Tag Archive for: diabetes

Elusive Blood Sugar Management

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Do you ever feel like regardless of what you do, your blood sugar is still all over the board?

Once you received the diagnosis of type 1 or type 2 diabetes, you should have been told to check your blood sugar several times each day to prevent complications that can develop from elevated blood sugar over a long time. Striving for normal blood sugar readings can feel extremely elusive and frustrating, but it doesn’t need to be. Checking your blood sugar level is like checking the speedometer on your car. It gives you information and tells you if you need to make adjustments. Blood sugar levels do not reflect personal character or intelligence.

There are many factors that affect your blood sugar.  What you do or don’t eat has a huge impact on your blood sugar level, but it is not the only factor involved. Here are some other factors that can affect your blood sugar.

Stress: 

We may not be attacked by predators nowadays, but we seem to be under constant lifestyle attack. Stress produced by a lion or your lifestyle will cause an increase in the hormones glucagon and cortisol, which increases blood sugar.  Sleep deprivation also causes stress and increases cortisol levels. The good news is exercise, relaxation, meditation, and adequate sleep can reduce stress and lower blood sugar levels.

Exercise:

Insulin sensitivity is increased with exercise, which means your cells are better able to use the sugar in your bloodstream. Thus lowering your blood sugar level.  Is your blood sugar high? Vacuum the floor, mow the lawn, clean out the garage, wash the windows, go for a walk or bike ride – these are all free, effective treatments to lower blood sugar.

Food: 

Are you tired of hearing the long litany of foods you shouldn’t eat because you have diabetes? Are there foods you might want to eat more of to improve your health and lower your blood sugar?

Carbohydrates (“carbs”) are to be managed, not eliminated. Your body breaks down carbs into sugars (mostly glucose) and then insulin helps your body use the sugar for energy. When you eat too many carbs or have insulin-function problems, this process fails and blood glucose levels can rise. A dietitian can assist you in identifying the appropriate amount, distribution, and type of carbs to manage your blood glucose. You need complex carbs at least for a third of your carb intake. If you are taking insulin, your dietitian can also calculate the appropriate carb-to-insulin ratio so you can be pro-active and determine how much insulin to take based on how many carb grams you ate at your meal.

Fiber, specifically soluble fiber, has been shown to improve blood sugar management. Fiber slows carb digestion and sugar absorption.  Fruits, vegetables, legumes, and whole grains are a great source of soluble fiber. Incorporating these foods in your diet would be very beneficial and effective for your blood sugar management. It is a balancing act to determine the appropriate amount because each of these foods also contributes to carbs.

Consult a dietitian who is also a Certified Diabetes Care and Education Specialist (CDCES) to find the answers tailored to your specific health needs and goals. CB

 

 

 

 

Why Is My A1c High?

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Your daily random blood glucose readings are good. You watch your carbohydrate intake, exercise, take your medication as prescribed, avoid smoking, and try to live a healthy lifestyle.  But still, your Hemoglobin A1c (“HbA1c” or just “A1c”) is over 7.0 which leaves you frustrated, wondering what you are doing wrong. One thing to consider is that you check your blood glucose only a limited number of times daily. Your daily readings may look good the 3-4 times you check, but what is your blood glucose doing throughout the day when you are not checking it?

Taking daily readings is good, but taking an A1c test through your healthcare provider every 3-6 months gives insight into your long-term glucose levels. The higher the glucose in your bloodstream, the greater the glucose attachment to the hemoglobin portion of your red blood cells. The lifetime of your red blood cells is 2-3 months; therefore your A1c reading reflects the glucose level of your blood over the past 2-3 months. A target A1c for most adults is under 7.0.

Insulin from your pancreas is essential for properly regulated glucose throughout the day, which determines your A1c. Several factors can interfere with the work insulin is trying to do, including:

Excess body weight

The accumulation of body fat, especially visceral fat (the kind that surrounds your internal organs causing an apple shape), interferes with the work of insulin. Just a 5-10% decrease in body weight will improve glucose levels.

Stress

When you are experiencing stress it is your body signaling that something needs to change. Unfortunately, many people choose to push through stress on a daily basis and never consider addressing the source of stress in their life. Stress contributes to insulin resistance. It can also raise your epinephrine and cortisol levels, causing an increase in A1c. You also may be one of those people who engage in stress-eating for temporary calming which will elevate your weight, blood glucose, and A1c.

Sleep deprivation

Poor sleep patterns impair glucose metabolism. If you are getting less than 7-8 hours of sleep on a regular basis, it would be wise to address your “sleep hygiene” (such as developing a calming routine at bedtime) to help lower your blood glucose.

Portion control

Even though you are choosing healthy foods, portion control is still necessary to manage your A1C. Healthy foods still contain carbohydrates, and although you need to limit carbohydrates, you do need appropriate amounts of them for fuel.

Exercise Levels

Cardiovascular and strength or resistance training are important to maintain your weight and manage your glucose and insulin levels. Strength training helps your body respond to insulin better, so it should be a part of your weekly fitness plan. Cardiovascular exercise directly improves blood glucose in the moment.

Mindfulness

“Mindfulness” is when your mind is fully attending to what’s happening and what you are doing in the present moment. Often, we are not fully present for our current moments of life experience. We take flight and soon we are worrying about our future or revisiting our past with obsessive thoughts.  Increasing mindfulness lowers blood glucose and eventually A1c.

So remember – you do have control over many of the factors that affect your A1c. CB

Tele-health/Tele-nutrition Video Conferencing

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Have you been pondering an appointment with a dietitian to help you improve your diabetes management, food allergy or celiac disease issues, lipid challenges, improve your athletic performance, lose weight or once and for all heal from your eating disorder? Scheduling and keeping appointments are a hassle, sometimes inconvenient and an expense.

Beyond the actual cost of the medical nutrition therapy appointment there are additional costs. How much does it cost you to take off an hour early from work to schedule an appointment? Are you driving across town or from Clinton, Guymon, or Muskogee for an appointment? Gas is not cheap. If you are driving to the city from out of town you will likely have meal expenses involved also. Do you have to pay child care costs while you are at an appointment?

The additional costs and inconvenience can be eliminated with “tele-nutrition video conferencing” appointments.  Banister Nutrition now provides the option for you to schedule an appointment with one of our dietitians and you can be in your kitchen, office or favorite coffee shop, where ever you please. We have a HIPPA compliant software program that allows us to easily connect with you via an e-mail address you provide. We offer packages of 3-4 appointments at a reduced cost, payable at the time of purchase with credit card.

“If” you want your insurance to cover your medical nutrition therapy appointments, insurance companies have placed limitations on what they will cover. These restrictions include:

  • Your referring physician must be located in a medically deprived area of the state which of course means rural Oklahoma.
  • At the time of your video conference you must be sitting in your physicians’ actual brick and mortar office space.
  • Medicare will cover 3 appointments per year for diabetes and renal disease only.

 

To assist patients with insurance coverage, if you have a rural physician you would like for us to approach regarding making this service available to you please provide us with your physicians name, office address and phone number . We will contact your physician to try make these arrangements for you.

Our experience has been that both physicians and patients living in rural Oklahoma have been very pleased with having medical nutrition therapy available via video conferencing. Initially we all (physicians, patients and dietitians) thought video conferencing would be a little awkward, relationships would not be easily built, and nutrition therapy via this platform would not be effective.  We are pleased to say this has not been the case. Everyone involved has found this new, convenient resource to improve your health care has been very appreciated and helpful.

 

CB

Turkey & Brown Rice Chili

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Happy December! Chili is such a popular staple food this season and we found this recipe just in time. While it cooks you have time to throw together a green, veggie salad to complete this hearty winter meal.

Ingredients:

  • 1 tablespoon olive oil
  • 1 pound uncooked ground turkey breast
  • 2½ cups coarsely chopped red and/or green bell peppers (2 large)
  • 1 cup chopped onion (1 large)
  • ½ cup chopped celery (1 stalk)
  • 2 cloves garlic, minced
  • 2 (14.5 ounce) cans 50%-less-sodium beef broth
  • 1 (15 ounce) can no-salt-added red kidney beans, rinsed and drained
  • 3 tablespoons no-salt-added tomato paste
  • 2 tablespoons packed brown sugar
  • 1 tablespoon chili powder
  • 2 teaspoons finely chopped canned chipotle chile peppers in adobo sauce
  • 1 teaspoon ground cumin
  • 2 cups cooked brown rice
  • Grated Cheddar cheese (optional)

Directions:

  1. Heat oil in a large saucepan over medium-high heat. Add turkey, bell peppers, onion, celery and garlic; cook until meat is brown, using a wooden spoon to break up meat as it cooks. Drain, if needed.
  2. Stir broth, kidney beans, tomatoes, tomato paste, brown sugar, chili powder, chile peppers and cumin into meat mixture in large saucepan. Bring to boiling; reduce heat. Simmer, covered, 45 minutes. Stir in brown rice. Cook, uncovered, 10 to 15 minutes more or until desired consistency. If desired, sprinkle individual servings with Cheddar cheese.

This recipe is from Diabetic Living Magazine* Picture from eatingwell.com*

Nutrition Information – Serving size: 1½ cup – Per serving: 306 calories; 4 g fat(1 g sat); 9 g fiber; 40 g carbohydrates; 27 g protein; 36 mcg folate; 37 mg cholesterol; 11 g sugars; 2,219 IU vitamin A; 72 mg vitamin C; 56 mg calcium; 3 mg iron; 346 mg sodium; 323 mg potassium Nutrition Bonus: Vitamin C (120% daily value), Vitamin A (44% dv) Carbohydrate Servings: 2½ – Exchanges: 2 starch, 1 lean protein, 1 vegetable

I Hate Diabetes

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If you have recently been diagnosed with diabetes and you find yourself saying “I hate having diabetes and all that it involves” you are normal, sane and emotionally healthy! I’ve never heard of anyone responding to their diagnosis of diabetes with a “yippee”!

Diabetes is a complex health concern that involves more than “go home and take this pill.” It will add to your daily “to-do” list.  But, it will not necessarily stop you from living life providing you decide to manage your diabetes opposed to allowing your diabetes to manage you.  You have the option to live with your head in the sand, try to ignore your diabetes, pretend it doesn’t really exist and continue to live a reckless lifestyle which will eventually create the perfect storm of possible stroke, heart attack, kidney failure, amputations and/or losing your eyesight with the back drop of low energy, mood swings, neuropathy, and hypoglycemia on occasion.

I have pondered over 30+ years of counseling patients with diabetes, why do some jump on the bandwagon of managing their diabetes and others follow a reckless abandon philosophy. I believe this fork in the road of “manage my diabetes OR my diabetes manages me” is greatly influenced by whether you have accepted the diagnosis or not. Accepting the diagnosis does not mean “yeah, I love having diabetes, watching my carb intake, poking my finger multiple times a day, taking pills and/or insulin, frequent doctor appointments and spending lots of money on diabetes.” Accepting the diagnosis means being realistic, acknowledging you are not a fan of all it involves but you are a fan of having energy, avoiding complications, feeling empowered and not feeling angry or this just isn’t fair.  Refusal to accept the diagnosis generally stems from some degree of “I hate diabetes” so if I refuse to embrace the tools to management my diabetes I can pretend I don’t really have diabetes.  I can choose excessive carbs too frequently, skip checking my blood glucose or taking my medication on occasion, justify avoiding exercise for a million random reasons, pay no attention to portions, maintain my overweight status and it seems easier to pretend I don’t have diabetes.

Living with diabetes is a major life adjustment and requires a great deal of support along with education for you and your family. The first line of treatment is for your physician to refer you to a dietitian and/or CDE (certified diabetes educator) who is experienced with diabetes management. You must request this if your physician happens to forget. There is a huge emotional toll that comes with this diagnosis because it is for the rest of your life. Negative thoughts must be tamed. Negative thoughts, feelings and actions will further increase stress hormone production which will increase blood sugar and blood pressure. Pay attention to what causes you stress and look for ways to counter this.  It requires educational and emotional empowerment to be able to identity the positive aspects of diabetes management you can focus on and accomplish.

You will experience set-backs in diabetes care. The key is to evaluate your situation and go at it again with a different approach. “Rethink it” — bring your thoughts back to the here and now. Focus on what you can do today. Aim for progress not perfection.

CB

Continuous Glucose Monitoring for Type 1 & Type 2 Diabetes

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Can you imagine knowing what your blood glucose is 96-288 times each day and only doing a finger stick 0-2x daily? This is possible with continuous glucose monitors (CGM’s) now available for patients use. These monitors have been available for over a decade but most people with diabetes are unfamiliar with this technology and how affordable it is. Two CGM’s on the market are DEXCOM and Freestyle Libre. DEXCOM provides glucose monitoring every 5 minutes and requires a fingerstick 2x/day for calibrating. Freestyle Libre provides glucose monitoring every 15 minutes with no finger sticks. The glucose data is available for real time viewing on a hand-held reader device and to download for review and pattern management with your dietitian.  Many mistakenly believe a CGM is only for those with type 1 diabetes or who inject insulin.  CGM’s are for anyone who really wants to be aware of their glucose level, so they can make informed lifestyle adjustments to improve their health.

Current studies indicate wearing a CGM does lower glucose levels and A1c. Hypoglycemia (low blood glucose) was also shown to be less frequent in the group of research patients wearing a CGM. Another study showed patients were very good overall about wearing their CGM and had a higher level of satisfaction with their treatment. Experience in our office at Banister Nutrition has shown once a patient has had access to their daily continuous glucose data they don’t want to be without their CGM.  They like knowing what their glucose is constantly (without finger sticks) and they know they make better management choices with food and exercise because of this easily accessible glucose data.

Will your insurance cover the expense of your CGM?  You won’t know until you ask. Insurance companies must become aware patients want these devices so contact your insurance company and inquire. Some insurance companies and policies are covering these devices. If your insurance company denies coverage, ask your pharmacy about a “pharmacy discount card” such as Good Rx, which will cost you nothing but will help decrease your cost for the CGM.  Banister Nutrition has learned from their patients with the pharmacy discount card patient cost for the Freestyle Libre was $65 for 3 sensors (sensor to be worn for 10 days) which will last for one month. The Freestyle Libre Reader patient cost was $65. Your physician must write two prescriptions: one prescription for the reader, and one prescription for the sensors.

Having access to continual information is far better than checking your blood glucose 2-3x/day. Continuous glucose monitors are moving to center stage for diabetes management and finger sticks will gradually be non-existent.

CB

 

*Picture provided by thediabetescouncil.com*