubbery.

Ingredients

1 tablespoon of margarine or spread. I prefer one made with olive oil.
¼ cup of mushrooms.
¼ cup (or a bit less) of finely chopped onions.
¼ cup of fresh spinach. Add more if you wish, but personally I find this is just right.
4 fl oz of liquid egg substitute.
1 tablespoon of fat-free milk.
¼ teaspoon of garlic powder.
¼ teaspoon of black pepper.

Instructions

In a frying pan, melt the margarine over a medium heat. The larger the pan, the larger and thinner the omelet.
Add the mushrooms and onions and cook until tender (about 3 minutes).
Stir in the spinach and leave on the heat for a minute until it is wilted
Remove the mixture from the frying pan and set it aside.
In a medium bowl, combine the milk, garlic powder, pepper, and egg substitute, mixing well.
Place the frying pan on the heat , add the egg mixture and stir gently for 1 minute. Wait another minute or so for the egg mixture to set. If the mixture sticks in the pan, try a little cooking spray in the pan before adding the egg mixture.
Spoon the veggies on top of the eggs and carefully fold in half. Slide the omelet on a plate and serve. If you’ve made enough for two, cut in half and serve on separate plates.

Flying With Diabetes

Air travel is commonplace. Maybe not as common as driving, but nonetheless very popular. And fairly inexpensive, especially if you are traveling alone. I’ve recently been contemplating a trip to visit family in Washington (state, not DC) for Thanksgiving. If it were just me, it would be cheaper to fly. Even for two, the additional expense would probably be worth it, if only for the convenience of a relatively short flight time when compared to driving time of about 12 hours.

But whatever your reasons for flying – business, pleasure, funeral, etc. – there are some essential precautions you need to take to avoid diabetic complications. Bear in mind that these are only general guidelines, and be sure to consult your doctor if in any doubt. Here are my top three recommendations,

Carry a letter from your doctor. This is not essential, but should help smooth the way for you when going through airport security. make sure the letter states your need to carry insulin, syringes, test strips, and any other supplies you may need. Along the same lines, make sure that you carry pill bottles and insulin vials which include pharmacy labels. This is not essential, but can avoid a lot of questions. Not that you would have anything to hide, but air travel is stressful enough as it is, so any way of reducing the stress should be looked for.

Plan your meals. Most airlines will allow you to pick a meal suited to your health needs. Request a diabetes-friendly meal, such as vegetarian. If you don’t like the idea of airline food, bring some with you – but be prepared to purchase any liquids in the airport after you have cleared security.

Keep your diabetes supplies in your carry-on, and bring more than you think you will need for the trip. The low temperatures in the cargo hold at 30,000+ feet are bad for your insulin. Even if you do not use insulin, you do not want to risk having no supplies with you in the event of a lost (more likely delayed) bag. The safest way to be sure that your supplies arrive at the destination with you is to have them with you at all times during your travel.

There are many other considerations. Click this link for some diabetes-related travel hacks. Or here for a fact sheet from the American Diabetes Association, and some advice from WebMD.

At the Optician

Diabetes can affect just about every part of your body. What could be more important optician1 than your eyes? Well, maybe a few things, like your heart and lungs, but can you imagine what your life would be like without your sight? Of all the various side-effects of diabetes, nerve pain (or diabetic neuropathy) is one of the more well-known, but did you know that it can also affect your eyes? This, of course, raises the subject of how often you should visit the eye doctor, and what questions you need to ask when you do go. There is every reason to go to the eye doctor if you are diabetic, regardless of whether or not you currently have perfect vision. In order to help protect your sight, learn the dangers and how to address them. Possible vision problems include diabetic retinopathy, diabetic cataracts, and glaucoma. Try these tips:

Keep your blood sugar levels as close to normal as possible. Tight control may help to prevent eye disease. In those cases where degeneration has already occurred, it may help to slow the symptoms.
Visit the optician at least once a year. Permanent damage can occur long before the symptoms are obvious to you. Regular eye exams help to catch problems early on, and keep you seeing clearly.
Make an appointment more often if you notice any change in your vision. Most insurances will cover multiple visits if you notice a change in your vision. I had an exam recently barely six months after my last exam because I found my prescription was no longer giving me clear vision. This was regarded as a medical necessity so there was no cost to me.
Have a dilated eye exam every year. Such exams are not normally routine for healthy patients, so be sure to advise your doctor that you have diabetes in order for it to be included as part of your routine visit.
Keep a close eye on any vision problems that you have. Be aware that most people with diabetes, for example, will develop some degree of retinopathy. Similarly, diabetics are far more likely to get cataracts compared to people without the disease.

In Your Family

The more people you have who are aware of your diabetes, the better off you will be. For example, you are less likely to allow yourself to slide on the little things because you know that others will be watching. Nowhere is this more true than in the family, and you will want your spouse and children to be able to look up to you and rely on you to do what you say you will do. Especially, do not try to hide your diabetes. The fact is, managing your diabetes affects so many aspects of your life that you cannot go it alone. For example, you need to eat healthy foods, but you are not going to be able to do that without the cooperation of everybody who lives under your roof. And besides, the healthy lifestyle changes you need to make will benefit all of you. Try these tips:

Buy smaller amounts of less-healthy food. You may be tempted to ban junk food from your home altogether. Unless you are the one who does all of the household grocery shopping, though, you really don’t have much control over whether tempting foods come into your house. Besides, why should you punish other family members for your illness, or make them feel guilty? Much better is to seek the middle ground, such as buying tempting foods in smaller sizes, like a quart of ice cream instead of a gallon. That way, if you feel tempted to eat a bag of potato chips, you have some portion control.
Make your own run to the grocery store. Try going with your spouse, and make sure that the cart contains items you like that are also healthful and fit into your diabetes eating plan. That way, home-cooked meals are more likely to appeal to you. In turn, this will help you reach your goals for blood sugar and weight loss. It may also have the added bonus of encouraging the rest of the family to eat healthily.
Make sure family members recognize the symptoms of low blood sugar. This won’t be easy because you may not recognize them yourself. Blurred vision, mental confusion and sweating are common for hypoglycemia. Make sure they know how to take the necessary emergency measures. bear in mind that most people fail to recognize their own symptoms. In my case, I may claim to feel fine, but I lose concentration and become irritable. But a drink of orange juice or a glucose tablet will have me feeling right as rain in a matter of minutes.
Eat your evening meal as a family. There are huge benefits to eating meals as a family on a regular basis. I think you’ll be surprised at some of those listed if you follow the link. Bottom line, though, people tend to eat in a more nutritious way and the behavior of children is better overall. This, in turn, leads to less stress in the home and, best of all, fewer problems with your blood sugar control which can be affected by stress.
Work with your spouse to establish health goals. He or she has a vested interest in keeping you happy and healthy. If you plan together there is likely to be less tension between you – at least as regards your diabetes care.

On the Road

Vacations are a time when it is far too easy to slip, and allow yourself to eat less-healthy foods, regardless of how good you usually are. This is especially true of the trip from home to the vacation and the trip back as well. If you have diabetes, it is not a matter of simply packing some clothes and jumping in the car. The road trip itself has a host of possible pitfalls. Such hazards, of course, are not unique to diabetics – boredom, for example – but the side-effects of low blood sugar (hypoglycemia) certainly need to be guarded against. Try these tips:

Instead of store-bought cookies or protein bars, make some of your own. For example, some chocolate chip protein bars, or some honey nut bars. Wrap the finished product in parchment and place in a sandwich bag to take along with you.
Bring some ready-prepared sandwiches with you. Regular sandwiches are in danger of coming apart as you eat, especially if you are doing the driving and are eating one-handed. As an alternative, make a wrap sandwich by placing a thin layer of ingredients (does chicken breast, spinach leaves, red onion and mayonnaise sound good?) on a tortilla and then rolling it up. As another alternative, place similar ingredients into a pita bread pocket. When you need to eat, even if it is one-handed, the result will not be a mess in your lap.
For longer trips, take a large cooler with you. When traveling by car on a long trip, it is very tempting to give in to your cravings and to buy junk food, especially as it’s an easy way to keep fractious children quiet. But if you have a large cooler with you, fill it with bottled water, precut carrots and celery, slices of red and green pepper, ready-prepared sandwiches, low-fat dip and so forth, you should be able to save a lot of calories, fat grams and money. Oh, and don’t forget a layer of ice.
Use the car’s cup holders to place easily accessible snacks before you start. Consider filling a plastic cup (or a paper cup if you feel that they are more environmentally-friendly) with carrots, snap peas, celery, or other vegetables, and place in the cupholder before you leave your driveway.
Be aware of your symptoms, especially for hypoglycemia. We are all different, of course, but you do need to be aware of how traveling affects your diabetes. For myself, the two biggest problems I have with low blood sugar are a reduced attention-span and irritability with those around me. I often fail to recognize this until somebody points it out to me. Neither situation is likely to help me drive better.